NSIDRC Journal Article Alert — July 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. Hutchison BL, Stewart AW, Mitchell EA
The prevalence of cobedding and SIDS-related child care practices
in twins
Eur J Pediatr. 2010 Jul 6. [Epub ahead of print]
Department of Paediatrics, Child and Youth Health, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand, bl.hutchison@auckland.ac.nz.
Sudden unexplained and unexpected death in twins has not been well studied, particularly in relation to the common practice of sleeping twin infants together in the same cot (cobedding). Postal surveys of 109 mothers of twins were undertaken when the infants were 6 weeks, 4 months, and 8 months of age to determine the prevalence of cobedding, infant care practices related to sudden infant death syndrome (SIDS), and the mother's knowledge of SIDS risk factors. SIDS risk factor knowledge was similar to an earlier survey of singletons in 2005. At 6 weeks, 76% of infants usually slept on the back; this changed to 86% at 4 months and 73% at 8 months. At 6 weeks, 52% usually cobedded with their twin all or part of the time. At 4 and 8 months, this had reduced to 31% and 10%, respectively. Side-by-side cobedding configurations were predominant at 6 weeks, with feet-to-feet configurations increasing as the infants grew older. Breastfeeding was reported in 83%, 61% and 31% of infants at 6 weeks, 4 months and 8 months, respectively. Pacifier use was reported in 38%, 50% and 33% at the respective surveys. As the age of the twins increased, mothers were significantly more likely to be concerned about deformational plagiocephaly in Twin 1 than in Twin 2. Conclusion: Despite a lack of evidence of the risks or benefits of cobedding, this practice was very popular, especially in the younger infants. More research is needed to establish the safety of cobedding in relation to the risk of SIDS.
2. Matturri L, Giuliani P, Mecchia D, Pizzo F, Lavezzi AM
Italian national data bank of stillbirth vs. SIDS
Public Health Rep. 2010 Jul-Aug;125(4):516
3. Klintschar M, Heimbold C
Questionable association between a monoamine oxidase A promoter
polymorphism and sudden infant death syndrome
Neurogenetics. 2010 Jul;11(3):367-8. Epub 2010 Apr 1
4. Opdal SH, Vege A, Stray-Pedersen A, Rognum TO
Aquaporin-4 gene variation and sudden infant death syndrome
Pediatr Res. 2010 Jul;68(1):48-51
Institute of Forensic Medicine, University of Oslo, Oslo 0027, Norway. s.h.opdal@medisin.uio.no
The purpose of this study was to investigate the aquaporin-4 (AQP4) gene in cases of sudden infant death syndrome (SIDS) and controls and 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 wk (p = 0.014, 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 3 mo of age.
5. Moon RY, Oden RP, Joyner BL, Ajao TI
Qualitative analysis of beliefs and perceptions about sudden
infant death syndrome in African-American mothers: implications
for safe sleep recommendations
J Pediatr. 2010 Jul;157(1):92-97.e2. Epub 2010 Mar 19
Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC 20010, USA. moon@cnmc.org
OBJECTIVE: To investigate, by using qualitative methods, perceptions about sudden infant death syndrome (SIDS) in African-American parents and how these influence decisions. STUDY DESIGN: Eighty-three mothers participated in focus groups or individual interviews. Interviews probed reasons for decisions about infant sleep environment and influences affecting these decisions. Data were coded, and themes were developed and revised in an iterative manner as patterns became more apparent. RESULTS: Themes included lack of plausibility, randomness, and vigilance. Many mothers believed that the link between SIDS and sleep position was implausible. Because the cause of SIDS was unknown, they did not understand how certain behaviors could be defined as risk factors. This confusion was reinforced by perceived inconsistency in the recommendations. Most mothers believed that SIDS occurred randomly ("God's will") and that the only way to prevent it was vigilance. CONCLUSIONS: Many African-American mothers may not understand the connection between SIDS and sleep behaviors or believe that behavior (other than vigilance) cannot affect risk. These beliefs, if acted on, may affect rates of safe sleep practices. Efforts to explain a plausible link between SIDS and safe sleep recommendations and to improve consistency of the message may result in increased adherence to these recommendations. Copyright (c) 2010 Mosby, Inc. All rights reserved.
6. Richardson HL, Walker AM, Horne RS
Influence of swaddling experience on spontaneous arousal patterns
and autonomic control in sleeping infants
J Pediatr. 2010 Jul;157(1):85-91. Epub 2010 Mar 15
Ritchie Centre for Baby Health Research, Monash Institute of Medical Research, Monash University, Melbourne, Victoria, Australia.
OBJECTIVE: To investigate the effects of swaddling experience on infant sleep, spontaneous arousal patterns and autonomic control. STUDY DESIGN: Twenty-seven healthy term infants, who were routinely swaddled at home (n=15) or "naïve" to swaddling (n=12), were monitored with daytime polysomnography in swaddled and unswaddled conditions at 3 to 4 weeks and at 3 months after birth. RESULTS: Swaddling did not alter sleep time, spontaneous arousability, or heart rate variability in routinely swaddled infants at either age. During active sleep at 3 months, cortical arousal frequency was decreased, and total sleep time was increased by swaddling in infants who were naïve to swaddling. Heart rate variability when swaddled was also highest in the naïve group. CONCLUSIONS: The effects of infant swaddling on sleep time, arousability, and autonomic control are influenced by previous swaddling experience. Infants in the naïve to swaddling group exhibited decreased spontaneous cortical arousal, similar to responses observed in future victims of sudden infant death syndrome. Infants in unfamiliar sleeping conditions may therefore be more susceptible to cardiorespiratory challenges that fail to stimulate arousal and may lead to sudden infant death syndrome. Copyright (c) 2010 Mosby, Inc. All rights reserved.
7. Poetsch M, Czerwinski M, Wingenfeld L, Vennemann M, Bajanowski
T
A common FMO3 polymorphism may amplify the effect of nicotine
exposure in sudden infant death syndrome (SIDS)
Int J Legal Med. 2010 Jul;124(4):301-6. Epub 2010 Mar 3
Institute of Legal Medicine, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany. micaela.poetsch@uk-essen.de
Smoking during pregnancy has been identified as one of the
major modifiable risk factors of sudden infant death syndrome
(SIDS). It has been demonstrated that the risk of SIDS increases
with increasing cigarette consumption. A variety of hypotheses
have been proposed for explanation, including a genetic predisposition.
The flavin-monooxygenase 3 (FMO3) is one of the enzymes metabolising
nicotine, and several polymorphisms have already been described
in this gene. Here, we studied variations in the exons and
introns of the FMO3 gene by direct sequencing analysis and
minisequencing in 159 SIDS cases and 170 controls. The three
common variants G472A (E158K), G769A (V257M) and A923G (E308G)
in the exons of the FMO3 gene were identified. The homozygote
472AA genotype occurred more frequently in SIDS cases than
in controls (p = 0.0054) and was more frequent in those SIDS
cases for which the mothers reported heavy smoking (p = 0.0084).
This study is the first to demonstrate a gene-environment interaction
in SIDS. The findings suggest that the common polymorphism
G472A of FMO3 could act as an additional genetic SIDS risk
factor in children whose mothers smoke. Parents who could pass
on the 472A allele should be informed of the increased risk
associated with smoking. Smoking mothers should be strongly
advised to give up smoking during pregnancy and for at least
the first year of the child's life.
Other Infant Death
1. 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 Jul-Aug;49(1-2):51-3. Epub 2010 Mar 31
Department of Microbiology and Infectious Diseases, SA Pathology at the Women's & Children's Hospital, 72 King William Road, North Adelaide, South Australia, Australia. amanda.highet@adelaide.edu.au
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 Elsevier Ltd. All rights
reserved.
Bereavement
1. Johnson O, Langford RW
Proof of life: a protocol for pregnant women who experience
pre-20-week perinatal loss
Crit Care Nurs Q. 2010 Jul-Sep;33(3):204-11
Lyndon Baines Johnson General Hospital, Houston, Texas 77026, USA. Olinda Johnson@hchd.tmc.edu
One in 6 pregnancies is lost before the 20th week of gestation and the psychological impacts of this loss are frequently unaddressed while attention is focused on immediate physiological needs. To improve the comprehensive care provided to women experiencing pre-20-week loss, an evidence-based intervention protocol was developed to provide emotional support to these women in the immediate aftermath of the loss. The protocol was tested using a sample of 40 women who experienced a pre-20-week perinatal loss and were being treated in a large county emergency center. Twenty randomly selected women received the intervention protocol while another 20 women received the usual standard of care. Both groups completed the Perinatal Grief Scale during a routine 2-week follow-up visit. The results indicated that the intervention was effective in ameliorating the degree of despair in women experiencing an early pregnancy loss. Women receiving the protocol expressed feelings of being supported and cared for by the staff. Secondary benefits were an increased collaboration among health care professionals, development of an environment of empathy, and a change in the culture of belief that these women needed only physical care. Results indicate a need for a support protocol for all women experiencing loss regardless of gestational age.
2. Lichtenthal WG, Currier JM, Neimeyer RA, Keesee NJ
Sense and significance: a mixed methods examination of meaning
making after the loss of one's child
J Clin Psychol. 2010 Jul;66(7):791-812
Department of Psychiatry and Behavioral Sciences, Evelyn H.
Lauder Breast Center, Memorial Sloan-Kettering Cancer Center,
New York, NY 10065, USA. lichtenw@mskcc.org
The purpose of this mixed methods study was to identify specific
themes of meaning making (sense making and benefit finding)
among bereaved parents, as well as to examine associations
of these themes to the severity of grief symptomatology. A
sample of 156 bereaved parents responded in writing to open-ended
questions about sense making and benefit finding. We assessed
normative grief symptoms with the Core Bereavement Items (Burnett,
Middleton, Raphael, & Martinek, 1997) and maladaptive grief
symptoms with the Inventory of Complicated Grief (Prigerson
et al., 1995). Qualitative analyses revealed 45% of the sample
could not make sense of their loss, and 21% could not identify
benefits related to their loss experience. These parents had
more severe normative and maladaptive grief symptoms. Overall,
parents discussed 32 distinct approaches to finding meaning
in their child's death, 14 of which involved sense making,
and 18 involved themes of benefit finding. The most common
sense-making themes involved spirituality and religious beliefs,
and the most common benefit-finding themes entailed an increase
in the desire to help and compassion for others' suffering.
These results further reinforce the importance of meaning making
for many bereaved parents and suggest the utility of developing
and evaluating meaning-centered grief interventions with this
population.
Miscarriage/Stillbirth/Prenatal Issues
1. Nielsen HS, Witvliet MD, Steffensen R, Haasnoot GW, Goulmy
E, Christiansen OB, Claas F
The presence of HLA-antibodies in recurrent miscarriage patients
is associated with a reduced chance of a live birth
J Reprod Immunol. 2010 Jul 3. [Epub ahead of print]
The Fertility Clinic, University Hospital Copenhagen, Rigshospitalet, Fertility Clinic 4071, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Anti-paternal HLA-antibodies are considered a harmless phenomenon during most pregnancies, whereas their role in recurrent miscarriage (RM) patients is disputed. In contrast to primary RM, patients with secondary RM have carried a fetus to term pregnancy prior to a series of miscarriages, which increases the chance that allogeneic fetal cells appear in the maternal circulation. This study investigates the frequency of HLA-antibodies in secondary RM, primary RM patients and parous controls and analyzes whether the presence of HLA-antibodies in early pregnancy is associated with pregnancy outcome. Sera from women with secondary RM (n=56), primary RM (n=13) and parous controls (n=24) were tested for HLA-antibodies using an ELISA assay and complement dependent cytotoxicity. Samples were taken at gestational week 4-5 in 62 (90%) of the patients. HLA-antibodies were significantly more frequent in secondary RM patients with a boy prior to the miscarriages (62%) compared to secondary RM patients with a firstborn girl (29%, p=0.03), primary RM patients (23%, p=0.02) and parous controls (25%, p=0.005). Forty-one percent of HLA-antibody positive pregnant RM patients had a live birth compared to 76% of HLA-antibody negative RM patients, p=0.006 (adjusted OR: 0.22 (0.07-0.68), p=0.008). In conclusion, HLA-antibodies are significantly more frequent in secondary RM patients with a firstborn boy than in other RM patients and controls. The presence of these antibodies in early pregnancy is associated with a reduced chance of a live birth. Further exploring this association may increase our understanding of maternal acceptance of the fetal allograft. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
2. Peck MG, Sappenfield WM, Skala J
Perinatal Periods of Risk: A Community Approach for Using Data
to Improve Women and Infants' Health
Matern Child Health J. 2010 Jul 3. [Epub ahead of print]
CityMatCH and the Department of Pediatrics, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE, 68198-2175, USA, mpeck@unmc.edu.
This paper provides an overview of the origins, purpose, and methods of the Perinatal Periods of Risk (PPOR) approach to community-based planning for action to improve maternal and infant health outcomes. PPOR includes a new analytic framework that enables urban communities to better understand and address fetal and infant mortality. This article serves as the core reference for accompanying specific PPOR methods and practice articles. PPOR is based on core principles of full community engagement and equity and follows a six stage community-based planning process. In Stage 1, communities are mobilized and engaged, related planning efforts aligned, and community and analytic readiness assessed. In Stage 2, feto-infant mortality is mapped, excess mortality is estimated, likely causes of feto-infant mortality are determined, and appropriate actions are suggested. Stage 3 produces action plans for targeted prevention strategies. Stages 4 and 5 include implementation, monitoring, and evaluation. Stage 6 fosters political will to sustain efforts. PPOR can be used in local maternal child health (MCH) practice for improving perinatal outcomes. MCH programs can use PPOR to integrate health assessments, initiate planning, identify significant gaps, target more in-depth inquiry, and suggest clear interventions for lowering feto-infant mortality. PPOR enables greater cooperation in improving MCH through more effective data use, strengthened data capacity, and greater shared understanding of complex infant mortality issues. PPOR offers local health departments and their community partners a comprehensive approach to address the health of women and infants in their jurisdictions.
3. Fehr L
A matter of maternal malnutrition? Explaining stillbirth/neonatal
death rates in developing nations
Midwifery Today Int Midwife. 2010 Summer;(94):16-7
4. Bogavac MA, Brkic S, Simin N, Nikolic A, Grujic Z, Milosevic
V, Bozin B
Can we use neopterin as marker of viral infections in pregnant
women with symptoms of imminent spontaneous abortion?
J Matern Fetal Neonatal Med. 2010 Jul;23(7):701-4
Department of Obstetrics and Gynecology, Clinical Centre Vojvodina, Alekse Santica 29, Novi Sad, Serbia. mbogavac@yahoo.com
PURPOSE: To find out if determination of neopterin can be used for the detection of viral infections in pregnant women with symptoms of imminent spontaneous abortion. METHODS: Eighty-eight pregnant women with symptoms of imminent spontaneous abortion (investigated group) and 88 healthy pregnant women were evaluated (control group). Neopterin level and IgM and IgG antibodies for eight viruses in the blood were determined. RESULTS: Parvo B19 virus and elevated neopterin values were found in significantly higher number in investigated group than in control. There was no correlation between women with acute ParvoB19 infection and elevated neopterin level. CONCLUSIONS: The determination of neopterin in the sera cannot be used for screening of viral infections in pregnancy.
5. Hasan R, Baird DD, Herring AH, Olshan AF, Jonsson Funk
ML, Hartmann KE
Patterns and predictors of vaginal bleeding in the first trimester
of pregnancy
Ann Epidemiol. 2010 Jul;20(7):524-31
Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, USA. reem_hasan@med.unc.edu <reem_hasan@med.unc.edu>
PURPOSE: Although first-trimester vaginal bleeding is an alarming symptom, few studies have investigated the prevalence and predictors of early bleeding. This study characterizes first trimester bleeding, setting aside bleeding that occurs at time of miscarriage. METHODS: Participants (n = 4539) were women ages 18 to 45 enrolled in Right From the Start, a community-based pregnancy study (2000-2008). Bleeding information included timing, heaviness, duration, color, and associated pain. Life table analyses were used to describe gestational timing of bleeding. Factors associated with bleeding were investigated by the use of multiple logistic regression with multiple imputation for missing data. RESULTS: Approximately one fourth of participants (n = 1207) reported bleeding (n = 1656 episodes), but only 8% of women with bleeding reported heavy bleeding. Of the spotting and light bleeding episodes (n = 1555), 28% were associated with pain. Among heavy episodes (n = 100), 54% were associated with pain. Most episodes lasted less than 3 days, and most occurred between gestational weeks 5 to 8. Twelve percent of women with bleeding and 13% of those without experienced miscarriage. Maternal characteristics associated with bleeding included fibroids and prior miscarriage. CONCLUSIONS: Consistent with the hypothesis that bleeding is a marker for placental dysfunction, bleeding is most likely to be observed around the time of the luteal-placental shift. Published by Elsevier Inc.
6. Wang Y, Hai T, Liu Z, Zhou S, Lv Z, Ding C, Liu L, Niu
Y, Zhao X, Tong M, Wang L, Jouneau A, Zhang X, Ji W, Zhou Q
HSPC117 deficiency in cloned embryos causes placental abnormality
and fetal death
Biochem Biophys Res Commun. 2010 Jul 2;397(3):407-12. Epub
2010 May 26
Department of Reproduction and Development, Kunming Institute of Zoology & Kunming Primate Research Center, Chinese Academy of Sciences, Kunming 650223, China.
Somatic cell nuclear transfer (SCNT) has been successfully used in many species to produce live cloned offspring, albeit with low efficiency. The low frequency of successful development has usually been ascribed to incomplete or inappropriate reprogramming of the transferred nuclear genome. Elucidating the genetic differences between normal fertilized and cloned embryos is key to understand the low efficiency of SCNT. Here, we show that expression of HSPC117, which encodes a hypothetical protein of unknown function, was absent or very low in cloned mouse blastocysts. To investigate the role of HSPC117 in embryo development, we knocked-down this gene in normal fertilized embryos using RNA interference. We assessed the post-implantation survival of HSPC117 knock-down embryos at 3 stages: E9 (prior to placenta formation); E12 (after the placenta was fully functional) and E19 (post-natal). Our results show that, although siRNA-treated in vivo fertilized/produced (IVP) embryos could develop to the blastocyst stage and implanted without any difference from control embryos, the knock-down embryos showed substantial fetal death, accompanied by placental blood clotting, at E12. Furthermore, comparison of HSPC117 expression in placentas of nuclear transfer (NT), intracytoplasmic sperm injection (ICSI) and IVP embryos confirmed that HSPC117 deficiency correlates well with failures in embryo development: all NT embryos with a fetus, as well as IVP and ICSI embryos, had normal placental HSPC117 expression while those NT embryos showing reduced or no expression of HSPC117 failed to form a fetus. In conclusion, we show that HSPC117 is an important gene for post-implantation development of embryos, and that HSPC117 deficiency leads to fetal abnormalities after implantation, especially following placental formation. We suggest that defects in HSPC117 expression may be an important contributing factor to loss of cloned NT embryos in vivo. Copyright 2010 Elsevier Inc. All rights reserved.
7. Alanis MC, Goodnight WH, Hill EG, Robinson CJ, Villers
MS, Johnson DD
Maternal super-obesity (body mass index > or = 50) and adverse
pregnancy outcomes
Acta Obstet Gynecol Scand. 2010 Jul;89(7):924-30
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina 29425, USA. alanis@musc.edu
OBJECTIVE: To determine if pregnancy complications are increased in super-obese (a body mass index (BMI) of 50 or more) compared to other, less obese parturients. DESIGN: Cross-sectional study. SETTING AND POPULATION: All 19,700 eligible women, including 425 (2.2%) super-obese women with singleton births between 1996 and 2007 delivering at a tertiary referral center, identified using a perinatal research database. METHODS: Bivariate and trend analyses were used to assess the relation between super-obesity and various pregnancy complications compared to other well-established BMI categories. Adjusted odds ratios (ORs) were calculated using multivariable logistic regression techniques. MAIN OUTCOME MEASURES: Outcomes for adjusted and unadjusted analyses were small-for-gestational age (SGA) birth, large-for-gestational age (LGA) birth, preeclampsia, gestational diabetes mellitus (GDM), fetal death, preterm birth, placental abruption, cesarean delivery, and Apgar scores < 7. RESULTS: Compared to all other obese and non-obese women, super-obese women had the highest rates of preeclampsia, GDM, LGA, and cesarean delivery (all p < 0.05 for trend test). Super-obesity was also associated with a 44% reduction in SGA compared to all other women (OR 0.55, 95% confidence interval (CI) 0.40-0.76) and a 25% reduction compared to other, less obese women (OR 0.75, 95% CI 0.54-1.03). Super-obesity was positively associated with LGA, GDM, preeclampsia, cesarean delivery, and a 5-minute Apgar score < 7 compared to all other women after controlling for important confounders. CONCLUSION: Super-obesity is associated with higher rates of pregnancy complications compared to women of all other BMI classes, including other obese women.
8. Vallgårda S
Why did the stillbirth rate decline in Denmark after 1940?
Popul Stud (Camb). 2010 Jul;64(2):117-30
University of Copenhagen
Stillbirth rates began declining in several industrialized countries simultaneously at the beginning of the 1940s. The reasons for this sudden decline have been discussed ever since. Changes in obstetric care, in risk factors, and in the composition of the population at risk have been suggested. One hypothesis is that it reflects a cohort effect of improved reproductive health status among women born during the first decades of the twentieth century arising from the decline in fertility. Other hypotheses point towards improved antenatal and obstetric care and changes in the prevalence of different risk factors. In this study, all death certificates for the stillborn in Denmark during 1938, 1941, 1945, and 1949 were used to investigate the different hypotheses. As possible contributing factors, the results suggest improvements in relation to the course of the delivery, changed parity distribution, and a cohort effect.
9. Palmirotta R, La Farina F, Ferroni P, Ludovici G, Nigro
C, Savonarola A, Raparelli V, Riondino S, Rampini MR, Guadagni
F, Basili S
TNFA gene promoter polymorphisms and susceptibility to recurrent
pregnancy loss in Italian women
Reprod Sci. 2010 Jul;17(7):659-66. Epub 2010 Apr 12
Department of Laboratory Medicine & Advanced Biotechnologies, IRCCS San Raffaele Pisana, Rome, Italy.
The aim of this study was to investigate the relationship between serum tumor necrosis factor alpha (TNF-alpha) levels and single nucleotide polymorphisms (SNPs) of the TNFA gene promoter (-376G/A, -308G/A, and -238G/A) in 100 Italian Caucasian women with reproductive failure and 100 fertile controls. Molecular analysis of TNFA SNPs showed higher frequencies of -238G allele (P = .028) as well as the presence of a 3-loci haplotype (-376G/-308A/-238G; P = .020) in fertile controls compared to women with reproductive failure. Serum TNF-alpha levels were higher in study women compared to controls ( P = .001). Of interest, the TNFA -376G/-308A/-238G haplotype was an independent predictor of low TNF-alpha levels (P = .021) and miscarriage (P = .023) in multivariate analyses. In conclusion, these findings support the concept of an association of TNFA polymorphisms and recurrent pregnancy loss (RPL). In particular, the TNFA -238GG variant and the TNFA -376G/-308A/-238G haplotype might represent protective factors, probably through reduced TNF-alpha production and/or mediated responses.
10. Nakashima A, Ito M, Shima T, Bac ND, Hidaka T, Saito S
Accumulation of IL-17-positive cells in decidua of inevitable
abortion cases
Am J Reprod Immunol. 2010 Jul 1;64(1):4-11. Epub 2010 Mar 4
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toyama, Toyama, Japan.
PROBLEM: Th17 cells, a new subset of helper T cells, have been focused on as a producer pro-inflammatory cytokines. It is, however, still unknown how Th17 cells affect pregnancy outcome. We investigated the expression of IL-17-producing cells in human spontaneous abortion. METHOD OF STUDY: IL-17 expression was analyzed in decidual tissues among normal pregnancy, missed abortion, and inevitable abortion cases by immunohistochemistry and flow cytometry. RESULTS: IL-17+ cells were accumulated in decidua and were detected in decidual CD4+ T cells and few decidual CD8+ T cells in spontaneous abortion cases. The number of decidual IL-17+ cells in inevitable abortion cases involving active genital bleeding was significantly higher than that in normal pregnancy cases (P < 0.05). On the other hand, there were no significant differences in the numbers of decidual IL-17+ cells between missed abortion cases and normal pregnancy subjects. Furthermore, the number of IL-17+ cells was positively correlated with the number of neutrophils in spontaneous abortion cases. CONCLUSION: IL-17+ cells might be involved in the induction of inflammation in the late stage of abortion, but not in the early stage of abortio
11. Grotegut CA, Moore NL, Reddick KL, Canzoneri BJ, Boyd
BK, Brown HL
Cervicovaginal fistula presenting during miscarriage
Ultrasound Obstet Gynecol. 2010 Jul;36(1):112-4
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA. chad.grotegut@duke.edu
Cervicovaginal fistula is a recognized complication of induced mid-trimester termination of pregnancy, but more recently it has also been recognized as representing a complication of prior cervical cerclage. We report the ultrasound findings of prolapse of the amniotic sac through a cervicovaginal fistula in a woman with prior cervical cerclage. A woman with cervical incompetence and prior failed McDonald cerclage presented for prophylactic Shirodkar cerclage. Before the procedure, transvaginal ultrasonography revealed a live intrauterine pregnancy at 14 weeks' gestation. Upon further ultrasound examination, the amniotic sac appeared to protrude through the posterior wall of the cervix into the vaginal vault. Pelvic examination verified prolapse of the amniotic sac through a cervicovaginal fistula. The patient underwent an uncomplicated dilatation and evacuation. Women with a history of cervical cerclage are at risk for the development of cervicovaginal fistula, the detection of which is important to prevent potential morbidity. Copyright 2010 ISUOG. Published by John Wiley & Sons, Ltd.
12. Heuser C, Manuck T, Hossain S, Silver R, Varner M
Non-anomalous stillbirth by gestational age: trends differ
based on method of epidemiologic calculation
J Matern Fetal Neonatal Med. 2010 Jul;23(7):720-4
Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA. Cara.heuser@utah.edu
OBJECTIVE: The objective of the study is to compare gestational age specific rates, risks and prospective risks of stillbirth. METHODS: A retrospective cohort study of women with a singleton non-anomalous pregnancy was conducted. Definitions were chosen to maintain consistency with previous literature. RESULTS: Rate was highest at 20 weeks, nadired at 41 weeks and rose thereafter. Risk was low earlier in gestation, nadired at 29 weeks and rose with increasing gestational age. Prospective risk was highest at 20 weeks, nadired at 40 weeks and rose at 42 weeks. CONCLUSIONS: Differences in trends of stillbirth are noted depending on the calculation. All of these calculations are useful in clinical practice.
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