NSIDRC Journal Article Alert — February 13, 2009

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.
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Other Infant Death

1. Badura M, Johnson K, Hench K, Reyes M

Healthy start lessons learned on interconception care

Womens Health Issues. 2008 Nov-Dec;18(6 Suppl):S61-6

U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Division of Healthy Start and Perinatal Services, Rockville, Maryland 20857, USA. mbadura@hrsa.gov

The Federal Healthy Start program was started in 1991 to address the factors that contribute to the Nation's high infant mortality rate, particularly among populations with disproportionately high rates of adverse perinatal health outcomes. The goals of Healthy Start are to reduce disparities in access to and utilization of health services by using a lifespan approach, improving the local health care system, and increasing consumer and community input into health care decisions. In 2007, Healthy Start served 99 communities in 38 states, the District of Columbia, and Puerto Rico. Most Healthy Start grantees are nonprofit organizations. Since 2005, all 97 Healthy Start grantees (and the 2 additional grantees funded in 2007) have been required to include an interconception care component. Three quarters of grantees enrolled the majority of their interconception clients during the prenatal period. Most grantees used care coordination and case management as the primary approach to improving interconception health care. In 2007, 93 interconception projects reported that 9 out of 10 women had an ongoing source of primary care. Grantees screened to detect health conditions and risks, as well as provided an opportunity to provide vital information to women about their risks for chronic conditions such as obesity, hypertension, and diabetes. The Healthy Start interconception components demonstrate a critical need for and the potential impact of a strong interconception care program for high-risk populations such as women living in poverty, in medically underserved communities, and without health coverage.

Miscarriage/Stillbirth/Prenatal Issues

1. Pineda B, Hermenegildo C, Tarín JJ, Laporta P, Cano A, García-Pérez MA

Alleles and haplotypes of the estrogen receptor alpha gene are associated with an increased risk of spontaneous abortion

Fertil Steril2009 Feb 5. [Epub ahead of print]

Research Foundation, Hospital Clínico Universitario, Valencia, Spain.

OBJECTIVE: To investigate whether polymorphisms in estrogen receptor alpha (ERalpha) or beta (ERbeta) genes are associated with a risk of miscarriage. DESIGN: A retrospectively analyzed, prospectively obtained database of cases and controls. SETTING: University hospital menopause unit. PATIENT(S): 177 women with at least one spontaneous abortion and 442 controls with at least one live birth and no history of miscarriage. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Genotype frequencies and odd ratios for abortion risk in cases and controls for four single nucleotide polymorphisms (SNPs) located in intron 1 (C>T and A>G), intron 4 (A>T), and exon 8 (T>C) for the ERalpha gene, and two SNPs located in intron 2 (C>T) and intron 8 (G>A) for the ERbeta gene. RESULT(S): A statistically significant association was found between spontaneous abortion and SNPs rs2234693 (C>T, defined by restriction enzyme PvuII) and rs9340799 (A>G, defined by restriction enzyme XbaI) in intron 1 of the ERalpha gene. The age-adjusted odds ratio for abortion risk was 1.29 for the TA haplotype (defined by PvuII-XbaI) with respect to the CG haplotype in women with at least one abortion, which increased to 1.9 in women with two or more abortions. CONCLUSION(S): The TA haplotype defined by PvuII and XbaI was associated with an increased risk of reproductive loss. No association was found for the ERbeta gene.

2. Lavezzi AM, Mauri M, Mecchia D, Matturri L

Developmental alterations of the prefrontal cerebral cortex in sudden unexplained perinatal and infant deaths

J Perinat Med. 2009 Feb 6. [Epub ahead of print]

"Lino Rossi" Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, University of Milan, Italy.

Abstract The aim of this study was to investigate the developmental patterns of the human prefrontal cortex involved in breathing control in a wide cohort of fetal and infant death victims, aged from the 22(nd) gestational week to 10 months of life, and to evaluate whether morpho-functional disorders are present in this specific cortical area in victims of sudden unexplained death. A further aim was to determine whether prenatal absorption of nicotine could also affect the maturational processes of the prefrontal cortex. A pronounced radial organization of the cerebral wall was evident from the 26(th) gestational week. By 36 gestational weeks this columnar structure disappeared, coinciding with the formation of a laminar cytoarchitecture. The mature cortex, observable from the 4(th) month of life, was organized horizontally into six laminae. In 33% of the sudden death victims the prefrontal cortex showed morphological alterations with anomalous laminar patterns and delayed neuronal maturation. A significant correlation with prenatal cigarette exposure was found.

3. Chuang CH, Chang PJ, Hsieh WS, Tsai YJ, Lin SJ, Chen PC

Chinese herbal medicine use in Taiwan during pregnancy and the postpartum period: A population-based cohort study

Int J Nurs Stud. 2009 Feb 2. [Epub ahead of print]

Department of Nursing, Chang Jung Christian University, Tainan County, Taiwan.

BACKGROUND: Using Chinese herbal medicines during pregnancy and postpartum is common in the Chinese community. OBJECTIVE: The purpose of this current study is to explore the use of Chinese herbal medicines by women during pregnancy and postpartum in Taiwan. DESIGN: It is an on-going prospective longitudinal study design. SETTING AND PARTICIPANTS: We used multistage stratified systematic sampling to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. Subjects underwent a home interview 6 months after their deliveries between June 2005 and July 2006. A structured questionnaire was successfully administered to 87.8% of the sampled population. RESULTS: At least one Chinese herbal medicine was used by 33.6% and 87.7% of the interviewed subjects during pregnancy and the postpartum period, respectively. An-Tai-Yin, Pearl powder, and Huanglian were the most commonly used during pregnancy, while Shen-Hua-Tang and Suz-Wu-Tang were the most commonly used by postpartum women. Pregnant women aged 20-34, with high education, threatened abortion, chronic disease, and primipara appeared to use more Chinese herbal medicines than others in the sample. Postpartum women with high education, primipara, normal spontaneous delivery, and breastfeeding were found to use more Chinese herbal medicines; but women with pregnancy-related illness used less. CONCLUSIONS: Chinese herbal medicines are frequently used by women during pregnancy and the postpartum period in Taiwan and those with high education and primipara used more such herbs. Due to limited safety information on these herbs, we would advise caution regarding their use either during pregnancy or postpartum breastfeeding period. Moreover, it is important for nurses/midwifes enquiring about such habits, and providing the adequate education to women during prenatal and postpartum care to prevent potential side effects.

4. Heimonen A, Janket SJ, Meurman JH, Furuholm J, Ackerson LK, Kaaja R

Oral health care patterns and the history of miscarriage

Oral Dis. 2008 Nov;14(8):734-40

Institute of Dentistry, Oulu University and Hospital, Oulu, Finland. auro.heimonen@oulu.fi

OBJECTIVE: Oral infections can trigger the production of pro-inflammatory mediators that may be risk factors for miscarriage. We investigated whether oral health care patterns that may promote or alleviate oral inflammation were associated with the history of miscarriage in 328 all-Caucasian women. MATERIALS AND METHODS: Of 328 women in this cross-sectional cohort, 74 had history of miscarriage (HMC). Medical, dental and sociodemographic data were collected through clinical examinations, medical record searches and structured questionnaires. RESULTS: The multivariate regression analyses indicated that urgency-based dental treatment demonstrated a significant association [odds ratio (OR) = 2.54; 95% confidence interval (CI): 1.21-5.37; P = 0.01] and preventive dental treatment demonstrated a marginally significant inverse association (OR = 0.53; CI: 0.26-1.06; P = 0.07) with HMC. Self-rated poor oral health had a non-significant positive association with HMC (OR 1.60; CI: 0.88-2.90). CONCLUSION: Our results provide sufficient evidence for hypothesis generation to test whether other precise measures of oral inflammation are associated with adverse birth outcomes.

5. Karmon A, Levy A, Holcberg G, Wiznitzer A, Mazor M, Sheiner E

Decreased perinatal mortality among women with diet-controlled gestational diabetes mellitus

Int J Gynaecol Obstet. 2008 Nov 25. [Epub ahead of print]

Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er-Sheva, Israel

OBJECTIVE: To examine pregnancy outcomes associated with diet-controlled gestational diabetes mellitus (GDM A1). METHODS: A retrospective cohort study compared pregnancy characteristics of women with and without GDM A1 at a center where GDM A1 patients are routinely induced at 40 weeks. RESULTS: Higher rates of complications such as shoulder dystocia, congenital malformation, and macrosomia were observed in GDM A1 patients. A lower incidence of perinatal mortality was present in GDM A1 women compared with women without GDM A1. This association lost its significance when controlled for maternal age, ethnicity, induction, cesarean delivery, and birth weight in a multivariate model. Although the stillbirth rate before 40 weeks of gestation was identical among all participants, after 40 weeks it was significantly higher in women without GDM A1. CONCLUSION: Induction of women with GDM A1 at 40 weeks may play a role in lowering perinatal mortality to below that of the general population.

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