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NSIDRC Journal Article Alert — December 11, 2009
Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University.
These articles have been selected from PubMed, a service of the National Library of Medicine that includes over 19 million citations from MEDLINE and other life science journals for biomedical articles back to 1948. PubMed includes links to full text articles and other related resources.
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.
Miscarriage/Stillbirth/Prenatal Issues
1. Li L, Kang J, Lei W
Role of Toll-like receptor 4 in inflammation-induced preterm delivery
Mol Hum Reprod. 2009 Dec 7. [Epub ahead of print]
Department of Obstetrics and Gynecology, Guangzhou Medical College Affiliated Guangzhou First Municipal People's Hospital, Guangzhou 510180, China.
The aim of the present study was to investigate the potential role of Toll-like receptor 4 (TLR4) in lipopolysaccharide (LPS)-induced preterm delivery. Intraperitoneal injection of LPS in the presence or absence of previous TLR4 blockade was performed to establish a murine model of preterm delivery. The incidences of preterm delivery and fetal death were calculated. Flow cytometry was performed to examine the percentages of blood CD45(+)CD86(+), CD3(+)CD69(+), CD19(+)CD69(+) and CD49b(+)CD69(+) cell subsets and the percentages of placenta CD45(+)CD86(+), CD45(+)CD49b(+) and CD49b(+)CD69(+) cell subpopulations. In our study, an inflammation-induced preterm delivery model was established by intraperitoneal injection of LPS. Blocking TLR4 significantly decreased LPS-induced preterm delivery and fetal death. LPS treatment markedly up-regulated the percentages of blood CD45(+)CD86(+), CD3(+)CD69(+), CD49b(+)CD69(+) cells, and placenta CD45(+)CD86(+), CD45(+)CD49b(+), CD49b(+)CD69(+) cells. TLR4 blockade almost completely abrogated LPS-induced elevated cell proportions. These data demonstrate that TLR4 plays a critical role in inflammation-induced preterm delivery.
2. Carmody D, Doyle A, Gr Firth R, Byrne MM, Daly S, Mc Auliffe F, Foley M, Coulter-Smith S, Brendan T K
Teenage pregnancy in type 1 diabetes mellitus
Pediatr Diabetes. 2009 Dec 8. [Epub ahead of print]
Dublin Diabetes in Pregnancy Service, Mater Misericordiae University Hospital, National Maternity Hospital, Coombe Women's Hospital and Rotunda Hospitals, Dublin, Ireland.
Younger maternal age at delivery has been linked to adverse reproductive outcomes. Pregnancy complicated by type 1 diabetes mellitus (T1DM) is also associated with adverse pregnancy outcomes. Optimising diabetic glycaemic control prior to pregnancy is known to reduce the rate of congenital abnormalities and improve pregnancy outcomes. Teenage pregnancies are not usually planned and little data exist on teenage pregnancy complicated by T1DM. We sought to identify the glycemic control achieved in teenage pregnancy with T1DM and to clarify if there is an associated increase in adverse pregnancy outcomes compared to those seen in older women with T1DM. We compared outcomes in 18 teenagers (TG) with 582 older women with T1DM (CON) from 1995-2007. TG booked to the combined diabetes-obstetrical service at a median gestational age of 11 weeks (range 6-22) compared to 7 weeks in CON (range 4-40, p < 0.02). Glycaemic was worse in TG compared to CON at 13, 26 and 35 weeks gestation, despite higher insulin doses. First trimester miscarriage rate did not differ between groups. Major congenital anomaly rate was 6.2% (1/16) compared to 3.2% in CON. This preliminary study has demonstrated that pregnant teenage women with T1DM book later to specialised care and have worse glycaemic control in pregnancy compared to older women with T1DM. This group also appear to be more insulin resistant than older women in early pregnancy. Our data would suggest that teenagers with type 1 diabetes mellitus may constitute a high-risk group for adverse pregnancy outcomes.
3. Ho SS, Chong SS, Koay ES, Ponnusamy S, Chiu L, Chan YH, Rauff M, Baig S, Chan J, Su LL, Biswas A, Hahn S, Choolani M
Noninvasive prenatal exclusion of haemoglobin Bart's using foetal DNA from maternal plasma
Prenat Diagn. 2009 Dec 3. [Epub ahead of print]
Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
OBJECTIVE: Prenatal diagnosis of alpha-thalassaemia requires invasive testing associated with a risk of miscarriage. Cell-free foetal DNA in maternal plasma presents an alternative source of foetal genetic material for noninvasive prenatal diagnosis. We aimed to exclude HbBart's noninvasively by detection of unaffected paternal alleles in maternal plasma using quantitative fluorescence PCR (QF-PCR). METHOD: Microsatellite markers (16PTEL05, 16PTEL06) within the breakpoint regions of -(SEA), -(FIL) and -(THAI) deletions were analysed using QF-PCR of maternal plasma from 30 families. In this blinded study, genotypes were confirmed using conventional PCR. Maternal plasma from two known cases of HbBart's were also analysed. RESULTS: HbBart's was excluded in 10 out of 30 (33.3%, 95% CI, 17.3-52.8%) mothers by identifying the presence of nondeleted paternally inherited fetal alleles; either only 16PTEL05 (n = 1) or only 16PTEL06 (n = 4), or both (n = 5), and confirmed through direct analysis of fetal DNA. Paternally inherited foetal alleles of 16PTEL05 and 16PTEL06 were not detected in maternal plasma of the two known HbBarts cases. False negatives were excluded with the detection of paternally inherited fetal control marker, D21S1270 in maternal plasma. CONCLUSION: We show proof-of-principle that such a test can accurately exclude HbBart's in the foetus by identifying the nondeleted paternally inherited fetal alleles in maternal plasma in one out of three pregnancies, avoiding invasive testing in these pregnancies. Copyright (c) 2009 John Wiley & Sons, Ltd.
4. El-Toukhy T, Campo R, Sunkara SK, Khalaf Y, Coomarasamy A
A multi-centre randomised controlled study of pre-IVF outpatient hysteroscopy in women with recurrent IVF implantation failure: Trial of Outpatient Hysteroscopy - [TROPHY] in IVF
Reprod Health. 2009 Dec 3;6(1):20. [Epub ahead of print]
ABSTRACT: BACKGROUND: The success rate of IVF treatment is low. A recent systematic review and meta-analysis found that the outcome of IVF treatment could be improved in patients who have experienced recurrent implantation failure if an outpatient hysteroscopy (OH) is performed before starting the new treatment cycle. However, the trials were of variable quality, leading to a call for a large and high-quality randomised trial. This protocol describes a multi-centre randomised controlled trial to test the hypothesis that performing an OH prior to starting an IVF cycle improves the live birth rate of the subsequent IVF cycle in women who have experienced two to four failed IVF cycles. Methods and design: Eligible and consenting women will be randomised to either OH or no OH using an internet based trial management programme that ensures allocation concealment and employs minimisation for important stratification variables including age, body mass index, basal follicle stimulating hormone level and number of previous failed IVF cycles. The primary outcome is live birth rate per IVF cycle started. Other outcomes include implantation, clinical pregnancy and miscarriage rates. The sample size for this study has been estimated as 758 participants with 379 participants in each arm. Interim analysis will be conducted by an independent Data Monitoring Committee (DMC), and final analysis will be by intention to treat. A favourable ethical opinion has been obtained (REC reference: 09/H0804/32). The trial has been assigned the following ISRCTN number: ISRCTN35859078.
Prepared by the
National Sudden and Unexpected Infant/Child Death and Pregnancy
Loss Resource Center
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