NSIDRC Journal Article Alert — January 11, 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: Finau E, Finau SA, Fuamatu N, Tukuitonga C.
SIDS or Sitisi: plight and response of Pacificans in New Zealand (Aotearoa).
Pac Health Dialog. 2003 Sep;10(2):182-92.

Pacific Health Research Centre, The University of Auckland, Private Bag 92029, Auckland, New Zealand. e.finau@auckland.ac.nz

Sudden Infant Death Syndrome (SIDS) or Sitisi was considered a rare event among Pacificans worldwide. However, recent findings in New Zealand (Aotearoa) have shown that at least 33% of Pacific infant deaths in New Zealand since 1991 have been due to Sitisi, and the incidence of Sitisi among Pacificans has been on the increase since 1986. These findings have necessitated the development of a Pacific response, especially since a National SIDS Prevention Programme in Aotearoa, implemented in 1991, had led to decreasing rates amongst Pakeha (Europeans) only. This paper reports the Pacificans' experience with Sitisi and the response to the control of yet another epidemic amongst migrants. The response included research; community consultation; and training of Pacifically appropriate Community SIDS Educators. The importance and initiation of community-based strategies is central to the Pacificans' response to Sitisi and its determinants. The success of this approach provides a model for intervention and health promotion, at least, among Pacificans globally.

2: Fa'alau F, Finau SA, Parks J, Abel S.
SIDS among Pacificans in New Zealand: an ecological perspective.
Pac Health Dialog. 2003 Sep;10(2):155-62.

metnigassa@msn.com

Sudden Infant Death Syndrome (SIDS) or Cot Death has unevenly affected ethnic groups more in New Zealand. This paper examines risk factors for SIDS from a political ecology perspective. The New Zealand Cot-Death Study (1987-1990) identified four modifiable risk factors of major concerns. These became the targets of a national prevention campaign. The four modifiable risk factors were: prone sleeping position of the baby, lack of breast feeding, maternal smoking and bed sharing. These four risk factors are more prevalent amongst Pacific and Mäori than others in New Zealand, and are influenced by cultural and other factors. This paper discusses these from a Pacific perspective. Through a discussion of the socio-economic situation of Pacific people in New Zealand and drawing on political ecology theory, it also challenges the classification of some risk factors as 'unmodifiable'. It argues that, through addressing the low socio-economic status of Pacificans, the so-called 'unmodifiable' risk factors are modifiable. Addressing these wider inequalities would contribute to the govaernment's aims of closing the social and economic gaps affecting Pacificans' health status and reduce the risk of SIDS among Pacific infants.

Miscarriage/Stillbirth/Prenatal Issues

1: Boomsma CM, Fauser BC, Macklon NS.
Pregnancy complications in women with polycystic ovary syndrome.
Semin Reprod Med. 2008 Jan;26(1):72-84.

Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. There is an increasing body of evidence indicating that PCOS may have significant implications for pregnancy outcomes and long-term health of a woman and her offspring. Whether or not PCOS itself or the symptoms that coincide with PCOS, like obesity and fertility treatment, are responsible for these increased risks is a continuing matter of debate. Miscarriage rates among women with PCOS are believed to be increased compared with normal fertile women, although supporting evidence is limited. Pregnant women with PCOS experience a higher incidence of perinatal morbidity from gestational diabetes, pregnancy-induced hypertension, and preeclampsia. Their babies are at an increased risk of neonatal complications, such as preterm birth and admission at a neonatal intensive care unit. Pre-pregnancy, antenatal, and intrapartum care should be aimed at reducing these risks. The use of insulin sensitizing drugs to decrease hyperinsulinemic insulin resistance has been proposed during pregnancy to reduce the risk of developing preeclampsia or gestational diabetes. Although metformin appears to be safe, there are too few data from prospective, randomized controlled trials to support treatment during pregnancy.

2: Kierans WJ, Joseph KS, Luo ZC, Platt R, Wilkins R, Kramer MS.
Does one size fit all? The case for ethnic-specific standards of fetal growth.
BMC Pregnancy Childbirth. 2008 Jan 8;8(1):1 [Epub ahead of print]

ABSTRACT: BACKGROUND: Birth weight for gestational age is a widely-used proxy for fetal growth. Although the need for different standards for males and females is generally acknowledged, the physiologic vs pathologic nature of ethnic differences in fetal growth is hotly debated and remains unresolved. METHODS: We used all stillbirth, live birth, and deterministically linked infant deaths in British Columbia from 1981 to 2000 to examine fetal growth and perinatal mortality in Chinese (n = 40,092), South Asian (n = 38,670), First Nations, i.e., North American Indian (n = 56,097), and other (n = 731,109) births. We used a new analytic approach based on total fetuses at risk to compare the four ethnic groups in perinatal mortality, mean birth weight, and "revealed" (<10th percentile) small-for-gestational age (SGA) among live births based on both a single standard and four ethnic-specific standards. RESULTS: Despite their lower mean birth weights and higher SGA rates (when based on a single standard), Chinese and South Asian infants had lower perinatal mortality risks throughout gestation. The opposite pattern was observed for First Nations births: higher mean birth weights, lower revealed SGA rates, and higher perinatal mortality risks. When SGA was based on ethnic-specific standards, however, the pattern was concordant with that observed for perinatal mortality. CONCLUSIONS: The concordance of perinatal mortality and SGA rates when based on ethnic-specific standards, and their discordance when based on a single standard, strongly suggests that the observed ethnic differences in fetal growth are physiologic, rather than pathologic, and make a strong case for ethnic-specific standards.

3: Chauleur C, Vulliez L, Seffert P.
Acute urine retention in early pregnancy resulting from fibroid incarceration: proposition for management.
Fertil Steril. 2008 Jan 4 [Epub ahead of print]

Gynecology-Obstetrics Department, University Hospital Nord, Saint-Etienne, France.

OBJECTIVE: To define a therapeutic strategy adapted to acute urine retention resulting from uterine incarceration in early pregnancy. DESIGN: Case report and review of the literature. SETTING: University hospital. PATIENT(S): Two cases of acute urine retention induced by severe fibroid incarceration in first trimester. INTERVENTION(S): After failure of preventive measures and maneuvers to reduce the incarceration, surgery was performed as a last resort. MAIN OUTCOME MEASURE(S): Pregnancy and birth after surgery. RESULT(S): One miscarriage 1 week after surgery and one normal pregnancy. CONCLUSION(S): Acute urine retention constitutes an emergency, and rapid measures are essential to avoid extremely serious maternal morbidity. We propose a therapeutic strategy for managing this condition. Simple measures may be sufficient to prevent incarceration. Otherwise, bladder catheterization should be performed rapidly, and reduction measures attempted. If this approach fails, the incarcerated uterus must be treated as a last resort by surgery.

4: Caughey AB, Washington AE, Kuppermann M.
Perceived risk of prenatal diagnostic procedure-related miscarriage and Down syndrome among pregnant women.
Am J Obstet Gynecol. 2008 Jan 4 [Epub ahead of print]

Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, CA.

OBJECTIVE: The objective of the study was to identify correlates of perceived risk of carrying a Down syndrome-affected fetus or experiencing a procedure-related miscarriage among a diverse group of pregnant women. STUDY DESIGN: We conducted a cross-sectional survey of 1081 English-, Spanish-, or Chinese-speaking women receiving prenatal care in the San Francisco Bay area. Perceived risk of procedure-related miscarriage or carrying a Down syndrome-affected fetus was assessed using a linear rating scale from 0 (no risk) to 1 (high risk). Bivariate and multivariable analyses were used to explore associations between maternal characteristics including age, race/ethnicity, and socioeconomic status and perceived risks of carrying a Down syndrome-affected fetus or experiencing a procedure-related miscarriage. RESULTS: Women aged 35 years old or older had a higher perceived risk of Down syndrome than younger women (0.28 vs 0.22 on a scale from 0 to 1, P < .001) but a lower perceived risk of a procedure-related miscarriage (0.31 vs 0.36, P = .004). In multivariable linear regression analysis among women younger than age 35 years, the perceived risk of carrying a Down syndrome-affected fetus was higher in women who had not attended college (+0.06, P = .019) or had poor self-perceived health status (+0.08, P = .045). Latinas (+0.11, P = .008), women with an annual income less than $35,000 (+0.09, P = .003), and those who had difficulty conceiving (+0.09, P = .026) had higher perceived procedure-related miscarriage risk. Among women aged 35 years or older, perceived risk of carrying a Down syndrome-affected fetus was associated with the inclination to undergo prenatal diagnosis. CONCLUSION: Women's perceived risks of carrying a Down syndrome-affected fetus or having a procedure-related miscarriage are associated with numerous characteristics that have not been shown to be associated with the actual risks of these events. These perceived risks are associated with prenatal diagnostic test inclination. Understanding patients' risk perceptions and effectively communicating risk is critical to helping patients make informed decisions regarding use of invasive prenatal testing.

5: Paul C, Melton DW, Saunders PT.
Do heat stress and deficits in DNA repair pathways have a negative impact on male fertility?
Mol Hum Reprod. 2008 Jan 5 [Epub ahead of print]

MRC Human Reproductive Sciences Unit, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ.

In Europe up to 1 in 4 couples experience difficulty conceiving and in half of these cases the problem has been attributed to sub- or in-fertility in the male partner. The development of assisted reproductive technologies (ART) such as in vitro fertilisation (IVF) and intra-cytoplasmic spermatozoa injection (ICSI) has allowed some such couples to achieve a pregnancy. Concerns have been raised over the increasing use of ART not least because of the discovery of elevated levels of DNA damage in sperm from subfertile men. The impact of damaged DNA originating in the male germ line is poorly understood, but is thought to contribute to early pregnancy loss (recurrent miscarriage), placental problems and have a long-term impact on the health of the offspring. DNA repair is essential for meiotic recombination and correction of DNA damage in germ cells and proteins involved in all the major repair pathways are expressed in the testis. In this review we will consider evidence that the production of sperm containing damaged DNA can be the result of suboptimal DNA repair and/or a mild environmental insult, such as heat stress, and how studies in mice may give us insight into the origins and consequences of DNA damage in human sperm.

6: Pollet TV, Nettle D.
Taller women do better in a stressed environment: Height and reproductive success in rural Guatemalan women.
Am J Hum Biol. 2008 Jan 2 [Epub ahead of print

Evolution and Behaviour Research Group, Division of Psychology, Newcastle University, United Kingdom.

Previous research on the relationship between height and reproductive success in women has produced mixed results. One possible explanation for these is mediation by ecological factors, such as environmental stress. Here we investigate female height and reproductive success under conditions of environmental stress (poverty) using a large scale dataset from Guatemala (n = 2,571). Controlling for educational attainment, age and ethnicity, we examined relationships between height and childlessness, occurrence of a stillbirth, fertility and child survival. There was no significant relationship between height and never haven given birth. Extremely short women had a significantly raised likelihood of experiencing stillbirth. There were curvilinear relationships between height and age at first birth, fertility, and survival rates for children. Overall, though, the penalties for short stature, particularly in terms of child survival, were far greater than those associated with extreme tallness, and so female height is positively associated with overall fitness in this population.

7: Badawy A, Aal IA, Abulatta M.
Clomiphene citrate or anastrozole for ovulation induction in women with polycystic ovary syndrome? A prospective controlled trial.
Fertil Steril. 2007 Dec 29 [Epub ahead of print]

Department of Obstetrics and Gynecology, Mansoura University, Mansoura, Egypt.

OBJECTIVE: To compare the effects of anastrozole (1 mg) and clomiphene citrate (CC; 100 mg) used for ovulation induction in women with polycystic ovary syndrome. DESIGN: Prospective controlled trial. SETTING: University teaching hospital and private-practice setting. PATIENT(S): The study comprised a total of 216 infertile women (469 cycles) with polycystic ovary syndrome. INTERVENTION(S): Patients received anastrozole (1 mg/d; 115 patients, 243 cycles) for 5 days, starting on day 3 of menses. A matched historical group of patients with polycystic ovary syndrome who were treated with CC (100 mg/d; 101 patients, 226 cycles) was used as a control group. Timed intercourse was advised 24-36 hours after hCG injection. MAIN OUTCOME MEASURE(S): Number of follicles, serum E(2), serum P, endometrial thickness, and pregnancy and miscarriage rates. RESULT(S): The mean age, parity, and duration of infertility in both groups were similar, but statistically significantly more polycystic ovaries were found in the anastrozole group (odds ratio = 2.44; 95% confidence interval = 1.19-5.02). The total numbers of follicles were significantly higher in the CC group (3.8 ± 0.6 vs. 3.4 ± 0.5). Endometrial thickness at the time of hCG administration was significantly greater in the anastrozole group (10.1 ± 0.22 mm vs. 8.2 ± 0.69 mm). The duration of stimulation was similar in the two groups. Ovulation occurred in 165 (67.9%) of 243 cycles in the anastrozole group and in 150 (68.6%) of 226 cycles in the CC group without significant difference. Serum P was significantly higher in the CC group (7.1 ± 1.11 vs. 8.1 ± 0.88 ng/mL). The pregnancy and miscarriage rates were similar in the two groups. CONCLUSION(S): Anastrozole was associated with significantly fewer mature and growing follicles, thicker endometrium, and slightly higher pregnancy rate. Anastrozole may be helpful in situations in which multiple pregnancy is not desirable or the risk of ovarian hyperstimulation syndrome is high.

8: Ozawa N, Maruyama T, Nagashima T, Ono M, Arase T, Ishimoto H, Yoshimura Y.
Pregnancy outcomes of reciprocal translocation carriers who have a history of repeated pregnancy loss.
Fertil Steril. 2007 Dec 29 [Epub ahead of print]

Department of Perinatal Medicine and Maternal Care, National Center for Child Health and Development, Tokyo, Japan.

Cytogenetic investigation of 2,324 Japanese couples with repeated pregnancy loss revealed that 4.91% of couples (n = 114) had chromosome abnormalities including reciprocal translocation (n = 74), Robertsonian translocation (n = 23), and inversion (n = 10). Parental reciprocal translocation was a significant predictor of subsequent miscarriage (adjusted odds ratio: 3.6, 95% confidence interval: 1.8-7.1), and most of the miscarriages of the carrier couples were inevitable because of abnormal karyotypes, despite appropriate treatments.

9: Ozkaya O, Sezik M, Kaya H.
Serum malondialdehyde, erythrocyte glutathione peroxidase, and erythrocyte superoxide dismutase levels in women with early spontaneous abortions accompanied by vaginal bleeding.
Med Sci Monit. 2008 Jan;14(1):CR47-51.

Department of Obstetrics and Gynecology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey.

Background: Malondialdehyde (MDA) is a marker of lipid peroxidation. Glutathione peroxidase (GPX) and superoxide dismutase (SOD) are the main enzymes responsible for the detoxification of superoxide anion. The aim was to assess whether serum MDA, erythrocyte GPX, and erythrocyte SOD levels altered during early spontaneous abortions presenting with vaginal bleeding. Material/Methods: A group of pregnant women at less than 8 weeks' gestation with spontaneous abortion and vaginal bleeding (n=23) and a control group of healthy pregnancies with similar characteristics (n=25) were included. Serum MDA levels, erythrocyte GPX, and SOD activities were determined and compared among the groups. Results: Characteristics, including maternal age, parity, gestational age, complete blood count values, serum total protein, serum albumin, and serum lipid profile, were similar across the groups. Spontaneous abortion prior to 8 weeks of gestation was associated with increased mean serum MDA levels and decreased mean erythrocyte SOD activity. Erythrocyte GPX values did not differ among the groups. Conclusions: Increased lipid peroxidation and inhibition of SOD activity might be involved in the termination of spontaneous abortions and expulsion of fetoplacental material out of the uterine cavity.

Prepared by the
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