NSIDRC Journal Article Alert — August 7, 2009
Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University.
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Sudden Infant Death
1. Hanzer M, Zotter H, Sauseng W, Pichler G, Müller W, Kerbl R
Non-Nutritive Sucking Habits in Sleeping Infants
Neonatology. 2009 Jul 31;97(1):61-66. [Epub ahead of print]
Divisions of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
Background: Pacifier use has been postulated to decrease the risk of sudden infant death syndrome (SIDS). The responsible mechanisms are, however, unclear. Objectives: Since little is known about the non-nutritive sucking (NNS) habits of infants during sleep, we investigated NNS patterns and changes of physiological parameters during NNS in sleeping infants. Methods: Polygraphic recordings were performed in 12 infants with a median age of 55 days (range 7-82) who regularly used a pacifier during sleep. Episodes of active suckling (bursts) and quiescent periods were differentiated by video observations. We evaluated the time of suckling in relation to the total time of pacifier use, the median number of bursts per min, the median duration of single bursts and the median interval between 2 sequent bursts. In 48 randomly selected bursts, we additionally analyzed changes in heart rate, respiratory frequency and oxygen saturation compared to the 10-second period preceding the burst. Results: Median sleep time with a pacifier held in mouth was 31.3 min (13.0-117.6), of which 15.5% (6.4-36.7%) was spent with active suckling. The median number of bursts per min was 2.2 (1.2-4.5). The median duration of a burst was 3 s (1-22) and the median interval between 2 bursts was 10 s (1-1,434). Heart rate, respiratory frequency and oxygen saturation did not change significantly during suckling bursts. Conclusions: This pilot study presents important data for sucking habits in pacifier users which may provide a basis for further investigations concerning the efficacy of pacifiers in SIDS prophylaxis. Copyright © 2009 S. Karger AG, Basel.
Miscarriage/Stillbirth/Prenatal Issues
1. Khashan AS, Kenny LC
The effects of maternal body mass index on pregnancy outcome
Eur J Epidemiol. 2009 Aug 4. [Epub ahead of print]
The Anu Research Centre, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland, a.khashan@ucc.ie.
The increasing prevalence of obesity is presenting a critical challenge to healthcare services. We examined the effect of Body Mass Index in early pregnancy on adverse pregnancy outcome. We performed a population register-based cohort study using data from the North Western Perinatal survey (N = 99,403 babies born during 2004-2006), based at The University of Manchester, UK. The main outcome measures were Caesarean section delivery, preterm birth, neonatal death, stillbirth, Macrosomia, small for gestational age and large for gestational age. The risk of preterm birth was reduced by almost 10% in overweight (RR = 0.89, [95% CI: 0.83, 0.95]) and obese women (RR = 0.90, [95% CI: 0.84, 0.97]) and was increased in underweight women (RR = 1.33, [95% CI: 1.16, 1.53]). Overweight (RR = 1.17, [95% CI: 1.09, 1.25]), obese (RR = 1.35, [95% CI: 1.25, 1.45]) and morbidly obese (RR = 1.24, [95% CI: 1.02, 1.52]) women had an elevated risk of post-term birth compared to normal women. The risk of fetal macrosomia and operative delivery increased with BMI such that morbidly obese women were at greatest risk of both (RR of macrosomia = 4.78 [95% CI: 3.86, 5.92] and RR of Caesarean section = 1.66 [95% CI: 1.61, 1.71] and a RR of emergency Caesarean section = 1.59 [95% CI: 1.45, 1.75]). Excessive leanness and obesity are associated with different adverse pregnancy outcomes with major maternal and fetal complications. Overweight and obese women have a higher risk of macrosomia and Caesarean delivery and lower risk of preterm delivery. The mechanism underlying this association is unclear and is worthy of further investigation.
2. Tiscia G, Colaizzo D, Chinni E, Pisanelli D, Sciannamè N, Favuzzi G, Margaglione M, Grandone E
Haplotype M2 in the annexin A5 (ANXA5) gene and the occurrence of obstetric complications
Thromb Haemost. 2009 Aug;102(2):309-13
Atherosclerosis and Thrombosis Unit, I.R.C.C.S. "Casa Sollievo della Sofferenza", Poliambulatorio Giovanni Paolo II, S. Giovanni Rotondo (FG), Italy. E-mail: e.grandone@operapadrepio.it.
Inherited or acquired thrombophilias have been largely explored as a cause of pregnancy complications. However, pathogenesis of obstetric complications, as fetal loss and pregnancy-related hypertensive disorders is still partly unexplained. Recently, a common haplotype (M2) within the annexin A5 (ANXA5) gene has been described as a risk factor in recurrent fetal losses (RFL). It has been demonstrated to reduce the promoter activity of the ANXA5 promoter in luciferase reporter assays. Aim of this study was to investigate the prevalence of M2 haplotype in three different settings of women with previous obstetric complications: RFL, intra-uterine fetal death (IUFD) and pregnancy-related hypertension (gestational hypertension [GH] and pre-eclampsia [PE]). One hundred three patients with previous RFL, 54 with IUFD, 158 with hypertensive disease (67 GH, 91 PE) were investigated. As controls, 195 women from the same ethnic background with uneventful pregnancies were enrolled. Logistic regression, correcting for age, gravidity and parity showed that the ANXA5 haplotype is significantly and independently associated with the occurrence of RFL (3.1; 95%CI: 1.1-9.5; p = 0.047) and pregnancy-related hypertensive disorders (2.1; 95%CI: 1.2-3.5; p = 0.008). The M2 haplotype might be a new and relevant risk factor for obstetric complications.
3. Warburton D, Kline J, Kinney A, Yu CY, Levin B, Brown S
Skewed X Chromosome Inactivation and Trisomic Spontaneous Abortion: No Association
Am J Hum Genet. 2009 Jul 29. [Epub ahead of print]
Department of Genetics and Development, Columbia University, New York, NY 10032, USA; Department of Pediatrics, Columbia University, New York, NY 10032, USA.
Several studies suggest that highly skewed X chromosome inactivation (HSXI) is associated with recurrent spontaneous abortion. We hypothesized that this association reflects an increased rate of trisomic conceptions due to anomalies on the X chromosome that lead both to HSXI and to a diminished oocyte pool. We compared the distribution of X chromosome inactivation (XCI) skewing percentages (range: 50%-100%) among women with spontaneous abortions in four karyotype groups-trisomy (n = 154), chromosomally normal male (n = 43), chromosomally normal female (n = 38), nontrisomic chromosomally abnormal (n = 61)-to the distribution for age-matched controls with chromosomally normal births (n = 388). In secondary analyses, we subdivided the nontrisomic chromosomally abnormal group, divided trisomies by chromosome, and classified women by reproductive history. Our data support neither an association of HSXI with all trisomies nor an association of HSXI with chromosomally normal male spontaneous abortions. We also find no association between HSXI and recurrent abortion (n = 45).
4. Peticca P, Keely EJ, Walker MC, Yang Q, Bottomley J
Pregnancy Outcomes in Diabetes Subtypes: How Do They Compare? A Province-based Study of Ontario, 2005-2006
J Obstet Gynaecol Can. 2009 Jun;31(6):487-96
Department of Medicine, The Ottawa Hospital, Ottawa ON.
Objective: To ascertain differences in pregnancy outcomes between women with diabetes subtypes (type 1 [DM1], type 2 [DM2], women with gestational [GDM])] and non-diabetic women within a large Canadian population. Methods: We performed a retrospective multi-cohort analysis of all obstetrical deliveries that occurred in the province of Ontario between April 1, 2005, and March 31, 2006. Data were extracted from the Ontario Niday Perinatal Database. Results: Increased rates of major negative maternal and perinatal outcomes (i.e. preterm delivery, Caesarean section, pregnancy-induced hypertension/preeclampsia) occurred in women with DM1. Both DM1 and GDM subtypes were associated with the greatest risk of macrosomia, shoulder dystocia, and congenital anomalies. DM2 did not demonstrate an association with an increased risk of congenital malformations and stillbirth. Conclusion: Diabetes in pregnancy, irrespective of subtype, predisposes women to poorer outcomes than those of the general obstetric population. However, this large population analysis is consistent with previous studies in showing that the adversity remains greatest for women with type 1 diabetes.
5. Rackham O, Paize F, Weindling AM
Cause of death in infants of women with pregestational diabetes mellitus and the relationship with glycemic control
Postgrad Med. 2009 Jul;121(4):26-32
Wirral University Teaching Hospital, NHS Foundation Trust, Wirral, United Kingdom. oliver.rackham@whnt.nhs.uk
BACKGROUND: Perinatal mortality remains high among infants of mothers with type 1 and type 2 diabetes mellitus. Although high glucose levels have been implicated, the mechanism is not well understood. AIMS: 1) to identify the causes of stillbirth and neonatal death in infants of women with type 1 and type 2 diabetes; 2) to determine whether the causes of perinatal mortality are the same for women with type 1 and type 2 diabetes; and 3) to ascertain the relationship between perinatal mortality and maternal glycemic control. MATERIALS AND METHODS: The case notes of women with type 1 and type 2 diabetes mellitus who had a stillbirth or neonatal death were identified and examined by 2 reviewers independently. RESULTS: Ninety-three perinatal deaths were identified (59 women with type 1 diabetes; 34 women with type 2 diabetes). There were 73 stillbirths, 12 were early neonatal deaths, and 8 were late neonatal deaths. Eighteen deaths were attributed to congenital anomalies, 64 to antepartum asphyxia, 4 to intrapartum asphyxia, 3 to postnatal hyaline membrane disease, 2 to postnatal infection, 1 was unclassifiable, and 1 case had no details available. Median postmenstrual age at death was 34 weeks for both women with type 1 and type 2 diabetes. Congenital anomalies were less common in women with type 1 diabetes than those with type 2 diabetes (rate ratio, 0.37 [95% confidence interval, 0.15-0.95]). The relationship between preconceptional and maximal maternal glycosylated hemoglobin (HbA1c) concentrations and birth weight was curvilinear: at low HbA1c levels, the fetal weight was normal; when HbA1c levels were moderately raised, there was macrosomia; very high HbA1c levels were associated with severe intrauterine growth restriction. CONCLUSION: We describe a relationship between HbA1c and fetal weight. We consider that this provides evidence that hyperglycemia not only causes fetal macrosomia but also an angiopathy affecting the utero-placental blood vessels and consequent fetal hypoxia. These observations provide further evidence that good pre- and periconceptional glycemic control is likely to be of great importance in improving the outcome of pregnancies of women with diabetes.
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