NSIDRC Journal Article Alert — March 12, 2010
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.
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Miscarriage/Stillbirth/Prenatal Issues
1. Bhattacharya S, Townend J, Bhattacharya S
Eur J Obstet Gynecol Reprod Biol. 2010 Mar 4. [Epub ahead of print]
Recurrent miscarriage: Are three miscarriages one too many? Analysis of a Scottish population-based database of 151,021 pregnancies
Obstetric Epidemiology, Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital, Aberdeen AB25 2ZD, United Kingdom.
OBJECTIVE: To assess the risk of further miscarriage or preterm delivery in women with a history of miscarriages in previous pregnancies, adjusting for maternal age and smoking. STUDY DESIGN: Retrospective cohort study using all women with first pregnancies recorded between 1950 and 2000 in the Aberdeen Maternity and Neonatal Databank.Exposure was one or more spontaneous miscarriages, while outcomes assessed were further miscarriage or preterm delivery. RESULTS: There were 143,595 pregnancies with none, 6,577 with one, 700 with two, 115 with three and 24 with four consecutive previous miscarriages. The odds of miscarriage were greater in pregnancies following one previous miscarriage than none {adj.O.R. 1.94 (95% C.I. 1.80, 2.09)}. The risk of miscarriage following two miscarriages was greater than in pregnancies following one {adj.O.R. 1.56 (95% C.I. 1.28, 1.90)}. However, there was no further significant increase in odds of miscarriage for pregnancies following three {adj.O.R. 1.37 (95% C.I. 0.86, 2.17)} previous consecutive miscarriages. Odds of spontaneous preterm delivery were greater following one miscarriage than none {adj.O.R. 1.52 (95% C.I. 1.36, 1.69)} but no further increases in risk were seen. CONCLUSION: After adjusting for age and smoking, the risk of a further miscarriage increased sequentially in women who had one and two miscarriages. Three miscarriages did not increase the odds any further. One miscarriage was associated with an increased chance of spontaneous preterm delivery, but two or three miscarriages did not increase the odds any further. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
2. Deans Z, Newson AJ
Should Non-Invasiveness Change Informed Consent Procedures for Prenatal Diagnosis?
Health Care Anal. 2010 Mar 9. [Epub ahead of print]
Centre for Ethics in Medicine, Department of Community Based Medicine, University of Bristol, 3rd Floor, Hampton House, Cotham Hill, Bristol, BS6 6AU, UK, zuzana.deans@bristol.ac.uk.
Empirical evidence suggests that some health professionals believe consent procedures for the emerging technology of non-invasive prenatal diagnosis (NIPD) should become less rigorous than those currently used for invasive prenatal testing. In this paper, we consider the importance of informed consent and informed choice procedures for protecting autonomy in those prenatal tests which will give rise to a definitive result. We consider whether there is anything special about NIPD that could sanction a change to consent procedures for prenatal diagnosis or otherwise render informed decision-making less important. We accept the claim that the absence of risk of miscarriage to some extent lessens the gravity of the decision to test compared with invasive methods of testing. However, we also claim that the definitive nature of the information received, and the fact that the information can lead to decisions of great significance, makes NIPD an important choice. This choice should only be made by means of a rigorous and appropriately supported decision-making process (assuming that this is what the pregnant woman wants). We conclude that, on balance, consent procedures for NIPD should mirror those for invasive testing, albeit without the need to emphasise procedure-related risk.
3. Varla-Leftherioti M, Keramitsoglou T, Parapanissiou E, Kurpisz M, Kontopoulou-Antonopoulou V, Tsekoura C, Kamieniczna M, Novokowska B, Paparistidis N, Vrani V, Daniilidis M, Spyropoulou-Vlachou M
HLA-DQA1*0505 sharing and Killer Immunoglobulin-like receptors in sub fertile couples: report of the 15th International Histocompatibility Workshop
Tissue Antigens. 2010 Mar 4. [Epub ahead of print]
Immunobiology Department, Helena Venizelou Maternity Hospital, Athens, Greece.
This aim of the study was to investigate whether human leukocyte antigen (HLA)-DQA1*0505 sharing or the maternal killer immunoglobulin-like receptor (KIR) repertoire is associated with recurrent spontaneous abortion (RSA) or repeated implantation failure (RIF). The study included 224 couples with RSA, 61 couples with RIF, 182 fertile couples, and 10 couples with successful in vitro fertilization and embryo transfer (IVF)/ET at first cycle. HLA-DQA1*0505 typing using polymerase chain reaction-sequence-specific oligonucleotide (PCR-SSO) was performed in 185 RSA (117 with alloimmune abnormalities and 68 of autoimmune etiology), 61 RIF and 182 control couples, and KIR genotyping using polymerase chain reaction-sequence-specific primer (PCR-SSP) in 167 RSA and 55 RIF cases as well as 46 RSA and 10 IVF controls. No differences in DQA1*0505 sharing were found between patients and controls. In RSA and RIF women, the ratio of inhibitory to activating KIRs was slightly lower (1.53 and 1.85 vs 2.03 in controls). The analysis of maternal inhKIR and fetal HLA-C molecule pairs showed that the 'less inhibiting' combination KIR2DL3-C1 was found in higher percentage in subfertile (mainly RIF) than in fertile couples. In contrast, the percentage of cases possessing the 'strong inhibiting' combination KIR2DL1-C2 was lower in the RSA and RIF groups in comparison with that in the control groups (17.36% vs 23.91 and 16.36% vs 40%, respectively). In women with >/= 6 implantation failures, the KIR2DL1-C2 combination was not found in any of them (P = 0.0014), and the KIR2DL3-C1 combination was not found in the control IVF group. The results oppose the suggestion that increased HLA-DQA1*0505 sharing predispose to RSA or RIF. The KIR2DL3-C1 combination (or lack of the KIR2DL1-C2 one) is associated with implantation failure.
4. Kasper DC, Mechtler TP, Reischer GH, Witt A, Langgartner M, Pollak A, Herkner KR, Berger A
The bacterial load of Ureaplasma parvum in amniotic fluid is correlated with an increased intrauterine inflammatory response
Diagn Microbiol Infect Dis. 2010 Mar 4. [Epub ahead of print]
Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, A-1090 Vienna, Austria; Research Core Unit of Pediatric Biochemistry and Analytics, Medical University of Vienna, A-1090 Vienna, Austria.
Ureaplasma spp. are the most frequently isolated microorganisms inside the amniotic cavity and have been associated with spontaneous abortion, chorioamnionitis, premature rupture of the membranes (PROM), and preterm labor (PL). We analyzed 118 samples from amniotic fluid of preterm infants before 34 weeks of gestation by quantitative polymerase chain reaction (qPCR). Bacterial load, Ureaplasma biovar discrimination (Ureaplasma urealyticum and Ureaplasma parvum), and the level of inflammation were correlated with short-term clinical outcome. U. parvum was the predominant biovar, and increased bacterial load was significantly linked to histologic chorioamnionitis, PROM + PL, early-onset sepsis, and bronchopulmonary dysplasia. Furthermore, there was a positive correlation between the amount of U. parvum and the magnitude of inflammatory response inside the amniotic cavity observed by elevated interleukin 8 levels. We postulate that the bacterial load of Ureaplasma spp. measured by qPCR should be determined in studies investigating the potential clinical impact of intrauterine Ureaplasma spp. on the outcome of preterm infants. Copyright © 2010 Elsevier Inc. All rights reserved.
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