NSIDRC Journal Article Alert — December 5, 2008
Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University.
Past issues of Resource Center 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. Laskey AL, Haberkorn KL, Applegate KE, Catellier MJ Postmortem Skeletal Survey Practice in Pediatric Forensic Autopsies: A National Survey* J Forensic Sci. 2008 Nov 21
Department of Pediatrics, Riley Hospital for Children, Children's Health Services Research, Indiana University School of Medicine, 410 West 10th Street, Suite 1020, Indianapolis, IN 46202.
Recommendations for the evaluation of an unexplained death in infancy include a postmortem skeletal survey (PMSS) to exclude skeletal trauma. Objectives of this study were to assess adherence to these recommendations in forensic autopsies in children equal to or less than 36 months of age, and what factors influence the use or nonuse of the PMSS. We surveyed pathologists who were members of the American Academy of Forensic Sciences. The survey included practice characteristics about where, when, and how PMSS were done. Nearly all respondents (99.6%) indicated they performed PMSS at least some of the time; however, almost a third did not use PMSS for all suspected Sudden Infant Death Syndrome (SIDS), abuse, unsafe sleep, or undetermined causes of death. Despite evidence that "babygrams" are inappropriate in a SIDS workup, 30% of pathologists use them preferentially. Despite SIDS being a diagnosis of exclusion that requires a PMSS, almost 10% of pathologists do not order a PMSS. Future research is necessary to reduce barriers to this important component of the pediatric forensic autopsy.
2. Sperhake JP, Zimmermann I, Püschel K Current recommendations on infants' sleeping position are being followed-initial results of a population-based sentinel study on risk factors for SIDS, 1996-2006, in Hamburg, Germany Int J Legal Med. 2008 Nov 19. [Epub ahead of print]
Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany, sperhake@uke.de.
Sudden infant death syndrome (SIDS) is a target for public health care in Germany. The aim of this study was to monitor data on risk-related behavior in the population of Hamburg, Germany, in order to respond to changes quickly and to estimate the effectiveness of prevention activities. Data have been gathered using the sentinel system with repeated surveys (1996, 1998, 2001, and 2006) in pediatric practices, thus allowing an estimate of the prevalence of risk factors in an urban population, both transversally and vertically. From 1996 to 2007, the SIDS rate in Hamburg fell from 0.9/1,000 live births to 0.1. The prevalence of infants sleeping prone declined from 8.1% in 1996 to 3.5% in 2006. In this small subgroup, up to 81.7% (2006) of the caretakers were well aware of the risk of sleeping prone. The prevalence of infants sleeping on their sides fell from 55.3% in 1998 to 10.6% in 2006. The sentinel setting is suitable for gathering risk-related data on SIDS. Despite the fact that, so far, no nationwide back-to-sleep campaign has been instituted in Germany, local campaigns have proved successful in reducing prone sleeping for infants. Moreover, the substantial reduction of side sleeping within a short time span going along with a reduced SIDS rate is an indicator of the effectiveness of prevention activities on a local basis.
3. Matturri L, Mauri M, Elena Ferrero M, Lavezzi AM Unexpected Perinatal Loss versus Sids-a Common Neuropathologic Entity Open Neurol J. 2008;2:45-50. Epub 2008 Sep 5
Lino Rossi" Research Center for the study and prevention of unexpected perinatal death and SIDS, University of Milan, Italy.
Objective: To evaluate the involvement of alterations of the central autonomic nervous system, particularly of the brainstem and cerebellum, in a wide set of victims of sudden and unexplained perinatal and infant death.Material and Methods: The study population consisted of 63 stillbirths, 28 neonatal deaths and 140 suspected SIDS. The victims were subjected to in-depth anatomopathological examination following appropriate guidelines. The protocol included, in particular, the histological evaluation on serial sections of the cardiorespiratory autonomic nervous system.Results: A diagnosis of "unexplained death" was established for 217 of the 231 victims (59 stillbirths, 28 newborns and 130 SIDS). In a very high percentage of these deaths (84%) we observed one or more anomalies of the nuclei and/or structures of the brainstem and cerebellum related to vital functions.Conclusion: Unexpected perinatal loss should not be regarded as a separate entity from SIDS, given the common neuropathological substrates.
Other Infant Death
1. Barnes GL Perspectives of African-American Women on Infant Mortality Soc Work Health Care. 2008;47(3):293-305
Twice as many African-American infants die each year when compared to White infants. This study explores the lived experiences of African-American women to identify factors related to this racial gap in infant mortality. Thirteen African-American women from two Virginia towns participated in either a focus group or in-depth interviews. Content and interpretive analysis revealed several themes. Participants indicated that the experiences of stress and racism are constant factors in African-American women's lives and are inseparable from their pregnancy experiences. Participants noted the importance of social support and the health care provider–client relationship for positive pregnancy outcomes.
Bereavement
1. Cartwright P, Read S Working with practitioners to develop training in peri-natal loss and bereavement: Evaluating three workshops Nurse Educ Pract. 2005 Sep;5(5):266-73
Wolstanton Medical Centre, Newcastle-under-Lyme PCT, UK.
Peri-natal loss is as profound as any other bereavement [Chambers, H.M., Chan, F.J., 2000. Support for women/families after peri-natal death. (Cochrane Review). Issue 1. The Cochrane Library, Oxford, Update Software], is commonplace, and its traumatic potential has long been overlooked by clinicians and researchers [Spechard, 1997. Traumatic death in pregnancy: the significance of meaning and attachment. In: Figley, C.R., Bride, B., Mazza, N., (Eds.), Death and Trauma: The Traumatology of Grieving. Taylor and Francis, London, 1997, pp. 67-98]. Previous miscarriage, stillbirth or neonatal death is implicated in post-natal depression and behaviour management difficulties after the birth of subsequent children. The involvement of the health visitor in supporting grieving parents may be crucial to medium and long-term family health [Hill, C., 1997. Evaluating the quality of after death care. Nursing Standard 12(8), 38-39]. However, service provision for such families appears to be inconsistent and depends on the skills, confidence and time constraints of individual practitioners, with little in the way of guidance and support in this sensitive area of care [Dent, A., Condon, L., Blair, P., Flemming, P., 1996. A study of bereavement care after a sudden and unexpected death. Archives of disease in childhood, 74, 552-526]. This paper outlines the development and evaluation of a series of workshops around peri-natal loss initially offered to health visitors in North Staffordshire (UK), and then expanded to incorporate midwives. The authors formally evaluated the three workshops (and their impact) retrospectively, and implemented the findings to further develop the workshops, thus ensuring relevance to professional practice. The rationale behind the introduction of the workshops and the contents are introduced; approaches to the evaluation process described; presentation of the findings offered; followed by a discussion of the key issues.
2. Mitchell M. Nurse Educ Pract. 2005 Mar;5(2):78-83 Preparing student midwives to care for bereaved parents
Faculty of Health and Social Care, School of Maternal and Child Health, University of the West of England, Blackberry Hill, Stapleton BS16 1DD, UK.
Caring for bereaved parents after the death of a baby is emotionally challenging for midwives. There is a lack of discussion and debate in the literature of how student midwives are prepared to undertake this role. This article describes the way student midwives undertaking 3 year and 18 month courses, in one university in the UK, are prepared to care for bereaved parents and their evaluation of this preparation. Verbal feedback and student's comments in the form of reflective writing formed the basis of the evaluation. Evaluation of the preparation included a focus on the use of the support group the Stillbirth and Neonatal Death Society, as this aspect has received little attention in the literature. In the analysis of the student feedback five main themes emerged. These were dealing with death and bereaved families, anxieties and fears, teaching strategies, user representation and preparedness for practice. Teaching about death is challenging and there is a need to share how educators undertake this task and to learn from each other. It is hoped that this discussion will stimulate a debate surrounding this issue.
Miscarriage/Stillbirth/Prenatal Issues
1. Dingle K, Alati R, Clavarino A, Najman JM, Williams GM Pregnancy loss and psychiatric disorders in young women: an Australian birth cohort study Br J Psychiatry. 2008 Dec;193(6):455-60
Level 2, Public Health Building, School of Population Health, University of Queensland, Herston Road, Herston, QLD 4006, Australia. s4002827@student.uq.edu.au.
BACKGROUND: Recent evidence has linked induced abortion with later adverse psychiatric outcomes in young women. AIMS: To examine whether abortion or miscarriage are associated with subsequent psychiatric and substance use disorders. METHOD: A sample (n=1223) of women from a cohort born between 1981 and 1984 in Australia were assessed at 21 years for psychiatric and substance use disorders and lifetime pregnancy histories. RESULTS: Young women reporting a pregnancy loss had nearly three times the odds of experiencing a lifetime illicit drug disorder (excluding cannabis): abortion odds ratio (OR)=3.6 (95% CI 2.0-6.7) and miscarriage OR=2.6 (95% CI 1.2-5.4). Abortion was associated with alcohol use disorder (OR=2.1, 95% CI 1.3-3.5) and 12-month depression (OR=1.9, 95% CI 1.1-3.1). CONCLUSIONS: These findings add to the growing body of evidence suggesting that pregnancy loss per se, whether abortion or miscarriage, increases the risk of a range of substance use disorders and affective disorders in young women.
2. Catov JM, Newman AB, Sutton-Tyrrell K, Harris TB, Tylavsky F, Visser M, Ayonayon HN, Ness RB; for the health ABC study Parity and Cardiovascular Disease Risk among Older Women: How Do Pregnancy Complications Mediate the Association? Ann Epidemiol. 2008 Dec;18(12):873-879
Departments of Obstetrics, Gynecology & Reproductive Sciences, Pittsburgh, PA; Department of Epidemiology, Pittsburgh, PA.
PURPOSE: To determine whether parity is associated with increased risk of cardiovascular disease (CVD) after accounting for perinatal complications. METHODS: CVD prevalence, number of births, and a history of preeclampsia, term low birth weight, preterm or stillbirth were evaluated among 540 women (mean age, 80 years; 47% black) enrolled in the Pittsburgh, PA site of the Health, Aging and Body Composition Study. Biomarkers were measured and CVD status was determined by self-report and hospital records. RESULTS: Nulliparous women (n = 89) had lower CVD prevalence compared with parous women (18.0% vs. 30.2%). Parous women without perinatal complications of interest (n = 321) had higher statin use compared with nulliparas, a trend accompanied by lower high-density lipoprotein (HDL) and higher triglycerides among women with perinatal complications (n = 130). After adjustment, parous women with no complicated births had a 1.95-fold (95% confidence interval [CI], 1.03-3.7) higher CVD prevalence compared to nulliparas. Among women with one or more pregnancy complications, CVD prevalence was 2.67 times (CI, 1.34-5.33) higher. Women with five or more births had the highest CVD prevalence (odds ratio [OR], 2.60; CI, 1.17-5.76) that was attenuated to 2.27 (1.00-5.15) after adjustment for complications of interest. CONCLUSIONS: History of pregnancy complications and higher statin use accounted for some but not all of the excess CVD prevalence among older parous women.
3. Cacciatore J, Rådestad I, Frederik Frøen J Effects of contact with stillborn babies on maternal anxiety and depression Birth. 2008 Dec;35(4):313-20
College of Human Services, Arizona State University, Phoenix, Arizona, USA.
Background: Some guidelines encourage mothers to see and hold their babies after stillbirth, which might be traumatizing. The study objective was to investigate the effects of women seeing and holding their stillborn baby on the risk of anxiety and depression in a subsequent pregnancy and in the long term. Methods: Thirty-seven organizations recruited women who had experienced stillbirth (N = 2,292 of whom 286 reported being pregnant). Anxiety and depressive symptoms were assessed by using the 25-item Hopkins Symptom Check List. Results: Among nonpregnant women, seeing and holding their stillborn baby were associated with lower anxiety symptoms (OR 0.68, 95% CI 0.49-0.95) and a tendency toward fewer symptoms of depression (OR 0.72, 95% CI 0.51-1.02), compared with pregnant women. Participants who were pregnant also had less depressive symptomatology (OR 0.57, 95% CI 0.43-0.75), but more symptoms of anxiety if they had seen and held their baby (OR 3.79, 95% CI 1.42-10.1). Conclusions: Seeing and holding the baby are associated with fewer anxiety and depressive symptoms among mothers of stillborn babies than not doing so, although this beneficial effect may be temporarily reversed during a subsequent pregnancy.
4. Wisborg K, Barklin A, Henriksen T, Hedegaard M Author response to: Psychological stress during pregnancy and stillbirth: no convincing evidence of an association BJOG. 2008 Nov;115(12):1585-6
Perinatal Epidemiology Research Unit, Department of Obstetrics and Paediatrics, Aarhus University Hospital, Aarhus N, Denmark.
5. Mikkelsen S Psychological stress during pregnancy and stillbirth: no convincing evidence of an association BJOG. 2008 Nov;115(12):1584-5
Department of Occupational Medicine, Copenhagen University Hospital, Glostrup, Denmark.
6. Leung T, Leung T, Sahota D, Chan O, Chan L, Fung T, Lau T Trends in maternal obesity and associated risks of adverse pregnancy outcomes in a population of Chinese women BJOG. 2008 Nov;115(12):1529-37
Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China.
Objective To assess the effect of increasing body mass index (BMI) on pregnancy outcome in a population of Chinese women. Design A retrospective study. Setting A university teaching hospital. Population Women delivering singleton babies between 1995 and 2005 who sought antenatal care before 20 weeks of gestation. Methods A total of 29 303 women were categorised into six BMI groups according to WHO's classification. Univariate, multivariate and logistic regression analysis were performed to compare obstetric and perinatal outcomes between BMI groups. Main outcome measures Incidences of caesarean delivery, pre-eclampsia, gestational diabetes, preterm delivery, small for gestational age (SGA) and large for gestational age (LGA), perinatal death, and the respective odd ratios in reference to the normal group with BMI >/= 18.5 kg/m(2) and <23 kg/m(2). Results The median BMI increased with increasing maternal age, parity, gestation at the first visit, but decreased with year of delivery (P < 0.001). Concerning the obstetric outcomes, increasing BMI was associated with increasing incidence of caesarean section, pre-eclampsia, gestational diabetes, preterm delivery, LGA, as well as SGA according to customised growth standards (P < 0.001). The odds ratios for most of these adverse outcomes are higher than those reported in Caucasian population. Increasing BMI was not associated with the rate of stillbirth, neonatal death or shoulder dystocia. Conclusion Increasing BMI is associated with increased risks of adverse obstetric outcomes. The impacts of high BMI on pre-eclampsia, gestational diabetes and preterm delivery in Chinese women might be stronger than that in Caucasian. Hence, it may be appropriate to use a lower BMI cutoff for defining overweight in Chinese.
7. Hvas AM, Ingerslev J, Salvig JD Scand J Clin Lab Invest. 2008 Nov 21:1-7. [Epub ahead of print] Thrombophilia risk factors are associated with intrauterine foetal death and pregnancy-related venous thromboembolism
Center for Haemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University Hospital, Skejby, Denmark.
Pregnancy in healthy women is accompanied by hypercoagulable changes that may interact with thrombophilia risk factors and threaten pregnancy. However, the literature on this issue is conflicting. In investigating the relationship between pregnancy-associated complications and the presence of thrombophilia risk factors, we studied the records of 414 women who had been examined for inherited and acquired thrombophilia in the period 1996 to 2006 because of pregnancy-associated complications. Of a total of 885 pregnancies among the women, 397 were recorded as foetal loss/intrauterine foetal death during the first (62 %), second (25 %) or third trimester (13 %). One-hundred-and-two (25 %) women had had a thromboembolic event during one of their pregnancies, and 98 (24 %) had had pre-eclampsia on at least one occasion. Intrauterine growth restriction was found in 105 (25 %) of the women, and 29 (7 %) suffered placental abruption. We found that 120 (29 %) women had at least one thrombophilia risk factor. Factor V Leiden heterozygosity was the most common thrombophilia factor (n = 52), mostly linked with the risk of venous thromboembolism during pregnancy or postpartum and to foetal death during the second or third trimester. Fifty-three (13 %) women had antiphospholipid antibodies (lupus anticoagulant and/or anti-beta2-glycoprotein 1 antibodies) mainly associated with the risk of spontaneous abortion during the first trimester. In conclusion, thrombophilia was found to be considerably more common in women with pregnancy-associated complications in comparison with the general population, and most frequently in conjunction with venous thromboembolism during pregnancy and the postpartum period.
8. Riggs R, Mayer J, Dowling-Lacey D, Chi TF, Jones E, Oehninger S Does storage time influence postthaw survival and pregnancy outcome? An analysis of 11,768 cryopreserved human embryos Fertil Steril. 2008 Nov 20. [Epub ahead of print]
The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia.
OBJECTIVE: To evaluate the impact of cryopreservation storage duration on embryo survival, implantation competence, and pregnancy outcome. DESIGN: Retrospective study. SETTING: Academic tertiary-referral infertility center. PATIENT(S): In vitro fertilization patients and recipients of oocyte donation cycles who had cryopreserved embryos and underwent at least one thaw cycle from 1986 to 2007. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Postthaw survival proportion and implantation, clinical pregnancy, miscarriage, and live birth rates. RESULT(S): Length of storage time did not have a significant effect on postthaw survival for IVF or oocyte donation cycles, or for embryos frozen at the pronuclear or cleavage stages. There was no significant impact of the duration of storage on clinical pregnancy, miscarriage, implantation, or live birth rate, whether from IVF or oocyte donation cycles. Logistic regression analysis demonstrated that the length of storage time or developmental stage at freezing were not predictive of embryo survival or pregnancy outcome. Only oocyte age, survival proportion, and number of transferred embryos were positive predictors of pregnancy outcome. CONCLUSION(S): Cryostorage duration did not adversely affect postthaw survival or pregnancy outcome in IVF or oocyte donation patients.
9. Topalidou M, Effraimidou S, Farmakiotis D, Papadakis E, Papaioannou G, Korantzis I, Garipidou V Low protein Z levels, but not the intron F G79A polymorphism, are associated with unexplained pregnancy loss Thromb Res. 2008 Nov 19. [Epub ahead of print]
Haemostasis Unit, Department of Haematology, "Papageorgiou" General Hospital, Thessaloniki, Greece.
INTRODUCTION: The present case-control study was designed in order to investigate the association between plasma protein Z (PZ) levels, the intron F G79A polymorphism and unexplained pregnancy loss. MATERIALS AND METHODS: 51 women with at least two consecutive or three non-consecutive fetal losses between the 8th and 12th week of gestation and 47 apparently healthy parous women of reproductive age with no history of pregnancy loss (controls) were enrolled. Allele frequencies of the PZ intron F G79A polymorphism and PZ levels were measured. RESULTS: PZ levels (mg/L) were significantly lower in cases (mean+/-S.D. 1.28+/-0.56) than controls (1.97+/-0.76, p<0.001) and in carriers of the A allele (1.46+/-0.62), compared to GG homozygous subjects (1.72+/-0.81, p=0.044). A higher proportion of cases (41.2%) were PZ-deficient (<1 mg/L), compared to controls (10.6%, p=0.001). No significant difference in the frequency of at least one A allele carriers was observed between cases (39.2%) and controls (40.4%). CONCLUSION(S): It is possible that low PZ levels are a novel risk factor for unexplained recurrent miscarriage or fetal death. The presence of the F 79A allele is associated with significantly lower PZ levels, but, in the present study, was unrelated to unexplained early pregnancy loss.
10. Salim R, Czarnowicki T, Nachum Z, Shalev E The impact of close surveillance on pregnancy outcome among women with a prior history of antepartum complications attributed to thrombosis: a cohort study Reprod Biol Endocrinol. 2008 Nov 21;6(1):55. [Epub ahead of print]
ABSTRACT: BACKGROUND: There is limited evidence, so far, as to the optimal management of women with a prior obstetric history of antepartum complications attributed to thrombosis. We aimed to investigate the contribution of close antepartum surveillance on pregnancy outcome among women with prior antepartum complications attributed to thrombosis. METHODS: The study was conducted on all women who were delivered, conceived and delivered again between January 2000 and January 2006 at a university teaching hospital. Women included were managed in previous pregnancy at a low risk setting and had unpredicted antepartum complications occurring at a gestational age of 23 weeks or more. Antepartum complications considered were intrauterine fetal death, neonates who were small for gestational age, severe pre-eclampsia and placental abruption. All women were tested for the presence of thrombophilia after delivery. In the following pregnancy, only women found to have any thrombophilia (thrombophilic group) were treated with enoxaparin. Both the thrombophilic group and the non-thrombophilic group (tested negatively for thrombophilia) were managed and observed closely at our high-risk pregnancy clinic. RESULTS: Ninety-seven women, who conceived at least once after the diagnosis of the relevant antepartum complications, were included in this study. Forty-nine had any thrombophilia and 48 tested negatively. Composite antepartum complications (all antepartum complications considered) were reduced significantly after close antepartum surveillance in both groups. Mean birth weight and mean gestational age improved significantly and were comparable between the groups. CONCLUSION: Close antepartum surveillance may contribute to improvement in the perinatal outcomes of women with prior antepartum complications attributed to thrombosis.
11. Pasupathy D, Dacey A, Cook E, Charnock-Jones DS, White IR, Smith GC Study protocol. A prospective cohort study of unselected primiparous women: the pregnancy outcome prediction study BMC Pregnancy Childbirth. 2008 Nov 19;8(1):51. [Epub ahead of print]
ABSTRACT: BACKGROUND: There have been dramatic changes in the approach to screening for aneuploidy over the last 20 years. However, the approach to screening for other complications of pregnancy such as intra-uterine growth restriction, pre-eclampsia and stillbirth remains largely unchanged. Randomised controlled trials of routine application of high tech screening methods to the general population have generally failed to show improvement in outcome. We have previously reviewed this and concluded it was due, in large part, to poor performance of screening tests. Here, we report a study design where the primary aim is to generate clinically useful methods to screen women to assess their risk of adverse pregnancy outcome. Methods/design: We report the design of a prospective cohort study of unselected primiparous women recruited at the time of their first ultrasound scan. Participation involves serial phlebotomy and obstetric ultrasound at the dating ultrasound scan (typically 10-14 weeks), 20 weeks, 28 weeks and 36 weeks gestation. In addition, maternal demographic details are obtained; maternal and paternal height are measured and maternal weight is serially measured during the pregnancy; maternal, paternal and offspring DNA are collected; and, samples of placenta and membranes are collected at birth. Data will be analysed as a prospective cohort study, a case-cohort study, and a nested case-control study. DISCUSSION: The study is expected to provide a resource for the identification of novel biomarkers for adverse pregnancy outcome and to evaluate the performance of biomarkers and serial ultrasonography in providing clinically useful prediction of risk.
Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center Georgetown University 2115 Wisconsin Avenue, N.W., Suite 601 Washington, DC 20007 (866) 866-7437 toll free (202) 687-7466 local (202) 784-9777 fax info@sidscenter.org http://www.sidscenter.org
