scholarly journals The Zambian Preterm Birth Prevention Study (ZAPPS): Cohort characteristics at enrollment

2019 ◽  
Vol 2 ◽  
pp. 25
Author(s):  
Marcela C. Castillo ◽  
Nurain M. Fuseini ◽  
Katelyn Rittenhouse ◽  
Joan T. Price ◽  
Bethany L. Freeman ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Gestational Age ◽  
Clinical Care ◽  
Phase 1 ◽  
Adverse Outcomes ◽  
Sub Saharan Africa ◽  
Growth Monitoring ◽  
Prevention Study ◽  
District Health

Background: Sub-Saharan Africa bears a disproportionate burden of preterm birth and other adverse outcomes. A better understanding of the demographic, clinical, and biologic underpinnings of these adverse outcomes is urgently needed to plan interventions and inform new discovery.  Methods: The Zambian Preterm Birth Prevention Study (ZAPPS) is a prospective observational cohort established at the Women and Newborn Hospital (WNH) in Lusaka, Zambia. We recruit pregnant women from district health centers and the WNH and offer ultrasound examination to determine eligibility. Participants receive routine obstetrical care, lab testing, midtrimester cervical length measurement, and serial fetal growth monitoring. At delivery, we assess gestational age, birthweight, vital status, and sex and assign a delivery phenotype. We collect blood, urine, and vaginal swab specimens at scheduled visits and store them in an on-site biorepository. In September 2017, enrollment of the ZAPPS Phase 1—the subject of this report—was completed. Phase 2, which is limited to HIV-uninfected women, reopened in January 2018.  Results: Between August 2015 and September 2017, we screened 1784 women, of whom 1450 (81.2%) met inclusion criteria and were enrolled. The median age at enrollment was 27 years (IQR 23–32) and median gestational age was 16 weeks (IQR 13–18). Among women with a previous pregnancy (n=1042), 19% (n=194) reported a prior miscarriage.  Among parous women (n=992), 41% (n=411) reported a prior preterm birth and 14% (n=126) reported a prior stillbirth. The HIV seroprevalence was 24%. Discussion: We have established a large cohort of pregnant women and newborns at the WNH to characterize the determinants of adverse birth outcomes in Lusaka, Zambia. Our overarching goal is to elucidate biological mechanisms in an effort to identify new strategies for early detection and prevention of adverse outcomes. We hope that findings from this cohort will help guide future studies, clinical care, and policy.

scholarly journals The Zambian Preterm Birth Prevention Study (ZAPPS): Cohort characteristics at enrollment

2018 ◽  
Vol 2 ◽  
pp. 25 ◽  
Author(s):  
Marcela C. Castillo ◽  
Nurain M. Fuseini ◽  
Katelyn Rittenhouse ◽  
Joan T. Price ◽  
Bethany L. Freeman ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Gestational Age ◽  
Clinical Care ◽  
Phase 1 ◽  
Adverse Outcomes ◽  
Sub Saharan Africa ◽  
Growth Monitoring ◽  
Prevention Study ◽  
District Health

Background:Sub-Saharan Africa bears a disproportionate burden of preterm birth and other adverse outcomes. A better understanding of the demographic, clinical, and biologic underpinnings of these adverse outcomes is urgently needed to plan interventions and inform new discovery.  Methods:The Zambian Preterm Birth Prevention Study (ZAPPS) is a prospective observational cohort established at the Women and Newborn Hospital (WNH) in Lusaka, Zambia. We recruit pregnant women from district health centers and the WNH and offer ultrasound examination to determine eligibility. Participants receive routine obstetrical care, lab testing, midtrimester cervical length measurement, and serial fetal growth monitoring. At delivery, we assess gestational age, birthweight, vital status, and sex and assign a delivery phenotype. We collect blood, urine, and vaginal swab specimens at scheduled visits and store them in an on-site biorepository. In September 2017, enrollment of the ZAPPS Phase 1 – the subject of this report – was completed. Phase 2 – which is limited to HIV-uninfected women – reopened in January 2018.  Results:Between August 2015 and September 2017, we screened 1784 women, of whom 1450 (81.2%) met inclusion criteria and were enrolled. The median age at enrollment was 27 years (IQR 23–32) and thee median gestational age was 16 weeks (IQR 13–18). Among parous women (N=866; 64%), 21% (N=182) reported a prior miscarriage, 49% (N=424) reported a prior preterm birth, and 13% (N=116) reported a prior stillbirth. The HIV seroprevalence was 24%. Discussion:We have established a large cohort of pregnant women and newborns at the WHN to characterize the determinants of adverse birth outcomes in Lusaka, Zambia. Our overarching goal is to elucidate biological mechanisms in an effort to identify new strategies for early detection and prevention of adverse outcomes. We hope that findings from this cohort will help guide future studies, clinical care, and policy.

scholarly journals The Zambian Preterm Birth Prevention Study (ZAPPS): Cohort characteristics at enrollment

2018 ◽  
Vol 2 ◽  
pp. 25 ◽  
Author(s):  
Marcela C. Castillo ◽  
Nurain M. Fuseini ◽  
Katelyn Rittenhouse ◽  
Joan T. Price ◽  
Bethany L. Freeman ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Clinical Care ◽  
Adverse Outcomes ◽  
Sub Saharan Africa ◽  
Growth Monitoring ◽  
Adverse Birth Outcomes ◽  
Prevention Study ◽  
Background Rate

Background: Sub-Saharan Africa bears a disproportionate burden of preterm birth and other adverse outcomes. Not only is the background rate of preterm birth higher than in North America and Europe, but many facilities lack essential equipment and personnel resources to care for preterm neonates. A better understanding of the demographic, clinical, and biologic underpinnings of preterm birth is urgently needed to plan interventions and inform new discovery.  Methods: The Zambian Preterm Birth Prevention Study (ZAPPS) is a prospective antenatal cohort established at the Women and Newborn Hospital of the University Teaching Hospital (UTH) in Lusaka, Zambia. We recruit pregnant women from the antenatal clinics of district health centers and the UTH for study participation. Women undergo ultrasound examination to determine eligibility by gestational age criteria. Enrolled participants receive routine antenatal and postnatal care, lab testing, midtrimester cervical length measurement, serial fetal growth monitoring and careful assessment of birth outcomes.  Results: Between August 2015 and September 2017, we screened 1784 women, of whom 1450 (81.2%) met inclusion criteria and were enrolled. The median age at enrollment of study participants is 27 years (IQR 23–32). Participants are enrolled at a median gestational age of 16 weeks (IQR 13–18). Among all parous participants (N=866; 64%), 21% (N=182) reported a prior miscarriage, 49% (N=424) reported a prior preterm birth, and 13% (N=116) reported a prior stillbirth. The HIV seroprevalence in our cohort is 24%. Discussion: We have established a large antenatal cohort to characterize the epidemiological and biological determinants of adverse birth outcomes in Lusaka, Zambia. Findings from this cohort will help guide future studies, clinical care, and policy in the prevention and treatment of adverse birth outcomes.

P2246Maternal and foetal outcomes of anticoagulation in pregnant women with preconception venous thromboembolism

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Soegaard ◽  
F Skjoth ◽  
P B Nielsen ◽  
J Beyer-Westendorf ◽  
T B Larsen
Keyword(s):  
Preterm Birth ◽  
Venous Thromboembolism ◽  
Pregnant Women ◽  
Gestational Age ◽  
First Trimester ◽  
Adverse Outcomes ◽  
Congenital Defects ◽  
Maternal Outcomes ◽  
Foetal Loss ◽  
Recurrent Vte

Abstract Background Anticoagulation is essential to prevent recurrent venous thromboembolism (VTE) during pregnancy in women with a history of preconception VTE. However, information on the safety of anticoagulant drugs in this setting is limited. Purpose To investigate the risk of maternal and foetal adverse outcomes associated with anticoagulant exposure during pregnancy. Methods Nationwide cohort of all pregnant women in Denmark with preconception VTE, 2000–2017. We linked individual-level data from nationwide registries on anticoagulant exposure, maternal and foetal outcomes. Results Among 5,099 pregnancies in 3,246 women with preconception VTE (mean age 31 years, 41% nulliparous), 36.4% were exposed to anticoagulants during first trimester (66.4% low-molecular-weight heparin (LMWH), 31.9% VKA, and 1.8% NOAC (Table). No maternal deaths occurred. Maternal outcomes were comparable among LMWH and unexposed women, whereas recurrent VTE and foetal loss was more prevalent in VKA and NOAC exposed women. Foetal risk was lowest in unexposed and LMWH exposed, whereas preterm birth was prevalent in VKA and NOAC exposed. Table 1. Maternal and foetal outcomes in pregnant women with preconception VTE according to first trimester anticoagulant exposure Maternal outcomes No anticoagulants LMWH VKA NOAC Total pregnancies/singleton foetuses, N 3,244/2,722 1231/1,124 591/442 33 /26 Recurrent VTE, % (N) 2.7 (89) 3.3 (41) 6.4 (38) – (<5) Antenatal bleeding, % (N) 2.3 (73) 2.7 (33) 1.5 (9) 0 Preeclampsia, % (N) 3.0 (98) 2.1 (26) 4.4 (26) – (<5) Foetal loss, % (N) 13.4 (436) 6.6 (81) 22.2 (131) 21.2 (7) Foetal outcomes in live singleton births, except stillbirth   Stillbirth, % (N) 0.6 (17) 0.6 (7) – (<5) 0   Mean gestational age, days/birthweight, gram 246/3,458 246/3,471 238/3,212 243/3,138   Preterm birth (<37 weeks), % (N) 41.1 (1,111) 38.3 (428) 63.2 (277) 57.7 (15)   Very preterm birth (<28 weeks), % (N) 0.9 (24) 1.3 (14) 2.7 (12) 0   Small for gestational age, % (N) 4.2 (109) 4.5 (49) 4.8 (20) – (<5)   Mean 5-minute Apgar score, (sd) 9.8 (0.8) 9.8 (0.7) 9.8 (1.0) 9.7 (1.0)   Congenital defects 8.4 (226) 9.0 (100) 10.0 (44) – (<5) Counts are supressed in cells with <5 observations to prevent disclosure of potentially identifiable information. Conclusion Our findings are reassuring and in support of the recommendation of LMWH for pregnant women with prior VTE. Few women were exposed to NOAC during pregnancy, and the safety of NOACs cannot be substantiated with the current level of evidence. Acknowledgement/Funding The Obel Family Foundation partly funded this research by an unrestricted grant.

scholarly journals Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts

2021 ◽  
Vol 10 (4) ◽  
pp. 643
Author(s):  
Veronica Giorgione ◽  
Corey Briffa ◽  
Carolina Di Fabrizio ◽  
Rohan Bhate ◽  
Asma Khalil
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Perinatal Death ◽  
Perinatal Outcomes ◽  
Adverse Outcomes ◽  
Chi Square ◽  
Increased Risk ◽  
Twin Pregnancies

Twin pregnancies are commonly assessed using singleton growth and birth weight reference charts. This practice has led to a significant number of twins labelled as small for gestational age (SGA), causing unnecessary interventions and increased risk of iatrogenic preterm birth. However, the use of twin-specific charts remains controversial. This study aims to assess whether twin-specific estimated fetal weight (EFW) and birth weight (BW) charts are more predictive of adverse outcomes compared to singleton charts. Centiles of EFW and BW were calculated using previously published singleton and twin charts. Categorical data were compared using Chi-square or McNemar tests. The study included 1740 twin pregnancies, with the following perinatal adverse outcomes recorded: perinatal death, preterm birth <34 weeks, hypertensive disorders of pregnancy (HDP) and admissions to the neonatal unit (NNU). Twin-specific charts identified prenatally and postnatally a smaller proportion of infants as SGA compared to singleton charts. However, twin charts showed a higher percentage of adverse neonatal outcomes in SGA infants than singleton charts. For example, perinatal death (SGA 7.2% vs. appropriate for gestational age (AGA) 2%, p < 0.0001), preterm birth <34 weeks (SGA 42.1% vs. AGA 16.4%, p < 0.0001), HDP (SGA 21.2% vs. AGA 13.5%, p = 0.015) and NNU admissions (SGA 69% vs. AGA 24%, p < 0.0001), when compared to singleton charts (perinatal death: SGA 2% vs. AGA 1%, p = 0.029), preterm birth <34 weeks: (SGA 20.6% vs. AGA 17.4%, p = 0.020), NNU admission: (SGA 34.5% vs. AGA 23.9%, p < 0.000). There was no significant association between HDP and SGA using the singleton charts (p = 0.696). In SGA infants, according to the twin charts, the incidence of abnormal umbilical artery Doppler was significantly more common than in SGA using the singleton chart (27.0% vs. 8.1%, p < 0.001). In conclusion, singleton charts misclassify a large number of twins as at risk of fetal growth restriction. The evidence suggests that the following twin-specific charts could reduce unnecessary medical interventions prenatally and postnatally.

scholarly journals Asexual and sexual stages of Plasmodium falciparum in Nigerian pregnant women attending antenatal booking clinic

2010 ◽  
Vol 3 (3) ◽  
pp. 106-109 ◽  
Author(s):  
S T Balogun ◽  
F A Fehintola ◽  
O A Adeyanju ◽  
A A Adedeji
Keyword(s):  
Plasmodium Falciparum ◽  
Preterm Birth ◽  
Infant Mortality ◽  
Pregnant Women ◽  
Blood Meal ◽  
Sub Saharan Africa ◽  
Female Mosquito ◽  
Susceptibility To Infection ◽  
Sexual Stages ◽  
Sub Saharan

Susceptibility to infection by Plasmodium falciparum is increased in pregnant women. In sub-Saharan Africa, the consequences of maternal malaria include preterm birth, fetal growth restriction and increased infant mortality. Malaria transmission requires the circulation of viable gametocytes that can be ingested by the female mosquito taking a blood meal. This study was conducted to evaluate the presence of asexual and sexual stages of P. falciparum in pregnant women attending antenatal booking clinics in south-western Nigeria, an area hyper-endemic for malaria. Gametocyte carriage was about 13%, similar to that documented for children symptomatic for malaria in our area of study.

scholarly journals Maternal metabolic profiling to assess fetal gestational age and predict preterm delivery: a two-centre retrospective cohort study in the US

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040647
Author(s):  
Karl G Sylvester ◽  
Shiying Hao ◽  
Jin You ◽  
Le Zheng ◽  
Lu Tian ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Metabolic Profiling ◽  
Retrospective Cohort ◽  
Clinical Care ◽  
Full Term ◽  
Additional Patient ◽  
Term Pregnancy

ObjectivesThe aim of this study was to develop a single blood test that could determine gestational age and estimate the risk of preterm birth by measuring serum metabolites. We hypothesised that serial metabolic modelling of serum analytes throughout pregnancy could be used to describe fetal gestational age and project preterm birth with a high degree of precision.Study designA retrospective cohort study.SettingTwo medical centres from the USA.ParticipantsThirty-six patients (20 full-term, 16 preterm) enrolled at Stanford University were used to develop gestational age and preterm birth risk algorithms, 22 patients (9 full-term, 13 preterm) enrolled at the University of Alabama were used to validate the algorithms.Outcome measuresMaternal blood was collected serially throughout pregnancy. Metabolic datasets were generated using mass spectrometry.ResultsA model to determine gestational age was developed (R2=0.98) and validated (R2=0.81). 66.7% of the estimates fell within ±1 week of ultrasound results during model validation. Significant disruptions from full-term pregnancy metabolic patterns were observed in preterm pregnancies (R2=−0.68). A separate algorithm to predict preterm birth was developed using a set of 10 metabolic pathways that resulted in an area under the curve of 0.96 and 0.92, a sensitivity of 0.88 and 0.86, and a specificity of 0.96 and 0.92 during development and validation testing, respectively.ConclusionsIn this study, metabolic profiling was used to develop and test a model for determining gestational age during full-term pregnancy progression, and to determine risk of preterm birth. With additional patient validation studies, these algorithms may be used to identify at-risk pregnancies prompting alterations in clinical care, and to gain biological insights into the pathophysiology of preterm birth. Metabolic pathway-based pregnancy modelling is a novel modality for investigation and clinical application development.

The correlation between vitamin D and maternal/infant outcomes, inflammatory response in pregnant women

2020 ◽  
Author(s):  
Yarong Wei ◽  
Xinye Jiang ◽  
Ting Qiu ◽  
Jinyan Fu ◽  
Heng Zhang ◽  
...  
Keyword(s):  
Vitamin D ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Vitamin D Deficiency ◽  
Spontaneous Abortion ◽  
Gestational Age ◽  
Serum Vitamin ◽  
Multivariate Logistic Regression Analysis ◽  
Premature Delivery ◽  
Vitamin D Levels

Abstract Purposes To analyze the effects of vitamin D deficiency in pregnant women on common adverse pregnancy outcomes and small for gestational age (SGA) and to detect the expression of inflammatory factors in pregnant women to provide a theoretical basis for the treatment of vitamin D deficiency in pregnant women. Methods Serum samples from pregnant women from January 2015 to December 2015 were collected to measure the 25-(OH)D level. The effects of maternal age, pregnancy, season, parity and temperature on vitamin D levels in pregnant women were recorded. Then, the relationship between vitamin D levels and gestational diabetes mellitus, gestational hypertension, premature rupture of membranes, cesarean section, premature delivery and spontaneous abortion, and neonatal gestational age were analyzed. The expression of IL-6 and TNF-α in serum was detected by RT-PCR and western blot. Results The incidence of vitamin D deficiency, insufficiency and sufficiency in pregnant women in this region was 83.28%, 15.36% and 1.36%, respectively. Age, pregnancy, sampling season and parity were the influencing factors on vitamin D level, and multivariate logistic regression analysis showed that summer, autumn and temperature were protective factors for adequate vitamin D in pregnant women (P <0.05). Vitamin D levels in pregnant women were associated with preterm birth, spontaneous abortion and SGA. The incidences of preterm birth, spontaneous abortion and SGA were higher in the vitamin D deficiency group (P<0.05). ConclusionThe serum vitamin D level of pregnant women in this area is low and is affected by multiple factors such as age, pregnancy, season, parity and temperature. Low vitamin D levels can increase the risk of premature birth, spontaneous abortion and SGA in pregnant women, and its low expression is common. As it also leads to inflammation, increasing the level of vitamin D in the serum of pregnant women can effectively reduce the occurrence of related diseases.

Early pregnancy serum neopterin concentrations predict spontaneous preterm birth in asymptomatic pregnant women

2016 ◽  
Vol 44 (5) ◽  
Author(s):  
Dan Bogdan Navolan ◽  
Simona Vladareanu ◽  
Imad Lahdou ◽  
Ioana Ciohat ◽  
Christian Kleist ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Early Pregnancy ◽  
Gestational Age ◽  
Odds Ratio ◽  
Considerable Increase ◽  
Second Trimester ◽  
Spontaneous Preterm Birth ◽  
Serum Neopterin

AbstractTo investigate if early pregnancy serum neopterin concentrations (EPSN) could predict spontaneous preterm birth (SPB).EPSN was measured in 92 sera collected from 46 pregnant women with birth at term and 40 sera from 20 pregnant women with preterm birth. Two sera were collected for each case: in the first and early second trimester.EPSN concentrations correlate with gestational age (ρ=0.275, P=0.001), a correlation which was present in both groups: term and preterm birth. EPSN were higher in pregnancies with SPB compared with normal pregnancies (6.27±1.03 vs. 6.04±0.15, P=0.039). Patients with SPB showed a considerable increase of EPSN in the second trimester compared with patients with birth at term (7.30±1.53 vs. 6.16±0.23, P=0.043). A sharper increase was found in the group with SPB before 32 weeks of pregnancy (wp) (9.83±4.36 vs. 6.16±0.23, P=0.016). Pregnant women with an early second trimester serum neopterin value of above 8 nmol/L are associated with a risk of SPB before 32 wp (odds ratio=14.4, P=0.01) and of SPB before 34 wp (odds ratio=3.6, P=0.05), respectively.EPSN increases with the gestational age and predicts SPB in asymptomatic pregnant women.

scholarly journals P0150APREECLAMPSIA ABOUT 252 PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Boubchir Akli ◽  
Boubchir Akli ◽  
Brahim Kichou ◽  
MADIOU ALI
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Pregnant Women ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Fetal Death ◽  
Gestational Hypertension ◽  
Adverse Outcomes ◽  
Previous Pregnancy ◽  
Fetal Complications

Abstract Background and Aims The main objective was to estimate the prevalence of pre-eclampsia (PE) in pregnant women in Tizi-ouzou (Algeria). Secondary objectives were to estimate the frequency of PE risk factors, and the incidence of maternal and fetal complications. Methods Our study was observational, prospective and descriptive, including all pregnant women at the prenatal appointment in the 2 maternity units of Tizi-ouzou, between January 2012 and June 2013. PE was diagnosed if gestational hypertension was associated with proteinuria &gt; 300mg/24h, after 20 weeks of gestation. Results We had 252 cases of PE on 3225 pregnant women. The prevalence of PE was 7.8% (CI 95%: 6.9%–8.7%). The most frequent PE risk factors were nulliparity (56%), age &gt;40 years (27%), obesity (26%) and PE in any previous pregnancy (21%). The incidence of maternal adverse events was 28.7% (CI 95%: 23.1%–34.3%), including 5 deaths. The rates of prematurity, small for gestational age infant and fetal death were 58.2%, 49.7% and 6.7%, respectively. Conclusion The prevalence of PE in pregnant women in Tizi-ouzou is around 8%. The incidence of maternal and fetal adverse outcomes remains high. Only earlier diagnosis and closer monitoring could improve the prognosis of our patients, since the treatment of PE remains currently childbirth.

Adverse Outcomes with Maternal Blood Pressure Less than 140/90 in Pregnancy Complicated by Hypertension

2019 ◽  
Vol 36 (13) ◽  
pp. 1394-1400 ◽  
Author(s):  
Courtney J. Mitchell ◽  
Alan Tita ◽  
Sarah B. Anderson ◽  
Daniel N. Pasko ◽  
Lorie M. Harper
Keyword(s):  
Blood Pressure ◽  
Preterm Birth ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Maternal Blood ◽  
Adverse Outcomes ◽  
Chronic Hypertension ◽  
Increased Risk

Objective We assessed the risk of small for gestational age and other outcomes in pregnancies complicated by chronic hypertension with blood pressure <140/90 mm Hg. Study Design Retrospective cohort of singletons with hypertension at a single institution from 2000 to 2014. Mean systolic blood pressure and mean diastolic blood pressure were analyzed as continuous and dichotomous variables (<120/80 and 120–139/80–89 mm Hg). The primary outcome was small for gestational age. Secondary outcomes included birth weight, preeclampsia, preterm birth <35 weeks, and a composite of adverse neonatal outcomes. Results Small for gestational age was not increased with a mean systolic blood pressure <120 mm Hg compared with a mean systolic blood pressure 120 to 129 mm Hg (adjusted odds ratio [AOR] 1.6; 95% confidence interval [CI] 0.92–2.79). Mean diastolic blood pressure <80 mm Hg was associated with a decrease in the risk preeclampsia (AOR 0.57; 95% CI 0.35–0.94), preterm birth <35 weeks (AOR 0.35; 95% CI 0.20–0.62), and the composite neonatal outcome (AOR 0.42; 95% CI 0.22–0.81). Conclusion Mean systolic blood pressure <120 mm Hg and mean diastolic blood pressure <80 mm Hg were not associated with increased risk of small for gestational age when compared with higher, normal mean systolic and diastolic blood pressures.

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