NSIDRC Journal Article Alert — November
9, 2007
Past issues of NSIDRC journal alerts are available at: http://www.sidscenter.org/
Graves CR.
*Antepartum fetal surveillance and timing of delivery in the
pregnancy complicated by diabetes mellitus.*
Clin Obstet Gynecol. 2007 Dec;50(4):1007-13.
Pregnancies complicated by diabetes mellitus are associated
with an increased risk of fetal and neonatal risks compared
with pregnancies in the healthy gravida. Data suggest that
stillbirth and perinatal mortality may be increased as much
as 5 times for patients with insulin-dependent diabetes than
in the general population. Pregnancies complicated by preexisting
diabetes should undergo twice weekly surveillance with nonstress
test or biophysical profile or a combination of both. Doppler
studies should be reserved for those patients with vascular
disease, intrauterine growth restriction, or hypertensive disorders.
Full-text available at: http://www.clinicalobgyn.com/
Moon RY, Horne RS, Hauck FR.
*Sudden infant death syndrome.*
Lancet. 2007 Nov 3;370(9598):1578-87.
Despite declines in prevalence during the past two decades,
sudden infant death syndrome (SIDS) continues to be the leading
cause of death for infants aged between 1 month and 1 year
in developed countries. Behavioural risk factors identified
in epidemiological studies include prone and side positions
for infant sleep, smoke exposure, soft bedding and sleep surfaces,
and overheating. Evidence also suggests that pacifier use at
sleep time and room sharing without bed sharing are associated
with decreased risk of SIDS. Although the cause of SIDS is
unknown, immature cardiorespiratory autonomic control and failure
of arousal responsiveness from sleep are important factors.
Gene polymorphisms relating to serotonin transport and autonomic
nervous system development might make affected infants more
vulnerable to SIDS. Campaigns for risk reduction have helped
to reduce SIDS incidence by 50-90%. However, to reduce the
incidence even further, greater strides must be made in reducing
prenatal smoke exposure and implementing other recommended
infant care practices. Continued research is needed to identify
the pathophysiological basis of SIDS.
Full-text available at: www.thelancet.com/ <http://www.thelancet.com/>
Michels TC, Tiu AY.
*Second trimester pregnancy loss.*
American Family Physician. 76(9): 1341-1346. November 1, 2007.
Second trimester pregnancy loss is uncommon, but it should
be regarded as an important event in a woman’s obstetric
history. Fetal abnormalities, including chromosomal problems,
and maternal anatomic factors, immunologic factors, infection,
and thrombophilia should be considered; however, a cause-and-effect
relationship may be difficult to establish. A thorough history
and physical examination should include inquiries about previous
pregnancy loss. Laboratory tests may identify treatable etiologies.
Although there is limited evidence that specific interventions
improve outcomes, management of contributing maternal factors
(e.g., smoking, substance abuse) is essential. Preventive measures,
including vaccination and folic acid supplementation, are recommended
regardless of risk. Management of associated chromosomal factors
requires consultation with a genetic counselor or obstetrician.
The family physician can play an important role in helping
the patient and her family cope with the emotional aspects
of pregnancy loss.
Full-text available at: http://www.aafp.org/
Reddy UM.
*Prediction and prevention of recurrent stillbirth.*
Obstet Gynecol. 2007 Nov;110(5):1151-64.
Stillbirth is one of the most common adverse pregnancy outcomes
in the United States, occurring in one out of every 200 pregnancies.
There is a paucity of information on the outcome of pregnancies
after stillbirth. Prior stillbirth is associated with a twofold
to 10-fold increased risk of stillbirth in the future pregnancy.
The risk depends on the etiology of the prior stillbirth, presence
of fetal growth restriction, gestational age of the prior stillbirth,
and race. Categorization of the cause of the initial stillbirth
will allow better estimates of individual recurrence risk and
guide management. A history of stillbirth also increases the
risk of other adverse pregnancy outcomes in the subsequent
pregnancy such as placental abruption, cesarean delivery, preterm
delivery, and low birth weight infants. Prospective studies
have revealed an increased risk of stillbirth with low pregnancy-associated
plasma protein A, elevated maternal serum alpha fetoprotein,
abnormal uterine artery Doppler studies, and antiphospholipid
antibodies. However, the positive predictive value of these
factors individually is poor. Because fetal growth restriction
is associated with almost half of all stillbirths, the correct
diagnosis of fetal growth restriction is essential. The use
of individualized or customized growth standards will improve
prediction of adverse pregnancy outcome by distinguishing growth-restricted
fetuses from constitutionally small, healthy fetuses. Antepartum
fetal surveillance and fetal movement counting are also mainstays
of poststillbirth pregnancy management.
Full-text available at: http://www.greenjournal.org/
Angle B, Burton BK.
*Risk of sudden death and acute life-threatening events in
patients with glutaric acidemia type II. *
Mol Genet Metab. 2007 Oct 30; [Epub ahead of print].
Glutaric acidemia type II (GAII) is an inborn error of metabolism
caused by defects in electron transport flavoprotein (ETF)
or ETF-ubiquinone oxidoreductase (ETF-QO) and typically presents
with hypo- or nonketotic hypoglycemia and metabolic acidosis.
The most severe forms present in early infancy and are associated
with a high mortality rate. The disorder can now be detected
by expanded newborn screening using tandem mass spectrometry
(MS/MS), providing the opportunity for diagnosis and treatment
in asymptomatic infants. We report here three infants who,
despite diagnosis and treatment in the neonatal period, experienced
either unexpected sudden death or an acute life-threatening
event (ALTE) during the first year of life. The possible etiologies
of these events and the potential impact of expanded newborn
screening on the long-term outcome of GAII are discussed.
Full-text available at: www.sciencedirect.com/ <http://www.sciencedirect.com/>
Lillian Hatch M.S.L.S.
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