NSIDRC Journal Article Alert — February 22, 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
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Sudden Infant Death
1: Esani N, Hodgman JE, Ehsani N, Hoppenbrouwers T.
Apparent life-threatening events and sudden infant death syndrome:
comparison of risk factors.
J Pediatr. 2008 Mar;152(3):365-70. Epub 2007 Nov 5.
University of Southern California, Division of Neonatal Medicine,
LAC + USC Medical Center, Women's and Children's Hospital,
and Children's Hospital Los Angeles, Keck School of Medicine,
University of Southern California, Los Angeles, CA, USA.
OBJECTIVE: To compare the risk factors of 153 cases of apparent
life-threatening event (ALTE) enrolled in the multicenter Collaborative
Home Infant Monitoring Evaluation (CHIME) from 1994 to 1998
with the published risk factors for sudden infant death syndrome
(SIDS). STUDY DESIGN: Trained CHIME interviewers gathered histories
of infants with ALTE who met the criteria. The following risk
factors were analyzed: male predominance, gestational age,
low birth weight, very low birth weight, incidence of small
for gestational age (SGA), age at the event, multiparity, maternal
age, and smoking. Population-based SIDS studies with >100
deaths, focusing on 1 or more pertinent risk factors and carried
out during the decade in which CHIME data were collected, were
chosen for comparison. RESULTS: One of the 153 infants with
ALTE in this study died during follow-up (0.6%). CHIME ALTE
differed significantly from SIDS in 4 respects: fewer infants
with low birth weight and SGA at birth, fewer teenage pregnancies,
and a younger infant age at ALTE. CONCLUSIONS: Although a number
of risk factors for ALTE are similar to those for SIDS, the
differences warrant a separate focus on ALTE beyond that on
SIDS.
2: Becher JC, Keeling JW, Bell J, Wyatt B, McIntosh N.
Apolipoprotein E e4 and its prevalence in early childhood death
due to sudden infant death syndrome or to recognised causes.
Early Hum Dev. 2008 Feb 15 [Epub ahead of print]
Section of Child Life & Health, University of Edinburgh,
Scotland, United Kingdom.
BACKGROUND:: Specific genetic polymorphisms have been shown
to be more common in unexplained infant death. The APOE genotype
exhibits opposite effects at the extremes of age with protective
effects of e4 on perinatal mortality but detrimental effects
as age progresses. OBJECTIVE:: To determine whether the APOE
e4 allele is associated with early childhood (1 week-2 years)
unexplained death ('sudden infant death syndrome', SIDS) or
with recognised causes (non-SIDS) and to compare these cohorts
with published perinatal and adult data. METHODS:: DNA was
extracted from spleen tissue of children dying in South East
Scotland between 1990 and 2002. APOE alleles (e2, e3, e4) were
determined using PCR. Comparisons of allele frequencies between
groups were made. RESULTS:: There were 167 SIDS cases and 117
non-SIDS cases. Allele distributions of SIDS cases were similar
to healthy newborns. Allele distributions of non-SIDS cases
were more similar to adults than to healthy newborns. The percentage
of children with at least one e4 allele was significantly lower
in non-SIDS compared to SIDS (p=0.016). Non-SIDS cases had
a higher frequency of e3 compared to SIDS cases (p=0.01) and
to healthy newborns (0.005). CONCLUSIONS:: Children dying from
identified causes have different APOE allele distributions
from SIDS cases, but are similar to adults. Children dying
from SIDS have an allele distribution comparable to healthy
newborns. The prevalence of e4 in SIDS is not of an order to
contribute significantly to the age-related decline in e4.
Other Infant Death
1: Eudy RL.
Infant Mortality in the Lower Mississippi Delta: Geography,
Poverty and Race.
Matern Child Health J. 2008 Feb 16 [Epub ahead of print]
Health Policy and Management, UAMS College of Public Health,
4301 W. Markham St., Little Rock, AR, 72206, USA, eudyruth@uams.edu.
OBJECTIVE: The objectives of this study were to explore regional,
economic and racial disparities in infant mortality rates between
geographic sub-regions within the eight states containing the
Delta and to test hypotheses that regional disparities would
decrease over time while county poverty level and racial composition
would remain significant predictors of infant mortality rates.
STUDY DESIGN: The study used secondary data analysis of county
level rates, including descriptive statistics, hierarchical
multiple regression with interaction effects and linear multiple
regression. Models testing the impact of sub-regional geographic
differences, percent of poverty, percent of black population
and interaction effects were conducted at three time periods,
the late 1970s, late 1980s and late 1990s. RESULTS: In the
first time period, regional differences, percent of poverty,
percent of black population and the interaction of region and
poverty were all predictive of infant mortality (R (2) = 0.31,
P < 0.0001). In the subsequent time periods, only percent
of poverty and percent of black population were significant
predictors (R (2) = 0.20, P < 0.0001 and R (2) = 0.26, P < 0.0001).
CONCLUSIONS: During the late 1970s and early 1980s, region,
poverty and racial composition of counties all played an important
part in predicting life chances for infants born in these eight
states. Furthermore, Central Delta infants in counties with
poverty levels of 30% or greater were significantly more likely
to die than infants in other areas with the same rates of poverty,
even after controlling for racial composition. The impact of
regional differences was no longer significant at the ends
of the subsequent two decades. Both medical and policy changes
during these decades may have contributed to the decreased
impact of region. However, both poverty and racial composition
continue as important factors, accounting for more variance
in the late 1990s than a decade before.
2: Emenike E, Lawoko S, Dalal K.
Intimate partner violence and reproductive health of women
in Kenya.
Int Nurs Rev. 2008 Mar;55(1):97-102.
Department of Public HEalth Sciences, Karolinska Institute,
Stockholm, Sweden.
BACKGROUND: Reproductive age represents an augmented risk
of intimate partner violence (IPV) despite its occurrence in
women of all ages. IPV has been associated with various reproductive
health outcomes (e.g. terminated pregnancies and infant mortality),
although multi-country studies indicate that the findings may
not be consistent across all cultures. STUDY AIM AND METHOD:
The current work describes the association between IPV and
reproductive health of women in Kenya using the Demographic
and Health Survey of 2003. RESULTS: A significant association
between physical/emotional/sexual abuse of women and negative
reproductive health outcomes such as terminated pregnancies
and infant mortality was identified. In addition, IPV exposure
was associated with use of family planning methods and high
fertility. CONCLUSION AND RECOMMENDATIONS: Practitioners in
the healthcare sector should inquire about abuse. Provision
of counselling services and information regarding IPV effects
on reproductive outcomes as well as referring abused women
to relevant institutions is recommended in secondary prevention
of IPV and to improve the reproductive health status of abused
women.
3: Milei J, Ottaviani G, Lavezzi AM, Grana DR, Stella I, Matturri
L.
Perinatal and infant early atherosclerotic coronary lesions.
Can J Cardiol. 2008 Feb;24(2):137-141.
University of Buenos Aires – CONICET, Buenos Aires,
Argentina.
OBJECTIVE: Because the fetal origin of coronary artery lesions
is controversial, early atherosclerotic coronary artery lesions
in late fetal stillborns and infants, as well as the possible
atherogenic role of maternal cigarette smoking, were studied.
METHODS: Twenty-two fetal death and 36 sudden infant death
syndrome victims were examined by autopsy. In 28 of 58 cases,
the mothers were smokers. Serially cut sections of coronary
arteries were stained for light microscopy and immunotypified
for CD68, CD34, alpha-smooth muscle actin, proliferating cell
nuclear antigen, c-fos and apoptosis. RESULTS: Multifocal coronary
lesions were detected in 10 of 12 fetuses and in 15 of 16 infants
whose mothers smoked. Arterial lesions in infants with nonsmoking
mothers were observed in only five cases (two of 10 fetuses
and three of 20 infants) (P<0.001). Alterations ranged from
focal areas with mild myointimal thickening in prenatal life
to early soft plaques in infants. Smooth muscle cells infiltrated
into the subendothelium. These early lesions demonstrated c-fos
gene activation in the smooth muscle cells of the media, and
in some of these, positivity for apoptosis was observed, suggesting
that c-fos overexpression may promote proliferation, as evidenced
by proliferating cell nuclear antigen-positive cells. CONCLUSIONS:
Early intimal alterations of the coronary arteries are detectable
in the prenatal and infancy period, and may be significantly
associated with maternal smoking.
Miscarriage/Stillbirth/Prenatal Issues
1: Mann JR, McKeown RE, Bacon J, Vesselinov R, Bush F.
Are married/cohabiting women less likely to experience pregnancy
loss?
J S C Med Assoc. 2007 Dec;103(9):266-7.
USC School of Medicine, Columbia, SC 29208, USA. joshua.mann@palmettohealth.org
Women who were neither married nor cohabiting were far more
likely to experience pregnancy loss. The reasons for this association
are unclear, and confounding due to medical, social or behavioral
factors that are correlated with marital/relationship status
is possible. On the other hand, our findings are consistent
with a recent British study in which women who were neither
married nor cohabiting had 73% greater odds of first trimester
miscarriage. Based on these two studies, we recommend that
clinicians who provide obstetrical care be especially vigilant
to encourage healthy prenatal behaviors for patients who are
not married or cohabiting.
2: Veleva Z, Tiitinen A, Vilska S, Hydén-Granskog C,
Tomás C, Martikainen H, Tapanainen JS.
High and low BMI increase the risk of miscarriage after IVF/ICSI
and FET.
Hum Reprod. 2008 Feb 15 [Epub ahead of print]
Department of Obstetrics and Gynecology, University of Oulu,
PO Box 5000, Oulu FIN-90014, Finland.
BACKGROUND The extremes of BMI are associated with an increased
risk of miscarriage both in spontaneously conceived pregnancies
and after fertility treatment. The aim of the present study
was to study the effect of BMI on miscarriage rate (MR) in
fresh IVF/ICSI, and in spontaneous and hormonally substituted
frozen-thawed embryo (FET) cycles. METHODS Analysis was carried
out on 3330 first pregnancy cycles, performed during the years
1999-2004, of which 2198 were fresh, 666 were spontaneous and
466 were hormonally substituted FET cycles. A categorical,
a linear and a quadratic models of the effect of BMI on miscarriage
were studied by logistic regression. Factors related to patient
characteristics, protocol and embryo parameters were also examined.
RESULTS MR was higher in hormonally substituted FET (23.0%),
compared with the fresh cycles (13.8%) and spontaneous FET
(11.4%, P < 0.0001). Multivariate logistic regression revealed
that the relationship between BMI and the risk of miscarriage
is not linear but quadratic (U-shaped) (P = 0.01), indicating
a higher risk of miscarriage in underweight and obese women.
Hormonal substitution for FET was also associated with a 1.7-fold
higher MR, compared with the fresh cycles (P = 0.002, 95% confidence
interval 1.2-2.3). CONCLUSIONS Obese and underweight women
have an increased risk of miscarriage, and hormonally substituted
FET is associated with an even higher MR.
3: Goldenberg N, Glueck C.
Medical therapy in women with polycystic ovarian syndrome before
and during pregnancy and lactation.
Minerva Ginecol. 2008 Feb;60(1):63-75.
Cholesterol Center, Jewish Hospital, Cincinnati, OH, USA glueckch@healthall.com.
Polycystic ovary syndrome (PCOS) is probably the most common
endocrinopathy in women of childbearing age, and is particularly
common in African-American and Hispanic ethnic groups. It is
characterized by oligo-amenorrhea, clinical and/or biochemical
hyperandrogenism, polycystic ovaries, and, often, morbid obesity.
PCOS is associated with infertility and frequent 1st trimester
miscarriage, and with an increased risk of gestational diabetes.
Insulin resistance with compensatory hyperinsulinemia plays
an important role in the pathogenesis of PCOS. Reduction of
hyperinsulinemia with metformin-diet is associated not only
with improvement of the biochemical endocrinopathy, but, commonly,
with restoration of menstrual cycles and fertility. The combination
of metformin and clomi-phene citrate (CC) in CC resistant patients
provides additional benefit to a subset of patients, not responsive
to metformin alone. Metformin appears to be safe for mothers
and neonates (non-teratogenic) during pregnancy, though the
results of double-blinded placebo-controlled studies are not
yet available. Benefits from metformin therapy during pregnancy
include reduction of miscarriage, reduction in likelihood of
developing gestational diabetes, reduction in fetal macrosomia,
and prevention of excessive maternal weight gain during pregnancy.
Rosiglitazone and pioglitazone are effective therapy for ovulation
induction, but pregnancy class C and should not be used during
pregnancy.
4: de Lange TE, Budde MP, Heard AR, Tucker G, Kennare R, Dekker
GA.
Avoidable risk factors in perinatal deaths: A perinatal audit
in South Australia.
Aust N Z J Obstet Gynaecol. 2008 Feb;48(1):50-7.
Discipline of Obstetrics and Gynaecology, University of Adelaide,
Adelaide, South Australia, Australia.
Objectives: To analyse risk factors of perinatal death, with
an emphasis on potentially avoidable risk factors, and differences
in the frequency of suboptimal care factors between maternity
units with different levels of care. Methods: Six hundred and
eight pregnancies (2001-2005) in South Australia resulting
in perinatal death were described and compared to 86 623 live
birth pregnancies. Results: Two hundred and seventy cases (44.4%)
were found to have one or more avoidable maternal risk factors,
31 cases (5.1%) had a risk factor relating access to care,
while 68 cases (11.2%) were associated with deficiencies in
professional care. One hundred and four women (17.1% of cases)
presented too late for timely medical care: 85% of these did
have a sufficient number of antenatal visits. The following
independent maternal risk factors for perinatal death were
found: assisted reproductive technology (adjusted odds ratio
(AOR) 3.16), preterm labour (AOR 22.05), antepartum haemorrhage
(APH) abruption (AOR 6.40), APH other/unknown cause (AOR 2.19),
intrauterine growth restriction (AOR 3.94), cervical incompetence
(AOR 8.89), threatened miscarriage (AOR 1.89), pre-existing
hypertension (AOR 1.72), psychiatric disorder (AOR 1.85) and
minimal antenatal care (AOR 2.89). The most commonly found
professional care deficiency in cases was the failure to act
on or recognise high-risk pregnancies/complications, found
in 49 cases (8.1%). Conclusion: Further improvements in perinatal
mortality may be achieved by greater emphasis on the importance
of antenatal care and educating women to recognise signs and
symptoms that require professional assessment. Education of
maternity care providers may benefit from a further focus on
how to recognise and/or manage high-risk pregnancies.
5: Daley AJ, Thorpe S, Garland SM.
Varicella and the pregnant woman: Prevention and management.
Aust N Z J Obstet Gynaecol. 2008 Feb;48(1):26-33.
Infection Control Department and Department of Microbiology
and Infectious Diseases, The Royal Women's Hospital and The
Royal Children's Hospital, Melbourne, and Department of Pathology,
Unviersity of Melbourne, Melbourne, Victoria, Australia.
Infection with varicella zoster virus (VZV) is often considered
a childhood 'right of passage'; however, primary infection
occurring in women of child-bearing age can have significant
adverse consequences both for the mother and for her fetus.
During the first trimester, primary VZV infection may result
in stillbirth or a baby born with the stigmata of the congenital
varicella syndrome, while infection in the peripartum period
can result in neonatal varicella, which carries a significant
mortality rate despite appropriate antiviral therapy. Varicella
in pregnant women can progress to pneumonitis and other severe
sequelae that may also compromise the viability of the fetus.
Exposure to VZV most commonly occurs in the community or from
children in the household, but occasionally, exposure may occur
in the hospital environment. Determining a woman's serostatus
prior to pregnancy is advised, as effective vaccines are now
available and should be administered to non-pregnant seronegative
women of child-bearing age. Clinical practice guidelines for
management of a pregnant woman exposed to VZV are presented.
6: Stratton K, Lloyd L.
Hospital-based interventions at and following miscarriage:
Literature to inform a research-practice initiative.
Aust N Z J Obstet Gynaecol. 2008 Feb;48(1):5-11.
Discipline of Social Work and Social Policy, University of
Western Australia, Perth, Western Australia, Australia.
Background: It is estimated that up to one in five pregnancies
will result in miscarriage, the spontaneous loss of pregnancy
up to 20 weeks gestation. Miscarriage is such a common form
of reproductive loss that it is often under acknowledged by
the community, including health professionals. Dissatisfaction
with care following miscarriage is well noted despite evidence
that the care provided in hospital can have a significant effect
on the experience of and the emotional and physical recovery
from a miscarriage. Aims: The aim of this literature review
was to determine any evidence-based guidelines for hospital-based
medical and psychosocial services following a miscarriage.
Methods: A search was made of medical and psychosocial databases
for key terms. Further searches were then carried out using
references. Articles were critically analysed and implications
for service delivery derived. Results: Indications for service
delivery at the time of miscarriage and follow up are clear
from the reported experiences of women and the psychological
sequelae of miscarriage. However, there is little evidence
to support the efficacy of follow up postdischarge. There are
implications for service delivery and research in six domains:
staff care, assessment, information, phone follow up, risk
assessment and care during subsequent pregnancies. Conclusions:
Further research is needed to establish the impact on women
and staff of routine follow-up care after a miscarriage.
7: Gharesi-Fard B, Zolghadri J, Kamali-Sarvestani E.
Effect of leukocyte therapy on tumor necrosis factor-alpha
and interferon-gamma production in patients with recurrent
spontaneous abortion.
Am J Reprod Immunol. 2008 Mar;59(3):242-50.
Department of Immunology, Shiraz University of Medical Sciences,
Shiraz, Iran.
Problem Considering the deleterious role of T helper1 (Th1)
cells in pregnancy outcome, a successful treatment for recurrent
spontaneous abortion (RSA) should be able to make a significant
shift away from Th1 responses. Although paternal leukocyte
immunization has been used for treatment of RSA for years,
because of methodological differences there is no consensus
on the mechanism of action and effectiveness of this method.
Method of study Twenty-five Iranian non-pregnant women with
RSA and 16 non-pregnant control women with at least two successful
pregnancies were included in this study. All cases were followed
up after leukocyte therapy for pregnancy outcome. Mononuclear
cells from women were co-cultured with the husband's mononuclear
cells before and after immunotherapy. The levels of tumor necrosis
factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) were
checked on culture supernatant by enzyme-linked immunosorbent
assay method. Results The mean concentration of TNF-alpha was
significantly higher in patients compared with that in normal
controls (P = 0.0001). After immunotherapy, the TNF-alpha level
was only significantly decreased in women with successful outcome
(P = 0.0001). Immunotherapy also induced a significant reduction
in the IFN-gamma level (P = 0.009). Conclusion The results
of this investigation confirm the role of TNF-alpha in RSA
and propose the assessment of TNF-alpha production as a valuable
prognostic parameter for the prediction of abortion after leukocyte
therapy.
8: Sugiura-Ogasawara M, Ozaki Y, Nakanishi T, Sato T, Suzumori
N, Kumagai K.
Occasional antiphospholipid antibody positive patients with
recurrent pregnancy loss also merit aspirin therapy: a retrospective
cohort-control study.
Am J Reprod Immunol. 2008 Mar;59(3):235-41.
Department of Obstetrics and Gynecology, Nagoya City University
Medical School, Mizuho-ku, Nagoya, Aichi, Japan.
Problem It is well known that treatment with aspirin plus
heparin is effective for patients with antiphospholipid syndrome
(APS) to prevent pregnancy loss. However, it is unclear if
occasional antiphospholipid antibodies (aPL) are a risk factor
and whether patients with aPL at one time point but not diagnosed
as APS should be treated. Method of study We therefore studied
whether aspirin alone is effective in patients with occasional
aPL who did not meet the criteria for APS. We compared live
birth rates between 52 patients with occasional aPL treated
with aspirin and 672 unexplained patients with no medication.
Patients in both group had a history of two or three pregnancy
losses. Results In all, 44 of 52 patients (84.6%) with occasional
aPL could experience live birth when treated with aspirin alone.
509 of 672 patients (75.7%) with unexplained pregnancy losses
could have babies. When miscarriage cases caused by an abnormal
embryonic karyotype were excluded, the success rates were 95.7%
(44/46) and 81.2% (509/621), respectively. The live birth rate
in patients with occasional aPL treated with aspirin was significantly
higher than that in unexplained patients with no medication
(P = 0.008). Conclusion We therefore conclude that aspirin
is also useful in patients with occasional aPL but not APS.
9: Piura B, Rabinovich A, Hershkovitz R, Maor E, Mazor M.
Twin pregnancy with a complete hydatidiform mole and surviving
co-existent fetus.
Arch Gynecol Obstet. 2008 Feb 14 [Epub ahead of print]
Unit of Gynecologic Oncology, Department of Obstetrics and
Gynecology, Soroka Medical Center and Faculty of Health Sciences,
Ben-Gurion University of the Negev, PO Box 151, Beer-Sheva,
84101, Israel, piura@bgu.ac.il.
INTRODUCTION: Twin pregnancy with complete hydatidiform mole
and co-existent fetus (CHMF) resulting in a healthy take-home
baby is rare, with only 30 cases documented in detail in the
literature. CASE REPORT: A 29-year-old woman conceived following
two cycles of ovulation induction with clomiphene citrate.
Successive ultrasound examinations demonstrated a normally
growing live fetus alongside a normal placenta and an additional
intrauterine echogenic mass with features of hydatidiform mole.
At 17 week gestation, serum beta-hCG level was 25.38 multiples
of the median. Genetic amniocentesis at 18.5 week gestation
showed normal fetal 46XX karyotype. A cesarean section performed
at 28 week gestation resulted in the delivery of a live normal
female infant and two adjoining placentas. One placenta was
normal and the other placenta was composed of vesicles of various
sizes. Microscopic examination of the abnormal placenta confirmed
complete hydatidifrom mole. The baby did well and serial maternal
serum beta-hCG levels showed a declining trend and were undetectable
by 7 weeks after delivery. CONCLUSION: Continuation of a twin
pregnancy with CHMF is an acceptable option. There is, however,
an increased risk of developing pre-eclampsia and fetal loss
due to miscarriage. The chance of a live term birth is <50%
with nearly 33% of the mothers developing persistent gestational
trophoblastic disease after delivery. Thus, close surveillance
of an ongoing twin pregnancy with CHMF is mandatory to detect
potential early signs of maternal and fetal complications.
10: Morland LA, Leskin GA, Block CR, Campbell JC, Friedman
MJ.
Intimate Partner Violence and Miscarriage: Examination of the
Role of Physical and Psychological Abuse and Posttraumatic
Stress Disorder.
J Interpers Violence. 2008 Feb 13 [Epub ahead of print]
Despite research documenting high rates of violence during
pregnancy, few studies have examined the impact of physical
abuse, psychological abuse, and posttraumatic stress disorder
(PTSD) on miscarriage. Secondary analysis of data collected
by the Chicago Women's Health Risk Study permitted an exploration
of the relationships among physical abuse, psychological abuse,
PTSD, and miscarriage among 118 primarily ethnic minority women.
The interaction between maximum severity of abuse and age provided
the best multivariate predictor of miscarriage rate, accounting
for 26.9% of the variance between live birth and miscarriage
outcome. Mean scores of psychological abuse, physical violence,
forced sex, and PTSD were significantly higher in the miscarriage
group than in the live birth group. Women who experience physical
violence and psychological abuse during pregnancy may be at
greater risk for miscarriage. Prospective studies can confirm
findings and determine underlying mechanisms. Routine screening
for traumatic stress and PTSD may reduce rates of miscarriage.
Prepared by the
National Sudden Infant Death Resource Center
Georgetown University
2115 Wisconsin Avenue, N.W., Suite 601
Washington, DC 20007
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