NSIDRC Journal Article Alert — April 9, 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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Sudden Infant Death
1. Norton PJ, Grellner KW
A Retrospective Study on Infant Bed-Sharing in a Clinical Practice
Population
Matern Child Health J. 2010 Apr 7. [Epub ahead of print]
Southwest Missouri Forensics, Landmark Building, 309N. Jefferson Avenue, Suite #222-C, Springfield, MO, 65806, USA, patricia.j.norton@gmail.com.
In 2005 the American Academy of Pediatrics published new recommendations on infant sleep environment which advised against infants bed-sharing. A retrospective study was done to determine the prevalence of infant bed-sharing and its associations in a clinical practice. Demographic data were collected from 2,405 infants from a large family practice residency program, which included OB care, in Missouri between March 2002 and February 2008. Data were extracted from electronic medical records at the first four well-child visits: 1 month, 2-3 months, 4-5 months, and 6-8 months of age. Data analysis was performed using SPSS statistical software package, version 12.0 and 15.0 (SPSS, Inc, Chicago, Ill). At the first, second, third, and fourth well-child visit 19, 18, 12, and 11% of infants bed-shared with an adult. Bed-sharing was associated with an infant missing one or more well-child visits (first and third visits only), breastfeeding (first and second well-child visits only), and low SES. Stratified analysis by residence showed that over the 6-year study the decrease in the rate of bed-sharing, in the urban and non-urban areas, was statistically significant (P = 0.005, 0.04, respectively). Infants born 2006-2007 had a decreased rate of bed-sharing compared to infants born 2002-2005 (0.22, 0.30, respectively, P = 0.00). In light of the high rate of bed-sharing recorded at the first well-child visit, the researchers recommend an increased emphasis on safe sleeping education during the third trimester of pregnancy.
2. Von Kohorn I, Corwin MJ, Rybin DV, Heeren TC, Lister G,
Colson ER
Influence of prior advice and beliefs of mothers on infant
sleep position
Arch Pediatr Adolesc Med. 2010 Apr;164(4):363-9
Department of Pediatrics, Yale University, New Haven, Connecticut, USA. isabelle.vonkohorn@yale.edu
OBJECTIVES: To determine the relationship between the advice mothers receive about infant sleep position and the actual position they place their infants in to sleep and to understand modifiers of that relationship, especially beliefs about infant comfort and safety. DESIGN: Cross-sectional, face-to-face interviews. SETTING: Women, Infants, and Children centers in the United States from 2006 to 2008. PARTICIPANTS: A total of 2299 predominantly African American mothers of infants younger than 8 months. MAIN EXPOSURE: Advice received and beliefs about infant sleep position. OUTCOME MEASURE: Usually supine infant sleep position. RESULTS: Advice for exclusively supine infant sleep position from family (OR, 1.6; 95% CI, 1.17-2.17), doctors (OR, 2.28; 95% CI, 1.77-2.93), nurses (OR, 1.46; 95% CI, 1.15-1.84), or the media (OR, 1.54; 95% CI, 1.22-1.95) was associated with usually placing an infant supine to sleep. Additional sources of advice for exclusively supine position significantly increase the odds that an infant will be placed supine. Mothers who believe an infant is comfortable supine are more likely to place their infants on their backs to sleep (OR, 4.05; 95% CI, 2.51-6.53). Mothers who believe an infant will choke on its back are less likely to place their infants supine (OR, 0.36; 95% CI, 0.24-0.54). CONCLUSION: Among predominantly African American mothers, increasing advice for exclusively supine sleep and addressing concerns about infant comfort and choking remain critical to getting more infants on their back to sleep.
3. Highet AR, Gibson CS, Goldwater PN
A polymorphism in a staphylococcal enterotoxin receptor gene
(T cell receptor BV3 recombination signal sequence) is not
associated with unexplained sudden unexpected death in infancy
in an Australian cohort
Microb Pathog. 2010 Mar 30. [Epub ahead of print]
Department of Microbiology and Infectious Diseases, SA Pathology at the Women's & Children's Hospital, 72 King William Road, North Adelaide, South Australia, Australia; University of Adelaide Discipline of Paediatrics, School of Paediatrics and Reproductive Health.
Polymorphisms in genes that influence the expression of toxin receptors could contribute to Sudden Infant Death Syndrome (SIDS) and unexplained Sudden Unexpected Death in Infancy (uSUDI) for which there is evidence of toxin involvement. We aimed to determine whether TCRBV3S1 allele 2 could be involved in a staphylococcal toxic shock hypothesis for uSUDI. Observed frequencies of the TCRBV3S1*2 allele and genotype in 48 Australian uSUDI cases and 96 live comparison infants did not differ. In future the role of other toxin receptor gene polymorphisms deserves investigation. Copyright © 2010. Published by Elsevier India Pvt Ltd.
4. Klintschar M, Heimbold C
Questionable association between a monoamine oxidase A promoter
polymorphism and sudden infant death syndrome
Neurogenetics. 2010 Apr 1. [Epub ahead of print]
Institute of Legal Medicine, Hannover Medical School, Hannover, Germany, klintschar.michael@mh-hannover.de.
5.Opdal SH, Vege A, Stray-Pedersen A, Rognum TO
Aquaporin-4 Gene Variation and Sudden Infant Death Syndrome
Pediatr Res. 2010 Mar 26. [Epub ahead of print]
Institute of Forensic Medicine [S.H.O., A.V., A.S.P., T.O.R], University of Oslo, Oslo 0027, Norway; Pathology Clinic [S.H.O., T.O.R.], Rikshospitalet University Hospital, Oslo 0027, Norway.
The purpose of the present study was to investigate the aquaporin-4 (AQP4) gene in cases of sudden infant death syndrome (SIDS) and controls, in order to elucidate the hypothesis that a genetically determined disturbed water homeostasis in the brain is involved as a predisposing factor in SIDS. The single nucleotide polymorphisms (SNPs) rs2075575, rs4800773, rs162004, and rs3763043 in the AQP4 gene were investigated in 141 SIDS cases and 179 controls. For each SIDS case, a brain/body weight ratio was calculated. The study revealed an association between the T allele and the CT/TT genotypes of rs2075575 and SIDS (C versus T, p<0.01, CC versus CT/TT, p=0.03). For the other three investigated SNPs there were no differences in genotype frequencies between SIDS cases and controls. For the SNP rs2075575 it was also found an association between brain/body weight ratio and genotype in the SIDS cases aged 0.3-12 weeks (p=0.016, median ratio CC 10.6, CT/TT 12.1). In conclusion, this study indicates that rs2075575 may be of significance as a predisposing factor for SIDS, and that the CT/TT genotypes are associated with an increased brain/body weight ratio in infants dying from SIDS during the vulnerable period from birth up to three months of age.
6. Ferrante L, Opdal SH, Vege A, Rognum TO
IL-1 gene cluster polymorphisms and sudden infant death syndrome
Hum Immunol. 2010 Apr;71(4):402-6. Epub 2010 Jan 29
Institute of Forensic Medicine, Rikshospitalet, University of Oslo, Oslo, Norway. linda.ferrante@medisin.uio.no
Several studies indicate that interleukin gene polymorphisms
are of importance to sudden infant death syndrome (SIDS), and
so far it has been reported that associations between SIDS
and polymorphism in the genes encoding tumor necrosis factor
alpha, IL (interleukin)-6, and IL-10. IL-1 are important for
the synthesis of acute phase proteins, and it is a pyrogen
cytokine that may cause fever. The purpose of the present study
was to investigate two polymorphisms in the IL-1alpha gene;
a variable number of tandem repeat (VNTR) in intron 6 and a
single nucleotide polymorphism in +4845G/T, as well as the
-511C/T polymorphism in the gene encoding IL-1beta, and a VNTR
in intron 2 of the competitive antagonist IL-1Ra, in SIDS cases,
cases of infectious death, and controls. Furthermore, the genotypes
were correlated with known external risk factors for SIDS.
When investigating each polymorphism separately, no differences
in genotype distribution between the diagnosis groups and controls
were found. However, when combining VNTR and single nucleotide
polymorphism genotypes, an association between the gene combination
IL-1alpha VNTR A1A1/IL-1beta+ +4845TT and SIDS was disclosed
(p < 0.01). In the SIDS group it was also found that the
genotypes IL-1beta -511CC/CT were significantly more frequent
in the SIDS victims found dead in a prone sleeping position,
compared with SIDS victims found dead in other sleeping positions
(p = 0.004). The findings in the present study indicate that
specific interleukin gene variants may be a predisposing factor
for sudden unexpected infant death.
Other Infant Death
1. Lavezzi AM, Corna MF, Mehboob R, Matturri L
Neuropathology of the intermediolateral nucleus of the spinal
cord in sudden unexplained perinatal and infant death
Int J Dev Neurosci. 2010 Apr;28(2):133-8. Epub 2010 Jan 18
Lino Rossi Research Center for The Study and Prevention of Unexpected Perinatal Death and SIDS-Department of Surgical, Reconstructive and Diagnostic Sciences, University of Milan, Via della Commenda, 19, Milan 20122, Italy. anna.lavezzi@unimi.it
Experimental studies have demonstrated that breathing activity in rats is generated early in embryonic stages in rostral spinal cord, precisely in the intermediolateral nucleus, then establishing a spinal cord-brainstem network. In this study we aimed to individuate and to define the developmental steps of the intermediolateral nucleus, still inadequately known in humans, in the thoracic spinal cord of a large series of perinatal and infant death victims, aged from 17 gestational weeks to 10 months of life. Besides we investigated a possible link between alterations of this nucleus and sudden unexplained perinatal and infant death. The normal developmental pattern of the human intermediolateral nucleus consists of a progressive maturation of its neurons, that change from a round to a polygonal shape with long axons and significantly decrease in number. Various degrees of intermediolateral nucleus hypodevelopment (neuronal immaturity in a normal structure/hypoplasia/agenesis) were found almost exclusively in unexplained fetal and infant death victims. Besides, a significant correlation was found between maternal smoking in pregnancy and the neuropathological results. In conclusion this work underlines the negative effects of prenatal nicotine exposure on the development of autonomic nervous centers checking the vital functions, already in early gestational stages, when the integrity of the intermediolateral nucleus is indispensable for the first breathing bursts. Copyright 2010 ISDN. Published by Elsevier Ltd. All rights reserved.
2. Sidebotham P, Blair PS, Evason-Coombe C, Edmond M, Heckstall-Smith
E, Fleming P
Responding to unexpected infant deaths: experience in one English
region
Arch Dis Child. 2010 Apr;95(4):291-5. Epub 2009 Nov 29
Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. p.sidebotham@warwick.ac.uk
AIM: New national procedures for responding to the unexpected
death of a child in England require a joint agency approach
to investigate each death and support the bereaved family.
As part of a wider population-based study of sudden unexpected
deaths in infancy (SUDI) we evaluated the implementation of
this approach. METHODS: A process evaluation was carried out
using a population-based study of all unexpected deaths from
birth to 2 years in the South West of England between January
2003 and December 2006. Local police and health professionals
followed a standardised approach to the investigation of each
death, supported by the research team set up to facilitate
this joint approach as well as collect data for a wider research
project. RESULTS: We were notified of 155/157 SUDI, with a
median time to notification of 2 h. Initial multi-agency discussions
took place in 93.5% of cases. A joint home visit by police
officers with health professionals was carried out in 117 cases,
75% within 24 h of the death. Time to notification and interview
reduced during the 4 years of the study. Autopsies were conducted
on all cases, the median time to autopsy being 3 days. At the
conclusion of the investigation, a local multi-agency case
discussion was held in 88% of cases. The median time for the
whole process (including family support) was 5 months. CONCLUSIONS:
This study has demonstrated that with appropriate protocols
and support, the joint agency approach to the investigation
of unexpected infant deaths can be successfully implemented.
Miscarriage/Stillbirth/Prenatal Issues
1. Gold KJ, Sen A, Hayward RA
Marriage and Cohabitation Outcomes After Pregnancy Loss
Pediatrics. 2010 Apr 5. [Epub ahead of print]
Departments of Family Medicine
Objective: The goal was to evaluate marriage and cohabitation outcomes for couples who experienced a live birth or fetal death at any gestational age. Methods: For married and cohabitating women who experienced live births, miscarriages, or stillbirths, we conducted a survival analysis (median follow-up period: 7.8 years), by using data from the National Survey of Family Growth, to examine the association between birth outcomes and subsequent relationship survival. The Cox proportional-hazards models controlled for multiple independent risk factors known to affect relationship outcomes. The main outcome measure was the proportion of intact marriages or cohabitations over time. Results: Of 7770 eligible pregnancies, 82% ended in live births, 16% in miscarriages, and 2% in stillbirths. With controlling for known risk factors, women who experienced miscarriages (hazard ratio: 1.22 [95% confidence interval: 1.08-1.38]; P = .001) or stillbirths (hazard ratio: 1.40 [95% confidence interval: 1.10-1.79]; P = .007) had a significantly greater hazard of their relationship ending, compared with women whose pregnancies ended in live births. Conclusions: This is the first national study to establish that parental relationships have a higher risk of dissolving after miscarriage or stillbirth, compared with live birth. Given the frequency of pregnancy loss, these findings might have significant societal implications if causally related.
2. Subramoney S, d'Espaignet ET, Gupta PC
Higher risk of stillbirth among lower and middle income women
who do not use tobacco, but live with smokers
Acta Obstet Gynecol Scand. 2010 Apr;89(4):572-7
Nordic School of Public Health, Gothenburg, Sweden. Subramoneys@gmail.com
OBJECTIVE: To investigate pregnancy outcomes among women living with smokers. DESIGN: Data were from a cohort study of 1,217 women recruited during 3-7th month of pregnancy and 96% followed-up after delivery. The main objective was to investigate effects of smokeless tobacco on pregnancy outcomes. SETTING: Lower and middle-class neighborhoods in Mumbai, India. Community health volunteers who had good rapport with the local population collaborated with the study personnel to help locate and interact with potential participants. POPULATION: Singleton births from non-tobacco users; n = 924/903/802 for stillbirth/gestational age/birthweight analysis. Non-smoking women who lived with smokers (28%) were categorized as 'exposed' to second hand smoke (SHS). METHODS: House-to-house surveys with questionnaire administration and medical records abstraction by trained personnel at recruitment and follow-up. OUTCOME MEASURES: Stillbirth (no evidence of life at birth after at least 20 weeks of gestation), low birthweight (<or= 2,499 g) and preterm birth (<or= 258 days of gestation). RESULTS: Rates of low birthweight and preterm birth were not significantly different between exposed and non-exposed. Hazard ratio for stillbirth in SHS exposed women (n = 261) was 2.2 (95% confidence interval 1.1-4.4). Survival times differed significantly between exposed and non-exposed, p = 0.012. Exposed and non-exposed groups differed significantly by education, socioeconomic status, parity and access of antenatal care. After adjustment for these potential confounders in Cox proportional hazards models (gestational age in days as timescale), hazard ratios for stillbirth in the exposed group remained unchanged: 2.1 (1.1-4.3). CONCLUSIONS: Pregnant women living with smokers in their household have a significantly higher risk of stillbirth, independent of differences in socio-demographic characteristics and antenatal care.
3. Lowit A, Bhattacharya S, Bhattacharya S
Obstetric performance following an induced abortion
Best Pract Res Clin Obstet Gynaecol. 2010 Mar 31. [Epub ahead
of print]
Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital, Cornhill Road, Aberdeen, AB25 2ZL, UK.
Abortion has been legalised in most of the Western world for the past four decades. In areas where abortion practices are legal and easy to access, the risk of short-term complications is very low. As most women requesting induced abortion (IA) are young, potential adverse effects on subsequent reproductive function are important to them. This review investigates obstetric performance following IA and highlights methodological problems associated with research in this area. Some data suggest that IA may be linked with an increased risk of low birth weight, miscarriage and placenta previa but could be protective for pre-eclampsia. Current evidence also suggests an association between IA and pre-term birth. Large prospective cohort studies, which permit meaningful subgroup analyses, are needed to provide definitive answers on outcomes following alternative methods of IA and the impact of gestational age at abortion on future obstetric outcomes. Copyright © 2010 Elsevier Ltd. All rights reserved.
4. Caby F, Lemercier D, Coulomb A, Grigorescu R, Paris L,
Touafek F, Carcelain G, Canestri A, Pauchard M, Katlama C,
Dommergues M, Tubiana
Fetal death as a result of placental immune reconstitution
inflammatory syndrome
J Infect. 2010 Mar 30. [Epub ahead of print]
Service des Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Assistance publique des hôpitaux de Paris (AP-HP), 75013 Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U943, Paris, France.
A 26-year-old woman was HIV-1 diagnosed at 11 weeks of pregnancy (CD4=7/mm(3), HIV-1RNA=108,000 copies/mL) with immunity against toxoplasmosis (Toxoplasma IgG=1800 UI/mL). A fetal death was diagnosed 7 weeks after starting HAART (CD4=185/mm(3), HIV-1RNA=391 copies/mL) with a positive Toxoplasma PCR on fetal tissues and amniotic fluid. The absence of severe toxoplasmic foetopathy, the very exaggerated and atypical placental inflammation and the immune restoration context led to the diagnosis of placental IRIS associated with Toxoplasma gondii reactivation. This outcome remains undescribed and could represent an issue in resource-limited settings where HIV-pregnant patients are often severely immunodeficient and infected with opportunistic pathogens. Copyright © 2010. Published by Elsevier Ltd.
5. Kowalik CR, Mol BW, Veersema S, Goddijn M
Critical appraisal regarding the effect on reproductive outcome
of hysteroscopic metroplasty in patients with recurrent miscarriage
Arch Gynecol Obstet. 2010 Apr 1. [Epub ahead of print]
Department of Obstetrics and Gynecology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands, c.r.kowalik@amc.uva.nl.
6. Barfield WD, Barradas DT, Manning SE, Kotelchuck M, Shapiro-Mendoza
C
Sickle cell disease and pregnancy outcomes: women of African
descent
Am J Prev Med. 2010 Apr;38(4 Suppl):S542-9
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia 30341, USA. wbarfield@cdc.gov
BACKGROUND: Sickle cell disease (SCD) is a severe hematologic condition that presents unique complications among affected pregnant women. Many studies of adverse perinatal outcomes associated with SCD are limited by small samples or fail to consider important risk factors. PURPOSE: This study compared perinatal outcomes among women of African ancestry with and without SCD in a large, population-based sample. METHODS: Data from the Massachusetts Pregnancy to Early Life Longitudinal (PELL) Data System were analyzed during June-August 2009 to identify in-state deliveries to resident women of African descent. Logistic regression analyses compared perinatal outcomes for deliveries among women with and without SCD, adjusted for maternal age, education, parity, plurality, insurance status, adequacy of prenatal care, smoking during pregnancy, and infant gender. RESULTS: During 1998-2006, there were 116,076 deliveries to 84,561 women; SCD prevalence was 0.6%. Adjusted odds of fetal death among deliveries to women with SCD were 2.2 times those among women without SCD (95% CI=1.2, 4.2). Compared to women without SCD, the odds of preterm delivery, low birth weight, and having babies small for gestational age (SGA) among women with SCD were 1.5 (95% CI=1.2, 1.8); 1.7 (95% CI=1.1, 2.6); and 1.3 (95% CI=1.0, 1.7), respectively. Sickle cell disease was positively associated with cesarean delivery and inductions. CONCLUSIONS: Population-based linked data systems are useful for assessing risks of adverse health outcomes among women with specific medical conditions, such as SCD. Women with SCD should seek preconception care to identify and modify risk behaviors and receive counseling regarding potential adverse sequelae associated with pregnancy-related morbidity and preterm delivery. Published by Elsevier Inc.
7. Wong EY, Ray R, Gao DL, Wernli KJ, Li W, Fitzgibbons ED,
Camp JE, Heagerty PJ, De Roos AJ, Holt VL, Thomas DB, Checkoway
H
Physical activity, physical exertion, and miscarriage risk
in women textile workers in Shanghai, China
Am J Ind Med. 2010 Mar 25. [Epub ahead of print]
Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington.
BACKGROUND: Strenuous occupational physical activity and physical demands may be risk factors for adverse reproductive outcomes. METHODS: A retrospective study in the Shanghai, China textile industry study collected women's self-reported reproductive history. Occupational physical activity assessment linked complete work history data to an industry-specific job-exposure matrix. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by multivariate logistic regression for the first pregnancy outcome and utilized generalized estimating equations to consider all pregnancies per woman. RESULTS: Compared with women employed in sedentary jobs, a reduced risk of miscarriage was found for women working in jobs with either light (OR 0.18, 95% CI: 0.07, 0.50) or medium (OR 0.24, 95% CI: 0.08, 0.66) physical activity during the first pregnancy and over all pregnancies (light OR 0.32, 95% CI: 0.17, 0.61; medium OR 0.43, 95% CI: 0.23, 0.80). Frequent crouching was associated with elevated risk (OR 1.82, 95% CI: 1.14, 2.93; all pregnancies per woman). CONCLUSIONS: Light/medium occupational physical activity may have reduced miscarriage risk, while specific occupational characteristics such as crouching may have increased risk in this cohort. Am. J. Ind. Med. 2010. (c) 2010 Wiley-Liss, Inc.
8. Geels YP, de Gouberville MC, Visser L, van Asten HA
Comparing vaginal and sublingual administration of misoprostol
for labour induction in women with intra-uterine fetal death
Trop Doct. 2010 Apr;40(2):77-80
Radboud University Nijmegen Medical Centre, Nijmegen Institute for International Health, Nijmegen, The Netherlands. ygeels@gmail.com
The objective of this study was to compare complications and effectiveness of induction after vaginal and sublingual administration of misoprostol for labor induction in women with intra-uterine fetal death (IUFD). In a district hospital in Ghana, 23 women with IUFD who underwent labor induction with sublingual misoprostol were compared with a control group of 21 women who received vaginal misoprostol. In the vaginal group 28.6% had one or more complications compared to 21.7% in the sublingual group. In the sublingual group three inductions did not lead to delivery within 48 hours (13%), compared to four in the other group (19%). The mean induction-to-delivery time in the sublingual group was 13 hours and 17 hours in the vaginal group. In this study, both sublingual and vaginal misoprostol were safe and efficient for labor induction in women with IUFD. However, more research on larger numbers of patients is needed, in order to compare complications.
9. Berger DS, Hogge WA, Barmada MM, Ferrell RE
Comprehensive analysis of HLA-G: implications for recurrent
spontaneous abortion
Reprod Sci. 2010 Apr;17(4):331-8
Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Miscarriage is one of the most common pregnancy complications. Recurrent spontaneous abortion is defined as 2 or more pregnancy losses and may be associated with genetic variation. Human leukocyte antigen-G (HLA-G) is a ligand for natural killer (NK) cell receptors and has the ability to block NK cell activity, which if not blocked can potentially harm a fetus. Consequently a deletion or mutation of the HLA-G gene could lead to miscarriage. Our cases (n = 238) include Caucasian women experiencing 2 or more spontaneous abortions, and controls (n = 233) include women with at least 1 live birth and no history of SA. We sequenced approximately 1400 base pairs (bp) of the HLA-G promoter region, genotyped the 14 bp exon 8 insertion/deletion and single nucleotide polymorphism (SNP) in the coding region of HLA-G. Promoter haplotypes were constructed from sequence information. Twenty-three SNPs were observed in the promoter region with minor allele frequency >0.02. Twelve SNPs differed significantly in frequency between cases and controls. Two haplotypes incorporating these 12 SNPs accounted for 90% of haplotypes and differed significantly in frequency between the 2 populations. Cases were more likely to carry haplotype 2 (P = .0078) and controls to have haplotype 6 (P = .0004). Cases also had a higher frequency of individuals homozygous for the 14 bp insertion. Among the 12 alleles carried on haplotype 2, 5 are predicted to disrupt transcription factor binding sites. The HLA-G promoter is highly associated with the risk of spontaneous abortion, but high linkage disequilibrium in the promoter prevents assignment of the causal variant.
10. Geller PA, Psaros C, Kornfield SL
Satisfaction with pregnancy loss aftercare: are women getting
what they want?
Arch Womens Ment Health. 2010 Apr;13(2):111-24. Epub 2010 Feb
23
Department of Psychology, Drexel University, MS 515, Philadelphia, PA 19102, USA. pg27@drexel.edu
While there is increasing recognition that early miscarriage represents a significant loss experience that often provokes depression and anxiety, women's dissatisfaction with some aspects of care received from healthcare professionals following a pregnancy loss and the potentially negative consequences of this are often less recognized. This review examines available literature to identify what comprises "treatment as usual," how satisfied women are with the typical services they receive from healthcare personnel, and whether these services are consistent with women's self-identified needs. Results are reviewed according to four major themes-patient satisfaction with: attitudes of healthcare providers, provision of information, interventions provided, and follow-up care. In general, women and families who have experienced a miscarriage report low levels of satisfaction in the presence of perceived negative attitudes from healthcare providers, insufficient provision of information, and inadequate follow-up care that did not focus on emotional well-being. Higher levels of satisfaction are reported among women whose providers were emotionally attuned to the magnitude of the loss, provided information, and involved women in treatment decisions when possible. Limitations of current research are reviewed and directions for future research, training, and practice are briefly discussed.
11. Mbah AK, Alio AP, Marty PJ, Bruder K, Whiteman VE, Salihu
HM
Pre-eclampsia in the first pregnancy and subsequent risk of
stillbirth in black and white gravidas
Eur J Obstet Gynecol Reprod Biol. 2010 Apr;149(2):165-9. Epub
2010 Jan 18.
Center for Research and Evaluation, The Chiles Center, University of South Florida, Tampa, FL 33612, United States.
OBJECTIVE: To examine the association between prior pre-eclampsia and subsequent stillbirth in black women and white women. STUDY DESIGN: This is a population-based retrospective study of Missouri maternally linked birth cohort files from 1989 to 2005. We analyzed singleton first and second births to mothers in the state of Missouri. The study population comprised women who experienced pre-eclampsia in their first pregnancy and a comparison group consisting of women who did not. The two groups were followed to their second pregnancy to document stillbirth occurrence. Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between prior pre-eclampsia and subsequent stillbirth were obtained from logistic regression models. RESULTS: Women who experienced prior pre-eclampsia had a 43% increased risk of subsequent stillbirth [OR=1.43; 95% CI=1.08-1.89]. Whereas women with a history of late-onset pre-eclampsia had no elevated risk for subsequent stillbirth, those whose first pregnancy resulted in early-onset pre-eclampsia had a more than 4-fold increased risk of stillbirth in their second pregnancy [OR=4.07; 95% CI=2.32-7.14]. When sub-analysis was performed on the two main racial groups in the State, we found that elevated risk for subsequent stillbirth in a second pregnancy was observed among black women with prior early-onset pre-eclampsia (OR=8.21; 95% CI=4.03-16.70) but not in whites (OR=1.95; 95% CI=0.72-5.26). CONCLUSION: Initiation of pregnancy with pre-eclampsia elevates the risk for subsequent stillbirth. The risk elevation is most pronounced in black women with early-onset pre-eclampsia in their first pregnancy. This information is valuable for inter-pregnancy counseling of affected women. Copyright (c) 2010. Published by Elsevier Ireland Ltd.
12. Gold KJ, Leon I, Chames MC
National survey of obstetrician attitudes about timing the
subsequent pregnancy after perinatal death
Am J Obstet Gynecol. 2010 Apr;202(4):357.e1-6. Epub 2010 Jan
15
Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI 48104-1213, USA. ktgold@umich.edu
OBJECTIVE: After stillbirth or early infant death, parents often query when they can try for another pregnancy. We conducted a national survey of US obstetricians to assess attitudes about optimal timing of next pregnancy and advice given to parents. STUDY DESIGN: The study was an anonymous mail survey of 1500 randomly selected US obstetricians asking about physician experiences with perinatal death. RESULTS: In all, 804 of 1500 obstetricians completed the survey for a 54% usable response rate. Two-thirds of respondents endorsed a waiting time <6 months for parents bereaved by stillbirth who desired another pregnancy. CONCLUSION: Physicians in this national survey supported very short interpregnancy intervals for parents bereaved by perinatal death. Responses may reflect efforts to support parents emotionally while recognizing individuals vary in coping and clinical circumstances. However, this is a provocative finding since short intervals may confer greater fetal risks for poor outcome. Copyright 2010 Mosby, Inc. All rights reserved.
13. Perrin A, Delobel B, Andrieux J, Gosset P, Gueganic N,
Petit F, De Braekeleer M, Morel F
Molecular cytogenetic analysis by genomic hybridization to
determine the cause of recurrent miscarriage
Fertil Steril. 2010 Apr;93(6):2075.e3-6. Epub 2010 Jan 13
Laboratoire d'Histologie, Embryologie et Cytogénétique, Faculté de Médecine et des Sciences de la Santé, Université de Brest, Brest, France.
OBJECTIVE: To characterize a t(2;6) by array-based comparative genomic hybridization (array-CGH) in a couple with recurrent miscarriage, to analyze the meiotic segregation of the t(2;6), and to discuss couple specific care-taking modality before intracytoplasmic sperm injection. DESIGN: Case report. SETTING: INSERM U613 in Brest, France. PATIENT(S): Couple consulting for infertility. INTERVENTION(S): Array-CGH to characterize a t(2;6) and fluorescence in situ hybridization (FISH) to analyze the meiotic segregation were performed. MAIN OUTCOME MEASURE(S): Array-CGH, FISH with a panel of bacterial artificial chromosome clones and commercial probes. RESULT(S): Analyses from peripheral blood lymphocytes identified a t(2;6)(q35;q24) unbalanced reciprocal translocation with microdeletions on the der(2) and the der(6). FISH on spermatozoa found that the frequency of normal (23,X or 23,Y) or "translocation-deletions" (23,X,der(2),der(6) or 23,Y,der(2),der(6)) spermatozoa was 41.10%. CONCLUSION(S): For our 46,XY,t(2;6)(q35;q24) carrier, more than 50% of the spermatozoa are chromosomally unbalanced. Moreover, FISH does not permit a distinction between normal and "translocation-deletion" phenotypes. So, in the possibility of preimplantation genetic diagnosis, is it necessary to select the normal embryos to the detriment of those translocation-deletions carriers? The pathogenicity of these microdeletions not been proved. Because the family history was oriented toward a variation of genetic equipment without phenotypic consequences, the couple decided not to make a selection between the normal embryos and the translocation-deletion carrier embryos. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
14. Toulis KA, Goulis DG, Venetis CA, Kolibianakis EM, Negro
R, Tarlatzis BC, Papadimas I
Risk of spontaneous miscarriage in euthyroid women with thyroid
autoimmunity undergoing IVF: a meta-analysis
Eur J Endocrinol. 2010 Apr;162(4):643-52. Epub 2009 Dec 2.
Unit of Reproductive Endocrinology Unit for Human Reproduction, First Department of Obstetrics and Gynecology, Medical School, Papageorgiou General Hospital, Aristotle University, Ring Road, Nea Efkarpia, 56403 Thessaloniki, Greece. toulis@endo.gr
OBJECTIVE: To investigate whether thyroid autoimmunity (TAI) is associated with increased risk for spontaneous miscarriage in subfertile, euthyroid women undergoing IVF. DESIGN: Meta-analysis of observational studies. PATIENT(S): Four prospective studies that reported data on 1098 subfertile women undergoing IVF (141 with TAI and 957 controls) were included in the meta-analysis. MAIN OUTCOME MEASURE: Miscarriage risk ratio (RR). SECONDARY OUTCOME MEASURES: Clinical pregnancy rate and delivery rate. RESULT(S): Euthyroid, subfertile women with TAI undergoing IVF demonstrated significantly higher risk for miscarriage compared with controls (four studies-fixed effects RR: 1.99, 95% confidence interval: 1.42- 2.79, P<0.001). No significant difference in clinical pregnancy and delivery rates was detected between groups. CONCLUSION: Based on the currently available evidence, it appears that the presence of TAI is associated with an increased risk for spontaneous miscarriage in subfertile women achieving a pregnancy through an IVF procedure.
15.Lavezzi AM, Corna M, Mingrone R, Matturri L
Study of the human hypoglossal nucleus: normal development
and morpho-functional alterations in sudden unexplained late
fetal and infant death
Brain Dev. 2010 Apr;32(4):275-84. Epub 2009 Jun 23
Lino Rossi Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS-Department of Surgical, Reconstructive and Diagnostic Sciences, University of Milan, Via della Commenda, 19, 20122 Milan, Italy. anna.lavezzi@unimi.it
This study evaluated the development and the involvement in sudden perinatal and infant death of the medullary hypoglossal nucleus, a nucleus that, besides to coordinate swallowing, chewing and vocalization, takes part in inspiration. Through histological, morphometrical and immunohistochemical methods in 65 cases of perinatal and infant victims (29 stillbirths, 7 newborns and 29 infants), who died of both unknown and known cause, the authors observed developmental anomalies of the hypoglossal nucleus (HGN) in high percentage of sudden unexplained fetal and infant deaths. In particular, HGN hypoplasia, hyperplasia, positive expression of somatostatin and absence of interneurons were frequently found particularly in infant deaths, with a significant correlation with maternal smoking. Copyright (c) 2009 Elsevier B.V. All rights reserved.
16. Sugiura-Ogasawara M, Ozaki Y, Kitaori T, Kumagai K, Suzuki
S
Midline uterine defect size is correlated with miscarriage
of euploid embryos in recurrent cases
Fertil Steril. 2010 Apr;93(6):1983-8. Epub 2009 Feb 27
Department of Obstetrics and Gynecology, Nagoya City University, Graduate School of Medical Sciences, Mizuho-ku, Nagoya, Japan. og.mym@med.nagoya-cu.ac.jp
OBJECTIVE: To compare subsequent pregnancy outcomes after two or more miscarriages in patients with and without congenital uterine anomalies. DESIGN: Case-control study. SETTING: Nagoya City University Hospital. PATIENT(S): A total of 42 patients with a bicornuate or septate uterus and 1528 with normal uteri. INTERVENTION(S): No surgery. MAIN OUTCOME MEASURE(S): The cumulative success rate for birth, abnormal chromosome karyotype rate in aborted concepti, and the predictive values of the height of the defect/length of the remaining uterine cavity ratio (D/C ratio). RESULT(S): Of the total of 1676 patients, 54 (3.2%) had congenital uterine anomalies; 25 (59.5%) of the 42 patients with a bicornuate or septate uterus had a successful first pregnancy after examination, while this was the case for 1096 (71.7%) of the 1528 with normal uteri. There was no difference in the cumulative live-birth rate (78.0% and 85.5%) within the follow-up period. However, the rates for an abnormal chromosome karyotype in aborted concepti in cases with and without uterine anomalies were 15.4% (two of 13) and 57.5% (134 of 233), respectively, with the latter being significantly higher. The D/C ratio in the miscarriage group was also significantly greater than that for the live-birth group. CONCLUSION(S): Congenital uterine anomalies have a negative impact on reproductive outcome in couples with recurrent miscarriage and are associated with further miscarriage with a normal embryonic karyotype. The D/C ratio was found to have a predictive value for further miscarriages in recurrent cases. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
17. Raffaelli F, Nanetti L, Vignini A, Mazzanti L, Giannubilo
SR, Curzi CM, Turi A, Vitali P, Tranquilli AL
Nitric oxide platelet production in spontaneous miscarriage
in the first trimester
Fertil Steril. 2010 Apr;93(6):1976-82. Epub 2009 Feb 12
Department of Biochemistry, Biology and Genetics, Marche Polytechnic University, Ancona, Italy. raffi.3@virgilio.it
OBJECTIVE: To investigate the role played by platelet nitric oxide (NO) metabolism in patients with spontaneous miscarriage (SM) and recurrent spontaneous miscarriage (RSM) compared with healthy pregnant women. DESIGN: Retrospective case-control study. SETTING: Patients and controls in an academic research environment. INTERVENTION(S): None. PATIENT(S): Thirty singleton pregnant women who experienced SM, nine singleton pregnant women who presented with RSM, and 30 singleton healthy pregnant women matched for age, parity, and gestational age were enrolled. MAIN OUTCOME MEASURE(S): NO levels and peroxynitrite (ONOO(-)) production; moreover, inducible NO synthase (iNOS), endothelial NO synthase (eNOS), and nitrotyrosine expression (N-Tyr) were observed in the same samples. RESULT(S): A significant increase was shown in platelet NO and ONOO(-) levels and in iNOS and N-Tyr both in SM and in RSM pregnant women compared with controls. CONCLUSION(S): The data herein reported imply that a modified NO pathway might play a key role in the physiological changes of advancing gestation but may also contribute to the pathophysiology of spontaneous miscarriage. Thus, any factors balancing NO metabolism might be useful in the treatment of miscarriage, thus reducing the substantial morbidity and associated mortality. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
18. Pineda B, Hermenegildo C, Tarín JJ, Laporta P, Cano A,
García-Pérez MA
Alleles and haplotypes of the estrogen receptor alpha gene
are associated with an increased risk of spontaneous abortion
Fertil Steril. 2010 Apr;93(6):1809-15. Epub 2009 Feb 6
Research Foundation, Hospital Clínico Universitario, Valencia, Spain.
OBJECTIVE: To investigate whether polymorphisms in estrogen receptor alpha (ERalpha) or beta (ERbeta) genes are associated with a risk of miscarriage. DESIGN: A retrospectively analyzed, prospectively obtained database of cases and controls. SETTING: University hospital menopause unit. PATIENT(S): 177 women with at least one spontaneous abortion and 442 controls with at least one live birth and no history of miscarriage. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Genotype frequencies and odd ratios for abortion risk in cases and controls for four single nucleotide polymorphisms (SNPs) located in intron 1 (C>T and A>G), intron 4 (A>T), and exon 8 (T>C) for the ERalpha gene, and two SNPs located in intron 2 (C>T) and intron 8 (G>A) for the ERbeta gene. RESULT(S): A statistically significant association was found between spontaneous abortion and SNPs rs2234693 (C>T, defined by restriction enzyme PvuII) and rs9340799 (A>G, defined by restriction enzyme XbaI) in intron 1 of the ERalpha gene. The age-adjusted odds ratio for abortion risk was 1.29 for the TA haplotype (defined by PvuII-XbaI) with respect to the CG haplotype in women with at least one abortion, which increased to 1.9 in women with two or more abortions. CONCLUSION(S): The TA haplotype defined by PvuII and XbaI was associated with an increased risk of reproductive loss. No association was found for the ERbeta gene. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
19. Lok IH, Yip AS, Lee DT, Sahota D, Chung TK
A 1-year longitudinal study of psychological morbidity after
miscarriage
Fertil Steril. 2010 Apr;93(6):1966-75. Epub 2009 Jan 30
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, People's Republic of China. ingridlok@cuhk.edu.hk
OBJECTIVE: To examine the 1-year longitudinal course of psychological outcomes after miscarriage. DESIGN: Longitudinal observational study. SETTING: University-affiliated teaching hospital. PATIENT(S): 280 miscarrying women and 150 nonpregnant women. INTERVENTION(S): Psychological outcomes were assessed using the 12-item General Health Questionnaire (GHQ-12) and Beck Depression Inventory (BDI) immediately, 3 months, 6 months, and 12 months after miscarriage. MAIN OUTCOME MEASURE(S): Scores on GHQ-12 and BDI. RESULT(S): Half (55%) of the miscarrying women scored high (>or=4) on the GHQ-12 immediately, 25% at 3 months; 17.8% at 6 months, and 10.8% at 1 year after miscarriage; 26.8% of the patients scored high on the BDI (>or=12) immediately, 18.4% at 3 months, 16.4% at 6 months, and 9.3% at 1 year after miscarriage. Patients who were initially more distressed continued to score higher on both the GHQ-12 and the BDI along the 1-year course when compared with those who were initially less distressed. When compared with the nonpregnant controls, the miscarrying women scored statistically significantly higher on the GHQ-12 and BDI; the differences became not statistically significant only 1 year after miscarriage. CONCLUSION(S): A statistically significant proportion of patients reported psychological morbidity shortly after miscarriage, but their level of distress reduced over time until they were comparable with the controls 1 year later. Patients who were initially more distressed continued to be throughout the 1-year course. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
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