NSIDRC Journal Article Alert — June 4, 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.
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 or Partners in Information Access for the Public Health Workforce's How to Access Journal Articles for more details.
Sudden Infant Death
1. Tan BH, Pundi KN, Van Norstrand DW, Valdivia CR, Tester
DJ, Medeiros-Domingo A, Makielski JC, Ackerman MJ
Sudden infant death syndrome-associated mutations in the sodium
channel beta subunits
Heart Rhythm. 2010 Jun;7(6):771-8. Epub 2010 Feb 1
Department of Medicine, Cardiovascular Section, University of Wisconsin, Madison, Wisconsin, USA.
Comment in
Heart Rhythm. 2010 Jun;7(6):779-80.
BACKGROUND: Approximately 10% of sudden infant death syndrome (SIDS) cases may stem from potentially lethal cardiac channelopathies, with approximately half of channelopathic SIDS involving the Na(V)1.5 cardiac sodium channel. Recently, Na(V) beta subunits have been implicated in various cardiac arrhythmias. Thus, the 4 genes encoding Na(V) beta subunits represent plausible candidate genes for SIDS. OBJECTIVE: This study sought to determine the spectrum, prevalence, and functional consequences of sodium channel beta-subunit mutations in a SIDS cohort. METHODS: In this institutional review board-approved study, mutational analysis of the 4 beta-subunit genes, SCN1B to 4B, was performed using polymerase chain reaction, denaturing high-performance liquid chromatography, and direct DNA sequencing of DNA derived from 292 SIDS cases. Engineered mutations were coexpressed with SCN5A in HEK 293 cells and were whole-cell patch clamped. One of the putative SIDS-associated mutations was similarly studied in adenovirally transduced adult rat ventricular myocytes. RESULTS: Three rare (absent in 200 to 800 reference alleles) missense mutations (beta3-V36M, beta3-V54G, and beta4-S206L) were identified in 3 of 292 SIDS cases. Compared with SCN5A+beta3-WT, beta3-V36M significantly decreased peak I(Na) and increased late I(Na), whereas beta3-V54G resulted in a marked loss of function. beta4-S206L accentuated late I(Na) and positively shifted the midpoint of inactivation compared with SCN5A+beta4-WT. In native cardiomyocytes, beta4-S206L accentuated late I(Na) and increased the ventricular action potential duration compared with beta4-WT. CONCLUSION: This study provides the first molecular and functional evidence to implicate the Na(V) beta subunits in SIDS pathogenesis. Altered Na(V)1.5 sodium channel function due to beta-subunit mutations may account for the molecular pathogenic mechanism underlying approximately 1% of SIDS cases. Copyright (c) 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
2. Towbin JA
The A, B, Cs of sudden infant death syndrome: an electrical
disorder?
Heart Rhythm. 2010 Jun;7(6):779-80. Epub 2010 Feb 20.
Comment on
Heart Rhythm. 2010 Jun;7(6):771-8.
PMID: 20176136 [PubMed - in process]
Bereavement
1. Erlandsson K, Avelin P, Säflund K, Wredling R, Rådestad
I
Siblings' farewell to a stillborn sister or brother and parents'
support to their older children: a questionnaire study from
the parents' perspective
J Child Health Care. 2010 Jun;14(2):151-60. Epub 2010 Mar 3.
Mälardalen University, Eskilstuna/Västerås Sweden. kerstin.erlandsson@mdh.se
This study aims to capture parental descriptions of how siblings take leave of and mourn a stillborn brother or sister and how their parents support them. Data were collected by questionnaires from 16 parents of siblings to a stillborn child one year after the stillbirth. Data were analysed numerically for the multiple-choice questions and content analysis was used for parental comments and descriptions. The results describe siblings' farewell to a stillborn brother or sister and how their parents in the midst of their own grief were involved in supporting siblings' wellbeing, and observed their mourning reactions. Although the findings need to be interpreted with caution, they may provide insight that enables staff to become more sensitive to the whole family experience in the practice of their profession. Further research into siblings' grief and parental support after stillbirth is crucial so that further light may be shed on their situation.
Miscarriage/Stillbirth/Prenatal Issues
1. Nakhai-Pour HR, Broy P, Bérard A
Use of antidepressants during pregnancy and the risk of spontaneous
abortion
CMAJ. 2010 May 31. [Epub ahead of print]
BACKGROUND: The risk of relapse of depression or the diagnosis of some other psychiatric disorders during pregnancy necessitates the use of antidepressants despite possible adverse effects. Whether such use increases the risk of spontaneous abortion is still being debated. We evaluated the risk of spontaneous abortion in relation to the use of antidepressants during pregnancy. METHODS: Using a nested case-control study design, we obtained data from the Quebec Pregnancy Registry for 5124 women who had a clinically detected spontaneous abortion. For each case, we randomly selected 10 controls from the remaining women in the registry who were matched by the case's index date (date of spontaneous abortion) and gestational age at the time of spontaneous abortion. Use of antidepressants was defined by filled prescriptions and was compared with nonuse. We also studied the classes, types and doses of antidepressants. RESULTS: A total of 284 (5.5%) of the women who had a spontaneous abortion had at least one prescription for an antidepressant filled during the pregnancy, as compared with 1401 (2.7%) of the matched controls (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.83-2.38). After adjustment for potential confounders, we found that the use of antidepressants during pregnancy was associated with an increased risk of spontaneous abortion (OR 1.68, 95% CI 1.38-2.06). Stratified analyses showed that use of selective serotonin reuptake inhibitors alone (OR 1.61, 95% CI 1.28-2.04), serotonin-norepinephrine reuptake inhibitors alone (OR 2.11, 95% CI 1.34-3.30) and combined use of antidepressants from different classes (OR 3.51, 95% CI 2.20-5.61) were associated with an increased risk of spontaneous abortion. When we looked at antidepressant use by type versus no use, paroxetine use alone (OR 1.75, 95% CI 1.31-2.34) and venlafaxine use alone (OR 2.11, 95% CI 1.34-3.30) were associated with an increased risk of spontaneous abortion. INTERPRETATION: The use of antidepressants, especially paroxetine, venlafaxine or the combined use of different classes of antidepressants, during pregnancy was associated with an increased risk of spontaneous abortion.
2. Tikkanen M
Etiology, clinical manifestations, and prediction of placental
abruption
Acta Obstet Gynecol Scand. 2010 Jun;89(6):732-40
Department of Obstetrics and Gynecology, University Central Hospital, Helsinki, Finland. minna.tikkanen@hus.fi
Placental abruption, defined as complete or partial detachment of the placenta before delivery, is one of the most devastating pregnancy complications. Bleeding and pain consist the classical symptoms of placental abruption but the clinical picture varies from asymptomatic, in which the diagnosis is made by inspection of the placenta at delivery, to massive abruption leading to fetal death and severe maternal morbidity. The diagnosis is always clinical. The etiology of placental abruption is not fully understood but impaired placentation, placental insufficiency, intrauterine hypoxia, and uteroplacental underperfusion are likely the key mechanisms causing abruption. Abruption results from a rupture of maternal decidual artery causing dissection of the decidual-placental interface. Acute vasospasm of small vessels may precede abruption. The trophoplastic invasion in the spiral arteries and subsequent early vascularization may be defective. Moreover, placental abruption may also be a manifestation of an inflammatory process which could affect vascular bed. Despite heightened awareness, placental abruption still remains unpredictable and unpreventable. A clinically useful predictive test is needed to detect individuals at risk. Although several biomarkers have been evaluated, none has so far turned out to be useful.
3. Threatened miscarriage and pregnancy outcome
BJOG. 2010 Jun;117(7):893; author reply 893-4
Comment on
BJOG. 2010 Feb;117(3):245-57.
4. Barber JC, Cockwell AE, Grant E, Williams S, Dunn R, Ogilvie
CM
Is karyotyping couples experiencing recurrent miscarriage worth
the cost?
BJOG. 2010 Jun;117(7):885-8
Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury District Hospital, Salisbury, UK. john.barber@soton.ac.uk
Karyotyping couples that have had recurrent miscarriages detects balanced rearrangements in carrier parents who can be offered prenatal cytogenetic analysis to prevent the birth of a subsequent child with an unbalanced rearrangement. In four UK centres, over periods of 5-30 years, balanced rearrangements were found in 406 out of 20,432 parents that had experienced miscarriage (1.9%), but only four unbalanced rearrangements were found after referral for prenatal diagnosis because of a balanced parental translocation ascertained for recurrent miscarriages. At an estimated cost of 3-4 million pounds, these data raise doubts about the cost effectiveness of current policies on the routine karyotyping of couples experiencing repeated miscarriages.
5. Nielsen HS, Steffensen R, Lund M, Egestad L, Mortensen
LH, Andersen AM, Lidegaard Ø, Christiansen OB
Frequency and impact of obstetric complications prior and subsequent
to unexplained secondary recurrent miscarriage
Hum Reprod. 2010 Jun;25(6):1543-52. Epub 2010 Apr 14
The Fertility Clinic 4071, University Hospital Copenhagen, Blegdamsvej 9, Rigshospitalet, DK-2100 Copenhagen Ø, Denmark. henriette.svarre.nielsen@rh.regionh.dk
BACKGROUND: The chance of a live birth after a diagnosis of secondary recurrent miscarriage (SRM) is reduced in patients who, prior to the miscarriages, gave birth to a boy and carry HLA class II alleles that efficiently present male-specific (H-Y) antigens to the immune system. Information about obstetric complications in births prior and subsequent to the SRM diagnosis is limited. The relations between maternal carriage of H-Y-restricting HLA, fetal sex, obstetric complications and prognosis are unknown. METHODS: Women with unexplained SRM referred to the Danish Recurrent Miscarriage Clinic between 1986 and 2006 (n = 358) were included; 213 gave birth after the diagnosis. Controls, retrieved from the Danish National Birth Registry, were all women with singleton birth of parity 0, 1982-2005 (n = 608,068) and parity 1, 1986-2008 (n = 510,264). Cross-linkage to the National Discharge Registry identified birth complication diagnoses related to the relevant births among patients and controls. RESULTS: The sex ratio was 1.49 in births prior to SRM and 0.76 in birth after SRM (P < 0.0001). For SRM patients with only late miscarriages (>10 weeks gestation), the corresponding sex ratios were 2.31 and 0.21. Compared with the control groups, obstetric complications were more frequent both before (39% versus 24% P <or= 0.01) and after (19% versus 14%, P = 0.01) SRM diagnosis. Births were more frequently complicated when the child was a boy (44% versus 31%, P = 0.02) before and a girl (24% versus 13%, P = 0.04) after SRM diagnosis. SRM patients with H-Y-restricting HLA class II alleles and a firstborn boy gave birth to children who weighed on average 381 g less (P = 0.006) and were born 0.9 weeks earlier (P = 0.06) and their births had more obstetric complications (P = 0.05) than patients with the same HLA alleles but a firstborn girl. CONCLUSIONS: Obstetric complications, sex ratios in births prior and subsequent to SRM and maternal carriage of H-Y-restricting HLA class II alleles are associated parameters. Immune responses against fetal H-Y antigens initiated in the pregnancy prior to the SRM may play a causal role in SRM.
6. van den Boogaard E, Kaandorp SP, Franssen MT, Mol BW, Leschot
NJ, Wouters CH, van der Veen F, Korevaar JC, Goddijn M
Consecutive or non-consecutive recurrent miscarriage: is there
any difference in carrier status?
Hum Reprod. 2010 Jun;25(6):1411-4. Epub 2010 Apr 10
Department of Obstetrics and Gynaecology, Academic Medical Center, Centre for Reproductive Medicine, H4-205, PO Box 22660, 1100 DD Amsterdam, The Netherlands. e.vandenboogaard@amc.uva.nl
BACKGROUND: Carrier status of a structural balanced chromosome
abnormality is associated with recurrent miscarriage. There
is, at present, no evidence of the impact of the sequence of
preceding pregnancies on the probability of carrier status.
The aim of our study was therefore to examine whether the history
of consecutive versus non-consecutive miscarriages in couples
with two or more miscarriages has any impact on the probability
of carrying a chromosome abnormality. METHODS: A nested case-control
study was performed in six centres for clinical genetics in
the Netherlands. Couples referred for chromosome analysis after
two or more miscarriages were included: 279 couples with a
carrier of a structural chromosomal abnormality and 428 non-carrier
couples who served as controls. Univariable and multivariable
logistic regression analyses, corrected for known risk factors
for carrier status, were performed. The main outcome measure
was the probability of carrier status. RESULTS: Two hundred
and fifty-six of 279 (92%) carrier couples and 381 of 428 (89%)
non-carrier couples had experienced consecutive miscarriages
(P = 0.21). A history of two or three consecutive miscarriages
did not alter the probability of carrier status when compared
with two [odds ratio (OR) 0.90, 95% confidence interval (CI)
0.48-1.7] or three (OR 0.71, 95% CI 0.39-1.3) non-consecutive
miscarriages. CONCLUSIONS: The sequence of preceding pregnancies
is not a risk factor for carrier status. Therefore, couples
with miscarriages interspersed with healthy child(ren) should
be managed the same as couples with consecutive miscarriages
regarding chromosome diagnosis.
7. Li Wang, Zeng Chan Wang, Cui Xie, Xiao Feng Liu, Mao Sheng
Yang
Genome-wide screening for risk Loci of idiopathic recurrent
miscarriage in a Han Chinese population: a pilot study
Reprod Sci. 2010 Jun;17(6):578-84. Epub 2010 Mar 19
Laboratory of Disorder Genes and Pharmacogenomics Research Center, Institute of Life Sciences, Chongqing University of Medical Sciences, Chongqing, People's Republic of China.
The etiology of recurrent miscarriage (RM) is extremely heterogeneous, including genetic, immunologic, anatomic, endocrinological, and infectious anomalies. About 50% of RM is unexplained or poorly understood, which is called idiopathic recurrent miscarriage (IRM). The primary aim of this study was to identify the genetic loci that might be susceptible to IRM. Forty-four Han Chinese patients with IRM during the first trimester of their pregnancies and 44 healthy sex- and ethnic-matched controls were enrolled in this study. A case-control and genome-wide study was performed and 430 polymorphic microsatellite markers were analyzed. Three loci, 6q27 (D6S446, P = .028), 9q33.1 (D9S1776, P = .037), and Xp22.11 (DXS1226, P = .008), significantly associated with IRM were found. This work identified 3 genetic regions that might harbor genes predisposed to IRM and provided new insights for future genetic and etiological study of IRM. Further study is required to confirm it.
8. Clark P, Walker ID, Langhorne P, Crichton L, Thomson A,
Greaves M, Whyte S, Greer IA; Scottish Pregnancy Intervention
Study (SPIN) collaborators.
Collaborators (14) Cumming G, Smith N, Crichton L, Brennand
J, Cameron A, Gaudoin M, Ramsay J, Maharaj S, Maclean M, McLellan
D, Mathers A, McLintock C, Thornton J, Wisdom S.
SPIN (Scottish Pregnancy Intervention) study: a multicenter,
randomized controlled trial of low-molecular-weight heparin
and low-dose aspirin in women with recurrent miscarriage
Blood. 2010 May 27;115(21):4162-7. Epub 2010 Mar 17
Department of Transfusion Medicine, Ninewells Hospital and Medical School, Dundee, UK. peterclark@nhs.net
To assess whether treatment with enoxaparin and low-dose aspirin, along with intensive pregnancy surveillance, reduces rate of pregnancy loss compared with intensive pregnancy surveillance alone in women with history of 2 or more consecutive previous pregnancy losses, a parallel group, multicenter, randomized controlled trial was performed in the United Kingdom and New Zealand. Participants (n = 294) presenting for initial antenatal care at fewer than 7 weeks' gestation with history of 2 or more consecutive previous pregnancy losses at 24 or fewer weeks' gestation and no evidence of anatomic, endocrine, chromosomal, or immunologic abnormality were randomly assigned to receive either enoxaparin 40 mg subcutaneously and 75 mg of aspirin orally once daily along with intense pregnancy surveillance or intense pregnancy surveillance alone from random assignment until 36 weeks' gestation. The primary outcome measure was pregnancy loss rate. Of the 147 participants receiving pharmacologic intervention, 32 (22%) pregnancy losses occurred, compared with 29 losses (20%) in the 147 subjects receiving intensive surveillance alone, giving an odds ratio of 0.91 (95% confidence interval, 0.52-1.59) of having a successful pregnancy with pharmacologic intervention. Thus, we observed no reduction in pregnancy loss rate with antithrombotic intervention in pregnant women with 2 or more consecutive previous pregnancy losses. The trial was registered at http://www.controlled-trials.com as ISRCTN06774126.
9. Aliyu MH, Salihu HM, Alio AP, Wilson RE, Chakrabarty S,
Clayton HB
Prenatal smoking among adolescents and risk of fetal demise
before and during labor
J Pediatr Adolesc Gynecol. 2010 Jun;23(3):129-35. Epub 2010
Feb 11
Department of Preventive Medicine & Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA.
STUDY OBJECTIVE: To investigate the relationship between smoking during pregnancy and the occurrence of stillbirth phenotypes among adolescent mothers. DESIGN: Retrospective cohort SETTING: Singleton births in Missouri from 1978 through 1997. PARTICIPANTS: Two groups of "younger" (<15 years) and "older" (15-19 years) adolescent mothers were compared to "mature" mothers (age 20-24 years). MAIN OUTCOME MEASURES: Cox Proportional Hazards Regression models generated adjusted risk estimates of the association between intrauterine nicotine exposure and the risk of total, antepartum, and intrapartum stillbirth in each age group. RESULTS: Approximately 32% (N=205,887) of the total 633,849 singleton births analyzed were among adolescent mothers. The overall prevalence of smoking was 31.2%, with the lowest prevalence (14.1%) among the youngest mothers while older adolescents had the highest (31.7%). The risk for intrapartum stillbirth among smoking adolescents <15 years of age was twice the risk for older adolescent and mature mothers. The risk of intrapartum stillbirth among smokers decreased as maternal age increased: [adjusted hazard ratio (AHR), 95% confidence interval (CI) for young mothers: 4.0, 95%CI=0.6-28.7; for older adolescents AHR=1.5, 95%CI=1.1-2.1 and for mature mothers AHR=1.8, 95% CI=1.4-2.2], respectively. CONCLUSIONS: In utero tobacco exposure has maternal age-related differential and lethal effects on the fetus. Young maternal age tends to potentiate these effects. There is a public health need to develop appropriate smoking cessation messages targeted specifically to this high risk group. Copyright 2010 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
10. Tranquilli AL, Saccucci F, Giannubilo SR, Cecati M, Nocchi
L, Lorenzi S, Emanuelli M
Unexplained fetal loss: the fetal side of thrombophilia
Fertil Steril. 2010 Jun;94(1):378-80. Epub 2009 Nov 11
Department of Clinical Sciences, Polytechnic University of Marche, Ancona, Italy.
Carrier status of the fetus for factor V polymorphism or double homozygosity for mutant alleles of the PAI-1 4 G/4 G and MTHFR T677 T polymorphisms must be considered risk factors for intrauterine fetal death. The clinical implications of these data need to be addressed in a prospective study to confirm our preliminary data and to answer the question of whether or not double homozygous individuals should be treated with low molecular-weight heparin and/or low-dose aspirin. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
11. Bohlmann MK, Luedders DW, Strowitzki T, von Wolff M
Specific secretory phase endometrial leukocytes of women with
two and more consecutive idiopathic abortions are not significantly
different from healthy controls
Arch Gynecol Obstet. 2010 Jun;281(6):983-90. Epub 2009 Jul
15
Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany. michael.bohlmann@uk-sh.de
OBJECTIVE: To analyze concentrations of endometrial leukocytes in patients with idiopathic-repeated abortions. MATERIALS AND METHODS: Biopsies of exactly dated secretory endometrium in 25 patients with idiopathic-repeated abortions and 10 control patients without a history of miscarriage were compared with respect to the concentrations of T-helper cells (CD4), cytotoxic T-cells (CD8), B-cells (CD19) and uterine natural killer cells (CD56) by immunohistochemistry and RNase protection assays. RESULTS: All examined cells were detectable within secretory endometrium. No statistically significant differences of the examined immune-cell concentrations were seen between the control group and the repeated miscarriage group by either test. CONCLUSION: This study suggests that the concentrations of specific endometrial leukocytes in a non-pregnant cycle are not associated with repeated pregnancy loss. Thus, the hypothesis of an altered endometrial immunity in patients with repeated miscarriages, symbolized by persistently differing local immune-cell concentrations, has to be questioned.
12. 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. 2010 Jun;125(6):505-10. Epub 2009 Oct 13
Department of Hemostasis, Finnish Red Cross Blood Service, Helsinki, Finland. leena.hiltunen@bts.redcross.fi
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 > or =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 (> or =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. Copyright 2009 Elsevier Ltd. All rights reserved.
13. Metwally M, Saravelos SH, Ledger WL, Li TC
Body mass index and risk of miscarriage in women with recurrent
miscarriage
Fertil Steril. 2010 Jun;94(1):290-5. Epub 2009 May 12
The Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield and Sheffield Teaching Hospitals, The Jessop Wing, Sheffield, United Kingdom. m.metwally@sheffield.ac.uk
OBJECTIVE: To investigate the effect of underweight, overweight, and obesity on the risk of miscarriage in the subsequent pregnancy in women with recurrent miscarriage. DESIGN: Retrospective analysis of prospectively collected data from the database of a tertiary recurrent miscarriage center. SETTING: The recurrent miscarriage clinic at Sheffield Teaching Hospitals. PATIENT(S): A total of 844 pregnancies from 491 patients with recurrent miscarriage were included in the analysis. MAIN OUTCOME MEASURE(S): The odds of miscarriage in the subsequent pregnancy for all pregnancies after referral to the recurrent miscarriage clinic as well as the first pregnancy post referral. RESULT(S): When analyzing all pregnancies, and compared to women with a normal body mass index, obese and underweight patients had a significantly higher odds of miscarriage in the subsequent pregnancy (OR, 1.71; 95% CI, 1.05-2.8; and OR, 3.98; 95% CI, 1.06-14.92; respectively), whereas there was no significantly increased odds of miscarriage in overweight women (OR, 1.02; 95% CI, 0.72-1.45). Logistic regression analysis showed that the most important factor predicting the occurrence of miscarriage was advanced maternal age (P=0.01) followed by an increased body mass index (P=0.04). CONCLUSION(S): In women with recurrent miscarriage, a mild increase in the body mass index does not increase the risk of miscarriage, whereas obese and underweight patients have a small but significant increased risk of miscarriage in the subsequent pregnancy. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
14. Homer H, Saridogan E
Uterine artery embolization for fibroids is associated with
an increased risk of miscarriage
Fertil Steril. 2010 Jun;94(1):324-30. Epub 2009 Apr 9
Department of Obstetrics & Gynaecology, Institute for Women's Health, University College London Hospitals, London, United Kingdom. h.homer@ucl.ac.uk
OBJECTIVE: To investigate how uterine artery embolization (UAE) might alter the risk profile for pregnancies complicated by fibroids. DESIGN: Systematic literature review and meta-analysis of existing studies. SETTING: Academic reproductive medicine unit. PATIENT(S): Women with fibroids. INTERVENTION(S): A systematic literature review, raw data extraction, and data analysis. MAIN OUTCOME MEASURE(S): Rates of miscarriage, preterm delivery, malpresentation, intrauterine growth restriction (IUGR), cesarean delivery, and postpartum hemorrhage (PPH). RESULT(S): Two hundred twenty-seven completed pregnancies after UAE were identified. Miscarriage rates were higher in UAE pregnancies (35.2%) compared with fibroid-containing pregnancies matched for age and fibroid location (16.5%) (odds ratio [OR] 2.8; 95% confidence interval [CI] 2.0-3.8). The UAE pregnancies were more likely to be delivered by cesarean section (66% vs. 48.5%; OR 2.1; 95% CI 1.4-2.9) and to experience PPH (13.9% vs. 2.5%; OR 6.4; 95% CI 3.5-11.7). Rates of preterm delivery (14% vs. 16%; OR 0.9; 95% CI 0.5-1.5), IUGR (7.3% vs. 11.7%; OR 0.6; 95% CI 0.3-1.3), and malpresentation (10.4% vs. 13%; OR 0.8; 95% CI 0.4-1.5) were similar in UAE pregnancies and in control pregnancies with fibroids. CONCLUSION(S): The risk of miscarriage seems to be increased after UAE. In contrast, apart from an increased risk of abdominal delivery and PPH, critical adverse obstetric sequelae of IUGR and prematurity appear no more likely after UAE. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
15. Vansenne F, de Borgie CA, Korevaar JC, Franssen MT, Pajkrt
E, Hansson KB, Leschot NJ, Bossuyt PM, van der Veen F, Goddijn
M.
Low uptake of prenatal diagnosis after established carrier
status of a balanced structural chromosome abnormality in couples
with recurrent miscarriage
Fertil Steril. 2010 Jun;94(1):296-300.e1-3. Epub 2009 Mar 27
Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands. f.vansenne@amc.uva.nl
OBJECTIVE: To evaluate to what extent couples carrying a balanced structural chromosome abnormality follow up the advice to opt for invasive prenatal diagnosis (PND) in subsequent pregnancies. DESIGN: Index-control study. SETTING: Six centers for Clinical Genetics in The Netherlands. PATIENT(S): Couples referred for chromosome analysis after recurrent miscarriage between 1992 and 2001 and with at least one pregnancy after disclosure; 239 carrier couples and 389 noncarrier couples. INTERVENTION(S): Questionnaire, medical record checking. MAIN OUTCOME MEASURE(S): Uptake of invasive PND. RESULT(S): Only 53 of 239 (22%) carrier couples underwent a PND procedure (CVS or amniocentesis) in all subsequent pregnancies. A relatively high number, 105 (44%) carrier couples, refrained from PND in all subsequent pregnancies. More carrier couples with maternal age >or=36 years (20/33 = 61%) refrained from PND, compared with carrier couples with maternal age <36 years (85/206 = 41%). In women >or=36 years, an equal proportion of carrier and noncarrier couples refrained from PND (61% vs. 54%). CONCLUSION(S): The advice to opt for invasive PND in carrier couples is poorly followed, especially in carrier couples with maternal age >or=36 years. The motivations of carrier couples to opt for or refrain from invasive PND procedures should be the topic for further research to optimize clinical care and informative decision making. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
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
