NSIDRC Journal Article Alert — May 23, 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.
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Sudden Infant Death
1. Anuntaseree W, Mo-Suwan L, Vasiknanonte P, Kuasirikul S,
Ma-A-Lee A, Choprapawon C
Factors associated with bed sharing and sleep position in Thai
neonates
Child Care Health Dev. 2008 May 14. [Epub ahead of print]
Department of Pediatrics, Faculty of Medicine, Prince of Songkla
University, Hat Yai, Songkhla, Thailand.
Background Sleep in a supine position and in a bed separate
from but proximate to adults is recommended, in several Western
countries, to prevent Sudden Infant Death Syndrome (SIDS).
Cultural differences and a lower rate of SIDS in Asian populations
may affect concern with this problem and thus infant sleeping
arrangements. Objective To study bed sharing and sleep position
in Thai neonates and the relationship to infant and maternal
characteristics. Methods A cross-sectional survey based on
interviews with parents of infants aged 21 days old, was conducted
under the Prospective Cohort Study of Thai Children. Results
Of the total sample, 2236/3692 (60.6%) infants shared a bed
with their parents. Sixty per cent of the parents placed their
infants to sleep in a supine position, 32.2% on their side
and 4.9% in a prone position. Bed sharing was associated with
older maternal age, higher education, Muslim mother, and with
work status of professional career or unemployed. Placing the
infants to sleep in a prone position was associated with infant
birth weight of greater than 2500 g, older maternal age, higher
education, Buddhist mother, mother with professional career
and middle-class household economic status. Conclusions Infant
bed sharing is a common practice in the Thai culture, as in
other Asian countries. The prone sleep position is less common
than in Western populations. The main factor associated with
both bed sharing and putting infants to sleep in the prone
position was a higher maternal socioeconomic status (SES),
in contrast to previous studies in some Western countries in
which both practices were associated with low maternal SES.
Cultural differences may play an important role in these different
findings.
2. Opdal SH, Vege A, Rognum TO
Serotonin transporter gene variation in sudden infant death
syndrome
Acta Paediatr. 2008 May 12. [Epub ahead of print]
Institute of Forensic Medicine, University of Oslo, Oslo,
Norway
Aim: To investigate polymorphisms in the serotonin transporter
(5-HTT) gene in cases of sudden infant death syndrome (SIDS)
and controls, and further to elucidate a possible relationship
between 5-HTT genotypes and external risk factors for SIDS.
Method: The subjects investigated consist of 163 SIDS cases
and 243 controls. Polymorphisms in both the promoter and intron
2 of the 5-HTT gene were investigated, and the genotypes were
determined using polymerase chain reaction (PCR) and gel electrophoresis.
Results: In the promoter, there was a tendency for the L allele
and L/L genotype to be found more often in the SIDS cases than
in the controls (p = 0.05 and p = 0.07, respectively). Regarding
the intron 2 polymorphism, there were no differences between
the groups, and the SIDS cases were not found to have a higher
frequency of either the L/L-12/12 genotype or the L-12 haplotype
than the controls. When investigating possible correlations
between genotype and risk factors for SIDS, there was a tendency
towards different distribution of the promoter genotypes in
cases found dead prone compared to cases found dead in other
sleeping positions (p = 0.06). Conclusion: Polymorphisms in
the promoter of the 5-HTT gene may be of importance with regard
to SIDS.
Other Infant Death
1. Boulet SL, Schieve LA, Nannini A, Ferre C, Devine O, Cohen
B, Zhang Z, Wright V, Macaluso M
Perinatal outcomes of twin births conceived using assisted
reproduction technology: a population-based study
Hum Reprod. 2008 May 16 [Epub ahead of print]
National Center on Birth Defects and Developmental Disabilities,
Centers for Disease Control and Prevention, 1600 Clifton Road,
MS-E86, Atlanta, GA 30333, USA.
BACKGROUND Approximately 18% of multiple births in the USA
result from assisted reproduction technology (ART). Although
many studies comparing ART and naturally conceived twins report
no difference in risks for perinatal outcomes, others report
slight to moderate positive or protective associations. METHODS
We selected twin deliveries with and without indication of
ART from Massachusetts live birth-infant death records from
1997 to 2000 linked to the US ART surveillance system. The
sample was restricted to deliveries by mothers with increased
socioeconomic status, private health insurance and intermediate/plus
prenatal care use. Our final sample included 1446 and 2729
ART and non-ART twin deliveries, respectively. Odds ratios
(OR) for associations between ART and perinatal outcomes were
adjusted for maternal demographic factors, smoking, prenatal
care and hospital care level. RESULTS ART twin deliveries were
less likely than non-ART to be very preterm (adjusted OR 0.75;
95% confidence interval 0.58-0.97) or include a very low birthweight
(<1500 g) infant (0.75; 0.58-0.95) or infant death (0.55;
0.35-0.88). In stratified analyses, these findings were observed
among primiparous deliveries, but there were no risk differences
among multiparous ART and non-ART twin deliveries. CONCLUSIONS
ART treatment was not a risk factor for adverse perinatal outcome,
and risks for several outcomes were somewhat lower among ART
twin deliveries. Nonetheless, ART is strongly associated with
twinning and twins remain a high-risk group, relative to singletons.
Promoting singleton gestation in assisted conception is an
important strategy for reducing adverse outcomes.
2. Donoso E, Carvajal JA
Maternal, perinatal and infant outcome of spontaneous pregnancy
in the sixth decade of life
Maturitas. 2008 May 13 [Epub ahead of print]
Unidad de Medicina Materno Fetal, Departamento de Obstetricia
y Ginecología, Pontificia Universidad Católica
de Chile, Santiago, Chile.
Pregnancy in the older woman is a well-known risk factor for
perinatal morbidity and mortality. OBJECTIVE: To evaluate perinatal
and infant morbidity and mortality in women 50 or more years
old. METHODS: A retrospective population based study (1990-2004)
evaluating spontaneously pregnant Chilean women more than 50
years old (217 live or stillbirths) compared to women 20-34
years old (2,817,742 neonates, control group). The comparison
was performed using Chi Square with Yates's correction or exact
Fisher test as appropriate. The risk analysis was performed
by odds ratio (OR) and confidence interval of 95% (CI 95%).
RESULTS: Women over 50 had a significantly greater risk of
fetal (OR: 3.7; CI 95%: 1.2-10.5), neonatal (OR: 10.4; CI 95%:
5.7-18.7), post-neonatal (OR: 9.5; CI 95%: 4.6-19.1) and infant
death (OR: 10.5; CI 95%: 6.6-16.7). There were no differences
between groups in the incidences of low and very low birth
weight. CONCLUSION: Pregnancy over 50 years of age entails
a very high risk of fetal, neonatal and early childhood death.
Unprotected sexual life for these women should be considered
only after evaluation of their potential fertility.
Miscarriage/Stillbirth/Prenatal Issues
1. Moll E, Korevaar JC, Bossuyt PM, van der Veen F
Does adding metformin to clomifene citrate lead to higher pregnancy
rates in a subset of women with polycystic ovary syndrome?
Hum Reprod. 2008 May 17 [Epub ahead of print]
Center for Reproductive Medicine, Department of Obstetrics
and Gynecology, Academic Medical Center, Meibergdreef 9, 1109
AZ Amsterdam, The Netherlands.
BACKGROUND An RCT among newly diagnosed, therapy naive women
with polycystic ovary syndrome (PCOS) showed no significant
differences in ovulation rate, ongoing pregnancy rate or spontaneous
abortion rate in favour of clomifene citrate plus metformin
compared with clomifene citrate. We wanted to assess whether
there are specific subgroups of women with PCOS in whom clomifene
citrate plus metformin leads to higher pregnancy rates. METHODS
Subgroup analysis based on clinical and biochemical parameters
of 111 women randomized to clomifene citrate plus metformin
compared with 114 women randomized to clomifene citrate plus
placebo. The data for age, BMI, waist-hip ratio (WHR) and plasma
testosterone were available in all women, 2 h glucose in 80%
of women and homeostatic model assessment for assessing insulin
sensitivity (HOMA) in 50% of women. RESULTS Of the women who
were allocated to the metformin group, 44 women (40%) reached
an ongoing pregnancy. In the placebo group, 52 women (46%)
reached an ongoing pregnancy. There was a significantly different
chance of an ongoing pregnancy for metformin versus placebo
between subgroups based on age and WHR (P = 0.014). There was
a positive effect of metformin versus placebo on pregnancy
rate in older women (>/=28 years) with a high WHR, a negative
effect of metformin versus placebo in young women (<28 years)
regardless of their WHR and no effect in older, not viscerally
obese women. No significant differences in effect of treatment
were found for groups based on BMI, 2 h glucose, HOMA or plasma
testosterone. CONCLUSIONS Metformin may be an effective addition
to clomifene citrate in infertile women with PCOS, especially
in older and viscerally obese patients.
2. Katz J, Khatry SK, Leclerq SC, Shrestha SR, West KP Jr,
Christian P
Miscarriage but not stillbirth rates are higher among younger
nulliparas in rural southern Nepal
J Adolesc Health. 2008 Jun;42(6):587-95. Epub 2008 Mar 4
Department of International Health, Johns Hopkins Bloomberg
School of Public Health, Baltimore, Maryland.
PURPOSE: To examine the impact of young maternal age on miscarriages
and stillbirths in rural Southern Nepal. METHOD: Pregnancies,
miscarriages, and stillbirths were prospectively identified
in two randomized trials of maternal micronutrient supplementation.
This analysis included 5861 women of parity 0 (nulliparas)
and 4459 of parity 1 (primiparas) who were <26 years of
age. RESULTS: Among nulliparous women, 5.7% and 4.6% of pregnancies
ended in miscarriage and stillbirth. The adjusted relative
risk of miscarriage was 2.07 for girls <15 (95% confidence
interval [CI] = 1.17-3.66) compared with those 18 and 19 years,
and was 1.40 (95% CI = 1.06-1.84) among those 15-17 years.
Stillbirth rates did not differ significantly by maternal age.
There were no differences in miscarriage or stillbirth rates
by maternal age among primiparas. CONCLUSION: Young maternal
age increased the risk of miscarriages but not stillbirths
for nulliparas. Miscarriages and stillbirths did not differ
by maternal age for primiparous women.
3. Wisborg K, Barklin A, Hedegaard M, Henriksen TB
Psychological stress during pregnancy and stillbirth: prospective
study
BJOG. 2008 Jun;115(7):882-5
Perinatal Epidemiology Research Unit, Department of Obstetrics
and Paediatrics, Aarhus University Hospital, Aarhus N, Denmark.
kirstenwisborg@dadlnet.dk
OBJECTIVE: To study the association between psychological
stress during pregnancy and stillbirth. DESIGN: Prospective
follow-up study. SETTING: Aarhus University Hospital, Skejby,
Denmark,1989-98. POPULATION: A total of 19 282 singleton pregnancies
in women with valid information about psychological stress
during pregnancy. METHODS: Information about psychological
stress during pregnancy was obtained from questionnaires and
measured by the 12-item General Health Questionnaires (GHQ).
A score was generated by the sum of all the answers, each contributing
a value between 0 (low psychological stress) and 3 (high psychological
stress). Women with an intermediate level of psychological
stress (scores of 7-11) were considered the reference group.
Scores of 0-6 were defined as a low level of psychological
stress and scores of 12-36 as the highest level. The association
between psychological stress and stillbirth was presented as
relative risks with 95% CIs. Adjustment for potential confounding
factors was carried out by logistic regression analyses. MAIN
OUTCOME MEASURES: Stillbirth (delivery of a dead fetus at >28
weeks of gestation). RESULTS: There were 66 stillbirths (3.4
per thousand) in the population studied. Compared with women
with an intermediate level of psychological stress during pregnancy,
women with a high level of stress had 80% increased risk of
stillbirth (relative risk = 1.8; 95% CI 1.1-3.2). Adjustment
for maternal age, parity, maternal pre-pregnancy body mass
index, smoking habits, alcohol and caffeine intake during pregnancy,
education and cohabitation failed to change the result. The
results remained essentially unchanged after exclusion of preterm
deliveries. Exclusion of women with complications during pregnancy
such as diabetes, hypertension, vaginal bleeding, immunisation
and imminent preterm delivery failed to change the results.
Likewise, restriction to women's first pregnancy in the cohort
did not change the results. CONCLUSION: Psychological stress
during pregnancy was associated with an increased risk of stillbirth.
4. Reeves S, Bernstein IM
Optimal growth modeling
Semin Perinatol. 2008 Jun;32(3):148-53
Department of Maternal Fetal Medicine, Women's Health Care
Service, Fletcher Allen Health Care, and Department of Obstetrics
and Gynecology, University of Vermont College of Medicine,
Burlington, VT.
Abnormal fetal growth is associated with preterm birth, stillbirth,
neonatal death, respiratory distress syndrome, and necrotizing
enterocolitis. An optimal fetal growth standard would be one
that most correctly identifies the fetus at risk for poor perinatal
outcome. A growth standard that is created using population-specific
data is more applicable than generalized growth curves since
there is evidence that optimal neonatal outcome is achieved
at different birth weights in different populations. The development
of fetal growth standards based exclusively on neonatal birth
weights is flawed as fetal growth restriction is associated
with preterm delivery. Likewise, employing clinically derived
ultrasound standards for term gestations would include a population
that is more likely to have abnormal growth. Novel approaches
to defining normal intrauterine growth combine birth weights
at term and fetal growth patterns in-utero to create growth
curves useful in defining the normal intrauterine growth experience.
This review examines the performance of a variety of the growth
characterizing standards that have been employed to define
abnormal growth and examines their performance in the prediction
of adverse perinatal outcome.
5. Suryanarayana V, Rao L, Kanakavalli M, Padmalatha V, Deenadayal
M, Singh L
Association Between Novel HLA-G Genotypes and Risk of Recurrent
Miscarriages: A Case-Control Study in a South Indian Population.
Reprod Sci. 2008 May 15 [Epub ahead of print]
HLA-G is a nonclassical histocompatibility complex member
associated with fetal tolerance of the mother observed during
pregnancy. Despite its being a less polymorphic gene, a number
of studies have evaluated the role of HLA-G gene polymorphisms
on the risk of pregnancy-related complications. A 14-bp deletion
polymorphism in exon 8 (3'UTR) was known to influence the levels
of soluble HLA-G, differential splicing of the transcript,
and also the induction of interleukin-10 secretion. The present
study is aimed at evaluating the variations in exon 2 and exon
8 of the HLA-G gene for the risk of recurrent miscarriages
in South Indian women. A total of 169 cases and 92 controls
are included in the study. Six novel polymorphisms were identified,
2 of which are in intron 2 near the exon-intron junction and
4 of which are present downstream to the 14-bp deletion in
3'UTR. The exon 2 and intron polymorphisms failed to show any
association. The T1570C and C1594A polymorphisms showed a significant
association (P = .002 and .021) with the risk of miscarriage
after categorization based on the 14-bp deletion. Linkage disequilibrium
analysis showed that the T allele of T1570C is in linkage disequilibrium
with the 14-bp deletion in cases but not in controls. In silico
RNA folding studies indicate that the T allele forms a more
stable secondary structure than the C allele, giving rise to
a more stable transcript. The authors demonstrate a significant
relation between the two 3'UTR polymorphisms and recurrent
miscarriages.
6. Reinmuth S, Liebeskind AK, Wickmann L, Bockelbrink A, Keil
T, Henze G, Borgmann A
Having children after surviving cancer in childhood or adolescence
- results of a berlin survey
Klin Padiatr. 2008 May-Jun;220(3):159-65
Department of Paediatric Oncology/Hematology, Charité-Universitätsmedizin
Berlin, Germany.
OBJECTIVE: To assess the desire to have children, the actual
number of children, and children's health in a survey of 752
adult survivors of paediatric or adolescent cancer in Berlin,
Germany. PATIENTS: The German Childhood Cancer Registry ( DEUTSCHES
KINDERKREBSREGISTER, DKKR) listed 752 paediatric cancer patients
who had been treated in 1 of the 2 paediatric oncology centres
in Berlin since 1980 and were 18 years of age or older at the
time of the survey. METHODS: A 4-page questionnaire assessing
pubertal development, fertility, the desire to have children,
the actual number of children, and children's health was sent
to 574 former patients located using data from the DKKR and
German Residents' Registration Office. RESULTS: In total, 45%
(n=260) of patients (140 women, 120 men) returned the questionnaire.
The mean age was 10.9 years at the time of diagnosis and 24.3
years at the time of the present survey. Various aspects of
puberty were assessed to evaluate pubertal development. Of
all study participants, 77% indicated a general desire to have
children. Reasons given for not having children included 'Still
too early to have children' (67%), 'Fear that my child will
develop cancer' (9%), and 'Fear that cancer will recur' (6%).
Transient amenorrhoea, lasting from 1 to 30 months, occurred
in 25 of 74 patients after chemo- and radiotherapy. Five of
136 participants indicated that they had already reached menopause.
Seventeen per cent of all participants or their partners had
already been pregnant. The miscarriage rate was 13%. Thirty
participants gave birth to or fathered a total of 41 children,
of whom 40 were healthy and 1 was born with a foot deformity
(Pes equinovarus). Among participants' children, mean weight
at birth was 3 458 g, and mean head circumference was 35 cm.
DISCUSSION: The desire to have children was lower among our
survey participants than in the general population of the same
age (77% vs. 90%). Participants' fears that their children
might develop cancer or that their own cancer might recur are
often unfounded. Paediatric cancer survivors, relatives, and
attending physicians should be well informed about this issue
by paediatric oncologists. The proportion of miscarriages,
mean weight at birth, and mean head circumference at birth
in our study were comparable to the German general population.
OUTLOOK: We intend to conduct a nationwide survey entitled
'Fertility after Chemo- and Radiotherapy in Paediatric and
Adolescent Patients' (FeCt). The aim is to gain valuable data
with a larger number of participants and more statistical power
to determine whether specific cytotoxic drugs or radiation
increase the risk of infertility, and if so, at what doses.
For the study, the DKKR has the addresses of more than 5 000
former patients in Germany who are now adults. The results
will be used to plan future treatment optimisation studies,
and to assess the need for prophylactic measures in cases where
fertility-compromising therapies are unavoidable. This nationwide
survey 'FeCt' will be supported by the Deutsche Kinderkrebsstiftung.
7. da Silva Kotze LM, de Carvalho EG, da Rosa Utiyama SR,
Nisihara RM, Messias-Reason I
Mannan-Binding Lectin Levels Related to Spontaneous Abortion
in Brazilian Patients with Celiac Disease
Dig Dis Sci. 2008 May 14 [Epub ahead of print]
Gastroenterology Service, Cajuru Hospital, Pontifical Catholic
University of Paraná, Curitiba, Parana, Brazil.
Low concentration of mannan-binding lectin (MBL) has been
related to unexplained spontaneous abortion (SA), which has
also been observed in an increased frequency in patients with
celiac disease (CD). In this study, plasma levels of MBL were
determined in patients with CD and irritable bowel syndrome
(IBS) in order to investigate whether there is an association
of MBL levels and the occurrence of SA in these patients. MBL
concentration was determined in 46 patients with CD (28 without
and 18 with report of SA) and 38 patients with IBS (25 without
and 13 with report of SA). A higher frequency of SA was observed
in women with CD when compared to IBS patients (23.2 vs. 13.9%;
P = 0.046). No significant difference was observed in MBL concentrations
between patients with CD, IBS, and healthy controls, nor between
patients with or without occurrence of SA. These results suggest
that the serum levels of MBL and the occurrence of SA in women
with CD and IBS are not causally related.
8. Slama R, Boutou O, Ducot B, Spira A
Reproductive life events in the population living in the vicinity
of a nuclear waste reprocessing plant
J Epidemiol Community Health. 2008 Jun;62(6):513-21.
INSERM, Institut National de la Santé et de la Recherche
Médicale, Unité 822 Epidémiologie, Démographie
et Sciences Sociales, IFR69 Le Kremlin-Bicêtre, France.
Remy.slama@ujf-grenoble.fr
OBJECTIVE: There is concern about the health of populations
living close to nuclear waste reprocessing plants. A comparative
study was conducted on reproductive life events in the general
population living near the nuclear waste reprocessing plant
in Beaumont-Hague, France and a reference area in Brittany.
DESIGN, SETTING AND PARTICIPANTS: Women were randomly selected
and retrospectively questioned on reproductive life events
occurring between 1985 and 2000. The monthly probability of
pregnancy (assessed by time to pregnancy for pregnancy attempts
leading or not to a live birth), occurrence of involuntary
infertility, miscarriage and birth weight were compared between
both areas using regression models with random effect. RESULTS:
Compared with the reference area (326 couples) and after adjustment
for sociodemographic and behavioural factors, couples from
Beaumont-Hague (857 couples) had an estimated hazard ratio
of pregnancy of 1.19 (95% CI 0.89 to 1.58). The prevalence
ratio of 12-month involuntary infertility was 0.99 (95% CI
0.64 to 1.55) and the odds ratio of miscarriage was 0.86 (95%
CI 0.85 to 1.33) for Beaumont-Hague, compared with the reference
area. Mean birth weight was similar in both areas (95% CI of
difference -85 g to 53 g). CONCLUSION: No increased risk of
adverse reproductive life events was highlighted in the population
living in the vicinity of the French nuclear waste reprocessing
plant, compared with the reference area. Reproductive health
is unlikely to be strongly altered in the general population
of Beaumont-Hague.
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
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