NSIDRC Journal Article Alert — August 13, 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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Readers: The NSIDRC Journal Article Alert will not be published on August 20 or August 27. The next issue will be published on September 2.
Miscarriage/Stillbirth/Prenatal Issues
1. Shelley J
Miscarriage and time to next pregnancy
BMJ. 2010 Aug 5;341:c4181. doi: 10.1136/bmj.c4181
School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
2. Love ER, Bhattacharya S, Smith NC, Bhattacharya S
Effect of interpregnancy interval on outcomes of pregnancy
after miscarriage: retrospective analysis of hospital episode
statistics in Scotland
BMJ. 2010 Aug 5;341:c3967. doi: 10.1136/bmj.c3967
University of Aberdeen, Aberdeen.
OBJECTIVE: To determine the optimum interpregnancy interval after miscarriage in a first recorded pregnancy. DESIGN: Population based retrospective cohort study. SETTING: Scottish hospitals between 1981 and 2000. PARTICIPANTS: 30 937 women who had a miscarriage in their first recorded pregnancy and subsequently became pregnant. MAIN OUTCOME MEASURES: The primary end point was miscarriage, live birth, termination, stillbirth, or ectopic pregnancy in the second pregnancy. Secondary outcomes were rates of caesarean section and preterm delivery, low birthweight infants, pre-eclampsia, placenta praevia, placental abruption, and induced labour in the second pregnancy. RESULTS: Compared with women with an interpregnancy interval of 6-12 months, those who conceived again within six months were less likely to have another miscarriage (adjusted odds ratio 0.66, 95% confidence interval 0.57 to 0.77), termination (0.43, 0.33 to 0.57), or ectopic pregnancy (0.48, 0.34 to 0.69). Women with an interpregnancy interval of more than 24 months were more likely to have an ectopic second pregnancy (1.97, 1.42 to 2.72) or termination (2.40, 1.91 to 3.01). Compared with women with an interpregnancy interval of 6-12 months, women who conceived again within six months and went on to have a live birth in the second pregnancy were less likely to have a caesarean section (0.90, 0.83 to 0.98), preterm delivery (0.89, 0.81 to 0.98), or infant of low birth weight (0.84, 0.71 to 0.89) but were more likely to have an induced labour (1.08, 1.02 to 1.23). CONCLUSIONS: Women who conceive within six months of an initial miscarriage have the best reproductive outcomes and lowest complication rates in a subsequent pregnancy.
3. Smyth A, Oliveira GH, Lahr BD, Bailey KR, Norby SM, Garovic
VD
A Systematic Review and Meta-Analysis of Pregnancy Outcomes
in Patients with Systemic Lupus Erythematosus and Lupus Nephritis
Clin J Am Soc Nephrol. 2010 Aug 5. [Epub ahead of print]
National University of Ireland, Galway, Ireland.
BACKGROUND AND OBJECTIVES: Studies of the impact of systemic lupus erythematosus (SLE) and its pregnancy complications have yielded conflicting results. Major limitations of these studies relate to their small numbers of patients and retrospective designs. The aim of this study was to perform a systematic literature review of pregnancy outcomes in women with SLE and a meta-analysis of the association of lupus nephritis with adverse pregnancy outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We searched electronic databases from 1980 to 2009 and reviewed papers with validity criteria. Random-effects analytical methods were used to evaluate pregnancy complications rates. RESULTS: Thirty-seven studies with 1842 patients and 2751 pregnancies were included. Maternal complications included lupus flare (25.6%), hypertension (16.3%), nephritis (16.1%), pre-eclampsia (7.6%), and eclampsia (0.8%). The induced abortion rate was 5.9%, and when excluded, fetal complications included spontaneous abortion (16.0%), stillbirth (3.6%), neonatal deaths (2.5%), and intrauterine growth retardation (12.7%). The unsuccessful pregnancy rate was 23.4%, and the premature birth rate was 39.4%. Meta-regression analysis showed statistically significant positive associations between premature birth rate and active nephritis and increased hypertension rates in subjects with active nephritis or a history of nephritis. History of nephritis was also associated with pre-eclampsia. Anti-phospholipid antibodies were associated with hypertension, premature birth, and an increased rate of induced abortion. CONCLUSIONS: In patients with SLE, both lupus nephritis and anti-phospholipid antibodies increase the risks for maternal hypertension and premature births. The presented evidence further supports timing of pregnancy relative to SLE activity and multispecialty care of these patients.
4. Skupski DW, Luks FI, Walker M, Papanna R, Bebbington M,
Ryan G, O'Shaughnessy R, Moldenhauer J, Bahtiyar O; North American
Fetal Therapy Network (NAFTNet)
Preoperative predictors of death in twin-to-twin transfusion
syndrome treated with laser ablation of placental anastomoses
Am J Obstet Gynecol. 2010 Aug 5. [Epub ahead of print]
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell College of Medicine, New York, NY.
OBJECTIVE: To determine preoperative predictive factors for donor and recipient death after laser ablation of placental vessels in twin-to-twin transfusion syndrome. STUDY DESIGN: Retrospective analysis of North American Fetal Therapy Network center laser procedures, 2002-2009. Factors associated with donor and recipient death were identified by regression analysis. RESULTS: There were 466 patients from 8 centers. Factors significantly associated with donor fetal death were low donor estimated fetal weight (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.55-0.87) and reversed end diastolic velocity in the umbilical artery (OR, 4.0; 95% CI, 1.54-10.2); for recipient fetal death-low recipient estimated fetal weight (OR, 0.65; 95% CI, 0.44-0.95), recipient reversed "a" wave in the ductus venosus (OR, 2.39; 95% CI, 1.27-4.51) and hydrops (OR, 3.7; 95% CI, 1.1-12.7); for recipient neonatal death-low donor estimated fetal weight (OR, 0.54; 95% CI, 0.30-0.95), high recipient estimated fetal weight (OR, 1.55; 95% CI, 1.06-2.26) and recipient reversed end diastolic velocity in the umbilical artery (OR, 7.8; 95% CI, 1.03-59.3). CONCLUSION: Preoperative findings predict fetal and neonatal demise in twin-to-twin transfusion syndrome treated with laser therapy. Copyright © 2010 Mosby, Inc. All rights reserved.
Prepared by the
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Loss Resource Center
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