NSIDRC Journal Article Alert — May 1, 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.
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. Rognum IJ, Haynes RL, Vege A, Yang M, Rognum TO, Kinney HC

Interleukin-6 and the serotonergic system of the medulla oblongata in the sudden infant death syndrome

Acta Neuropathol. 2009 Apr 26. [Epub ahead of print]

Department of Pathology, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA, ingvarjo@stud.ntnu.no.

Mild infection may trigger sudden death in the vulnerable infant by cytokine interactions with a compromised medullary serotonergic (5-HT) system, leading to disrupted cardiorespiratory regulation and sleep-related sudden death. The cytokine interleukin (IL)-6 is elevated in the cerebrospinal fluid in SIDS. We tested the hypothesis that the expression of IL-6 receptors (IL-6R) and/or gp130 (involved in IL-6R signaling) is altered in the medullary 5-HT system in SIDS. Immunohistochemistry of IL-6R and gp130 was performed on medullae from 25 SIDS infants, 20 infectious deaths, and 14 controls using a semi-quantitative grading system. In the SIDS cases, mean IL-6R intensity grade in the arcuate nucleus (major component of medullary 5-HT system) was significantly higher than in the control group (2.00 +/- 0.07 vs. 1.77 +/- 0.08, P = 0.04), with no other differences in IL-6R or gp130 expression at any other site. Arcuate 5-HT neurons expressed IL-6R, indicating a site of IL-6/5-HT interaction. In SIDS, IL-6R expression is abnormal in the arcuate nucleus, the putative human homolog of rodent ventral medullary chemosensitivity sites involving 5-HT. Aberrant interactions between IL-6 and the arcuate nucleus may contribute to impaired responses to hypercapnia generated by infection (hyper-metabolism) combined with rebreathing.

Other Infant Death

1. Macdorman MF, Kirmeyer S

The challenge of fetal mortality

NCHS Data Brief. 2009 Apr;(16):1-8

Centers for Disease Control and Prevention National Center for Health Statistics 3311 Toledo Road, Hyattsville, Maryland 20782, USA.

Data from the Fetal Death Data File and Linked Birth/Infant Death Data Set, National Vital Statistics System. The magnitude of fetal mortality is considerable: About 1 million fetal deaths occur at any gestational age in the United States each year, including almost 26,000 at 20 weeks of gestation or more; Even when limited to fetal deaths of 20 weeks of gestation or more, nearly as many fetal deaths as infant deaths occur in the United States each year; After decades of decline, the U.S. fetal mortality rate (fetal deaths of 20 weeks of gestation or more) did not decrease from 2003 to 2005; Fetal mortality rates are substantially higher for non-Hispanic black and American Indian or Alaska Native women than for non-Hispanic white women; Compared with the U.S. average, fetal mortality rates are higher for teenagers and for women aged 35 years and over, for twin and higher-order pregnancies, and for women with more than two previous pregnancies. Fetal mortality is a major, but often overlooked, public health problem. Fetal mortality refers to spontaneous intrauterine death at any time during pregnancy. Fetal deaths later in pregnancy are sometimes referred to as stillbirths (at 20 weeks of gestation or more, or 28 weeks or more, for example). Much of the public concern regarding reproductive loss has concentrated on infant mortality, as less is known about fetal mortality. However, the impact of fetal mortality on U.S. families is considerable.This report examines fetal death data from the National Vital Statistics System (NVSS). Vital statistics fetal death data are generally presented for fetal deaths of 20 weeks of gestation or more. Other data sources provide estimates of fetal deaths for all periods of gestation. For example, the National Survey of Family Growth estimates about 1 million fetal losses per year in the United States, with the vast majority of these occurring before 20 weeks of gestation. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

2. Macdorman MF, Mathews TJ

Recent trends in infant mortality in the United States

NCHS Data Brief. 2008 Oct;(9):1-8

Centers for Disease Control and Prevention National Center for Health Statistics 3311 Toledo Road, Hyattsville, Maryland 20782, USA.

KEY FINDINGS: Data from the Linked Birth/Infant Death Data Set and Preliminary Mortality Data File, National Vital Statistics System. The U.S. infant mortality rate did not decline from 2000 to 2005. Data from the preliminary mortality file suggest a 2% decline in the infant mortality rate from 2005 to 2006. The U.S. infant mortality rate is higher than those in most other developed countries, and the gap between the U.S. infant mortality rate and the rates for the countries with the lowest infant mortality appears to be widening. The infant mortality rate for non-Hispanic black women was 2.4 times the rate for non-Hispanic white women. Rates were also elevated for Puerto Rican and American Indian or Alaska Native women. Increases in preterm birth and preterm-related infant mortality account for much of the lack of decline in the United States' infant mortality rate from 2000 to 2005. Infant mortality is one of the most important indicators of the health of a nation, as it is associated with a variety of factors such as maternal health, quality and access to medical care, socioeconomic conditions, and public health practices. The U.S. infant mortality rate generally declined throughout the 20th century. In 1900, the U.S. infant mortality rate was approximately 100 infant deaths per 1,000 live births, while in 2000, the rate was 6.89 infant deaths per 1,000 live births. However, the U.S. infant mortality rate did not decline significantly from 2000 to 2005, which has generated concern among researchers and policy makers. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Bereavement

1. Boelen PA

The centrality of a loss and its role in emotional problems among bereaved people

Behav Res Ther. 2009 Mar 27. [Epub ahead of print]

Department of Clinical and Health Psychology, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands.

In literature on posttraumatic stress-disorder (PTSD) there is growing interest in the concept "centrality of event", referring to the degree to which the memory of a traumatic event is central to one's everyday inferences, life-story, and identity. Using self-reported data from 254 bereaved individuals, this study examined the centrality of the loss-event in emotional problems following loss. Findings showed that this centrality (a) varied as a function of kinship to the deceased but not other loss-related variables, (b) was correlated with complicated grief (CG), depression, PTSD, and with neuroticism and several cognitive-behavioural variables, and (c) remained correlated with CG but not depression and PTSD when controlling for the shared variance between these symptoms, neuroticism, and these cognitive-behavioural variables.

Miscarriage/Stillbirth/Prenatal Issues

1. Early pregnancy loss in celiac women: The role of genetic markers of thrombophilia

Ciacci C, Tortora R, Scudiero O, Di Fiore R, Salvatore F, Castaldo G

Dig Liver Dis. 2009 Apr 21. [Epub ahead of print]

Gastroenterologia, Dipartimento di Medicina Clinica e Sperimentale, University of Naples Federico II, Naples, Italy.

BACKGROUND: Adverse pregnancy outcomes are more frequent in celiac than in non-celiac women. AIMS: To investigate a possible role of genetic prothrombotic variants in early pregnancy loss of celiac women. METHODS: Thirty-nine celiac women who had experienced early pregnancy losses (at least two losses within the first 3 months of pregnancy), and 72 celiac women with a history of one or more normal pregnancies and no pregnancy loss (controls) entered the study, at the moment of diagnosis for celiac disease. A clinical history was obtained from each woman. DNA from leukocytes was tested for: factor V Leiden (mutation G1691A), factor V R2 (H1299R), factor II (G20210A), methylenetetrahydrofolate reductase (MTHFR) (C677T and A1298C), beta-fibrinogen (-455 G>A), PAI-1 alleles 4G/5G, factor XIII (V34L), and HPA-1 (L33P). RESULTS: Age at diagnosis was significantly higher (p=0.002) in the celiac women with pregnancy losses than in controls. Of the gene variants studied, the allelic frequency of 4G variant of PAI-1, and the frequency of mutant genotypes were significantly more frequent in the group of celiac women with early pregnancy loss (p=0.00003 and 0.028, respectively). Surprisingly, the beta-fibrinogen -455 G>A genotype distribution (but not the allelic frequency of the variant allele) significantly differed between the two groups, since variant genotypes were more frequent in the control group (p=0.009). CONCLUSION: The 4G variant of the PAI-I gene may predispose to miscarriage a subset of celiac women; these data should be verified on larger populations.

2. Mycophenolate: miscarriage and birth defects

Prescrire Int. 2009 Feb;18(99):25

About 30% of pregnancies exposed to mycophenolate end in miscarriage. When the pregnancy continues, about 20% of foetuses and newborns have malformations of various types.

3. Niinimäki M, Karinen P, Hartikainen AL, Pouta A

Treating miscarriages: a randomised study of cost-effectiveness in medical or surgical choice

BJOG. 2009 Apr 7. [Epub ahead of print]

Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland.

Objective The aim was to carry out a cost effectiveness analysis (CEA) of medical and surgical treatment of miscarriage using quantitative and qualitative indicators. Design A prospective study where the data of the clinical course of the treatment and the patients; experiences (pain and satisfaction) were collected from a previous randomised study. Setting Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland. Population Ninety-eight eligible women with a diagnosed miscarriage. Methods The incremental cost-effectiveness ratio (ICER) was calculated by using institutional prices (provider's aspect) of the medical care and the number of patients who experienced pain, dissatisfaction or unsuccessful treatment while treated for the miscarriage. Main outcome measures Primary (uncomplicated treatment) and secondary (complications and other unplanned events) costs of the treatments. Results Primary costs of the surgical treatment were higher, but the more frequent unplanned events and complications in the medical group brought the costs to the same level. In the medical group, based on the ICER, 12 patients more experienced pain, 7 patients more were dissatisfied with the treatment and 5 patients more had unsuccessful treatment compared with surgically treated patients. In theory, these negative outcomes could have been avoided by investing euro1688 more in the surgical treatment. Conclusions Medical treatment of miscarriage was not more cost-effective, when the adverse events were considered. As neither of these two methods was economically superior, the treatment choice should be made on an individual basis by respecting the patient's choice.

4. Gallicchio L, Miller S, Greene T, Zacur H, Flaws JA

Cosmetologists and Reproductive Outcomes

Obstet Gynecol. 2009 May;113(5):1018-1026

From the 1Prevention and Research Center, the Weinberg Center for Women's Health & Medicine, Mercy Medical Center, Baltimore, Maryland; 2Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; and 3Department of Veterinary Biosciences, University of Illinois, Urbana, Illinois.

OBJECTIVE: To test the hypothesis that cosmetologists are at increased risk of poor pregnancy outcomes compared with women of the same age who are not cosmetologists. METHODS:: Participants were recruited through mass mailing of questionnaires. To be included in the study, respondents to the survey had to be aged between 21 and 55 years and not have had a hysterectomy or oophorectomy. This analysis focused on 350 cosmetologists and 397 women in other occupations who met these inclusion criteria and who reported five or fewer singleton pregnancies. The main outcome measures were miscarriage, stillbirth, the occurrence of maternal health conditions during pregnancy (preeclampsia, high blood pressure, diabetes), hospitalization or physician-ordered bed rest during pregnancy, preterm labor, and premature delivery (before 37 weeks at delivery). RESULTS:: There were no statistically significant associations between occupation and the pregnancy outcomes after adjustment for age, race, education, and smoking and alcohol use at the time of pregnancy. A statistically significant association was found between race and low birth weight such that nonwhite women were at increased risk of reporting a low birth weight neonate compared with white women (odds ratio [OR] 3.35, 95% confidence interval [CI] 1.53-7.26). Similarly, current smoking was found to be positively associated with miscarriage (OR 1.53, CI 1.09-2.16) and miscarriage or stillbirth (OR 1.64, 95% CI 1.18-2.28). CONCLUSION:: Risk of adverse pregnancy outcomes among cosmetologists is not increased compared with women of the same age working in other occupations. LEVEL OF EVIDENCE:: II.

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


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	Center Resources Bereavement Support Bibliographies Child Care and SIDS Definitions En Español First Responders For Families Infant Mortality Journal Alerts MCH Alert Multimedia Pregnancy Loss Professional Resources Safe Sleep Environment Statistics Training Toolkit Partner SIDS/ID Centers National SIDS & Infant Death Program Support Center / First Candle National SIDS & Infant Death Project IMPACT National Center for Cultural Competence SIDS/ID Project For more information on maternal and child health topics, visit the MCH Library	NSIDRC Journal Article Alert — May 1, 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. 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. Rognum IJ, Haynes RL, Vege A, Yang M, Rognum TO, Kinney HC Interleukin-6 and the serotonergic system of the medulla oblongata in the sudden infant death syndrome Acta Neuropathol. 2009 Apr 26. [Epub ahead of print] Department of Pathology, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA, ingvarjo@stud.ntnu.no. Mild infection may trigger sudden death in the vulnerable infant by cytokine interactions with a compromised medullary serotonergic (5-HT) system, leading to disrupted cardiorespiratory regulation and sleep-related sudden death. The cytokine interleukin (IL)-6 is elevated in the cerebrospinal fluid in SIDS. We tested the hypothesis that the expression of IL-6 receptors (IL-6R) and/or gp130 (involved in IL-6R signaling) is altered in the medullary 5-HT system in SIDS. Immunohistochemistry of IL-6R and gp130 was performed on medullae from 25 SIDS infants, 20 infectious deaths, and 14 controls using a semi-quantitative grading system. In the SIDS cases, mean IL-6R intensity grade in the arcuate nucleus (major component of medullary 5-HT system) was significantly higher than in the control group (2.00 +/- 0.07 vs. 1.77 +/- 0.08, P = 0.04), with no other differences in IL-6R or gp130 expression at any other site. Arcuate 5-HT neurons expressed IL-6R, indicating a site of IL-6/5-HT interaction. In SIDS, IL-6R expression is abnormal in the arcuate nucleus, the putative human homolog of rodent ventral medullary chemosensitivity sites involving 5-HT. Aberrant interactions between IL-6 and the arcuate nucleus may contribute to impaired responses to hypercapnia generated by infection (hyper-metabolism) combined with rebreathing. Other Infant Death 1. Macdorman MF, Kirmeyer S The challenge of fetal mortality NCHS Data Brief. 2009 Apr;(16):1-8 Centers for Disease Control and Prevention National Center for Health Statistics 3311 Toledo Road, Hyattsville, Maryland 20782, USA. Data from the Fetal Death Data File and Linked Birth/Infant Death Data Set, National Vital Statistics System. The magnitude of fetal mortality is considerable: About 1 million fetal deaths occur at any gestational age in the United States each year, including almost 26,000 at 20 weeks of gestation or more; Even when limited to fetal deaths of 20 weeks of gestation or more, nearly as many fetal deaths as infant deaths occur in the United States each year; After decades of decline, the U.S. fetal mortality rate (fetal deaths of 20 weeks of gestation or more) did not decrease from 2003 to 2005; Fetal mortality rates are substantially higher for non-Hispanic black and American Indian or Alaska Native women than for non-Hispanic white women; Compared with the U.S. average, fetal mortality rates are higher for teenagers and for women aged 35 years and over, for twin and higher-order pregnancies, and for women with more than two previous pregnancies. Fetal mortality is a major, but often overlooked, public health problem. Fetal mortality refers to spontaneous intrauterine death at any time during pregnancy. Fetal deaths later in pregnancy are sometimes referred to as stillbirths (at 20 weeks of gestation or more, or 28 weeks or more, for example). Much of the public concern regarding reproductive loss has concentrated on infant mortality, as less is known about fetal mortality. However, the impact of fetal mortality on U.S. families is considerable.This report examines fetal death data from the National Vital Statistics System (NVSS). Vital statistics fetal death data are generally presented for fetal deaths of 20 weeks of gestation or more. Other data sources provide estimates of fetal deaths for all periods of gestation. For example, the National Survey of Family Growth estimates about 1 million fetal losses per year in the United States, with the vast majority of these occurring before 20 weeks of gestation. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. 2. Macdorman MF, Mathews TJ Recent trends in infant mortality in the United States NCHS Data Brief. 2008 Oct;(9):1-8 Centers for Disease Control and Prevention National Center for Health Statistics 3311 Toledo Road, Hyattsville, Maryland 20782, USA. KEY FINDINGS: Data from the Linked Birth/Infant Death Data Set and Preliminary Mortality Data File, National Vital Statistics System. The U.S. infant mortality rate did not decline from 2000 to 2005. Data from the preliminary mortality file suggest a 2% decline in the infant mortality rate from 2005 to 2006. The U.S. infant mortality rate is higher than those in most other developed countries, and the gap between the U.S. infant mortality rate and the rates for the countries with the lowest infant mortality appears to be widening. The infant mortality rate for non-Hispanic black women was 2.4 times the rate for non-Hispanic white women. Rates were also elevated for Puerto Rican and American Indian or Alaska Native women. Increases in preterm birth and preterm-related infant mortality account for much of the lack of decline in the United States' infant mortality rate from 2000 to 2005. Infant mortality is one of the most important indicators of the health of a nation, as it is associated with a variety of factors such as maternal health, quality and access to medical care, socioeconomic conditions, and public health practices. The U.S. infant mortality rate generally declined throughout the 20th century. In 1900, the U.S. infant mortality rate was approximately 100 infant deaths per 1,000 live births, while in 2000, the rate was 6.89 infant deaths per 1,000 live births. However, the U.S. infant mortality rate did not decline significantly from 2000 to 2005, which has generated concern among researchers and policy makers. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. Bereavement 1. Boelen PA The centrality of a loss and its role in emotional problems among bereaved people Behav Res Ther. 2009 Mar 27. [Epub ahead of print] Department of Clinical and Health Psychology, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands. In literature on posttraumatic stress-disorder (PTSD) there is growing interest in the concept "centrality of event", referring to the degree to which the memory of a traumatic event is central to one's everyday inferences, life-story, and identity. Using self-reported data from 254 bereaved individuals, this study examined the centrality of the loss-event in emotional problems following loss. Findings showed that this centrality (a) varied as a function of kinship to the deceased but not other loss-related variables, (b) was correlated with complicated grief (CG), depression, PTSD, and with neuroticism and several cognitive-behavioural variables, and (c) remained correlated with CG but not depression and PTSD when controlling for the shared variance between these symptoms, neuroticism, and these cognitive-behavioural variables. Miscarriage/Stillbirth/Prenatal Issues 1. Early pregnancy loss in celiac women: The role of genetic markers of thrombophilia Ciacci C, Tortora R, Scudiero O, Di Fiore R, Salvatore F, Castaldo G Dig Liver Dis. 2009 Apr 21. [Epub ahead of print] Gastroenterologia, Dipartimento di Medicina Clinica e Sperimentale, University of Naples Federico II, Naples, Italy. BACKGROUND: Adverse pregnancy outcomes are more frequent in celiac than in non-celiac women. AIMS: To investigate a possible role of genetic prothrombotic variants in early pregnancy loss of celiac women. METHODS: Thirty-nine celiac women who had experienced early pregnancy losses (at least two losses within the first 3 months of pregnancy), and 72 celiac women with a history of one or more normal pregnancies and no pregnancy loss (controls) entered the study, at the moment of diagnosis for celiac disease. A clinical history was obtained from each woman. DNA from leukocytes was tested for: factor V Leiden (mutation G1691A), factor V R2 (H1299R), factor II (G20210A), methylenetetrahydrofolate reductase (MTHFR) (C677T and A1298C), beta-fibrinogen (-455 G>A), PAI-1 alleles 4G/5G, factor XIII (V34L), and HPA-1 (L33P). RESULTS: Age at diagnosis was significantly higher (p=0.002) in the celiac women with pregnancy losses than in controls. Of the gene variants studied, the allelic frequency of 4G variant of PAI-1, and the frequency of mutant genotypes were significantly more frequent in the group of celiac women with early pregnancy loss (p=0.00003 and 0.028, respectively). Surprisingly, the beta-fibrinogen -455 G>A genotype distribution (but not the allelic frequency of the variant allele) significantly differed between the two groups, since variant genotypes were more frequent in the control group (p=0.009). CONCLUSION: The 4G variant of the PAI-I gene may predispose to miscarriage a subset of celiac women; these data should be verified on larger populations. 2. Mycophenolate: miscarriage and birth defects Prescrire Int. 2009 Feb;18(99):25 About 30% of pregnancies exposed to mycophenolate end in miscarriage. When the pregnancy continues, about 20% of foetuses and newborns have malformations of various types. 3. Niinimäki M, Karinen P, Hartikainen AL, Pouta A Treating miscarriages: a randomised study of cost-effectiveness in medical or surgical choice BJOG. 2009 Apr 7. [Epub ahead of print] Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland. Objective The aim was to carry out a cost effectiveness analysis (CEA) of medical and surgical treatment of miscarriage using quantitative and qualitative indicators. Design A prospective study where the data of the clinical course of the treatment and the patients; experiences (pain and satisfaction) were collected from a previous randomised study. Setting Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland. Population Ninety-eight eligible women with a diagnosed miscarriage. Methods The incremental cost-effectiveness ratio (ICER) was calculated by using institutional prices (provider's aspect) of the medical care and the number of patients who experienced pain, dissatisfaction or unsuccessful treatment while treated for the miscarriage. Main outcome measures Primary (uncomplicated treatment) and secondary (complications and other unplanned events) costs of the treatments. Results Primary costs of the surgical treatment were higher, but the more frequent unplanned events and complications in the medical group brought the costs to the same level. In the medical group, based on the ICER, 12 patients more experienced pain, 7 patients more were dissatisfied with the treatment and 5 patients more had unsuccessful treatment compared with surgically treated patients. In theory, these negative outcomes could have been avoided by investing euro1688 more in the surgical treatment. Conclusions Medical treatment of miscarriage was not more cost-effective, when the adverse events were considered. As neither of these two methods was economically superior, the treatment choice should be made on an individual basis by respecting the patient's choice. 4. Gallicchio L, Miller S, Greene T, Zacur H, Flaws JA Cosmetologists and Reproductive Outcomes Obstet Gynecol. 2009 May;113(5):1018-1026 From the 1Prevention and Research Center, the Weinberg Center for Women's Health & Medicine, Mercy Medical Center, Baltimore, Maryland; 2Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; and 3Department of Veterinary Biosciences, University of Illinois, Urbana, Illinois. OBJECTIVE: To test the hypothesis that cosmetologists are at increased risk of poor pregnancy outcomes compared with women of the same age who are not cosmetologists. METHODS:: Participants were recruited through mass mailing of questionnaires. To be included in the study, respondents to the survey had to be aged between 21 and 55 years and not have had a hysterectomy or oophorectomy. This analysis focused on 350 cosmetologists and 397 women in other occupations who met these inclusion criteria and who reported five or fewer singleton pregnancies. The main outcome measures were miscarriage, stillbirth, the occurrence of maternal health conditions during pregnancy (preeclampsia, high blood pressure, diabetes), hospitalization or physician-ordered bed rest during pregnancy, preterm labor, and premature delivery (before 37 weeks at delivery). RESULTS:: There were no statistically significant associations between occupation and the pregnancy outcomes after adjustment for age, race, education, and smoking and alcohol use at the time of pregnancy. A statistically significant association was found between race and low birth weight such that nonwhite women were at increased risk of reporting a low birth weight neonate compared with white women (odds ratio [OR] 3.35, 95% confidence interval [CI] 1.53-7.26). Similarly, current smoking was found to be positively associated with miscarriage (OR 1.53, CI 1.09-2.16) and miscarriage or stillbirth (OR 1.64, 95% CI 1.18-2.28). CONCLUSION:: Risk of adverse pregnancy outcomes among cosmetologists is not increased compared with women of the same age working in other occupations. LEVEL OF EVIDENCE:: II. 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
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NSIDRC Journal Article Alert — May 1, 2009

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