NSIDRC Journal Article Alert — December 19, 2008
Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University.
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Miscarriage/Stillbirth/Prenatal Issues
1. Freak-Poli R, Chan A, Tucker G, Street J Previous abortion and risk of pre-term birth: a population study J Matern Fetal Neonatal Med. 2008 Dec 13:1-7. [Epub ahead of print]
Discipline of Public Health, University of Adelaide, South Australia, Australia.
Objective. This population study was undertaken to determine whether previous abortion is an independent risk factor for pre-term birth and to calculate population-attributable risks for risk factors. Methods. All South Australian first singleton births in 1998-2003 (n = 42 269) were included in a multivariable logistic regression analysis, comparing pre-term births with term births. Results. Risk factors for pre-term birth were found to be: being indigenous, single, a smoker [adjusted odds ratio (AOR) 1.28, 95% confidence interval 1.17-1.41], age 40 years or older, reproductive technology assistance, threatened miscarriage, antepartum haemorrhage, urinary tract infection, pregnancy hypertension and suspected intra-uterine growth restriction. A previous spontaneous abortion was of borderline statistical significance, whereas a previous induced abortion (AOR 1.25, 1.13-1.40) was an independent risk factor. A dose-response relationship was found with increasing number of previous spontaneous or induced abortions. Population-attributable risks were highest for pregnancy hypertension (12.4%) and antepartum haemorrhage (9.2%). Smoking and previous induced abortion had risks of 4.7% and 2.7%, respectively. Among indigenous women, 51% of whom smoked, 16.4% of pre-term birth could be attributed to smoking. Conclusions. A previous induced abortion and smoking during pregnancy (particularly among indigenous women) are preventable risk factors for pre-term birth. Their population-attributable risks are likely to be under-estimates from under-reporting.
2. Wang Q, Li TC, Wu YP, Cocksedge KA, Fu YS, Kong QY, Yao SZ Reprod Biomed Online. 2008;17(6):814-819. Reappraisal of peripheral NK cells in women with recurrent miscarriage
Gynaecology and Obstetric Department, Reproductive Medicine Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Reproductive Medicine and Surgery Unit, University of Sheffield, Sheffield Teaching Hospitals, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.
The aim of this study was to examine the relationship between peripheral natural killer (NK) cells and recurrent miscarriage by improved methods. Peripheral NK cell measurement was carried out using flow cytometry of morning blood samples obtained in the early follicular phase, analysed within 8 h of collection. Eighty-five Chinese women with recurrent miscarriage who previously tested negative for autoantibodies, and 27 control subjects who were not using any hormonal methods for contraception, were recruited. No significant difference was found in the number of peripheral NK cells and their subsets between women with recurrent miscarriages and control subjects. Only 5% of women with recurrent miscarriage had high peripheral NK cells. The number of previous miscarriages did not appear to have an impact on the number of NK cells. In conclusion, there appears to be limited value in the routine measurement of peripheral NK cells in women with recurrent miscarriage.
3. Terrabuio DR, Abrantes-Lemos CP, Carrilho FJ, Cançado EL Follow-up of Pregnant Women With Autoimmune Hepatitis: The Disease Behavior Along With Maternal and Fetal Outcomes J Clin Gastroenterol. 2008 Dec 10. [Epub ahead of print]
Department of Gastroenterology daggerLaboratory of Medical Investigation, Immunopathology of Schistosomiasis, Institute of Tropical Medicine, University of São Paulo School of Medicine, Sao Paulo, SP, Brazil.
GOALS: To assess maternal and fetal outcomes and clinical management of pregnancy in patients with autoimmune hepatitis (AIH). BACKGROUND: There is a paucity of information about maternal and fetal outcomes, and AIH activity during pregnancy and in the postpartum period. There is no consensus about the administration of azathioprine during pregnancy and breastfeeding. STUDY: Retrospective analysis of 54 pregnancies (3 still in progress) in 39 AIH patients. RESULTS: The median age at conception was 24 years, and 68.4% of women had liver cirrhosis. Before conception and in early pregnancy, azathioprine and prednisone were administered in 48.1%, but treatment regimen was usually changed further to 20 mg/d prednisone; and 20.4% were off treatment. There were 36 livebirths, and fetal loss rates were 29.4% (13 miscarriages, 1 stillbirth, and 1 ectopic pregnancy). Preterm birth rate was 11.8%. In 2 cases, there was acute fetal distress; and in 2 others congenital malformations (3.9%). The rate of serious maternal complication was 7.8%, with no deaths. There were no flares in 41.2% pregnancies, but aminotransferase elevations occurred in 54.9%, 31.4% of which were true AIH relapses, only registered in the postpartum period. CONCLUSIONS: Despite the high fetal miscarriage rate, pregnancy in AIH was safe. Patients needed careful monitoring, especially in the postpartum period because of relapses. There was no evidence of a cause and effect relationship among azathioprine administration and premature births and congenital abnormalities, but more studies are necessary. Higher doses of prednisone may be an alternative option for those who prefer azathioprine withdrawal during pregnancy.
4. Kamilova N, Sultanova I, Akhmed-Zadeh V Diagnostic indices of fetoplacental complex in pregnancy assessment of women with genital infections Georgian Med News. 2008 Nov;(164):23-7
Azerbaijan Medical University, Depat of obstetrics and Gynaecology 1.
Miscarrying of pregnancy remains a major problem in obstetrics and gynecology. Inflammatory disease is known to affect reproductive function. To identify the role of the urogenital infection in the genesis of miscarriage, 58 women with complicated obstetrical anamnesis are examined. It is found that the persisting sexually transmitted urogenital infection plays a leading role in the genesis of miscarrying. The way of treatment for imminent abortion which significantly increases (70-90%) the rate of full term viable babies in women with habitual noncarrying of pregnancy is offered. Prophylactic measures aimed at against placental insufficiency in early period of pregnancy are proposed. Of a special importance is the prenatal observation, timely diagnostics and correction of disorders in order to prevent imminent abortion, habitual abortion and prematurity or too early birth.
5. Zain MM, Norman RJ Womens Health (Lond Engl). 2008 Mar;4:183-94. Impact of obesity on female fertility and fertility treatment
University of Adelaide, Research Centre for Reproductive Health, School of Paediatrics & Reproductive Health, South Australia, Australia. murizah.mohdzain@adelaide.edu.au , 2Alor Setar Hospital, Department of Obstetric & Gynaecology, Kedah, Malaysia.
Obesity and overweight are common conditions that have consequences not only on general health but also to a great extent on reproductive health. There is a high prevalence of obese women in the infertile population and numerous studies have highlighted the link between obesity and infertility. Obesity contributes to anovulation and menstrual irregularities, reduced conception rate and a reduced response to fertility treatment. It also increases miscarriage and contributes to maternal and perinatal complication. Reduction of obesity, particularly abdominal obesity, is associated with improvements in reproductive functions; hence, treatment of obesity itself should be the initial aim in obese infertile women before embarking on ovulation-induction drugs or assisted reproductive techniques. While various strategies for weight reduction, including diet, exercise, pharmacological and surgical intervention exist, lifestyle modification continues to be of paramount importance.
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