NSIDRC Journal Article Alert — February 8, 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
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Sudden Infant Death
1: Thach B.
Tragic and sudden death. Potential and proven mechanisms causing
sudden infant death syndrome.
EMBO Rep. 2008 Feb;9(2):114-8.
Bradley Thach is Professor of Pediatrics at Washington University
in St. Louis, MO, USA. thach@kids.wustl.edu.
Miscarriage/Stillbirth/Prenatal Issues
1: Kaare M, Painter JN, Ulander VM, Kaaja R, Aittomäki
K.
Sex chromosome characteristics and recurrent miscarriage.
Fertil Steril. 2008 Feb 2 [Epub ahead of print]
Folkhälsan Institute of Genetics, University of Helsinki,
Helsinki, Finland.
OBJECTIVE: To investigate whether skewed X chromosome inactivation
(XCI) and Y chromosome microdeletions are associated with recurrent
miscarrige (RM). DESIGN: A retrospective study. SETTING: University
hospital and genetic laboratory. PATIENT(S): Altogether, 46
women with a history of RM, defined as at least three miscarriages,
and a control group of 95 women with no history of miscarriage
were included in the XCI study. In the Y chromosome microdeletion
study 40 male partners of women with RM were studied. INTERVENTION(S):
Blood samples for DNA extraction. MAIN OUTCOME MEASURE(S):
X chromosome inactivation patterns in the females were analyzed
using a methylation-sensitive assay. The DNA from males was
tested for Y chromosome microdeletions by analyzing 37 sequence
tagged sites. RESULTS: Mildly skewed XCI (>85% inactivation
of one allele) was detected in 4 of 43 (9.3%) patients, and
9 of 81 (11.1%) controls. Among these women, extremely skewed
XCI (>90% inactivation of one allele) was detected in 2
of 43 (4.7%) patients, and 4 of 81 (4.9%) controls. No statistical
differences could be shown between the groups. No microdeletions
were found in the male partners. CONCLUSION(S): The frequency
of both extremely and mildly skewed XCI was similar in patients
and control women. Y chromosome microdeletions were not found
in spouses of patients. Based on these results we conclude
that skewed X inactivation and Y chromosome microdeletions
are not associated with RM in our study couples.
2: Settimi L, Spinelli A, Lauria L, Miceli G, Pupp N, Angotzi
G, Fedi A, Donati S, Miligi L, Osborn J, Figà-Talamanca
I.
Spontaneous abortion and maternal work in greenhouses.
Am J Ind Med. 2008 Feb 4 [Epub ahead of print]
National Institute of Health, Rome, Italy.
BACKGROUND: A positive association between maternal occupational
exposure to pesticide and spontaneous abortion has been reported
in some studies. Work in greenhouses may imply exposure of
pregnant women to pesticides continuously and at elevated level.
METHODS: A total of 717 women working in greenhouses provided
information on 973 pregnancies, including 110 spontaneous abortions.
These pregnancies were classified as exposed or not exposed
according to maternal occupation, re-entry activities and application
of pesticides in greenhouses during at least 1 month in the
first trimester of pregnancy. The ORs for spontaneous abortion
were estimated through a generalised estimate equations model
for all orders of pregnancy together, and through a logistic
regression model limited to first pregnancies. RESULTS: Increased
risks of spontaneous abortion were found for maternal re-entry
activities within 24 hr after pesticides were applied (all
orders of pregnancy: OR 3.2, 95% CI 1.3-7.7; first pregnancies:
OR 3.8, 95% CI 1.0-13.9) and for those who applied pesticides
(all orders of pregnancy: OR 2.6, 95% CI 1.0-6.6; first pregnancies:
OR 3.7, 95% CI 0.7-20,6) CONCLUSIONS: The observed results
support the hypothesis of an association between maternal work
in greenhouses and spontaneous abortion. The main limitations
of the study are lack of information on the specific chemicals
used and the small number of pregnancies heavily exposed to
pesticides. Am. J. Ind. Med. (c) 2008 Wiley-Liss, Inc.
3: Finning KM, Chitty LS.
Non-invasive fetal sex determination: Impact on clinical practice.
Semin Fetal Neonatal Med. 2008 Feb 1 [Epub ahead of print]
International Blood Group Reference Laboratory, Southmead
Road, Bristol, UK.
Prenatal fetal sex determination is undertaken in women at
high risk of serious genetic disorders affecting a specific
sex. Traditionally, this is undertaken by invasive testing,
usually chorionic villus sampling, which carries a risk of
miscarriage of around 1%. The identification of cell-free fetal
DNA in the maternal circulation has allowed the development
of 'non-invasive prenatal diagnostic tests', which permit fetal
sex determination without risk to the pregnancy.
4: Rahimi R, Nikfar S, Rezaie A, Abdollahi M.
Pregnancy outcome in women with inflammatory bowel disease
following exposure to 5-aminosalicylic acid drugs: A meta-analysis.
Reprod Toxicol. 2007 Dec 4 [Epub ahead of print]
Faculty of Pharmacy, and Pharmaceutical Sciences Research
Center, Tehran University of Medical Sciences, PO Box 14155-6451
Tehran, Iran.
5-ASA drugs are commonly used for management of inflammatory
bowel disease (IBD) during pregnancy. The safety of drug therapy
for IBD during pregnancy is an important clinical concern.
The present meta-analysis was performed to explore the risk
of adverse pregnancy outcomes in women with IBD following exposure
to 5-ASA drugs (mesalazine, sulfasalazine, balsalazide, and
olsalazine). Bibliographic databases were searched upto June
2007 for studies investigating pregnancy outcomes in women
with IBD following exposure to any 5-ASA drugs. The outcomes
of interest were congenital abnormalities, stillbirth, spontaneous
abortion, preterm delivery, and low birth weight. The odds
ratios (OR) and confidence interval (CI) for the individual
studies were pooled and heterogeneity analysis was performed.
Seven studies with a total of 2200 pregnant women with IBD
were included; 642 received 5-ASA drugs (mesalazine, sulfasalazine
or olsalazine) and 1158 received no medication. The OR was
found 1.16 (95% CI: 0.76-1.77, P=0.57) for congenital abnormalities,
2.38 (95% CI: 0.65-8.72, P=0.32) for stillbirth, 1.14 (95%
CI: 0.65-2.01, P=0.74) for spontaneous abortion, 1.35 (95%
CI: 0.85-2.13, P=0.26) for preterm delivery, and 0.93 (95%
CI: 0.46-1.85, P=0.96) for low birth weight. In conclusion,
this meta-analysis suggest that there is no more than an 1.16-fold
increase in congenital malformations, an 2.38-fold increase
in stillbirth, an 1.14-fold increase in spontaneous abortion,
an 1.35-fold increase in preterm delivery, and an 0.93-fold
increase in low birth weight.
5: Hardell L, Sage C.
Biological effects from electromagnetic field exposure and
public exposure standards.
Biomed Pharmacother. 2007 Dec 31 [Epub ahead of print]
Department of Oncology, University Hospital, SE-701 85 Örebro,
Sweden.
During recent years there has been increasing public concern
on potential health risks from power-frequency fields (extremely
low frequency electromagnetic fields; ELF) and from radiofrequency/microwave
radiation emissions (RF) from wireless communications. Non-thermal
(low-intensity) biological effects have not been considered
for regulation of microwave exposure, although numerous scientific
reports indicate such effects. The BioInitiative Report is
based on an international research and public policy initiative
to give an overview of what is known of biological effects
that occur at low-intensity electromagnetic fields (EMFs) exposure.
Health endpoints reported to be associated with ELF and/or
RF include childhood leukaemia, brain tumours, genotoxic effects,
neurological effects and neurodegenerative diseases, immune
system deregulation, allergic and inflammatory responses, breast
cancer, miscarriage and some cardiovascular effects. The BioInitiative
Report concluded that a reasonable suspicion of risk exists
based on clear evidence of bioeffects at environmentally relevant
levels, which, with prolonged exposures may reasonably be presumed
to result in health impacts. Regarding ELF a new lower public
safety limit for habitable space adjacent to all new or upgraded
power lines and for all other new constructions should be applied.
A new lower limit should also be used for existing habitable
space for children and/or women who are pregnant. A precautionary
limit should be adopted for outdoor, cumulative RF exposure
and for cumulative indoor RF fields with considerably lower
limits than existing guidelines, see the BioInitiative Report.
The current guidelines for the US and European microwave exposure
from mobile phones, for the brain are 1.6W/Kg and 2W/Kg, respectively.
Since use of mobile phones is associated with an increased
risk for brain tumour after 10 years, a new biologically based
guideline is warranted. Other health impacts associated with
exposure to electromagnetic fields not summarized here may
be found in the BioInitiative Report at www.bioinitiative.org.
6: Adesiyun AG, Eseigbe E.
Triplet gestation: clinical outcome of 14 cases.
Ann Afr Med. 2007 Mar;6(1):12-6.
Department of Obstetrics and Gynaecology, Ahmadu Bello University
Teaching Hospital, Shika, Zaria, Nigeria. adebiyi_g@yahoo.com
BACKGROUND/OBJECTIVE: To determine maternal complications
and fetal outcome of triplet gestations. METHOD: Retrospective
study of pregnant women with triplet gestation managed in 10
years. RESULTS: Fourteen women were managed with triplet gestation,
of these, (71.4%) were booked for antenatal care and four (28.6%)
were unbooked. The mean age of the women was 31.3 years. The
age range was between twenty seven years and thirty nine years.
The mean gestational age at diagnosis for the booked women
was 18.6 weeks. Of the fourteen patients, ten (71.4%) had spontaneous
conception, three (21.4%) followed ovulation induction and
one (7.2%) resulted from invitro fertilization and embryo transfer.
Two (14.3%) patients had cervical cerclage based on their past
obstetric history and assessment of the cervix. Six (42.9%)
patients were hospitalized and treated for preeclampsia 3 patients,
spontaneous abortion 1 patient and cervical incompetence 2
patients. Eleven (78.6%) patients had preterm birth. The mean
gestational age at delivery was 33.4 weeks. Of the thirteen
deliveries, nine (69.2%) had caesarean section and four (30.8%)
delivered per vaginam. A total of thirty nine babies were delivered,
thirty four (87.2%) babies survived and five (12.8%) died.
Perinatal mortality was 11.9% and the "take home" baby
rate was 81%. CONCLUSION: Antenatal care with initiation of
specialized prenatal care and planned delivery in triplet gestation
improves fetal outcome.
7: Heimstad R, Romundstad PR, Salvesen KA.
Induction of labour for post-term pregnancy and risk estimates
for intrauterine and perinatal death.
Acta Obstet Gynecol Scand. 2008;87(2):247-9.
Department of Obstetrics and Gynecology, St. Olavs' Hospital,
Trondheim University Hospital, Norway. runa.heimstad@ntnu.no
BACKGROUND: Beyond term there is increased risk of intrauterine
fetal death (IUFD) and perinatal death, and we aimed to assess
this risk beyond 41 weeks and estimate numbers needed to treat
to avoid 1 fetal or neonatal death. DESIGN AND METHODS: All
singletons births beyond 41 weeks from 1999-2005 registered
in the Norwegian Medical Birth Registry were assessed concerning
IUFD and perinatal death day by day, and numbers needed to
induce to avoid 1 death was estimated. RESULTS: The perinatal
death rate increased with increasing gestational age. NNT for
perinatal death was 527 at day 287, and 195 at day 302 + (p-value=0.02).
Routine induction of labour at 41 weeks implicates >14,000
inductions per year. CONCLUSIONS: NNT to avoid 1 fetal or neonatal
death is high (671-195), but decreases constantly with gestational
age beyond 41 weeks.
8: Moxley K, Knudtson EJ.
Resolution of hydrops secondary to cytomegalovirus after maternal
and fetal treatment with human cytomegalovirus hyperimmune
globulin.
Obstet Gynecol. 2008 Feb;111(2):524-6.
Department of Obstetrics and Gynecology, Division of Maternal
Fetal Medicine, the University of Oklahoma Health Sciences
Center, Oklahoma City, Oklahoma.
BACKGROUND: Congenital cytomegalovirus (CMV) is a common infection
with limited treatment options. Vertical transmission can lead
to fetal death or long-term neurologic injury. We present a
case wherein fetal hydrops resolved after maternal and fetal
intravenous administration of CMV hyperimmune globulin. CASE:
A 20-year-old gravida 3, para 0 was referred for Level II ultrasonography
secondary to hydrops fetalis. Amniocentesis demonstrated in
utero CMV infection. Resolution of hydrops occurred after the
administration of CMV hyperimmune globulin to the patient and
then to her fetus. CONCLUSION: Resolution of hydrops secondary
to congenital CMV was temporally related to the administration
of maternal and fetal hyperimmune globulin.
9: Lee YM, Wylie BJ, Simpson LL, D'Alton ME.
Twin chorionicity and the risk of stillbirth.
Obstet Gynecol. 2008 Feb;111(2):301-8.
Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology,
Columbia University Medical Center, New York, New York.
OBJECTIVE: To estimate the effect of chorionicity on the risk
of stillbirth in twins. METHODS: A retrospective cohort analysis
was performed of all twin deliveries of at least 24 weeks of
gestation at a single tertiary care center from December 2000
to May 2007. The risk of fetal death with advancing gestation
was calculated for monochorionic-diamniotic twins and for dichorionic-diamniotic
twins. Overall in utero survival was compared by using Kaplan-Meier
analysis and a hazards ratio with 95% confidence intervals
estimated to assess the degree of difference. Pregnancies affected
by growth abnormalities, anomalies, or twin-twin transfusion
syndrome were subsequently excluded and survival by chorionicity
similarly compared within these "apparently normal" gestations.
RESULTS: Data from 1,000 consecutive twin pairs (196 monochorionic-diamniotic
twins and 804 dichorionic-diamniotic twins) were analyzed.
Stillbirths occurred in seven (3.6%) monochorionic-diamniotic
and nine (1.1%) dichorionic-diamniotic twin pairs. Monochorionic-diamniotic
twins had a higher risk of stillbirth compared with dichorionic-diamniotic
twins, both overall (log-rank P=.004) and at each gestational
age after 24 weeks, with this risk persisting in the subset
of 771 (130 monochorionic-diamniotic twins and 641 dichorionic-diamniotic
twins) "apparently normal" twins (log-rank P=.039).
CONCLUSION: Monochorionicity has a negative effect on the in
utero survival of twins, even among monochorionic-diamniotic
twins without abnormalities. LEVEL OF EVIDENCE: II.
10: Reime B, Schuecking BA, Wenzlaff P.
Reproductive Outcomes in Adolescents Who Had a Previous Birth
or an Induced Abortion Compared to Adolescents' First Pregnancies.
BMC Pregnancy Childbirth. 2008 Jan 31;8(1):4 [Epub ahead of
print]
ABSTRACT: BACKGROUND: Recently, attention has been focused
on subsequent pregnancies among teenage mothers. Previous studies
that compared the reproductive outcomes of teenage nulliparae
and multiparae often did not consider the adolescents'reproductive
histories. Thus, the authors compared the risks for adverse
reproductive outcomes of adolescent nulliparae to teenagers
who either have had an induced abortion or a previous birth.
METHODS: In this retrospective cohort study we used perinatal
data prospectively collected by obstetricians and midwives
from 1990-1999 (participation rate 87-98% of all hospitals)
in Lower Saxony, Germany. From the 9742 eligible births among
adolescents, women with multiple births, >1 previous pregnancies,
or a previous spontaneous miscarriage were deleted and 8857
women <19 years remained. Of these 8857 women, 7845 were
nulliparous, 801 had one previous birth, and 211 had one previous
induced abortion. The outcomes were stillbirths, neonatal mortality,
perinatal mortality, preterm births, and very low birthweight.
Bivariate and multivariable logistic regression models were
conducted. RESULTS: In bivariate logistic regression analyses,
compared to nulliparous teenagers, adolescents with a previous
birth had higher risks for perinatal [OR=2.08, CI=1.11,3.89]
and neonatal [OR=4.31, CI=1.77,10.52] mortality and adolescents
with a previous abortion had higher risks for stillbirths [OR=3.31,
CI=1.01,10.88] and preterm births [OR=2.21, CI=1.07,4.58].
After adjusting for maternal nationality, partner status, smoking,
prenatal care and pre-pregnancy BMI, adolescents with a previous
birth were at higher risk for perinatal [OR=2.35, CI=1.14,4.86]
and neonatal mortality [OR= 4.70, CI=1.60,13.81] and adolescents
with a previous abortion had a higher risk for very low birthweight
infants [OR=2.74, CI=1.06,7.09] than nulliparous teenagers.
CONCLUSIONS: The results suggest that teenagers who give birth
twice as adolescents have worse outcomes in their second pregnancy
compared to those teenagers who are giving birth for the first
time. The prevention of the second pregnancy during adolescence
is an important public health objective and should be addressed
by health care providers who attend the first birth or the
abortion and the follow-up care. Also, health care workers
should attempt to improve the pregnancy outcomes of repeat
teenage pregnancies by addressing modifiable risk factors,
for example, supporting smoking cessation and utilization of
prenatal care.
11: Russell NE, Holloway P, Quinn S, Foley M, Kelehan P, McAuliffe
FM.
Cardiomyopathy and cardiomegaly in stillborn infants of diabetic
mothers.
Pediatr Dev Pathol. 2008 Jan-Feb;11(1):10-4.
To report the incidence of cardiomegaly in stillborn normally
formed infants of mothers with diabetes mellitus. This is a
retrospective study with institutional ethics approval. The
presence of cardiomegaly was recorded in stillborn infants
of diabetic mothers (N = 27) and compared with that recorded
in stillborn large-for-gestational age (LGA > 90th percentile,
n = 18) and stillborn appropriately grown (10th to 90th percentiles,
n = 107) nondiabetic infants. Blinded to the clinical details,
the histology slides were reviewed to measure cardiac wall
thickness and to record the presence or absence of myocardial
fiber disarray. Stillborn infants of mothers with diabetes
mellitus, when compared with appropriately grown stillborn
nondiabetic infants and when adjusted for birth weight, had
heavier hearts, thicker ventricular free wall measurements,
and lighter brains. While cardiomegaly was reported in 22%
of stillborn LGA infants, comparison with stillborn appropriately
grown infants revealed no difference in heart weights corrected
for birth weight. Comparison of LGA nondiabetic infants with
stillborn diabetes mellitus infants revealed greater actual
heart weight/expected for birth weight (P < 0.05) and lighter
brains (actual brain weight/expected for birth weight, P < 0.05)
in the diabetes mellitus group. Cardiomegaly is a common finding
in stillborn infants of mothers with diabetes mellitus and
may contribute to the risk of fetal death in these pregnancies.
12: Shea AK, Steiner M.
Cigarette smoking during pregnancy.
Nicotine Tob Res. 2008 Feb;10(2):267-78.
Women's Health Concerns Clinic, St. Joseph's Healthcare, Department
of Psychiatry & Behavioural Neuroscience and Obstetrics & Gynecology,
McMaster University.
Maternal smoking during pregnancy is associated with several
adverse developmental outcomes in the offspring. These include
preterm delivery, spontaneous abortion, growth restriction,
increased risk of sudden infant death syndrome (SIDS), as well
as long-term behavioral and psychiatric disorders. However,
the underlying physiological mechanisms for these ill-effects
are not fully understood. The aim of this paper is to review
the animal and human data to date, linking in utero smoke exposure
to negative neurodevelopmental outcomes. It is known that nicotine
from cigarette smoke exerts its effects by affecting placental
vasculature, and also by nicotinic acetylcholine receptor binding
in fetal membranes. Thus, subsequent consequences involve a
cascade of events causing not only dysregulation of the nicotinic
and muscarinic, but also catecholaminergic and serotonergic
neurotransmitter systems. These observations provide some insight
into how smoking can impair neurodevelopment, but the long-term
neurotransmitter involvement in dysregulation of emotion and
attention awaits further elucidation. It is important that
pregnant women are warned of the detrimental effects of smoking,
and encouraged to abstain for healthy fetal development.
13: Aliyu MH, Salihu HM, Wilson RE, Alio AP, Kirby RS.
The risk of intrapartum stillbirth among smokers of advanced
maternal age.
Arch Gynecol Obstet. 2008 Jan 31 [Epub ahead of print]
Department of Family and Community Medicine, Meharry Medical
College, Nashville, TN, USA.
BACKGROUND/AIM: The effects of advanced maternal age and smoking
in pregnancy on fetal survival have previously been reported.
However, whether advanced maternal age modifies the relationship
between smoking in pregnancy and intrapartum stillbirth remains
unknown. We therefore set out to determine the impact of advanced
maternal age (>/=35 years) on the association between smoking
during pregnancy and intrapartum stillbirth by employing retrospective
analysis of birth registry data. METHODS: We used a cohort
of singleton births in Missouri from 1978 through 1997 (N =
1,436,628) to compute the risk of total, antepartum, and intrapartum
stillbirth in smoking mothers. We categorized mothers into
two age groups: "younger" (<35 years), and "older" (>/=35
years). Non-smoking mothers age <35 years were the referent
category. Cox regression models were used to generate independent
measures of association between intrauterine tobacco exposure
and the risk of total, antepartum, and intrapartum stillbirth
in each age group. RESULTS: A total of 5,772 counts of stillbirth
were identified, yielding a stillbirth rate of 4.0 per 1,000.
Approximately 33% (N = 1,900) occurred among older smokers
resulting in a stillbirth rate of 9.1 per 1,000. The probability
of intrapartum stillbirth was greatest among older smokers,
followed by younger smokers and lowest among younger non-smokers
(P < 0.01). As compared to non-smoking younger gravidas,
younger smoking mothers had a 30% greater likelihood for both
antepartum and intrapartum stillbirth (adjusted hazard ratio
[95% confidence interval]: 1.3 [1.2-1.4] and 1.3 [1.2-1.5],
respectively). Among older smokers the risk for intrapartum
stillbirth was three times that of the referent group (adjusted
hazard ratio: 3.2, 95% confidence interval: 2.2-4.5). CONCLUSIONS:
The risk of intrapartum stillbirth associated with smoking
in pregnancy is potentiated by the age of the mother. This
information will help policy makers develop targeted smoking
cessation campaigns and positively impact quit rates in older
mothers.
14: Gaylord M, Greer M, Botti J.
Improving perinatal health: a novel approach to improve community
and adult health.
J Perinatol. 2008 Feb;28(2):91-6.
1OB/GYN-Regional Perinatal Program, University of Tennessee
Medical Center, Knoxville, TN, USA.
Recent trends of increasing infant morbidity and mortality
are inconsistent with this nation's vision of advances in adult
quality of life and longevity. Infant mortality and weight
at birth are important predictors of the health of a society,
making these findings all the more disturbing. Infant morbidity
could be a reflection or alternatively, a harbinger of increasing
national rates of obesity, diabetes mellitus, community violence
and widening economic disparities. This paper presents the
linkage between perinatal health and adult health using infant
morbidities (infant mortality, low birthweight, prematurity)
as examples. Infant morbidities/mortalities are social problems
with health-care consequences. All social classes suffer the
results of poor infant health. Improving perinatal health can
improve the health of a community in a cyclic fashion. We propose
that improving the health of reproductive age women and infants;
will result in a reduction in the incidence of severe/chronic
and costly adult health outcomes.Journal of Perinatology (2008)
28, 91-96; doi:10.1038/sj.jp.7211887.
15: Sharma A, Rasul ES, Hazarika NK.
A serological study of cytomegalovirus infection in pregnant
and non-pregnant women at Gauhati Medical College and Hospital.
J Indian Med Assoc. 2007 Jun;105(6):320, 322-3.
Department of Microbiology, Gauhati Medical College and Hospital,
Guwahati.
Primary cytomegalovirus infection is the most common infection
during pregnancy that may have long-term neurodevelopmental
sequelae in children born to these mothers. It is also associated
with many obstetric complications. So the aim of this study
was to determine the seroprevalence of cytomegalovirus infection
in local antenatal population with bad obstetric history and
to see the effects, if any, of age, socio-economic status,
presenting features and different gestational periods. Seventy-five
pregnant women with bad obstetric history were screened for
the presence of cytomegalovirus specific IgM and IgG antibodies
by doing enzyme-linked immunosorbent assay, out of which 17(22.66%)
had evidence of recurrent cytomegalovirus infection as demonstrated
by the presence of cytomegalovirus specific IgM antibodies.
All were found to be positive for cytomegalovirus specific
IgG antibodies. This indicates that the presence of cytomegalovirus
specific IgM antibodies in this population is an evidence of
reactivation of a latent infection or re-infection with a different
strain of cytomegalovirus. Increased IgM seropositivity was
found to be associated with advancing age, poor, socio-economic
status, third trimester of pregnancy and bad obstetric history
like premature delivery, stillbirth, recurrent spontaneous
abortions, intra-uterine growth retardation. Out of 25 randomly
selected non-pregnant women of childbearing age, all showed
presence of cytomegalovirus specific IgG antibodies and none
was found to be positive for primary or recurrent cytomegalovirus
infection.
16: Usta IM, Zoorob D, Abu-Musa A, Naassan G, Nassar AH.
Obstetric outcome of teenage pregnancies compared with adult
pregnancies.
Acta Obstet Gynecol Scand. 2008;87(2):178-83.
Department of Obstetrics and Gynecology, American University
of Beirut Medical Center, Beirut, Lebanon.
BACKGROUND: To compare the obstetric outcome of teenage pregnancies
with that of older women. METHODS: Retrospective chart review
of singleton births > or =24 weeks' gestational age at the
American University of Beirut from 1994 to 2003. Adolescents
(<20 years) were compared to subsequently delivered women
aged 25-30 years (controls), n=486 each. RESULTS: Only 131
(27.0%) adolescents were <18 years. More adolescents were
nulliparous (79.8 versus 17.9%; p<0.0001). Preterm delivery <37
but not <34 weeks occurred more frequently in cases (11.1
versus 5.8%, p=0.004). Pre-eclampsia was more commonly encountered
(2.9 versus 0.6%; p=0.012) and mean predelivery haematocrit
was lower in cases (30.6+/-3.3 versus 33.8+/-4.3%, p<0.001),
but the incidence of gestational diabetes, placenta previa,
abruptio placentae, breech presentation, or meconium-stained
amniotic fluid were similar. Caesarean delivery was performed
less frequently in cases (9.2 versus 14.0%; p=0.028), but primary
caesarean and operative vaginal delivery rates were similar
though vacuum was used more frequently in multiparous controls
(0.2 versus 2.7%, p=0.011). Nulliparous cases had shorter first
and second stages of labour (384+/-304 versus 524+/-339 min,
p<0.0001 and 47+/-36 versus 63+/-50 min, p=0.002), respectively.
Mean birth weight was higher in controls (3177+/-567 versus
3284+/-511 g, p<0.001), but intrauterine growth restriction,
birth weight <2500 g, low Apgar scores, intrauterine fetal
death, and stillbirths were similar in both groups. CONCLUSIONS:
Adolescents are more likely to deliver preterm than older women,
and are more likely to suffer from anaemia and pre-eclampsia.
Nulliparous adolescents have a quicker progress of labour while
multiparous adolescents require vacuum less frequently compared
to their older counterparts. In most other respects, they have
comparable maternal and perinatal morbidity.
Prepared by the
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