NSIDRC Journal Article Alert — May 16, 2008

Prepared by the National Sudden Infant Death Resource Center at Georgetown University.

This journal article alert provides selected items added to the National Library of Medicine’s PubMed database in the last week.

Past issues of NSIDRC journal alerts are available at http://www.sidscenter.org.
Availability of full-text journal articles is often limited to subscribers or through inter-library loan. Please see your local library for copies of these articles, or view PubMed's How to Get the Journal Article for more details.

Sudden Infant Death

1. Pinho AP, Aerts D, Nunes ML
Risk factors for sudden infant death syndrome in a developing country
Rev Saude Publica. 2008 Jun;42(3):396-401

Departamento de Neurologia, Hospital São Lucas, Pontifícia Universidade do Rio Grande do Sul, Porto Alegre, RS, Brasil

OBJECTIVE: To analyze whether previously identified risk factors for sudden death syndrome have a significant impact in a developing country. METHODS: Retrospective longitudinal case-control study carried out in Porto Alegre, Southern Brazil. Cases (N=39) were infants born between 1996 and 2000 who died suddenly and unexpectedly at home during sleep and were diagnosed with sudden death syndrome. Controls (N=117) were infants matched by age and sex who died in hospitals due to other conditions. Data were collected from postmortem examination records and questionnaires answers. A conditional logistic model was used to identify factors associated with the outcome. RESULTS: Mean age at death of cases was 3.2 months. The frequencies of infants regarding gestational age, breastfeeding and regular medical visits were similar in both groups. Sleeping position for most cases and controls was the lateral one. Supine sleeping position was found for few infants in both groups. Maternal variables, age below 20 years (OR=2, 95% CI: 1.1; 5.1) and smoking of more than 10 cigarettes per day during pregnancy (OR=3, 95% CI: 1.3; 6.4), significantly increased the risk for the syndrome. Socioeconomic characteristics were similar in both groups and did not affect risk. CONCLUSIONS: Infant-maternal and socioeconomic profiles of cases in a developing country closely resembled the profile described in the literature, and risk factors were similar as well. However, individual characteristics were identified as risks in the population studied, such as smoking during pregnancy and maternal age below 20 years.

2. Kiechl-Kohlendorfer U, Moon RY
Sudden infant death syndrome (SIDS) and child care centres (CCC)
Acta Paediatr. 2008 May 7 [Epub ahead of print]

Department of Paediatrics, Division of Neonatology, Neuropaediatrics and Metabolic Diseases, Innsbruck Medical University, Innsbruck, Austria

Our aim was to review the risk of sudden infant death syndrome (SIDS) when infants are in child care (CC), to discuss factors potentially responsible for SIDS in this setting and to describe the impact of previous information campaigns on SIDS in CC. There is a remarkably increased risk of SIDS in CC settings. Special education focussing on a safe sleeping environment has resulted in a decrease of practices known to be associated with SIDS. However, despite a safe sleep environment SIDS prevalence remains disproportionately high. Conclusion: Efforts must continue to ensure safe sleeping practices in CC facilities. The possibility of other explanations for the increased prevalence of SIDS in CC settings, such as changes in infant care or stress, must be considered as well

Other Infant Death

1. Paul DA, Mackley A, Locke RG, Stefano JL, Kroelinger C
State Infant Mortality: An Ecologic Study to Determine Modifiable Risks and Adjusted Infant Mortality Rates
Matern Child Health J. 2008 May 13 [Epub ahead of print]

Pediatrics and Neonatology, Christiana Care Health Services, Christiana Hospital, 4745 Ogeltown-Stanton Road, MAP-1, Suite 217, Newark, DE, 19713, USA, dpaul@christianacare.org

Objective To determine factors contributing to state infant mortality rates (IMR) and develop an adjusted IMR in the United States for 2001 and 2002. Design/Methods Ecologic study of factors contributing to state IMR. State IMR for 2001 and 2002 were obtained from the United States linked death and birth certificate data from the National Center for Health Statistics. Factors investigated using multivariable linear regression included state racial demographics, ethnicity, state population, median income, education, teen birth rate, proportion of obesity, smoking during pregnancy, diabetes, hypertension, cesarean delivery, prenatal care, health insurance, self-report of mental illness, and number of in-vitro fertilization procedures. Final risk adjusted IMR's were standardized and states were compared with the United States adjusted rates. Results Models for IMR in individual states in 2001 (r (2) = 0.66, P < 0.01) and 2002 (r (2) = 0.81, P < 0.01) were tested. African-American race, teen birth rate, and smoking during pregnancy remained independently associated with state infant mortality rates for 2001 and 2002. Ninety five percent confidence intervals (CI) were calculated around the regression lines to model the expected IMR. After adjustment, some states maintained a consistent IMR; for instance, Vermont and New Hampshire remained low, while Delaware and Louisiana remained high. However, other states such as Mississippi, which have traditionally high infant mortality rates, remained within the expected 95% CI for IMR after adjustment indicating confounding affected the initial unadjusted rates. Conclusions Non-modifiable demographic variables, including the percentage of non-Hispanic African-American and Hispanic populations of the state are major factors contributing to individual variation in state IMR. Race and ethnicity may confound or modify the IMR in states that shifted inside or outside the 95% CI following adjustment. Other factors including smoking during pregnancy and teen birth rate, which are potentially modifiable, significantly contributed to differences in state IMR. State risk adjusted IMR indicate that other factors impact infant mortality after adjustment by race/ethnicity and other risk factors.

2. Lin CC, Wang JD, Hsieh GY, Chang YY, Chen PC
Health risk in the offspring of female semiconductor workers
Occup Med (Lond). 2008 May 7 [Epub ahead of print]

Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan

BACKGROUND: There are no published studies focusing on adverse birth outcomes or infant mortality in the semiconductor industry. AIM: To investigate whether female workers have higher risks of any adverse birth outcome or death from congenital malformation. METHODS: A total of 27 610 female workers had been employed in eight semiconductor companies in Taiwan between 1980 and 2000. Using the national birth registry, their live born children were identified, and then any deaths under 5 years of age with or without congenital malformations were identified by linking with the national death registry. Periconceptional exposure was defined as the mother having been employed in the semiconductor industry 3 months before and 3 months after conception of the live born infants. RESULTS: A total of 24 223 live births were included. No significant association between adverse birth outcomes or death with congenital malformation and maternal employment in semiconductor industry was found either in the period of 1980-94 or 1995-2000. CONCLUSIONS: There is no convincing evidence that female workers employed during the periconceptional period in the semiconductor industry had higher risks of having adverse birth outcomes or death due to congenital malformations. However, prospective research is warranted to confirm these findings.

3. Dominguez TP
Race, racism, and racial disparities in adverse birth outcomes
Clin Obstet Gynecol. 2008 Jun;51(2):360-70

School of Social Work, University of Southern California, Los Angeles, California, USA. tyanpark@usc.edu

While the biologic authenticity of race remains a contentious issue, the social significance of race is indisputable. The chronic stress of racism and the social inequality it engenders may be underlying social determinants of persistent racial disparities in health, including infant mortality, preterm delivery, and low birth weight. This article describes the problem of racial disparities in adverse birth outcomes; outlines the multidimensional nature of racism and the pathways by which it may adversely affect health; and discusses the implications for clinical practice.

4. Mangano JJ
Excess infant mortality after nuclear plant startup in rural Mississippi
Int J Health Serv. 2008;38(2):277-91

Radiation and Public Health Project, Ocean City, NJ 08226, USA. odiejoe@aol.com

In the United States, utility companies have recently begun ordering new nuclear power reactors, the first such orders in the country since 1978. One potential site would be the Grand Gulf plant near Port Gibson, Mississippi. In 1983-1984, the first two years in which the existing Grand Gulf reactor operated, significant increases were observed in local rates of infant deaths (+35.3%) and fetal deaths (+57.8%). Local infant mortality remained elevated for the next two decades. These changes match those experienced in the same five local counties during atomic bomb testing in the 1950s and 1960s. This report examines potential reasons why an indigent, largely African American community may be at higher risk than other populations from exposure to an environmental toxin such as radiation. It also considers potential health risks posed by new reactors at Grand Gulf.

Miscarriage/Stillbirth/Prenatal Issues

1. Roche N, Skurnick J, Brown K, Heller DS
Do stillborns with no identifiable pathology have leaner cords than liveborns?
J Reprod Med. 2008 Apr;53(4):283-6

Department of Obstetrics, Gynecology and Women's Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark 07101, USA

OBJECTIVE: To evaluate whether stillbirths with no explanation found at autopsy have thinner cords than live, gestational-age-matched controls. STUDY DESIGN: Stillbirth autopsies performed at University Hospital, Newark, New Jersey, from January 1995 to October 2002 were reviewed. Cases with no explanation for the death at autopsy had their umbilical cord diameters compared to those in 3 groups of age-matched controls: stillbirths with an identifiable cause of death, liveborns with placentas submitted for pathology evaluation and liveborns from which the placentas were not submitted to pathology. Age-adjusted ANOVAs were performed for comparisons. RESULTS: Of 181 autopsies performed during the review period, 21 cases (11.6%) provided no information at autopsy that would explain or contribute to an understanding of the death. There was no significant difference in cord diameters between either group ofstillbirths or the pathology-submitted controls. Third-trimester placentas from liveborns without placental submission to pathology had significantly greater cord diameters (p = 0.001). CONCLUSION: This study does not support the theory that a cord accident or decreased umbilical blood flow resulting from a leaner umbilical cord can explain a significant number of stillbirths with no other findings at autopsy. However, it supports the literature in that leaner cords appear to be associated with a wide variety of adverse perinatal conditions.

2. Wigle DT, Arbuckle TE, Turner MC, Bérubé A, Yang Q, Liu S, Krewski D
Epidemiologic evidence of relationships between reproductive and child health outcomes and environmental chemical contaminants
J Toxicol Environ Health B Crit Rev. 2008 May;11(5-6):373-517

McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada. don.wigle@sympatico.ca

This review summarizes the level of epidemiologic evidence for relationships between prenatal and/or early life exposure to environmental chemical contaminants and fetal, child, and adult health. Discussion focuses on fetal loss, intrauterine growth restriction, preterm birth, birth defects, respiratory and other childhood diseases, neuropsychological deficits, premature or delayed sexual maturation, and certain adult cancers linked to fetal or childhood exposures. Environmental exposures considered here include chemical toxicants in air, water, soil/house dust and foods (including human breast milk), and consumer products. Reports reviewed here included original epidemiologic studies (with at least basic descriptions of methods and results), literature reviews, expert group reports, meta-analyses, and pooled analyses. Levels of evidence for causal relationships were categorized as sufficient, limited, or inadequate according to predefined criteria. There was sufficient epidemiological evidence for causal relationships between several adverse pregnancy or child health outcomes and prenatal or childhood exposure to environmental chemical contaminants. These included prenatal high-level methylmercury (CH(3)Hg) exposure (delayed developmental milestones and cognitive, motor, auditory, and visual deficits), high-level prenatal exposure to polychlorinated biphenyls (PCBs), polychlorinated dibenzofurans (PCDFs), and related toxicants (neonatal tooth abnormalities, cognitive and motor deficits), maternal active smoking (delayed conception, preterm birth, fetal growth deficit [FGD] and sudden infant death syndrome [SIDS]) and prenatal environmental tobacco smoke (ETS) exposure (preterm birth), low-level childhood lead exposure (cognitive deficits and renal tubular damage), high-level childhood CH(3)Hg exposure (visual deficits), high-level childhood exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) (chloracne), childhood ETS exposure (SIDS, new-onset asthma, increased asthma severity, lung and middle ear infections, and adult breast and lung cancer), childhood exposure to biomass smoke (lung infections), and childhood exposure to outdoor air pollutants (increased asthma severity). Evidence for some proven relationships came from investigation of relatively small numbers of children with high-dose prenatal or early childhood exposures, e.g., CH(3)Hg poisoning episodes in Japan and Iraq. In contrast, consensus on a causal relationship between incident asthma and ETS exposure came only recently after many studies and prolonged debate. There were many relationships supported by limited epidemiologic evidence, ranging from several studies with fairly consistent findings and evidence of dose-response relationships to those where 20 or more studies provided inconsistent or otherwise less than convincing evidence of an association. The latter included childhood cancer and parental or childhood exposures to pesticides. In most cases, relationships supported by inadequate epidemiologic evidence reflect scarcity of evidence as opposed to strong evidence of no effect. This summary points to three main needs: (1) Where relationships between child health and environmental exposures are supported by sufficient evidence of causal relationships, there is a need for (a) policies and programs to minimize population exposures and (b) population-based biomonitoring to track exposure levels, i.e., through ongoing or periodic surveys with measurements of contaminant levels in blood, urine and other samples. (2) For relationships supported by limited evidence, there is a need for targeted research and policy options ranging from ongoing evaluation of evidence to proactive actions. (3) There is a great need for population-based, multidisciplinary and collaborative research on the many relationships supported by inadequate evidence, as these represent major knowledge gaps. Expert groups faced with evaluating epidemiologic evidence of potential causal relationships repeatedly encounter problems in summarizing the available data. A major driver for undertaking such summaries is the need to compensate for the limited sample sizes of individual epidemiologic studies. Sample size limitations are major obstacles to exploration of prenatal, paternal, and childhood exposures during specific time windows, exposure intensity, exposure-exposure or exposure-gene interactions, and relatively rare health outcomes such as childhood cancer. Such research needs call for investments in research infrastructure, including human resources and methods development (standardized protocols, biomarker research, validated exposure metrics, reference analytic laboratories). These are needed to generate research findings that can be compared and subjected to pooled analyses aimed at knowledge synthesis.

3. Franz MB, Lack N, Schiessl B, Mylonas I, Friese K, Kainer F
Stillbirth following previous cesarean section in Bavaria/Germany 1987-2005
Arch Gynecol Obstet. 2008 May 10 [Epub ahead of print]

Department of Obstetrics and Gynaecology, Ludwig-Maximilians-University Munich, Maistrasse 11, 80337, Munich, Germany

BACKGROUND: An elevated risk for unexplained stillbirth in subsequent pregnancies after cesarean section was reported in 2003. This finding would imply renewed discussions about stronger indications for cesarean sections. OBJECTIVE: To find out whether there is an elevated risk for stillbirth in subsequent pregnancies after cesarean section in our cohort in Bavaria. METHODS: As data linkage of records is not possible in Germany, we devised a suitable adjustment for bias correction. Second pregnancies in Bavaria/Germany after previous vaginal birth and previous cesarean section from 1987 to 2005 were analyzed. Risk of unexplained stillbirth was estimated by time-to-event analysis. RESULTS: In our cohort of 629,815 second pregnancies, no elevated stillbirth risk in pregnancies after previous cesarean section compared to previous vaginal birth was noted (crude risk 0.22% in both groups; hazard ratio (HR) 1.00; P = 1.0). A slightly decreased risk for stillbirth after previous cesarean section for the period of 1994-2005 (HR 0.674; P = 0.04) could be shown. CONCLUSION: We found no elevated stillbirth risk in pregnancies after previous cesarean section. The significantly lower risk for stillbirths after previous cesarean section in the period 1994-2005 is interpreted as consequence of improved obstetric surveillance. With our adjustment for bias correction, we hope to have found a way to make our data largely comparable with other sources reported in the literature. However, because of the strict German data protection act, the Bavarian birth register is only of limited use for the presented study.

4. Tsukimori K, Tokunaga S, Shibata S, Uchi H, Nakayama D, Ishimaru T, Nakano H, Wake N, Yoshimura T, Furue M
Long-term effects of polychlorinated biphenyls and dioxins on pregnancy outcomes in women affected by the yusho incident
Environ Health Perspect. 2008 May;116(5):626-30

Department of Obstetrics and Gynecology

BACKGROUND: Maternal exposure to polychlorinated biphenyls (PCBs) is associated with increased proportions of spontaneous abortion and stillbirth in animal studies. In Japan in 1968, accidental human exposure to rice oil contaminated with PCBs and other dioxin-related compounds, such as polychlorinated dibenzofurans (PCDFs), led to the development of what was later referred to as Yusho oil disease. OBJECTIVE: The aim of this study was to investigate the association of maternal PCB and dioxin exposure with adverse pregnancy outcomes in Yusho women. METHODS: In 2004, we interviewed 214 Yusho women (512 pregnancies) about their pregnancy outcomes over the past 36 years. Pregnancy outcomes included induced abortion, spontaneous abortion, preterm delivery, and pregnancy loss. RESULTS: In pregnancy years 1968-1977 (within the first 10 years after exposure), the proportions of induced abortion [odds ratio adjusted for age at delivery (OR(adj)) = 5.93; 95% confidence interval (CI), 2.21-15.91; two-tailed p < 0.001) and preterm delivery (OR(adj) = 5.70; 95% CI, 1.17-27.79; p = 0.03) were significantly increased compared with the proportions in pregnancy years 1958-1967 (10 years before the incident). Spontaneous abortion (OR(adj) = 2.09; 95% CI, 0.84-5.18), and pregnancy loss (OR(adj) = 2.11; 95% CI, 0.92-4.87) were more frequent (OR = 2.18; 95% CI, 1.02-4.66), but these were not significant (p = 0.11 and p = 0.08, respectively) in pregnancy years 1968-1977. We found no significant increases in the proportions of these adverse pregnancy outcomes in pregnancies occurring during 1978-1987 or 1988-2003 compared with those in pregnancies before 1968. CONCLUSION: High levels of PCB/PCDF exposure had some adverse effects on pregnancy outcome in Yusho women.

5. Bedaiwy MA, Fathalla MM, Shaaban OM, Ragab MH, Elbaba S, Luciano M, El-Nashar SA, Falcone T
Reproductive implications of endoscopic third ventriculostomy for the treatment of hydrocephalus
Eur J Obstet Gynecol Reprod Biol. 2008 May 6 [Epub ahead of print]

Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA; Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt

OBJECTIVE: The objective of this study was to compare reproductive function after two neurosurgical procedures for treating non-neoplastic hydrocephalus; endoscopic third ventriculostomy (ETV) and ventriculo-peritoneal shunt (VP). STUDY DESIGN: A cohort of 96 women who underwent neurosurgical procedures to treat non-neoplastic hydrocephalus at the Cleveland Clinic between January 1995 and January 2004 was identified. A follow up mailed survey was sent to all identified women between 15 and 45 years of age. In addition, phone interviews were performed to complete the required data. Clinical, laboratory and operative details were collected from 69 participants. RESULTS: There was a two-fold significant increase in the menstrual irregularities after the procedure in the ETV group [5/52(10%)-10/52(19%), P=0.03] while those treated with VP shunt maintained the same menstrual pattern postoperatively. The rate of pregnancy was higher in the VP group compared to the ETV group, but did not reach statistical significance [8/17(47%) vs. 17/52(33%), P=0.462]. Similarly, the rate of term pregnancies was higher in the VP group compared to ETV group [8/8(100%) vs. 13/17(76%), P=0.269], which reflected a higher spontaneous miscarriage rate in ETV compared to VP group [4/17(33%) vs. 0/8(0%), P=0.269]. CONCLUSION: ETV appears to alter reproductive function postoperatively. In patients who establish a pregnancy, abortion rates seem to be higher in the ETV group; however, a prospective study will be required to validate these observations.

6. Beigi RH, Wiesenfeld HC, Landers DV, Simhan HN
High rate of severe fetal outcomes associated with maternal parvovirus b19 infection in pregnancy
Infect Dis Obstet Gynecol. 2008;2008:524601

Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. rbeigi@mail.magee.edu

OBJECTIVE: To augment the understanding of parvovirus B19 infection in pregnancy with respect to maternal characteristics and their corresponding fetal outcomes. STUDY DESIGN: Retrospective case-series of all women referred to Magee-Women_s Hospital with serologically-documented parvovirus B19 infection during pregnancy from 1998-2001. RESULTS: All 25 cases that are available for analysis occurred from January through June. The frequency of cases varied substantially from year to year, with 14 cases in 1998, 0 cases in 1999 and 2000, and 11 cases in 2001. In contrast to previous reports, the minority of women [4/25(16%)] experienced symptoms attributable to parvovirus B-19 infection although 3 of 25 (12%) fetuses developed hydrops fetalis and 4/25 (16%) suffered an intrauterine of fetal death. CONCLUSIONS: These findings suggest that parvovirus B19 infection in pregnancy follows seasonal and annual trend variation, may produce a lower frequency of maternal symptoms and a higher fetal loss rate than previously reported. Synopsis. Maternal parvovirus B19 infection follows seasonal and annual variation is often asymptomatic and may have higher fetal loss rates than previously reported. Continued surveillance is warranted.

7. Field DJ, Dorling JS, Manktelow BN, Draper ES
Survival of extremely premature babies in a geographically defined population: prospective cohort study of 1994-9 compared with 2000-5
BMJ. 2008 May 9 [Epub ahead of print]

Department of Health Sciences, University of Leicester, Leicester

OBJECTIVE: To assess changes in survival for infants born before 26 completed weeks of gestation. DESIGN: Prospective cohort study in a geographically defined population. SETTING: Former Trent health region of the United Kingdom. SUBJECTS: All infants born at 22+0 to 25+6 weeks' gestation to mothers living in the region. Terminations were excluded but all other births of babies alive at the onset of labour or the delivery process were included. MAIN OUTCOME MEASURES: Outcome for all infants was categorised as stillbirth, death without admission to neonatal intensivecare, death before discharge from neonatal intensivecare, and survival to discharge home in two time periods: 1994-9 and 2000-5 inclusive. RESULTS: The proportion of infants dying in delivery rooms was similar in the two periods, but a significant improvement was seen in the number of infants surviving to discharge (P<0.001). Of 497 infants admitted to neonatal intensive care in 2000-5, 236 (47%) survived to discharge compared with 174/490 (36%) in 1994. These changes were attributable to substantial improvements in the survival of infants born at 24 and 25 weeks. During the 12 years of the study none of the 150 infants born at 22 weeks' gestation survived. Of the infants born at 23 weeks who were admitted to intensive care, there was no significant improvement in survival to discharge in 2000-5 (12/65 (18%) in 2000-5 v 15/81 (19%) in 1994-9). CONCLUSIONS: Survival of infants born at 24 and 25 weeks of gestation has significantly increased. Although over half the cohort of infants born at 23 weeks wasadmitted to neonatalintensive care, there was no improvement in survival at this gestation. Care for infants born at 22 weeks remained unsuccessful.

8. Dendrinos S, Grigoriou O, Sakkas EG, Makrakis E, Creatsas G
Hysteroscopy in the evaluation of habitual abortions
Eur J Contracept Reprod Health Care. 2008 Jun;13(2):198-200

2nd Department of Obstetrics and Gynaecology, "Aretaieion" Hospital, Medical School, University of Athens, Athens, Greece

Objectives To evaluate the incidence of structural uterine anomalies (SUAs) in women with habitual abortion (HA) as diagnosed by means of hysteroscopy and to study hysteroscopy's therapeutic potential with regard to that pathology. Methods Forty-eight women with more than three consecutive pregnancy losses which occurred prior to the 20th week were included and hysteroscopy was performed on all of them. Results Twenty-five women (52%) had a normal hysteroscopy. The remaining 23 women (48%) presented SUAs: nine patients (19%) had intrauterine adhesions, four (8%) had submucous myomas, two (4%) had polyps and eight (17%) had congenital structural uterine anomalies (five cases of septate uterus and three of bicornuate uterus). Patients with abnormal hysteroscopy underwent appropriate therapy, when applicable. In the SUA group, 18 patients (78%) achieved a successful pregnancy, and five patients (22%) had another miscarriage. In the normal hysteroscopy group, eight patients (32%) achieved a successful pregnancy without additional treatment, 15 patients (60%) had recurrent miscarriages, and two patients (8%) had persistent secondary infertility. Conclusions SUAs were detected in nearly half of the patients with HA. After appropriate treatment when applicable, 78% of patients with SUAs achieved a successful ongoing pregnancy. Hysteroscopy has much to offer in the diagnosis and treatment of SUAs.

9. Weck RL, Paulose T, Flaws JA
Impact of environmental factors and poverty on pregnancy outcomes
Clin Obstet Gynecol. 2008 Jun;51(2):349-59

Department of Veterinary Biosciences, University of Illinois Urbana-Champaign, Urbana, Illinois, USA

Studies have indicated that various societal factors such as toxicant exposure, maternal habits, occupational hazards, psychosocial factors, socioeconomic status, racial disparity, chronic stress, and infection may impact pregnancy outcomes. These outcomes include spontaneous abortion, preterm birth, alterations in the development of the fetus, and long-term health of offspring. Although much is known about individual pregnancy outcomes, little is known about the associations between societal factors and pregnancy outcomes. This manuscript reviews some of the literature available on the effects of the above-mentioned societal factors on pregnancy outcomes and examines some potential remedies for preventing adverse pregnancy outcomes in the future.

10. Ruffatti A, Tonello M, Cavazzana A, Bagatella P, Pengo V
Laboratory classification categories and pregnancy outcome in patients with primary antiphospholipid syndrome prescribed antithrombotic therapy
Thromb Res. 2008 May 5 [Epub ahead of print]

Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Padua, Italy

BACKGROUND: A relationship between antibody profile and pregnancy outcome in patients with a previous diagnosis of primary antiphospholipid syndrome (APS) has not been clearly documented. METHODS: Women attending our Center with primary APS characterized by the presence in the blood of one or more of the following: Lupus Anticoagulant (LA), IgG/IgM anticardiolipin (aCL), IgG/IgM anti-human beta2-Glycoprotein I (abeta2GPI) antibodies (confirmed after a minimum of 3 months) were considered eligible for this study. Women who became pregnant during the study period with the exception of those with congenital thrombophilia or other congenital abnormalities were included in our analysis. Primary outcome events, defined as early abortion or fetal death, were evaluated in relation to the laboratory classification category assigned to each patient at the time they were diagnosed with APS. RESULTS: A total of 97 pregnancies occurring in 79 primary APS patients during the study period were analyzed. Twelve out of 97 pregnancies were unsuccessful, 11 out of 65 (16.9%) in category I patients (more than one positive laboratory test) and 1 out of 32 (3.1%) in category II patients (single positive test; adjusted hazard ratio 1.9; 95% CI, 0.2 to 18.9, p=0.6). Pregnancy loss took place in 10 out of 19 pregnancies (52.6%) in women belonging to category I with triple positivity and in 1 out of 46 pregnancies (2.2%) in patients with double positivity. The rate of pregnancy loss was more frequent in the 19 pregnancies of patients with triple positivity than in the 46 pregnancies of double positive patients (adjusted hazard ratio 23, 95% CI, 1.3 to 408, p=0.03). CONCLUSION: Poor pregnancy outcomes occur more frequently in category I than in category II primary APS patients. However, it has been seen that a greater predictability is achieved when category I patients are grouped into triple and double positivity states.

11. Lalioti MD
Can preimplantation genetic diagnosis overcome recurrent pregnancy failure?
Curr Opin Obstet Gynecol. 2008 Jun;20(3):199-204

Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA

PURPOSE OF REVIEW: Preimplantation genetic diagnosis is widely used for the detection of embryo aneuploidy before implantation, with the aim of avoiding miscarriage or pregnancy termination of an aneuploid fetus. The majority of first trimester miscarriages occur due to chromosomal imbalances. The aim of this review is to assess whether preimplantation genetic diagnosis can help women who suffer from recurrent pregnancy loss. RECENT FINDINGS: Several in-vitro fertilization clinics have employed preimplantation genetic diagnosis in women with recurrent pregnancy loss. Patients were classified into groups according to their age. Preimplantation genetic diagnosis was very successful in treating couples where one of the parents was a carrier of a balanced chromosomal abnormality such as a translocation. Similarly, recurrent pregnancy loss rate was reduced in women more than 35 years in age with a normal karyotype. On the other hand, in younger patients the beneficial effect of this procedure is debatable. In general, women with recurrent pregnancy loss produced more abnormal embryos than control groups. SUMMARY: Preimplantation genetic diagnosis can be beneficial for three major subgroups of patients with recurrent pregnancy loss: couples carrying chromosomal translocations; women more than 35 years of age; women of any age whose previous miscarriages were due to fetal aneuploidy. It is likely that the rate of miscarriage will be further reduced with the new advances in methods of performing preimplantation genetic diagnosis for more chromosomes.

Prepared by the
National Sudden Infant Death Resource Center
Georgetown University
2115 Wisconsin Avenue, N.W., Suite 601
Washington, DC  20007
(866) 866-7437 toll free
(202) 687-7466 local
(202) 784-9777 fax
info@sidscenter.org
http://www.sidscenter.org