NSIDRC Journal Article Alert — June 19, 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.

Miscarriage/Stillbirth/Prenatal Issues

1. Sieroszewski P, Jasi?ski A, Perenc M, Banach R, Oszukowski P J Matern Fetal
The Arabin pessary for the treatment of threatened mid-trimester miscarriage or premature labour and miscarriage: a case series
Neonatal Med. 2009 Jun;22(6):469-72

Department of Obstetrics and Gynaecology, Medical University of Lodz, Lodz, Poland. advances@csk.umed.lodz.pl

OBJECTIVE: The Arabin pessary may be beneficial in the treatment of cervical incompetence. The aim of the study was to analyse the efficacy of the treatment method of pregnant women with cervical incompetence. METHODS: A non-randomised study performed in the obstetrical wards in Lodz, Poland utilising 54 pregnant women with cervical incompetence was developed to assess the efficiency of treatment methods of cervically incompetent women. These women were diagnosed by vaginal ultrasound examination during the course of the study. Patients with a cervical length of 15-30 mm before 28 weeks an Arabin cervical pessary were inserted, women whose cervical length was less than 15 mm were treated with cervical cerclage. The main end points of the study were preterm or term delivery. RESULTS: In the Arabin pessary group, 1.9% of women delivered before the 29th week of gestation and 83.3% of women delivered after 37 weeks of pregnancy. Eighty-seven per cent of pregnant women treated for cervical incompetence by Arabin pessary delivered by normal spontaneous labour, 1.9% delivered by forceps labour and 11.1% of patients by caesarean section. Among pregnant women treated by Arabin pessary, 3.7% of newborns were estimated as having a score of 0-4 on the Apgar scale, 13% a score of 5-7 and 83.3% a score of 8-10. CONCLUSIONS: Cervical incompetence treatment effectively prolongs the duration of gestation. Application of the Arabin pessary is an effective method of cervical incompetence treatment.

2. Bâ A
Alcohol and B1 vitamin deficiency-related stillbirths
J Matern Fetal Neonatal Med. 2009 May;22(5):452-7

Universite de Cocody, UFR Biosciences, Côte d'Ivoire. abdouba3000@hotmail.com

OBJECTIVE: The present study attempts to determine whether prenatal thiamine (B1 vitamin) deficiency and prenatal alcohol exposure are risk factors for stillbirths. METHODS: From conception to parturition, Wistar rat dams were exposed to the following treatments: (1) Rat dams consuming a thiamine-deficient diet; (2) 12% alcohol/water drinking mothers; (3) mothers drinking 12% alcohol/water + thiamine hydrochloride mixture. Appropriate pair-fed controls and ad libitum controls were assessed. Gestation outcome and fetal parameters, including spontaneous abortion, still-born fetuses, litter size and birth weight, were assessed from the dams of each experimental group. RESULTS: Both alcohol and thiamine deficiency during pregnancy increased fetal death (48.26%vs. 84.47%), reduced litter size (44.54%vs. 72.7%), respectively, and lowered birth weight. Thiamine administration reversed the effects of alcohol-induced fetal death, suggesting that a part of deleterious actions of alcohol on fetal death was mediated by thiamine deficiency. Prenatal thiamine deficiency increased singularly spontaneous abortion with abundant bleeding (40%), rising the occurrence of stillbirth. Such a pathology was not observed in alcohol group. CONCLUSIONS: The results indexed thiamine deficiency as a potent risk factor for stillbirths. The vitamin supply during pregnancy prevents stillbirths related to chronic alcoholism and different facets of malnutrition.

3. Vargas RG, Bompeixe EP, França PP, Marques de Moraes M, da Graça Bicalho M
Activating killer cell immunoglobulin-like receptor genes' association with recurrent miscarriage
Am J Reprod Immunol. 2009 Jul;62(1):34-43

Genetics Department, Universidade Federal do Paraná, Curitiba, Brazil.

PROBLEM: Natural killer (NK) cells are regulated through NK cell receptors such as killer cell immunoglobulin-like receptors (KIRs). KIRs are suspected of being involved in the causes of recurrent miscarriage (RM) as a higher proportion of activated NK cells were observed in women with RM when compared with that in controls. The aim of this study was to investigate if KIR genes coding for receptors known to have as ligands HLA class I molecules are correlated with RM. METHOD OF STUDY: A matched case-control study was carried out in 68 south Brazilian Caucasian patient couples with RM and 68 control fertile couples. KIR genes were typed by PCR-Reverse SSO method. RESULTS: The rate of possession of an elevated number of activating KIR genes (positive for five or six activating KIR genes out of six different activating KIR genes analyzed) in RM patient women was significantly higher (P = 0.0201) when compared with that in control fertile women. These data suggest that women carrying a high content of activating KIR genes have about threefold increased probability to develop RM [OR = 2.71; 95% CI (1.23-6.01)]. CONCLUSION: Our results indicate that RM could be associated with NK cell activation mediated by a profile rich in activating KIR genes.

4. Bewley S
Remember violence when investigating stress and stillbirth
BJOG. 2009 Jun;116(7):1004
BJOG. 2008 Jun;115(7):882-5

5. Jivraj S, Makris M, Saravelos S, Li TC
Pregnancy outcome in women with factor V Leiden and recurrent miscarriage
BJOG. 2009 Jun;116(7):995-8. Epub 2009 Apr 15

Department of Obstetrics & Gynaecology, Jessop Wing, Sheffield, UK. sjivraj007@aol.com

We compared the outcome of 25 untreated pregnancies among women with recurrent miscarriage (RM) at <12 weeks' gestation who were heterozygous for factor V Leiden with women with unexplained RM. The livebirth rate was lower among pregnancies in carriers of factor V Leiden (12/25; 48%) compared with pregnancies in women with unexplained RM (175/307; 57%), but the difference did not reach statistical significance. The best possible treatment regimen to improve livebirth rate in this group of women needs to be assessed in the form of a randomised controlled trial.

6. Mitic G, Kovac M, Povazan L, Magic Z, Djordjevic V, Salatic I, Mitic I, Novakov-Mikic A
Inherited Thrombophilia is Associated With Pregnancy Losses That Occur After 12th Gestational Week in Serbian Population
Clin Appl Thromb Hemost. 2009 Jun 10. [Epub ahead of print]

Recurrent fetal loss (RFL) is a significant clinical problem, occurring in 1% to 5% of reproductive females. Inherited or acquired thrombophilia has been diagnosed in 50% to 65% of women with history of unexplained fetal loss. The objective of our study was to determine the prevalence of thrombophilia in women with unexplained RFL in Serbian population and to find out whether the presence of thrombophilia is associated with pregnancy losses that occur later than 12th gestational week. We have examined 147 women with unexplained RFL or intrauterine fetal death and 128 healthy women with at least 1 uncomplicated pregnancy. The antithrombin (AT), protein C (PC), protein S (PS), activated protein C (APC) resistance, factor V (FV) G1691A, factor II (FII) G20210A, and MTHFR C677T were determined. At least 1 inherited thrombophilic defect was found in 54 (36.7%) of 147 women with repeated fetal losses and in 11 (8.59%) of 128 controls (P < .001, OR 6.17, 95% CI 3.06-12.48). The most common thrombophilic abnormalities were homozygosity for MTHFR 677TT, FV Leiden, and FII G20210A. Deficiency of natural anticoagulants occurred in 10 patients, with protein S deficiency being the most frequent one. Thrombophilia was found in 46 of 94 women with RFL that occurred later than the 12th gestational week and in only 8 of 53 with RPL earlier than 12th week (P = .001). Our study has shown the association between the hereditary thrombophilia and RFL that occurred after the 12th gestational week in Serbian population.

7. Olabi B
Effect of miscarriage on subsequent pregnancies
BJOG. 2009 Jul;116(8):1140-1; author reply 1141
BJOG. 2008 Dec;115(13):1623-9

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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Please see your local library for copies of these articles, or view PubMed's How to Get the Journal Article for more details. Miscarriage/Stillbirth/Prenatal Issues 1. Sieroszewski P, Jasi?ski A, Perenc M, Banach R, Oszukowski P J Matern Fetal The Arabin pessary for the treatment of threatened mid-trimester miscarriage or premature labour and miscarriage: a case series Neonatal Med. 2009 Jun;22(6):469-72 Department of Obstetrics and Gynaecology, Medical University of Lodz, Lodz, Poland. advances@csk.umed.lodz.pl OBJECTIVE: The Arabin pessary may be beneficial in the treatment of cervical incompetence. The aim of the study was to analyse the efficacy of the treatment method of pregnant women with cervical incompetence. METHODS: A non-randomised study performed in the obstetrical wards in Lodz, Poland utilising 54 pregnant women with cervical incompetence was developed to assess the efficiency of treatment methods of cervically incompetent women. These women were diagnosed by vaginal ultrasound examination during the course of the study. Patients with a cervical length of 15-30 mm before 28 weeks an Arabin cervical pessary were inserted, women whose cervical length was less than 15 mm were treated with cervical cerclage. The main end points of the study were preterm or term delivery. RESULTS: In the Arabin pessary group, 1.9% of women delivered before the 29th week of gestation and 83.3% of women delivered after 37 weeks of pregnancy. Eighty-seven per cent of pregnant women treated for cervical incompetence by Arabin pessary delivered by normal spontaneous labour, 1.9% delivered by forceps labour and 11.1% of patients by caesarean section. Among pregnant women treated by Arabin pessary, 3.7% of newborns were estimated as having a score of 0-4 on the Apgar scale, 13% a score of 5-7 and 83.3% a score of 8-10. CONCLUSIONS: Cervical incompetence treatment effectively prolongs the duration of gestation. Application of the Arabin pessary is an effective method of cervical incompetence treatment. 2. Bâ A Alcohol and B1 vitamin deficiency-related stillbirths J Matern Fetal Neonatal Med. 2009 May;22(5):452-7 Universite de Cocody, UFR Biosciences, Côte d'Ivoire. abdouba3000@hotmail.com OBJECTIVE: The present study attempts to determine whether prenatal thiamine (B1 vitamin) deficiency and prenatal alcohol exposure are risk factors for stillbirths. METHODS: From conception to parturition, Wistar rat dams were exposed to the following treatments: (1) Rat dams consuming a thiamine-deficient diet; (2) 12% alcohol/water drinking mothers; (3) mothers drinking 12% alcohol/water + thiamine hydrochloride mixture. Appropriate pair-fed controls and ad libitum controls were assessed. Gestation outcome and fetal parameters, including spontaneous abortion, still-born fetuses, litter size and birth weight, were assessed from the dams of each experimental group. RESULTS: Both alcohol and thiamine deficiency during pregnancy increased fetal death (48.26%vs. 84.47%), reduced litter size (44.54%vs. 72.7%), respectively, and lowered birth weight. Thiamine administration reversed the effects of alcohol-induced fetal death, suggesting that a part of deleterious actions of alcohol on fetal death was mediated by thiamine deficiency. Prenatal thiamine deficiency increased singularly spontaneous abortion with abundant bleeding (40%), rising the occurrence of stillbirth. Such a pathology was not observed in alcohol group. CONCLUSIONS: The results indexed thiamine deficiency as a potent risk factor for stillbirths. The vitamin supply during pregnancy prevents stillbirths related to chronic alcoholism and different facets of malnutrition. 3. Vargas RG, Bompeixe EP, França PP, Marques de Moraes M, da Graça Bicalho M Activating killer cell immunoglobulin-like receptor genes' association with recurrent miscarriage Am J Reprod Immunol. 2009 Jul;62(1):34-43 Genetics Department, Universidade Federal do Paraná, Curitiba, Brazil. PROBLEM: Natural killer (NK) cells are regulated through NK cell receptors such as killer cell immunoglobulin-like receptors (KIRs). KIRs are suspected of being involved in the causes of recurrent miscarriage (RM) as a higher proportion of activated NK cells were observed in women with RM when compared with that in controls. The aim of this study was to investigate if KIR genes coding for receptors known to have as ligands HLA class I molecules are correlated with RM. METHOD OF STUDY: A matched case-control study was carried out in 68 south Brazilian Caucasian patient couples with RM and 68 control fertile couples. KIR genes were typed by PCR-Reverse SSO method. RESULTS: The rate of possession of an elevated number of activating KIR genes (positive for five or six activating KIR genes out of six different activating KIR genes analyzed) in RM patient women was significantly higher (P = 0.0201) when compared with that in control fertile women. These data suggest that women carrying a high content of activating KIR genes have about threefold increased probability to develop RM [OR = 2.71; 95% CI (1.23-6.01)]. CONCLUSION: Our results indicate that RM could be associated with NK cell activation mediated by a profile rich in activating KIR genes. 4. Bewley S Remember violence when investigating stress and stillbirth BJOG. 2009 Jun;116(7):1004 BJOG. 2008 Jun;115(7):882-5 5. Jivraj S, Makris M, Saravelos S, Li TC Pregnancy outcome in women with factor V Leiden and recurrent miscarriage BJOG. 2009 Jun;116(7):995-8. Epub 2009 Apr 15 Department of Obstetrics & Gynaecology, Jessop Wing, Sheffield, UK. sjivraj007@aol.com We compared the outcome of 25 untreated pregnancies among women with recurrent miscarriage (RM) at <12 weeks' gestation who were heterozygous for factor V Leiden with women with unexplained RM. The livebirth rate was lower among pregnancies in carriers of factor V Leiden (12/25; 48%) compared with pregnancies in women with unexplained RM (175/307; 57%), but the difference did not reach statistical significance. The best possible treatment regimen to improve livebirth rate in this group of women needs to be assessed in the form of a randomised controlled trial. 6. Mitic G, Kovac M, Povazan L, Magic Z, Djordjevic V, Salatic I, Mitic I, Novakov-Mikic A Inherited Thrombophilia is Associated With Pregnancy Losses That Occur After 12th Gestational Week in Serbian Population Clin Appl Thromb Hemost. 2009 Jun 10. [Epub ahead of print] Recurrent fetal loss (RFL) is a significant clinical problem, occurring in 1% to 5% of reproductive females. Inherited or acquired thrombophilia has been diagnosed in 50% to 65% of women with history of unexplained fetal loss. The objective of our study was to determine the prevalence of thrombophilia in women with unexplained RFL in Serbian population and to find out whether the presence of thrombophilia is associated with pregnancy losses that occur later than 12th gestational week. We have examined 147 women with unexplained RFL or intrauterine fetal death and 128 healthy women with at least 1 uncomplicated pregnancy. The antithrombin (AT), protein C (PC), protein S (PS), activated protein C (APC) resistance, factor V (FV) G1691A, factor II (FII) G20210A, and MTHFR C677T were determined. At least 1 inherited thrombophilic defect was found in 54 (36.7%) of 147 women with repeated fetal losses and in 11 (8.59%) of 128 controls (P < .001, OR 6.17, 95% CI 3.06-12.48). The most common thrombophilic abnormalities were homozygosity for MTHFR 677TT, FV Leiden, and FII G20210A. Deficiency of natural anticoagulants occurred in 10 patients, with protein S deficiency being the most frequent one. Thrombophilia was found in 46 of 94 women with RFL that occurred later than the 12th gestational week and in only 8 of 53 with RPL earlier than 12th week (P = .001). Our study has shown the association between the hereditary thrombophilia and RFL that occurred after the 12th gestational week in Serbian population. 7. Olabi B Effect of miscarriage on subsequent pregnancies BJOG. 2009 Jul;116(8):1140-1; author reply 1141 BJOG. 2008 Dec;115(13):1623-9 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 — June 19, 2009

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