NSIDRC Journal Article Alert — October 23, 2009

Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University.

These articles have been selected from PubMed, a service of the National Library of Medicine that includes over 19 million citations from MEDLINE and other life science journals for biomedical articles back to 1948. PubMed includes links to full text articles and other related resources.

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.

Past issues of Resource Center Journal Alerts

Sudden Infant Death

1. Casale V, Oneda R, Lavezzi AM, Matturri L
Optimisation of Postmortem Tissue Preservation and Alternative Protocol for Serotonin Transporter Gene Polymorphisms Amplification in Sids and Siud Cases
Exp Mol Pathol. 2009 Oct 15. [Epub ahead of print]

Lino Rossi" Research Center for the study and prevention of unexpected perinatal death and SIDS, University of Milan, via Commenda 19, 20122 Milan, Italy.

The major obstacle to genetic research in SIUD (Sudden Intrauterine Unexplained Death) and SIDS (Sudden Infant Death Syndrome) cases is the complex characteristics of the human anatomic samples available. In fact, in Italy autopsies are performed at least 24h post-mortem and tissues can be left in formalin for long fixation times (> 4/5 days), thus compromising nucleic acids integrity. In this study we compared the quality of DNA and RNA extracted from tissues differently preserved. As expected, the DNA and RNA from formalin-fixed and paraffin-embedded tissues, formalin-acetic acid-alcohol tissues and ethanol tissues were of poor quality and not adequate for subsequent molecular analysis. The best results were obtained with RNAlater preserved tissues: this buffer was equivalet, if not superior, to freezing method for preservation of postmortem DNA and RNA. In addition, we introduce a new protocol for the amplification of the serotonin transporter gene promoter region (5-HTT) ideal to obtain the increase of specific product, avoiding artifacts formation.

2. Blair PS, Sidebotham P, Evason-Coombe C, Edmonds M, Heckstall-Smith EM, Fleming P
Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England
Department of Community Based Medicine, University of Bristol

BMJ. 2009 Oct 13;339:b3666. doi: 10.1136/bmj.b3666.

Comment in:

* BMJ. 2009;339:b3466

OBJECTIVES: To investigate the factors associated with sudden infant death syndrome (SIDS) from birth to age 2 years, whether recent advice has been followed, whether any new risk factors have emerged, and the specific circumstances in which SIDS occurs while cosleeping (infant sharing the same bed or sofa with an adult or child). DESIGN: Four year population based case-control study. Parents were interviewed shortly after the death or after the reference sleep (within 24 hours) of the two control groups. SETTING: South west region of England (population 4.9 million, 184 800 births). PARTICIPANTS: 80 SIDS infants and two control groups weighted for age and time of reference sleep: 87 randomly selected controls and 82 controls at high risk of SIDS (young, socially deprived, multiparous mothers who smoked). RESULTS: The median age at death (66 days) was more than three weeks less than in a study in the same region a decade earlier. Of the SIDS infants, 54% died while cosleeping compared with 20% among both control groups. Much of this excess may be explained by a significant multivariable interaction between cosleeping and recent parental use of alcohol or drugs (31% v 3% random controls) and the increased proportion of SIDS infants who had coslept on a sofa (17% v 1%). One fifth of SIDS infants used a pillow for the last sleep (21% v 3%) and one quarter were swaddled (24% v 6%). More mothers of SIDS infants than random control infants smoked during pregnancy (60% v 14%), whereas one quarter of the SIDS infants were preterm (26% v 5%) or were in fair or poor health for the last sleep (28% v 6%). All of these differences were significant in the multivariable analysis regardless of which control group was used for comparison. The significance of covering the infant's head, postnatal exposure to tobacco smoke, dummy use, and sleeping in the side position has diminished although a significant proportion of SIDS infants were still found prone (29% v 10%). CONCLUSIONS: Many of the SIDS infants had coslept in a hazardous environment. The major influences on risk, regardless of markers for socioeconomic deprivation, are amenable to change and specific advice needs to be given, particularly on use of alcohol or drugs before cosleeping and cosleeping on a sofa.

3. Mitchell EA
Risk factors for SIDS
BMJ. 2009 Oct 13;339:b3466. doi: 10.1136/bmj.b3466
* BMJ. 2009;339:b3666

Publication Types:

* Comment
* Editorial

4. Coleman JJ
Culture care meanings of African American parents related to infant mortality and health care
J Cult Divers. 2009 Fall;16(3):109-19

Ida V. Moffett School of Nursing, Samford University, Birmingham, Alabama, USA.

This study describes perceptions of African American mothers related to infant health care. The study s significance arises from the increased incidence of SIDS and disparity in infant mortality among African Americans. SIDS disproportionately affects African American infants and failure of parents to adhere to supine sleep is offered as a contributing factor. An understanding of parents' perceptions of healthcare provider interactions can uncover barriers to adherence with recommendations for safe infant sleep. Interviews revealed that African American mothers valued care from friendly, caring, attentive, respectful nurses. As a result of receiving respectful care, mothers indicated increased likelihood of adhering to health teachings.

Miscarriage/Stillbirth/Prenatal Issues

1. Cervera R, Balasch J
Autoimmunity and Recurrent Pregnancy Losses
Clin Rev Allergy Immunol. 2009 Oct 20. [Epub ahead of print]

Department of Autoimmune Diseases, Institut Clínic of Medicine and Dermatology, Faculty of Medicine-University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain, rcervera@clinic.ub.es.

The relationship between autoimmunity and reproduction has long been recognized. This relationship is bidirectional and includes many diverse issues, but in this review article, we focus on which autoimmune disturbances are the basic cause of recurrent pregnancy losses in patients with autoimmune diseases. The antiphospholipid antibodies seem to be clearly associated with recurrent miscarriage. Although there is no agreement on the mechanisms of recurrent pregnancy losses in patients with these antibodies, vasculopathy of the terminal spiral arteries may be implicated and there is a general consensus to routinely screen for antiphospholipid antibodies in patients with recurrent miscarriage. Well-designed diagnostic studies are needed to estimate the true association between other specific autoantibodies and recurrent miscarriage.

2. Qublan HS, Amarin ZO, Abu-Salem AN, Malkawi HY
J Obstet Gynaecol. 2009 May;29(4):318-21
Miscarriage and clinical correlates of leukocyte count in patients with ovarian hyperstimulation syndrome

Department of Obstetrics and Gynecology, Royal Medical Services, Jordan University of Science and Technology, Irbid, Jordan.

SUMMARY: This study was conducted to determine the pregnancy outcome in women with ovarian hyperstimulation syndrome and leukocytosis. From a total of 944 women who underwent IVF-ET, 89 (9.4%) developed OHSS, of whom 67 underwent embryo transfer. The criteria of the study were met by 53 women and underwent WBC count and haematological, hormonal and biochemical tests were performed on the day of HCG administration. Statistical comparison was made between women with a WBC count of >15,000 and those with a WBC count of <15,000. Patients with WBC count of >15,000 at the time of HCG administration (n = 24) had significantly increased rate of early pregnancy loss than women who had WBC count of <15,000 (n = 29). No other blood, chemical and hormonal parameters were different between the two groups. It is concluded that women with ovarian hyperstimulation syndrome in an IVF-ET cycle are more likely to miscarry if they have a WBC count of >15,000 on the day of HCG administration.

3. Yildizhan R, Kurdoglu M, Adali E, Kolusari A
Fetal death due to upper airway compromise complicated by thyroid storm in a mother with uncontrolled Graves' disease: a case report
J Med Case Reports. 2009 May 28;3:7297

Department of Obstetrics and Gynecology, Yuzuncu Yil University School of Medicine Van Turkey.

INTRODUCTION: We report an unusual case of upper airway compromise complicated by thyroid storm in a pregnant woman with Graves' disease, ending with the in utero death of the fetus. This complication might have developed due to upper airway edema as a result of poorly controlled hyperthyroidism. CASE PRESENTATION: A 41-year-old Turkish woman at 27 weeks' gestation suffering from Graves' disease was referred to our emergency department with a diagnosis of respiratory arrest. She was unconscious and had been intubated. Her laboratory results were compatible with thyrotoxicosis. The patient had suffered from respiratory difficulty for a long time and had stopped using her antithyroid medications after the first trimester of pregnancy. One day before, she had visited an obstetrician because her respiratory distress had increased. At that time, her fetus was still alive. She was given oxygen therapy and then sent home. With a presumptive diagnosis of thyroid storm, she was admitted to the intensive care unit and treated with aggressive medical therapy. The baby was found to be no longer alive and was delivered vaginally after labor induction. The mother was discharged 10 days later with maintenance therapy. CONCLUSION: Hyperthyroidism during pregnancy warrants very close attention and should almost always be treated with appropriate antithyroid medications. Maternal respiratory distress in such patients can be an early sign of impending upper airway compromise and thyroid storm, which can endanger the mother and fetus unless prompt and aggressive therapy is initiated.

4. Sutan R, Campbell D, Prescott GJ, Smith WCJ
The risk factors for unexplained antepartum stillbirths in Scotland, 1994 to 2003
Perinatol. 2009 Oct 15. [Epub ahead of print]

Department of Community Health, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia.

Objective:To determine the factors contributing to unexplained antepartum stillbirth in Scotland.Study Design:A 10-year birth database in Scotland was used to compare the unexplained antepartum stillbirth with other birth outcomes. The sample unit was a pregnant mother with a gestational age of 20 weeks and above and with a fetal birth weight of 200 g and above.Result:Maternal age of 35 years and above, lower deprivation category, inaccessible area of residence, maternal smoking, maternal height of <160 cm and gestational age of above 39 weeks were significantly associated with unexplained antepartum stillbirth. In multivariable analysis only maternal age (adjusted odds ratio (OR): 1.8, confidence interval (CI): 1.1 to 3.0, P=0.02), smoking during pregnancy (adjusted OR: 2.0, CI: 1.1 to 3.5, P=0.02), and maternal height (adjusted OR: 1.4, CI: 1.1 to 1.8, P=0.01), remain significant. Screening of pregnancies based on these three risk factors had 4.2% sensitivity and 99.4% specificity. The prevalence of stillbirth for this population was 0.2%. A positive predictive value of only 1.2% implies that only 1 in 83 women with these three risk factors will have antepartum stillbirth. The remaining 82 will suffer needless anxiety and potentially diagnostic procedures.Conclusion:Advanced maternal age, maternal smoking, and shorter maternal height were associated risk for unexplained antepartum stillbirth but screening based on these factors would be of limited value.Journal of Perinatology advance online publication, 15 October 2009; doi:10.1038/jp.2009.158.

5. Hiltunen LM, Laivuori H, Rautanen A, Kaaja R, Kere J, Krusius T, Paunio M, Rasi V
Factor V Leiden as risk factor for unexplained stillbirth - a population-based nested case-control study
Thromb Res. 2009 Oct 12. [Epub ahead of print]

Department of Hemostasis, Finnish Red Cross Blood Service, Helsinki, Finland.

INTRODUCTION: Stillbirth is a relatively uncommon pregnancy complication in developed countries yet causing strong emotional burden. Thrombophilia has been associated with stillbirth but population-based studies are few. We assessed selected genetic and acquired parameters for the risk of unexplained stillbirth, including FV Leiden. MATERIALS AND METHODS: We performed a population-based nested case-control study of 100,000 consecutive pregnancies in Finland. Cases and controls were identified by combining national registers and accepted according to strict criteria after checking their medical records. Stillbirth was defined as intrauterine fetal death >/=22weeks of gestation. We excluded stillbirths due to lethal congenital developmental conditions, umbilical cord complications, and infections. We studied 44 cases of unexplained stillbirth and 766 controls. RESULTS: FV Leiden was associated with 3.8-fold (95% CI 1.2-11.6) risk for unexplained stillbirth, 3.9-fold (95% CI 1.1-13.9) risk for unexplained late stillbirth (>/=28weeks of gestation), and 10.8-fold (95% CI 2.1-55.3) risk for unexplained stillbirth with placental lesions. The same figures for singleton pregnancies were 3.1-fold (95% CI 0.9-10.9), 4.3-fold (95% CI 1.2-15.3), and 10.6-fold (95% CI 2.1-54.3). Slightly increased risk associated with blood group O was not statistically significant. We found a trend for increased risk in advanced maternal age and smoking during pregnancy. High pre-pregnancy BMI was not associated with increased risk, nor was low educational level or first pregnancy. CONCLUSIONS: Our population-based study from a country with comprehensive prenatal care confirms the association between FV Leiden and unexplained stillbirth.

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 — October 23, 2009 Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University. More about PubMed Copyright and Disclaimers These articles have been selected from PubMed, a service of the National Library of Medicine that includes over 19 million citations from MEDLINE and other life science journals for biomedical articles back to 1948. PubMed includes links to full text articles and other related resources. 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. Past issues of Resource Center Journal Alerts Sudden Infant Death 1. Casale V, Oneda R, Lavezzi AM, Matturri L Optimisation of Postmortem Tissue Preservation and Alternative Protocol for Serotonin Transporter Gene Polymorphisms Amplification in Sids and Siud Cases Exp Mol Pathol. 2009 Oct 15. [Epub ahead of print] Lino Rossi" Research Center for the study and prevention of unexpected perinatal death and SIDS, University of Milan, via Commenda 19, 20122 Milan, Italy. The major obstacle to genetic research in SIUD (Sudden Intrauterine Unexplained Death) and SIDS (Sudden Infant Death Syndrome) cases is the complex characteristics of the human anatomic samples available. In fact, in Italy autopsies are performed at least 24h post-mortem and tissues can be left in formalin for long fixation times (> 4/5 days), thus compromising nucleic acids integrity. In this study we compared the quality of DNA and RNA extracted from tissues differently preserved. As expected, the DNA and RNA from formalin-fixed and paraffin-embedded tissues, formalin-acetic acid-alcohol tissues and ethanol tissues were of poor quality and not adequate for subsequent molecular analysis. The best results were obtained with RNAlater preserved tissues: this buffer was equivalet, if not superior, to freezing method for preservation of postmortem DNA and RNA. In addition, we introduce a new protocol for the amplification of the serotonin transporter gene promoter region (5-HTT) ideal to obtain the increase of specific product, avoiding artifacts formation. 2. Blair PS, Sidebotham P, Evason-Coombe C, Edmonds M, Heckstall-Smith EM, Fleming P Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England Department of Community Based Medicine, University of Bristol BMJ. 2009 Oct 13;339:b3666. doi: 10.1136/bmj.b3666. Comment in: * BMJ. 2009;339:b3466 OBJECTIVES: To investigate the factors associated with sudden infant death syndrome (SIDS) from birth to age 2 years, whether recent advice has been followed, whether any new risk factors have emerged, and the specific circumstances in which SIDS occurs while cosleeping (infant sharing the same bed or sofa with an adult or child). DESIGN: Four year population based case-control study. Parents were interviewed shortly after the death or after the reference sleep (within 24 hours) of the two control groups. SETTING: South west region of England (population 4.9 million, 184 800 births). PARTICIPANTS: 80 SIDS infants and two control groups weighted for age and time of reference sleep: 87 randomly selected controls and 82 controls at high risk of SIDS (young, socially deprived, multiparous mothers who smoked). RESULTS: The median age at death (66 days) was more than three weeks less than in a study in the same region a decade earlier. Of the SIDS infants, 54% died while cosleeping compared with 20% among both control groups. Much of this excess may be explained by a significant multivariable interaction between cosleeping and recent parental use of alcohol or drugs (31% v 3% random controls) and the increased proportion of SIDS infants who had coslept on a sofa (17% v 1%). One fifth of SIDS infants used a pillow for the last sleep (21% v 3%) and one quarter were swaddled (24% v 6%). More mothers of SIDS infants than random control infants smoked during pregnancy (60% v 14%), whereas one quarter of the SIDS infants were preterm (26% v 5%) or were in fair or poor health for the last sleep (28% v 6%). All of these differences were significant in the multivariable analysis regardless of which control group was used for comparison. The significance of covering the infant's head, postnatal exposure to tobacco smoke, dummy use, and sleeping in the side position has diminished although a significant proportion of SIDS infants were still found prone (29% v 10%). CONCLUSIONS: Many of the SIDS infants had coslept in a hazardous environment. The major influences on risk, regardless of markers for socioeconomic deprivation, are amenable to change and specific advice needs to be given, particularly on use of alcohol or drugs before cosleeping and cosleeping on a sofa. 3. Mitchell EA Risk factors for SIDS BMJ. 2009 Oct 13;339:b3466. doi: 10.1136/bmj.b3466 * BMJ. 2009;339:b3666 Publication Types: * Comment * Editorial 4. Coleman JJ Culture care meanings of African American parents related to infant mortality and health care J Cult Divers. 2009 Fall;16(3):109-19 Ida V. Moffett School of Nursing, Samford University, Birmingham, Alabama, USA. This study describes perceptions of African American mothers related to infant health care. The study s significance arises from the increased incidence of SIDS and disparity in infant mortality among African Americans. SIDS disproportionately affects African American infants and failure of parents to adhere to supine sleep is offered as a contributing factor. An understanding of parents' perceptions of healthcare provider interactions can uncover barriers to adherence with recommendations for safe infant sleep. Interviews revealed that African American mothers valued care from friendly, caring, attentive, respectful nurses. As a result of receiving respectful care, mothers indicated increased likelihood of adhering to health teachings. Miscarriage/Stillbirth/Prenatal Issues 1. Cervera R, Balasch J Autoimmunity and Recurrent Pregnancy Losses Clin Rev Allergy Immunol. 2009 Oct 20. [Epub ahead of print] Department of Autoimmune Diseases, Institut Clínic of Medicine and Dermatology, Faculty of Medicine-University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain, rcervera@clinic.ub.es. The relationship between autoimmunity and reproduction has long been recognized. This relationship is bidirectional and includes many diverse issues, but in this review article, we focus on which autoimmune disturbances are the basic cause of recurrent pregnancy losses in patients with autoimmune diseases. The antiphospholipid antibodies seem to be clearly associated with recurrent miscarriage. Although there is no agreement on the mechanisms of recurrent pregnancy losses in patients with these antibodies, vasculopathy of the terminal spiral arteries may be implicated and there is a general consensus to routinely screen for antiphospholipid antibodies in patients with recurrent miscarriage. Well-designed diagnostic studies are needed to estimate the true association between other specific autoantibodies and recurrent miscarriage. 2. Qublan HS, Amarin ZO, Abu-Salem AN, Malkawi HY J Obstet Gynaecol. 2009 May;29(4):318-21 Miscarriage and clinical correlates of leukocyte count in patients with ovarian hyperstimulation syndrome Department of Obstetrics and Gynecology, Royal Medical Services, Jordan University of Science and Technology, Irbid, Jordan. SUMMARY: This study was conducted to determine the pregnancy outcome in women with ovarian hyperstimulation syndrome and leukocytosis. From a total of 944 women who underwent IVF-ET, 89 (9.4%) developed OHSS, of whom 67 underwent embryo transfer. The criteria of the study were met by 53 women and underwent WBC count and haematological, hormonal and biochemical tests were performed on the day of HCG administration. Statistical comparison was made between women with a WBC count of >15,000 and those with a WBC count of <15,000. Patients with WBC count of >15,000 at the time of HCG administration (n = 24) had significantly increased rate of early pregnancy loss than women who had WBC count of <15,000 (n = 29). No other blood, chemical and hormonal parameters were different between the two groups. It is concluded that women with ovarian hyperstimulation syndrome in an IVF-ET cycle are more likely to miscarry if they have a WBC count of >15,000 on the day of HCG administration. 3. Yildizhan R, Kurdoglu M, Adali E, Kolusari A Fetal death due to upper airway compromise complicated by thyroid storm in a mother with uncontrolled Graves' disease: a case report J Med Case Reports. 2009 May 28;3:7297 Department of Obstetrics and Gynecology, Yuzuncu Yil University School of Medicine Van Turkey. INTRODUCTION: We report an unusual case of upper airway compromise complicated by thyroid storm in a pregnant woman with Graves' disease, ending with the in utero death of the fetus. This complication might have developed due to upper airway edema as a result of poorly controlled hyperthyroidism. CASE PRESENTATION: A 41-year-old Turkish woman at 27 weeks' gestation suffering from Graves' disease was referred to our emergency department with a diagnosis of respiratory arrest. She was unconscious and had been intubated. Her laboratory results were compatible with thyrotoxicosis. The patient had suffered from respiratory difficulty for a long time and had stopped using her antithyroid medications after the first trimester of pregnancy. One day before, she had visited an obstetrician because her respiratory distress had increased. At that time, her fetus was still alive. She was given oxygen therapy and then sent home. With a presumptive diagnosis of thyroid storm, she was admitted to the intensive care unit and treated with aggressive medical therapy. The baby was found to be no longer alive and was delivered vaginally after labor induction. The mother was discharged 10 days later with maintenance therapy. CONCLUSION: Hyperthyroidism during pregnancy warrants very close attention and should almost always be treated with appropriate antithyroid medications. Maternal respiratory distress in such patients can be an early sign of impending upper airway compromise and thyroid storm, which can endanger the mother and fetus unless prompt and aggressive therapy is initiated. 4. Sutan R, Campbell D, Prescott GJ, Smith WCJ The risk factors for unexplained antepartum stillbirths in Scotland, 1994 to 2003 Perinatol. 2009 Oct 15. [Epub ahead of print] Department of Community Health, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia. Objective:To determine the factors contributing to unexplained antepartum stillbirth in Scotland.Study Design:A 10-year birth database in Scotland was used to compare the unexplained antepartum stillbirth with other birth outcomes. The sample unit was a pregnant mother with a gestational age of 20 weeks and above and with a fetal birth weight of 200 g and above.Result:Maternal age of 35 years and above, lower deprivation category, inaccessible area of residence, maternal smoking, maternal height of <160 cm and gestational age of above 39 weeks were significantly associated with unexplained antepartum stillbirth. In multivariable analysis only maternal age (adjusted odds ratio (OR): 1.8, confidence interval (CI): 1.1 to 3.0, P=0.02), smoking during pregnancy (adjusted OR: 2.0, CI: 1.1 to 3.5, P=0.02), and maternal height (adjusted OR: 1.4, CI: 1.1 to 1.8, P=0.01), remain significant. Screening of pregnancies based on these three risk factors had 4.2% sensitivity and 99.4% specificity. The prevalence of stillbirth for this population was 0.2%. A positive predictive value of only 1.2% implies that only 1 in 83 women with these three risk factors will have antepartum stillbirth. The remaining 82 will suffer needless anxiety and potentially diagnostic procedures.Conclusion:Advanced maternal age, maternal smoking, and shorter maternal height were associated risk for unexplained antepartum stillbirth but screening based on these factors would be of limited value.Journal of Perinatology advance online publication, 15 October 2009; doi:10.1038/jp.2009.158. 5. Hiltunen LM, Laivuori H, Rautanen A, Kaaja R, Kere J, Krusius T, Paunio M, Rasi V Factor V Leiden as risk factor for unexplained stillbirth - a population-based nested case-control study Thromb Res. 2009 Oct 12. [Epub ahead of print] Department of Hemostasis, Finnish Red Cross Blood Service, Helsinki, Finland. INTRODUCTION: Stillbirth is a relatively uncommon pregnancy complication in developed countries yet causing strong emotional burden. Thrombophilia has been associated with stillbirth but population-based studies are few. We assessed selected genetic and acquired parameters for the risk of unexplained stillbirth, including FV Leiden. MATERIALS AND METHODS: We performed a population-based nested case-control study of 100,000 consecutive pregnancies in Finland. Cases and controls were identified by combining national registers and accepted according to strict criteria after checking their medical records. Stillbirth was defined as intrauterine fetal death >/=22weeks of gestation. We excluded stillbirths due to lethal congenital developmental conditions, umbilical cord complications, and infections. We studied 44 cases of unexplained stillbirth and 766 controls. RESULTS: FV Leiden was associated with 3.8-fold (95% CI 1.2-11.6) risk for unexplained stillbirth, 3.9-fold (95% CI 1.1-13.9) risk for unexplained late stillbirth (>/=28weeks of gestation), and 10.8-fold (95% CI 2.1-55.3) risk for unexplained stillbirth with placental lesions. The same figures for singleton pregnancies were 3.1-fold (95% CI 0.9-10.9), 4.3-fold (95% CI 1.2-15.3), and 10.6-fold (95% CI 2.1-54.3). Slightly increased risk associated with blood group O was not statistically significant. We found a trend for increased risk in advanced maternal age and smoking during pregnancy. High pre-pregnancy BMI was not associated with increased risk, nor was low educational level or first pregnancy. CONCLUSIONS: Our population-based study from a country with comprehensive prenatal care confirms the association between FV Leiden and unexplained stillbirth. 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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For more information on maternal and child health topics, visit the MCH Library

NSIDRC Journal Article Alert — October 23, 2009

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Centers