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Biophysical Profile Cuts ADD Risk.

MIAMI BEACH -- Use of biophysical profiling to enable swift delivery at the first sign of fetal asphyxia appears to be associated with a reduced risk of attention-deficit disorder and several other disorders later in life.

In fact, in a study of 153,593 children, those born to high-risk women who were carefully watched and delivered if there were signs of fetal asphyxia were seven times less likely to develop attention-deficit disorder (ADD) as children born to low-risk mothers who were not monitored, Dr. Frank A. Manning said in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Rates of cerebral palsy, mental retardation, and cortical blindness were also significantly lower in the carefully watched group.

Dr. Manning and his colleagues at Albert Einstein College of Medicine in New York used biophysical profiling (BPP), which reflects fetal adaption and is a proxy for fetal pH, to monitor the fetuses of 36,388 pregnant women who were deemed to be at high risk due to diabetes, hypertension, a history of stillbirth, and other factors.

They also tracked long-term outcomes among another 117,255 fetuses of low-risk women who were not profiled.

As many as 97% of the fetuses of high-risk women had normal BPP. The other 3% had BPP scores of 6 or less, which indicated fetal acidemia, and were delivered immediately.

"We initially expected that the high-risk women--whether they had diabetes, hypertension, or whatever--would have a higher rate of children with problems. But what we found was that the nontested group had an incidence of ADD that was about seven times higher," he told this newspaper.

By age 10, the incidence of ADD among the children in the nonprofiled group was 2.8%, compared with 0.47% among children in the profiled group.

The same protective effect of BPP monitoring was seen--although to a less dramatic degree--in the rates of cerebral palsy (0.1% versus 0.5%), mental retardation (0.09% versus 0.3%), and cortical blindness (0.07% versus 0.1%).

Furthermore, when the investigators controlled for genetic and postnatal causes of mental retardation, leaving only those cases of unknown etiology, mental retardation was still more prevalent in the untested group at 0.45%, compared with 0.29% in the tested group.

The risk of these adverse outcomes rises as BPP scores fall, so chronic asphyxia of the fetus probably plays some role in their etiologies, according to Dr. Manning.

"If you test for and treat chronic asphyxia, you can't eliminate these problems, but you can decrease their frequency, particularly that of ADD," he asserted.

If these data are ever substantiated, they would make a strong argument in favor of routine BPP screening.

"It will take a lot more evidence before we can justify the expense of wide-scale [BPP monitoring]. The next step is to try and identify who specifically is at risk and who isn't," he said.

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Title Annotation:attention-deficit disorder
Author:JOHNSON, KATE
Publication:Family Practice News
Geographic Code:1USA
Date:Apr 1, 2000
Words:482
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