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Abstract
BACKGROUND Although diabetic ketoacidosis (DKA) in pregnancy can result in significant adverse consequences for both mother and fetus, the response to treatment, time course of recovery, and perinatal outcomes have not been well studied in pregnancy. OBJECTIVE We examined the precipitating factors, laboratory abnormalities, treatment strategies, and clinical recovery in pregnancies complicated by DKA. STUDY DESIGN This is a retrospective cohort study of pregnancies complicated by DKA between October 1999 and June 2015. The diagnosis was verified by hyperglycemia; anion gap >12 mEq/L, pH <7.3, HCO3 <15 mEq/L; and the presence of ketones. Each episode of DKA was reviewed and subsequent perinatal outcomes analyzed. RESULTS During this period, we identified 33 women with 40 admissions (incidence: 0.2%). The majority of women had type 1 diabetes (67%), and almost all presented with nausea and vomiting (97%). Over half had poor compliance with prescribed insulin. The initial mean blood glucose was 380 mg/dL, within 6 hours, it was <200 mg/dL. By 12 hours, the acidosis had resolved in 90% of patients. CONCLUSION Nausea and vomiting is a prominent presenting feature of DKA in pregnancy. With aggressive insulin and resuscitation, hyperglycemia and acidosis improve rapidly. With current treatment, good perinatal outcomes can be expected.
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Abstract
Most IVF-conceived children are healthy, but IVF has also been associated with adverse obstetric and perinatal outcomes as well as congenital anomalies. There is also literature suggesting an association between IVF and neurodevelopmental disorders as well as potentially long-term metabolic outcomes. The main driver for adverse outcomes is the higher risk of multiple gestations in IVF, but as the field moves toward single embryo transfer, the rate of multiple gestations is decreasing. Studies have shown that singleton IVF pregnancies still have a higher incidence of adverse outcomes compared to unassisted singleton pregnancies. Infertility itself may be an independent risk factor. Animal models suggest that epigenetic changes in genes involved in growth and development are altered in IVF during the hormonal stimulation and embryo culture. Further animal research and prospective human data are needed to elucidate the mechanisms by which IVF may contribute to adverse outcomes and to decrease risks.
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Affiliation(s)
- Chantae S Sullivan-Pyke
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 810, Philadelphia, PA 19104
| | - Suneeta Senapati
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 810, Philadelphia, PA 19104.
| | - Monica A Mainigi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 810, Philadelphia, PA 19104
| | - Kurt T Barnhart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 810, Philadelphia, PA 19104
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Andersen SL, Lönn S, Vestergaard P, Törring O. Birth defects after use of antithyroid drugs in early pregnancy: a Swedish nationwide study. Eur J Endocrinol 2017; 177:369-378. [PMID: 28780518 DOI: 10.1530/eje-17-0314] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/02/2017] [Accepted: 07/31/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Antithyroid drugs (ATDs) may have teratogenic effects, but more evidence is needed on the risk and types of birth defects after the use of methimazole (MMI) and propylthiouracil (PTU). This study aimed to evaluate the association between the use of ATDs in early pregnancy and birth defects. DESIGN Swedish nationwide register-based cohort study. METHODS The study included 684 340 children live-born in Sweden from 2006 to 2012. Exposure groups defined by maternal ATD use in early pregnancy were MMI (n = 162); PTU (n = 218); MMI and PTU (n = 66); ATD before or after, but not in pregnancy (n = 1551) and non-exposed (never ATD (n = 682 343)). Outcome was cumulative incidence of birth defects diagnosed before two years of age. RESULTS The cumulative incidence of birth defects was not significantly different in children exposed to MMI (6.8%, P = 0.6) or PTU (6.4%, P = 0.4) vs non-exposed (8.0%). For subtypes of birth defects, MMI was associated with an increased incidence of septal heart defects (P = 0.02). PTU was associated with ear (P = 0.005) and obstructive urinary system malformations (P = 0.006). A case of choanal atresia was observed after exposure to both MMI and PTU. The incidence of birth defects in children born to mothers who received ATD before or after, but not in pregnancy, was 8.8% and not significantly different from non-exposed (P = 0.3), MMI exposed (P = 0.4) or PTU exposed (P = 0.2). CONCLUSIONS MMI and PTU were associated with subtypes of birth defects previously reported, but the frequency of ATD exposure in early pregnancy was low and severe malformations described in the MMI embryopathy were rarely observed.
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Affiliation(s)
- Stine Linding Andersen
- Departments of Endocrinology
- Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Stefan Lönn
- Department of Research and Development, Region Halland, Halmstad, Sweden
| | - Peter Vestergaard
- Departments of Endocrinology
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ove Törring
- Department of Clinical Research and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Division of Endocrinology, Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
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Ma CM, Lin LH, Chang HY, Chou PC, Liao PC, Chen HY, Man KM, Chiang JH, Chang YJ, Tsai MY, Chen WC, Chen YH. Association of congenital anomalies with fracture of spine, trunk, and upper and lower limbs among young people: A population-based matched cohort study in Taiwan. Medicine (Baltimore) 2017; 96:e7980. [PMID: 28885353 PMCID: PMC6392606 DOI: 10.1097/md.0000000000007980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
According to the Traditional Chinese Medicine (TCM) theory, congenital anomalies are caused by kidney malfunctions, which decreased the bone quality, and may eventually result in bone fractures. This retrospective cohort study investigated the relationship between congenital anomalies and fracture of spine, trunk, and upper and lower limbs in young people. We utilized data from the National Health Insurance Research Database of Taiwan. This study included patients with congenital anomalies (International Classification of Diseases/ICD-9 code: 740-759) and a comparison group of patients without congenital anomalies. Cases evaluated were fracture of spine and trunk (ICD-9 codes: 805-809), fracture of upper limbs (ICD-9 codes: 810-819), and fracture of lower limbs (ICD-9 codes: 820-829). Our study shows that in comparison to the control group, patients with congenital anomalies are 1.11 times more likely to develop fractures. This is the first documented research study that supports the TCM theory that "the Kidney governs the bones, and healthy bones give the body stabilization and prevent fracture."
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Affiliation(s)
- Chia-Man Ma
- Department of Dermatology, Department of Urology, Taichung Veterans General Hospital, Taichung
| | - Lih-Hwa Lin
- Division of Chinese Medicine, An Nan Hospital, China Medical University, Tainan
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, Research Center for Chinese Medicine & Acupuncture, College of Medicine, China Medical University, Taichung
| | - Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli
| | - Pei-Chi Chou
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, Research Center for Chinese Medicine & Acupuncture, College of Medicine, China Medical University, Taichung
- Departments of Chinese Medicine, Obstetrics and Gynecology, Anesthesiology, Urology, and Medical Research, Management Office for Health Data, China Medical University Hospital, Taichung
| | - Po-Chi Liao
- Department of Dermatology, Department of Urology, Taichung Veterans General Hospital, Taichung
| | - Huey-Yi Chen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, Research Center for Chinese Medicine & Acupuncture, College of Medicine, China Medical University, Taichung
- Departments of Chinese Medicine, Obstetrics and Gynecology, Anesthesiology, Urology, and Medical Research, Management Office for Health Data, China Medical University Hospital, Taichung
| | - Kee-Ming Man
- Departments of Chinese Medicine, Obstetrics and Gynecology, Anesthesiology, Urology, and Medical Research, Management Office for Health Data, China Medical University Hospital, Taichung
- Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Changhua
| | - Jen-Huai Chiang
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, Research Center for Chinese Medicine & Acupuncture, College of Medicine, China Medical University, Taichung
- Departments of Chinese Medicine, Obstetrics and Gynecology, Anesthesiology, Urology, and Medical Research, Management Office for Health Data, China Medical University Hospital, Taichung
| | - Yin-Jen Chang
- Departments of Chinese Medicine, Obstetrics and Gynecology, Anesthesiology, Urology, and Medical Research, Management Office for Health Data, China Medical University Hospital, Taichung
| | - Ming-Yen Tsai
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, Research Center for Chinese Medicine & Acupuncture, College of Medicine, China Medical University, Taichung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Wen-Chi Chen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, Research Center for Chinese Medicine & Acupuncture, College of Medicine, China Medical University, Taichung
- Departments of Chinese Medicine, Obstetrics and Gynecology, Anesthesiology, Urology, and Medical Research, Management Office for Health Data, China Medical University Hospital, Taichung
| | - Yung-Hsiang Chen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, Research Center for Chinese Medicine & Acupuncture, College of Medicine, China Medical University, Taichung
- Departments of Chinese Medicine, Obstetrics and Gynecology, Anesthesiology, Urology, and Medical Research, Management Office for Health Data, China Medical University Hospital, Taichung
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung , Taiwan
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Parnell AS, Correa A, Reece EA. Pre-pregnancy Obesity as a Modifier of Gestational Diabetes and Birth Defects Associations: A Systematic Review. Matern Child Health J 2017; 21:1105-1120. [PMID: 28120287 DOI: 10.1007/s10995-016-2209-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Inconsistent findings of associations between gestational diabetes mellitus (GDM) and birth defects suggest unaccounted confounders may underlie the actual basis for such associations. We conducted a systematic review to assess observed associations between GDM and birth defects and the extent to which these could be explained by pre-pregnancy obesity. Methods Using a combination of search terms for GDM and birth defects, we searched PubMed, Scopus, CINAHL, and ClinicalTrials.gov for human-based studies published through September 2013. Studies were eligible for inclusion if they included information on maternal diabetes status, method of diagnosis of GDM, and assessment of birth defects. Twenty-four of 768 potential articles were included. We collected information on study design, location and period, method of determination of diabetes status, types of birth defects, and measures of association reported. Results There was no evidence for consistent association of GDM with birth defects, with the exception of a weak association between GDM and congenital heart defects. When stratified by maternal pre-pregnancy BMI, an association between GDM and congenital heart defects and between GDM and neural tube defects was evident only in women with both GDM and pre-pregnancy obesity. Conclusions for Practice Our findings suggest reported associations between GDM and birth defects may be due, in part, to undiagnosed metabolic disorders associated with obesity, such as pregestational diabetes mellitus, rather than GDM. These findings highlight the need for increased efforts for pre-pregnancy screening for undiagnosed diabetes and awareness of the importance of weight management among women of childbearing age with obesity.
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Affiliation(s)
- Aimee S Parnell
- Department of Pediatrics, University of Mississippi School of Medicine, 2500 North State Street, Jackson, MS, 39216, USA.
- Children's of Mississippi, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Adolfo Correa
- Department of Pediatrics, University of Mississippi School of Medicine, 2500 North State Street, Jackson, MS, 39216, USA
- Department of Medicine, University of Mississippi School of Medicine, 2500 North State Street, Jackson, MS, 39216, USA
| | - E Albert Reece
- University of Maryland School of Medicine, 655 W. Baltimore Street, Room 14-029, Baltimore, MD, 21201-1559, USA
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Hall NB, Broussard K, Evert N, Canfield M. Notes from the Field: Zika Virus-Associated Neonatal Birth Defects Surveillance - Texas, January 2016-July 2017. MMWR Morb Mortal Wkly Rep 2017; 66:835-836. [PMID: 28796762 PMCID: PMC5687783 DOI: 10.15585/mmwr.mm6631a5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
On November 28, 2016, the Texas Department of State Health Services (Texas DSHS) reported its first confirmed case of local mosquitoborne Zika virus transmission in the city of Brownsville, located in south Texas along the U.S.-Mexico border. Zika virus infection during pregnancy has been linked to adverse congenital outcomes including microcephaly, neural tube defects, early brain malformations, structural eye abnormalities, congenital deafness, and limb contractures (1). On January 1, 2016, Texas DSHS established enhanced surveillance to identify women with laboratory evidence of possible Zika virus infection during pregnancy and suspected cases of Zika virus-associated birth defects among completed pregnancies.
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Murcia Pascual FJ, Delgado Cotán L, Jiménez Crespo V, Vázquez Rueda F, Rodríguez Cano E, Miño Mora M, Paredes Esteban RM. [Correlation between prenatal ultrasound and postnatal diagnosis of birth defects]. Cir Pediatr 2017; 30:126-130. [PMID: 29043688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess the accuracy of prenatal ultrasound diagnosis and to analyze the protocol applied for congenital defects (CD) in our environment. METHODS Descriptive study of prenatally diagnosed CD in our area between 2004-2013. Includes: total births, fetal medicine referrals (number of consultations, ultrasound, invasive techniques) anatomical and chromosomal abnormalities, confirmed diagnoses, necropsies performed, false diagnoses, absence of prenatal diagnoses, and number and reasons for abortions (VIEs). RESULTS Mean annual births were 3,646 ± 1,299, with a mean prenatal ultrasound of 2,144 ± 307 and 512 ± 74 invasive techniques per year. The annual average of prenatal chromosomopathies diagnosed were 26 ± 8 and 140 ± 14 anatomical abnormalities, which represents a 36.44% from all of the prenatal ultrasound performed. These include: neurological, cardiac and nephron-urological anatomic anomalies. Pre and post-natal correlation was observed in 95.6% of the DCs detected. Most common causes of abortion were chromosomal abnormalities, heart and neurological diseases. CONCLUSIONS Due to the variety of CD that cause VIEs, a highly specialized multidisciplinary approach is recommended to ensure optimal information for parents.
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Affiliation(s)
- F J Murcia Pascual
- Unidad de Gestión Clínica de Cirugía Pediátrica. Hospital Universitario Reina Sofía. Córdoba
| | - L Delgado Cotán
- Unidad de Gestión Clínica de Cirugía Pediátrica. Hospital Universitario Reina Sofía. Córdoba
| | - V Jiménez Crespo
- Unidad de Gestión Clínica de Cirugía Pediátrica. Hospital Universitario Reina Sofía. Córdoba
| | - F Vázquez Rueda
- SUnidad de Gestión Clínica de Cirugía Pediátrica. Hospital Universitario Reina Sofía. Córdoba
| | - E Rodríguez Cano
- Unidad de Gestión Clínica de Cirugía Pediátrica. Hospital Universitario Reina Sofía. Córdoba
| | - M Miño Mora
- Unidad de Gestión Clínica de Cirugía Pediátrica. Hospital Universitario Reina Sofía. Córdoba
| | - R M Paredes Esteban
- Unidad de Gestión Clínica de Cirugía Pediátrica. Hospital Universitario Reina Sofía. Córdoba
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Williams LS, Demir Eksi D, Shen Y, Lossie AC, Chorich LP, Sullivan ME, Phillips JA, Erman M, Kim HG, Alper OM, Layman LC. Genetic analysis of Mayer-Rokitansky-Kuster-Hauser syndrome in a large cohort of families. Fertil Steril 2017; 108:145-151.e2. [PMID: 28600106 PMCID: PMC5770980 DOI: 10.1016/j.fertnstert.2017.05.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To study the genetic cause of Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH). Although a few candidate genes and genomic domains for have been reported for MRKH, the genetic underpinnings remain largely unknown. Some of the top candidate genes are WNT4, HNF1B, and LHX1. The goals of this study were to: 1) determine the prevalence of WNT4, HNF1B, and LHX1 point mutations, as well as new copy number variants (CNVs) in people with MRKH; and 2) identify and characterize MRKH cohorts. DESIGN Laboratory- and community-based study. SETTING Academic medical centers. PATIENT(S) A total of 147 MRKH probands and available family members. INTERVENTIONS(S) DNA sequencing of WNT4, HNF1B, and LHX1 in 100 MRKH patients, chromosomal microarray analysis in 31 North American MRKH patients, and characterization and sample collection of 147 North American and Turkish MRKH probands and their families. MAIN OUTCOME MEASURE(S) DNA sequence variants and CNVs; pedigree structural analysis. RESULT(S) We report finding CNVs in 6/31 people (∼19%) with MRKH, but no point mutations or small indels in WNT4, HNF1B, or LHX1 in 100 MRKH patients. Our MRKH families included 43 quads, 26 trios, and 30 duos. Of our MRKH probands, 87/147 (59%) had MRKH type 1 and 60/147 (41%) had type 2 with additional anomalies. CONCLUSION(S) Although the prevalence of WNT4, HNF1B, and LHX1 point mutations is low in people with MRKH, the prevalence of CNVs was ∼19%. Further analysis of our large familial cohort of patients will facilitate gene discovery to better understand the complex etiology of MRKH.
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Affiliation(s)
- Lacey S Williams
- Section of Reproductive Endocrinology, Infertility, and Genetics, Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Durkadin Demir Eksi
- Department of Medical Biology and Genetics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Yiping Shen
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pathology, Harvard Medical School, Boston, Massachusetts; Guangxi Maternal and Child Health Hospital, Nanning, People's Republic of China; Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Amy C Lossie
- Beautiful You MRKH Foundation, Silver Spring, Maryland
| | - Lynn P Chorich
- Section of Reproductive Endocrinology, Infertility, and Genetics, Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Megan E Sullivan
- Section of Reproductive Endocrinology, Infertility, and Genetics, Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - John A Phillips
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Munire Erman
- Department of Obstetrics and Gynecology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Hyung-Goo Kim
- Section of Reproductive Endocrinology, Infertility, and Genetics, Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Ozgul M Alper
- Department of Medical Biology and Genetics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Lawrence C Layman
- Section of Reproductive Endocrinology, Infertility, and Genetics, Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia; Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia; Department of Physiology, Medical College of Georgia, Augusta University, Augusta, Georgia.
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Pietryga M, Dydowicz P, Toboła K, Napierała M, Miechowicz I, Gąsiorowska A, Brązert M, Florek E. Selected oxidative stress biomarkers in antenatal diagnosis as 11-14 gestational weeks. Free Radic Biol Med 2017; 108:517-523. [PMID: 28428000 DOI: 10.1016/j.freeradbiomed.2017.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/03/2017] [Accepted: 04/16/2017] [Indexed: 10/19/2022]
Abstract
The primary objective in modern obstetrics and prenatal diagnosis is to predict risks of congenital abnormalities. The aim of the research was to assess the correlation between selected oxidative stress biomarkers with the risk of foetal chromosomal aberration evaluated at the first trimester screening. A series of studies show that balanced free radical activity and oxidative homeostasis are essential for proper bodily growth and function. Reactive oxygen species (ROS) may be one of the factors associated with disruption of cell cycle and tissue development, thus leading to developmental abnormalities. That's why it's so important to examine connection between level of oxidative stress and congenital abnormalities. Using ultrasonography examinations between 11-13+6d gestational weeks combined with serum levels of pregnancy associated plasma protein A and human chorionic gonadotropin and spectrophotometric analysis of oxidative stress markers such as glutathione (GSH), S-transferase, S-nitrosothiols (RSNO), trolox equivalent antioxidant capacity (TEAC), protein and nitrites we tried to find correlation between birth defects and oxidative stress status. In conclusion, our analysis suggests that elevated maternal serum levels of protein, S-transferase and TEAC as well as decreased maternal serum levels of GSH and protein correlated with the risk of chromosomal aberrations and congenital developmental defects in a foetus.
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Affiliation(s)
- Marek Pietryga
- Ultrasound and Prenatal Diagnostic Laboratory, Gynaecology and Obstetrics Hospital K. Marcinkowski Poznań University of Medical Sciences, Poland; Department of Obstetrics and Female Health, Chair of Gynaecology, Obstetrics and Gynaecological Oncology, K. Marcinkowski Poznań University of Medical Sciences, Poland.
| | - Piotr Dydowicz
- Ultrasound and Prenatal Diagnostic Laboratory, Gynaecology and Obstetrics Hospital K. Marcinkowski Poznań University of Medical Sciences, Poland; Department of Gynaecology and Obstetrics, Chair of Medical Education, Faculty of Health Sciences, K. Marcinkowski Poznań University of Medical Sciences, Poland.
| | - Kinga Toboła
- Ultrasound and Prenatal Diagnostic Laboratory, Gynaecology and Obstetrics Hospital K. Marcinkowski Poznań University of Medical Sciences, Poland; Department of Obstetrics and Female Health, Chair of Gynaecology, Obstetrics and Gynaecological Oncology, K. Marcinkowski Poznań University of Medical Sciences, Poland.
| | - Marta Napierała
- Laboratory of Environmental Research, Department of Toxicology, K. Marcinkowski Poznań University of Medical Sciences, Poland.
| | - Izabela Miechowicz
- Department of Computer Science and Statistics, K. Marcinkowski Poznań University of Medical Sciences, Poland.
| | - Anna Gąsiorowska
- Gynaecology and Obstetrics Ward, Podhalański Specialist Hospital in Nowy Targ, Poland.
| | - Maciej Brązert
- Department of Reproductive Medicine, Chair of Gynaecology, Obstetrics and Gynaecological Oncology, K. Marcinkowski Poznań University of Medical Sciences, Poland.
| | - Ewa Florek
- Laboratory of Environmental Research, Department of Toxicology, K. Marcinkowski Poznań University of Medical Sciences, Poland.
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Fatema K, Das T, Mannan A, Zaman SM. Frequency, Distribution of Congenital Anomaly and Associated Maternal Risk Factors. Mymensingh Med J 2017; 26:658-666. [PMID: 28919624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study was done to find out the maternal risk factors associated with congenital anomaly. This cross-sectional observational study was carried out in the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital, Dhaka, Bangladesh from January 2011 to December 2011. During this study period 78 patients had pregnancy with congenital anomaly and delivered in the Department of Obstetrics and Gynaecology. Women with ultrasound report of congenitally abnormal fetus irrespective of gestational age were included. Clinical evaluation of neonates was done by experienced neonatologist. The frequency of congenital anomaly was 3.46%. Most of the women belong to age <35 years (97.43%). Congenital anomalies more commonly were seen in the primiparas (64.10%). Most frequent associated risk factor was the history of abortions (35.89%). Maternal infections during antenatal period were also high (15.58%). There were 58 males (74.35%) and 20 females (25.64%). There was positive history of delivery of congenital abnormal babies in 6 cases (7.6%). Mothers of eight cases (10.25%) had history of drug ingestion during pregnancy. Four cases (5.12%) of mothers had hypothyroidism and 6 cases of mothers (7.69%) had diabetes mellitus respectively.
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Affiliation(s)
- K Fatema
- Dr Kaniz Fatema, Assistant Professor, Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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The prevention of congenital and genetic disorders in the Eastern Mediterranean Region. East Mediterr Health J 2017; 23:321-3. [PMID: 30378669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Persson M, Cnattingius S, Villamor E, Söderling J, Pasternak B, Stephansson O, Neovius M. Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons. BMJ 2017; 357:j2563. [PMID: 28615173 PMCID: PMC5470075 DOI: 10.1136/bmj.j2563] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective To estimate the risks of major congenital malformations in the offspring of mothers who are underweight (body mass index (BMI) <18.5), overweight (BMI 25 to <30), or in obesity classes I (BMI 30 to <35), II (35 to <40), or III (≥40) compared with offspring of normal weight mothers (BMI 18.5 to <25) in early pregnancy.Design Population based cohort study.Setting Nationwide Swedish registries.Participants 1 243 957 liveborn singleton infants from 2001 to 2014 in Sweden. Data on maternal and pregnancy characteristics were obtained by individual record linkages.Exposure Maternal BMI at the first prenatal visit.Main outcome measures Offspring with any major congenital malformation, and subgroups of organ specific malformations diagnosed during the first year of life. Risk ratios were estimated using generalised linear models adjusted for maternal factors, sex of offspring, and birth year.Results A total of 43 550 (3.5%) offspring had any major congenital malformation, and the most common subgroup was for congenital heart defects (n=20 074; 1.6%). Compared with offspring of normal weight mothers (risk of malformations 3.4%), the proportions and adjusted risk ratios of any major congenital malformation among the offspring of mothers with higher BMI were: overweight, 3.5% and 1.05 (95% confidence interval 1.02 to 1.07); obesity class I, 3.8% and 1.12 (1.08 to 1.15), obesity class II, 4.2% and 1.23 (1.17 to 1.30), and obesity class III, 4.7% and 1.37 (1.26 to 1.49). The risks of congenital heart defects, malformations of the nervous system, and limb defects also progressively increased with BMI from overweight to obesity class III. The largest organ specific relative risks related to maternal overweight and increasing obesity were observed for malformations of the nervous system. Malformations of the genital and digestive systems were also increased in offspring of obese mothers.Conclusions Risks of any major congenital malformation and several subgroups of organ specific malformations progressively increased with maternal overweight and increasing severity of obesity. For women who are planning pregnancy, efforts should be encouraged to reduce adiposity in those with a BMI above the normal range.
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Affiliation(s)
- Martina Persson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Department of Diabetes and Endocrinology, Sachsska Children's Hospital, Södersjukhuset, Stockholm, Sweden
| | - Sven Cnattingius
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Eduardo Villamor
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Department of Epidemiology, School of Public Health and Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Jonas Söderling
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Björn Pasternak
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Olof Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Martin Neovius
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
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Davies-Tuck ML, Davey MA, Wallace EM. Maternal region of birth and stillbirth in Victoria, Australia 2000-2011: A retrospective cohort study of Victorian perinatal data. PLoS One 2017; 12:e0178727. [PMID: 28586367 PMCID: PMC5460852 DOI: 10.1371/journal.pone.0178727] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/17/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is growing evidence from high-income countries that maternal country of birth is a risk factor for stillbirth. We aimed to examine the association between maternal region of birth and stillbirth between 2000 and 2011 inclusive in Victoria, Australia. METHODS Retrospective population based cohort study of all singleton births at 24 or more weeks gestational age from 2000-2011 in Victoria, Australia. Stillbirths due to termination of pregnancy, babies with congenital anomalies and Indigenous mothers were excluded. Main Outcome Measure: Stillbirth. RESULTS Over the 12-year period there were 685,869 singleton births and 2299 stillbirths, giving an overall stillbirth rate of 3·4 per 1000 births. After adjustment for risk factors, compared to women born in Australia/New Zealand, women born in South Asia (aOR 1.27, 95% CI 1.01-1.53, p = 0.01), were more likely to have a stillbirth whereas women born in South East and East Asia were (aOR 0.60, (95% CI 0.49-0.72, p<0.001) less likely to have a stillbirth. Additionally, the increasing rate of stillbirth as gestation length progressed began to rise earlier and more steeply in the South Asian compared to Australian/New Zealand born women. The following risk factors were also significantly associated with an increased odds of stillbirth in multivariate analyses: maternal age <20 and 35 years and more, nulliparity, low socio-economic status, previous stillbirth, no ultrasound reported in 1st trimester, pre-existing hypertension, antepartum haemorrhage and failure to detect growth restriction antenatally. CONCLUSION Maternal region of birth is an independent risk factor for stillbirth. Improvements in the rate of stillbirth, particularly late pregnancy stillbirth, are likely to be gained in high-income settings where clinical care is informed by maternal region of birth.
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Affiliation(s)
- Miranda L. Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Melbourne, Victoria, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Euan M. Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Melbourne, Victoria, Australia
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215
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Zahed Pasha Y, Vahedi A, Zamani M, Alizadeh-Navaei R, Zahed Pasha E. Prevalence of Birth Defects in Iran: A Systematic Review and Meta-Analysis. Arch Iran Med 2017. [PMID: 28646847 DOI: 0172006/aim.0010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Birth defects are a series of disorders that occur during embryonic life. In Iran, no national situation analysis is available to show the rate of congenital disorders. We aimed to estimate the prevalence of structural birth defects in Iran. METHODS We searched for English studies on PubMed, Scopus and Google Scholar from January 1990 to July 2016. The search for Persian articles was performed in Scientific Information Database and Magiran. Two reviewers assessed the identified articles independently. The relevant studies were selected based on predefined criteria. Data were analyzed using the Comprehensive Meta-Analysis software. Random effect method was used for meta-analysis. RESULTS In total, 42 studies were included. The prevalence of congenital anomalies was as follows: orofacial clefts, 1.4 per 1,000 births (95% confidence interval [CI]: 1.2-1.6); neural tube defects, 3.2 per 1,000 births (95% CI: 2.5-4.3); urogenital anomalies, 3.9 per 1,000 births (95% CI: 1.2-12.9); musculoskeletal malformations, 3.3 per 1,000 births (95% CI: 2.3-4.9); cardiovascular anomalies, 3.3 per 1,000 births (95% CI: 2.2-5.1); Down syndrome, 0.9 per 1,000 births (95% CI: 0.7-1.2); gastrointestinal disorders, 1.4 per 1,000 births (95% CI: 0.9-2.1). CONCLUSION Our results show that urogenital disorders are the most prevalent births defects in Iran, followed by musculoskeletal and cardiovascular malformations.
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Affiliation(s)
- Yadollah Zahed Pasha
- Permanent Member of the Academy of Medical Sciences of Islamic Republic of Iran, Babol University of Medical Sciences, Babol, Iran
| | - Amin Vahedi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Zamani
- 2)Student Research Committee, Babol University of Medical Sciences, Babol, Iran. 3)Cancer Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ermia Zahed Pasha
- Department of Pathology, Rohani Hospital, Babol University of Medical Sciences, Babol, Iran
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216
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Kiroglu AF, Ari M, Bozan N, Parlak M, Cankaya H. Etiological and epidemiological factors in hearing-impaired students in Van, East of Turkey: A case series. J PAK MED ASSOC 2017; 67:951-953. [PMID: 28585603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of the present case series was to investigate the causes of hearing loss in the children studying at a primary School for the deaf in Van Province, Turkey. The present series included 95 children with sensorineural hearing loss. Otoscopic and ophthalmological examinations, pure-tone audiometry, and tympanometry were performed for each patient. Measles IgG, rubella IgG, cytomegalovirus (CMV) IgG, toxoplasma IgG, herpes simplex virus (HSV) Type I (HSV-I) IgG, HSV Type II (HSV-II) IgG, and Mycoplasma pneumonia IgG were evaluated in serum samples. Temporal bone anomalies were analyzed on temporal bone computed tomography (CT). A total of 7 radiologically distinct inner ear malformations were detected in 19 children. Twelve children were detected with various fundus pathologies. The most common cause of hearing loss was family-related factors (52%). In conclusion, the etiological and epidemiological factors were consistent with those reported in the literature.
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Affiliation(s)
| | - Muzaffer Ari
- Department of Otorhinolaryngology, Head and Neck Surgery, Mardin Park Hospital, Mardin, Turkey
| | - Nazim Bozan
- Department of Otorhinolaryngology, Head and Neck Surgery, Van, Turkey
| | - Mehmet Parlak
- Department of Medical Microbiology, Yuzuncu Yil University, Faculty of Medicine, Van, Turkey
| | - Hakan Cankaya
- Department of Otorhinolaryngology, Head and Neck Surgery, Van, Turkey
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217
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Abstract
Objective To assess causation and clinical presentation of major birth defects.Design Population based case cohort.Setting Cases of birth defects in children born 2005-09 to resident women, ascertained through Utah's population based surveillance system. All records underwent clinical re-review.Participants 5504 cases among 270 878 births (prevalence 2.03%), excluding mild isolated conditions (such as muscular ventricular septal defects, distal hypospadias).Main outcome measures The primary outcomes were the proportion of birth defects with a known etiology (chromosomal, genetic, human teratogen, twinning) or unknown etiology, by morphology (isolated, multiple, minors only), and by pathogenesis (sequence, developmental field defect, or known pattern of birth defects).Results Definite cause was assigned in 20.2% (n=1114) of cases: chromosomal or genetic conditions accounted for 94.4% (n=1052), teratogens for 4.1% (n=46, mostly poorly controlled pregestational diabetes), and twinning for 1.4% (n=16, conjoined or acardiac). The 79.8% (n=4390) remaining were classified as unknown etiology; of these 88.2% (n=3874) were isolated birth defects. Family history (similarly affected first degree relative) was documented in 4.8% (n=266). In this cohort, 92.1% (5067/5504) were live born infants (isolated and non-isolated birth defects): 75.3% (4147/5504) were classified as having an isolated birth defect (unknown or known etiology).Conclusions These findings underscore the gaps in our knowledge regarding the causes of birth defects. For the causes that are known, such as smoking or diabetes, assigning causation in individual cases remains challenging. Nevertheless, the ongoing impact of these exposures on fetal development highlights the urgency and benefits of population based preventive interventions. For the causes that are still unknown, better strategies are needed. These can include greater integration of the key elements of etiology, morphology, and pathogenesis into epidemiologic studies; greater collaboration between researchers (such as developmental biologists), clinicians (such as medical geneticists), and epidemiologists; and better ways to objectively measure fetal exposures (beyond maternal self reports) and closer (prenatally) to the critical period of organogenesis.
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Affiliation(s)
- Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, 295 Chipeta Way, Suite 2S010, University of Utah School of Medicine, Salt Lake City, UT, USA,
| | - John C Carey
- Division of Medical Genetics, Department of Pediatrics, 295 Chipeta Way, Suite 2S010, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Janice L B Byrne
- Division of Medical Genetics, Department of Pediatrics, 295 Chipeta Way, Suite 2S010, University of Utah School of Medicine, Salt Lake City, UT, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sergey Krikov
- Division of Medical Genetics, Department of Pediatrics, 295 Chipeta Way, Suite 2S010, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lorenzo D Botto
- Division of Medical Genetics, Department of Pediatrics, 295 Chipeta Way, Suite 2S010, University of Utah School of Medicine, Salt Lake City, UT, USA
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218
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Ovalle A, Fuentes A, Chacón V, Espinoza C, González R, Ramos M, Geraldo J, Osses L, Kakarieka E. [A new fetal death classification system]. Rev Med Chil 2017; 144:1020-1028. [PMID: 27905648 DOI: 10.4067/s0034-98872016000800009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 04/22/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stillbirth is the mayor contributor to perinatal mortality. AIM To report a system for classification of fetal deaths. MATERIAL AND METHODS Retrospective cohort study of 29,916 births with 258 fetal deaths that occurred in a public hospital. Data were obtained from audit reports of stillbirths. The method for classification obstetric condition relevant to the death was applied, based on obstetric and placental pathological findings analyzed exclusively by a single obstetrician and a single pathologist. RESULTS Ninety two percent of obstetric conditions causing fetal death were identified. The most commonly reported were ascending bacterial infection in 26%, congenital anomalies in 19%, arterial hypertension in 12% and placental pathology in 12%. Fetal growth restriction was identified in 50% of stillbirths. Ninety percent were secondary to a primary obstetric condition and 10% had an unexplained cause. Placental abruption as the final cause of fetal death was identified in 60% of cases with arterial hypertension, 43% of cases with placental pathology and 37% of ascending infections. Fetal deaths occurred during pregnancy in 82% of cases and during labor in 17%. Intrapartum asphyxia occurred in 0.8% of stillbirths and presented in term pregnancies. CONCLUSIONS The obstetric condition relevant to the death method for classification of fetal death is effective to identify the originating obstetric cause of stillbirth and reduces the impact of fetal growth restriction and intrapartum asphyxia as the leading causes of death.
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219
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Wang L, Qian Y, Jin F. [Research progress on the safety of offsprings conceived by assisted reproductive technology]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2017; 46:279-284. [PMID: 29039170 PMCID: PMC10396927 DOI: 10.3785/j.issn.1008-9292.2017.06.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Assisted reproductive technology (ART) employs superovulation, in vitro culture and other micromanipulation to complete oocyte maturation, fertilization and early embryo development. Although these techniques have been successfully applied to solve infertility problems, the process may interfere in cell proliferation, differentiation and growth. The clinical and laboratory studies on the safety issue of ART are reviewed in this article. Studies found that the incidence of birth defects increased in ART offspring. Superovulation, in vitro culture and intracytoplasmic sperm injection may induce epigenetic aberrations during embryo development, which would influence the development of ART conceived children. The epigenetic susceptibility related to ART might be transmitted to subsequent generations, and the potential impact on ART offspring still need further investigation. In addition, ART treatments may also increase the risk of genetic diseases.
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Affiliation(s)
- Liya Wang
- Department of Reproductive Genetics, Women's Hospital, Zhejiang University School of Medicine, Key Laboratory of Reproductive Genetics, Ministry of Education, Hangzhou 310006, China
| | - Yeqing Qian
- Department of Reproductive Genetics, Women's Hospital, Zhejiang University School of Medicine, Key Laboratory of Reproductive Genetics, Ministry of Education, Hangzhou 310006, China
| | - Fan Jin
- Department of Reproductive Genetics, Women's Hospital, Zhejiang University School of Medicine, Key Laboratory of Reproductive Genetics, Ministry of Education, Hangzhou 310006, China.
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220
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Bai R, Wang L, Zhang Q, Dang S, Mi B, Yan H. [Spatial distribution and clustering in birth defects from 2010 to 2013 in Shaanxi Province]. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2017; 42:451-456. [PMID: 28490705 DOI: 10.11817/j.issn.1672-7347.2017.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
To explore the spatial distribution and clustering in birth defects from 2010 to 2013 in Shaanxi Province.
Methods: Spatial distribution was used to describe the birth defects, while ordinary Kriging method was used to predict the status of birth defects in Shaanxi province. The spatial characteristics for the birth defects at the county/district level were analyzed by spatial autocorrelation.
Results: The overall incidence of birth defects was 219.196/10 000; Birth defect did not appear to be a random distribution but show a significant spatial aggregation. Spatial interpolation predicted the geographic distribution for occurrence of birth defects in Shaanxi Province. Local autocorrelation analysis showed nine "hot spot areas" for birth defects, such as Qian County, Liquan County, Yongshou County, Bin County, Fufeng County, Jingyang County, Chunhua County, Wugong County and Xingping City, and seven "cold spot areas" including Jia County, Yuyang District, Mizhi County, Suide County, Wubu County, Qingjian County and Zizhou District.
Conclusion: There are spatial clustering in birth defects from 2010 to 2013 in Shaanxi Province. Spatial interpolation and spatial autocorrelation can be used to predict the spatial features of birth defects in the whole province and provide evidence for the further intervention.
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Affiliation(s)
- Ruhai Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Health Science Center of Xi'an Jiaotong University, Xi'an 710061, China
| | - Lingling Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Health Science Center of Xi'an Jiaotong University, Xi'an 710061, China
| | - Qi Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Health Science Center of Xi'an Jiaotong University, Xi'an 710061, China
| | - Shaonong Dang
- Department of Epidemiology and Biostatistics, School of Public Health, Health Science Center of Xi'an Jiaotong University, Xi'an 710061, China
| | - Baibing Mi
- Department of Epidemiology and Biostatistics, School of Public Health, Health Science Center of Xi'an Jiaotong University, Xi'an 710061, China
| | - Hong Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Health Science Center of Xi'an Jiaotong University, Xi'an 710061, China
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Reynolds MR, Jones AM, Petersen EE, Lee EH, Rice ME, Bingham A, Ellington SR, Evert N, Reagan-Steiner S, Oduyebo T, Brown CM, Martin S, Ahmad N, Bhatnagar J, Macdonald J, Gould C, Fine AD, Polen KD, Lake-Burger H, Hillard CL, Hall N, Yazdy MM, Slaughter K, Sommer JN, Adamski A, Raycraft M, Fleck-Derderian S, Gupta J, Newsome K, Baez-Santiago M, Slavinski S, White JL, Moore CA, Shapiro-Mendoza CK, Petersen L, Boyle C, Jamieson DJ, Meaney-Delman D, Honein MA. Vital Signs: Update on Zika Virus-Associated Birth Defects and Evaluation of All U.S. Infants with Congenital Zika Virus Exposure - U.S. Zika Pregnancy Registry, 2016. MMWR Morb Mortal Wkly Rep 2017; 66:366-373. [PMID: 28384133 PMCID: PMC5657905 DOI: 10.15585/mmwr.mm6613e1] [Citation(s) in RCA: 203] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background In collaboration with state, tribal, local, and territorial health departments, CDC established the U.S. Zika Pregnancy Registry (USZPR) in early 2016 to monitor pregnant women with laboratory evidence of possible recent Zika virus infection and their infants. Methods This report includes an analysis of completed pregnancies (which include live births and pregnancy losses, regardless of gestational age) in the 50 U.S. states and the District of Columbia (DC) with laboratory evidence of possible recent Zika virus infection reported to the USZPR from January 15 to December 27, 2016. Birth defects potentially associated with Zika virus infection during pregnancy include brain abnormalities and/or microcephaly, eye abnormalities, other consequences of central nervous system dysfunction, and neural tube defects and other early brain malformations. Results During the analysis period, 1,297 pregnant women in 44 states were reported to the USZPR. Zika virus–associated birth defects were reported for 51 (5%) of the 972 fetuses/infants from completed pregnancies with laboratory evidence of possible recent Zika virus infection (95% confidence interval [CI] = 4%–7%); the proportion was higher when restricted to pregnancies with laboratory-confirmed Zika virus infection (24/250 completed pregnancies [10%, 95% CI = 7%–14%]). Birth defects were reported in 15% (95% CI = 8%–26%) of fetuses/infants of completed pregnancies with confirmed Zika virus infection in the first trimester. Among 895 liveborn infants from pregnancies with possible recent Zika virus infection, postnatal neuroimaging was reported for 221 (25%), and Zika virus testing of at least one infant specimen was reported for 585 (65%). Conclusions and Implications for Public Health Practice These findings highlight why pregnant women should avoid Zika virus exposure. Because the full clinical spectrum of congenital Zika virus infection is not yet known, all infants born to women with laboratory evidence of possible recent Zika virus infection during pregnancy should receive postnatal neuroimaging and Zika virus testing in addition to a comprehensive newborn physical exam and hearing screen. Identification and follow-up care of infants born to women with laboratory evidence of possible recent Zika virus infection during pregnancy and infants with possible congenital Zika virus infection can ensure that appropriate clinical services are available.
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Scala C, Familiari A, Pinas A, Papageorghiou AT, Bhide A, Thilaganathan B, Khalil A. Perinatal and long-term outcomes in fetuses diagnosed with isolated unilateral ventriculomegaly: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2017; 49:450-459. [PMID: 27091707 DOI: 10.1002/uog.15943] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/12/2016] [Accepted: 04/14/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The majority of studies on fetal ventriculomegaly have focused on the perinatal and long-term outcomes in fetuses with an antenatal diagnosis of bilateral ventriculomegaly. The aim of this study was to undertake a systematic review and meta-analysis to quantify the perinatal and long-term outcomes in fetuses diagnosed in the second or third trimester of pregnancy with isolated unilateral ventriculomegaly. METHODS MEDLINE, EMBASE and The Cochrane Library were searched electronically. Outcomes investigated included incidence of aneuploidy, congenital infection, progression of ventriculomegaly, associated brain and extracerebral abnormalities in the apparently isolated cases and neurodevelopmental delay in both apparently and truly isolated cases. Sensitivity analysis was performed according to whether the ventriculomegaly was mild/moderate (atrial width < 15 mm) or severe (atrial width ≥ 15 mm). Reference lists within relevant articles and reviews were hand-searched for additional reports. Cohort and case-control studies were included. Meta-analysis of proportions was used, and between-study heterogeneity was assessed using the I2 test. RESULTS The search yielded 2053 citations. The full text was retrieved for 202, and 11 studies were included in the systematic review. In fetuses with apparently isolated unilateral ventriculomegaly, no chromosomal abnormalities were identified and the pooled prevalence of congenital infection was 8.2% (95% CI, 3.6-14.5%). The pooled prevalence of additional brain abnormalities detected prenatally and postnatally by magnetic resonance imaging was 5.1% (95% CI, 0.2-16.1%) and 6.4% (95% CI, 0.3-19.4%), respectively. The pooled prevalence of abnormal neurodevelopment was 5.9% (95% CI, 2.2-11.2%) in apparently isolated cases with an atrial width of < 15 mm, and it was 7.0% (95% CI, 3.2-12.2%) in fetuses with truly isolated unilateral ventriculomegaly. Most cases with apparently isolated ventriculomegaly were classified as mild/moderate (93.5%) and therefore the outcomes in this group were similar to those in the whole cohort of apparently isolated ventriculomegaly. CONCLUSIONS The prevalence of aneuploidy, congenital infection and neurodevelopmental delay in fetuses with a prenatal diagnosis of isolated unilateral ventriculomegaly is likely to be low. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Scala
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A Familiari
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A Pinas
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A T Papageorghiou
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A Bhide
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - B Thilaganathan
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A Khalil
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
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223
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Abstract
BACKGROUND The quadrivalent human papillomavirus (HPV) vaccine is recommended for all girls and women 9 to 26 years of age. Some women will have inadvertent exposure to vaccination during early pregnancy, but few data exist regarding the safety of the quadrivalent HPV vaccine in this context. METHODS We assessed a cohort that included all the women in Denmark who had a pregnancy ending between October 1, 2006, and November 30, 2013. Using nationwide registers, we linked information on vaccination, adverse pregnancy outcomes, and potential confounders among women in the cohort. Women who had vaccine exposure during the prespecified time windows were matched for propensity score in a 1:4 ratio with women who did not have vaccine exposure during the same time windows. Outcomes included spontaneous abortion, stillbirth, major birth defect, small size for gestational age, low birth weight, and preterm birth. RESULTS In matched analyses, exposure to the quadrivalent HPV vaccine was not associated with significantly higher risks than no exposure for major birth defect (65 cases among 1665 exposed pregnancies and 220 cases among 6660 unexposed pregnancies; prevalence odds ratio, 1.19; 95% confidence interval [CI], 0.90 to 1.58), spontaneous abortion (20 cases among 463 exposed pregnancies and 131 cases among 1852 unexposed pregnancies; hazard ratio, 0.71; 95% CI, 0.45 to 1.14), preterm birth (116 cases among 1774 exposed pregnancies and 407 cases among 7096 unexposed pregnancies; prevalence odds ratio, 1.15; 95% CI, 0.93 to 1.42), low birth weight (76 cases among 1768 exposed pregnancies and 277 cases among 7072 unexposed pregnancies; prevalence odds ratio, 1.10; 95% CI, 0.85 to 1.43), small size for gestational age (171 cases among 1768 exposed pregnancies and 783 cases among 7072 unexposed pregnancies; prevalence odds ratio, 0.86; 95% CI, 0.72 to 1.02), or stillbirth (2 cases among 501 exposed pregnancies and 4 cases among 2004 unexposed pregnancies; hazard ratio, 2.43; 95% CI, 0.45 to 13.21). CONCLUSIONS Quadrivalent HPV vaccination during pregnancy was not associated with a significantly higher risk of adverse pregnancy outcomes than no such exposure. (Funded by the Novo Nordisk Foundation and the Danish Medical Research Council.).
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Affiliation(s)
- Nikolai M Scheller
- From the Department of Epidemiology Research, Statens Serum Institut, Copenhagen (N.M.S., B.P., D.M.-N., H.S., A.H.); and the Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm (B.P.)
| | - Björn Pasternak
- From the Department of Epidemiology Research, Statens Serum Institut, Copenhagen (N.M.S., B.P., D.M.-N., H.S., A.H.); and the Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm (B.P.)
| | - Ditte Mølgaard-Nielsen
- From the Department of Epidemiology Research, Statens Serum Institut, Copenhagen (N.M.S., B.P., D.M.-N., H.S., A.H.); and the Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm (B.P.)
| | - Henrik Svanström
- From the Department of Epidemiology Research, Statens Serum Institut, Copenhagen (N.M.S., B.P., D.M.-N., H.S., A.H.); and the Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm (B.P.)
| | - Anders Hviid
- From the Department of Epidemiology Research, Statens Serum Institut, Copenhagen (N.M.S., B.P., D.M.-N., H.S., A.H.); and the Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm (B.P.)
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Miles M, Dung KTK, Ha LT, Liem NT, Ha K, Hunt RW, Mulholland K, Morgan C, Russell FM. The cause-specific morbidity and mortality, and referral patterns of all neonates admitted to a tertiary referral hospital in the northern provinces of Vietnam over a one year period. PLoS One 2017; 12:e0173407. [PMID: 28282433 PMCID: PMC5345801 DOI: 10.1371/journal.pone.0173407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/19/2017] [Indexed: 12/03/2022] Open
Abstract
Objective To describe the cause-specific morbidity and mortality, and referral patterns of all neonates admitted to a tertiary referral hospital in the northern provinces of Vietnam. Design A prospective hospital based observational study. Setting The Neonatal Department, National Hospital of Pediatrics, Hanoi, Vietnam. Patients All admissions to the Neonatal Department over a 12 month period. Main outcome measures Cause-specific morbidity and mortality; deaths. Results There were 5064 admissions with the commonest discharge diagnoses being infection (32%) and prematurity (29%). The case fatality ratio (CFR) was 13.9% (n = 703). Infection (38%), cardio/respiratory disorders (27%), congenital abnormalities (20%) and neurological conditions (10%) were the main causes of death. Of all the deaths, 38% had an admission weight ≥2500g. Higher CFR were associated with lower admission weights. Very few deaths (3%) occurred in the first 24 hours of life. Most referrals and deaths came from Hanoi and neighbouring provincial hospitals, with few from the most distant provinces. Two distant referral provinces had the highest CFR. Conclusions The CFR was high and few deaths occurred in neonates <24 hours old. The high rates of infection call for an improvement in infection control practices and peripartum antibiotic use at provincial and tertiary level. Understanding provincial hospital capacity and referral pathways is crucial to improving the outcomes at tertiary centres. A quality of care audit tool would enable more targeted interventions and monitoring of health outcomes.
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Affiliation(s)
- Merinda Miles
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | | | - Le Thi Ha
- National Hospital of Pediatrics, Hanoi, Vietnam
| | | | - Khu Ha
- National Hospital of Pediatrics, Hanoi, Vietnam
| | - Rod W. Hunt
- Murdoch Childrens Research Institute, The Royal Children’s Hospital, Melbourne, Australia
- Department of Neonatal Medicine, The Royal Children’s Hospital, Melbourne, Australia
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Kim Mulholland
- Murdoch Childrens Research Institute, The Royal Children’s Hospital, Melbourne, Australia
- Menzies School of Health Research, Darwin, Australia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chris Morgan
- Centre for International Health, Burnet Institute, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Fiona M. Russell
- Murdoch Childrens Research Institute, The Royal Children’s Hospital, Melbourne, Australia
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- * E-mail:
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225
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Santoro M, Minichilli F, Pierini A, Astolfi G, Bisceglia L, Carbone P, Conti S, Dardanoni G, Iavarone I, Ricci P, Scarano G, Bianchi F. Congenital Anomalies in Contaminated Sites: A Multisite Study in Italy. Int J Environ Res Public Health 2017; 14:ijerph14030292. [PMID: 28287452 PMCID: PMC5369128 DOI: 10.3390/ijerph14030292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/08/2017] [Indexed: 11/16/2022]
Abstract
The health impact on populations residing in industrially contaminated sites (CSs) is recognized as a public health concern especially in relation to more vulnerable population subgroups. The aim of this study was to estimate the risk of congenital anomalies (CAs) in Italian CSs. Thirteen CSs covered by regional CA registries were investigated in an ecological study. The observed/expected ratios (O/E) with 90% confidence intervals (CI) for the total and specific subgroups of CAs were calculated using the regional areas as references. For the CSs with waste landfills, petrochemicals, and refineries, pooled estimates were calculated. The total number of observed cases of CAs was 7085 out of 288,184 births (prevalence 245.8 per 10,000). For some CSs, excesses for several CA subgroups were observed, in particular for genital and heart defects. The excess of genital CAs observed in Gela (O/E 2.36; 90% CI 1.73–3.15) is consistent with findings from other studies. For CSs including petrochemical and landfills, the pooled risk estimates were 1.10 (90% CI 1.01–1.19) and 1.07 (90% CI 1.02–1.13), respectively. The results are useful in identifying priority areas for analytical investigations and in supporting the promotion of policies for the primary prevention of CAs. The use of short-latency effect indicators is recommended for the health surveillance of the populations residing in CSs.
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Affiliation(s)
- Michele Santoro
- Institute of Clinical Physiology, National Research Council, Unit of Environmental Epidemiology and Disease Registries, 56124 Pisa, Italy.
| | - Fabrizio Minichilli
- Institute of Clinical Physiology, National Research Council, Unit of Environmental Epidemiology and Disease Registries, 56124 Pisa, Italy.
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council, Unit of Environmental Epidemiology and Disease Registries, 56124 Pisa, Italy.
| | - Gianni Astolfi
- Registro IMER, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche dell'Università di Ferrara, 44100 Ferrara, Italy.
| | - Lucia Bisceglia
- Agenzia Regionale Sanitaria della Puglia, 70100 Bari, Italy.
| | - Pietro Carbone
- National Center for Rare Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy.
| | - Susanna Conti
- Unit of Statistics, Istituto Superiore di Sanità, 00161 Rome, Italy.
| | - Gabriella Dardanoni
- Osservatorio Epidemiologico Regionale, Assessorato Salute Regione Siciliana, 90145 Palermo, Italy.
| | - Ivano Iavarone
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy.
| | - Paolo Ricci
- Epidemiological Unit, NHS Mantua, 46100 Mantua, Italy.
| | - Gioacchino Scarano
- Program Director Birth Defects Registry of Campania, UO Genetica Medica, Azienda Ospedaliera G.Rummo, 82100 Benevento, Italy.
| | - Fabrizio Bianchi
- Institute of Clinical Physiology, National Research Council, Unit of Environmental Epidemiology and Disease Registries, 56124 Pisa, Italy.
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226
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Cragan JD, Mai CT, Petersen EE, Liberman RF, Forestieri NE, Stevens AC, Delaney A, Dawson AL, Ellington SR, Shapiro-Mendoza CK, Dunn JE, Higgins CA, Meyer RE, Williams T, Polen KN, Newsome K, Reynolds M, Isenburg J, Gilboa SM, Meaney-Delman DM, Moore CA, Boyle CA, Honein MA. Baseline Prevalence of Birth Defects Associated with Congenital Zika Virus Infection - Massachusetts, North Carolina, and Atlanta, Georgia, 2013-2014. MMWR Morb Mortal Wkly Rep 2017; 66:219-222. [PMID: 28253231 PMCID: PMC5657891 DOI: 10.15585/mmwr.mm6608a4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Zika virus infection during pregnancy can cause serious brain abnormalities, but the full range of adverse outcomes is unknown (1). To better understand the impact of birth defects resulting from Zika virus infection, the CDC surveillance case definition established in 2016 for birth defects potentially related to Zika virus infection* (2) was retrospectively applied to population-based birth defects surveillance data collected during 2013-2014 in three areas before the introduction of Zika virus (the pre-Zika years) into the World Health Organization's Region of the Americas (Americas) (3). These data, from Massachusetts (2013), North Carolina (2013), and Atlanta, Georgia (2013-2014), included 747 infants and fetuses with one or more of the birth defects meeting the case definition (pre-Zika prevalence = 2.86 per 1,000 live births). Brain abnormalities or microcephaly were the most frequently recorded (1.50 per 1,000), followed by neural tube defects and other early brain malformations† (0.88), eye abnormalities without mention of a brain abnormality (0.31), and other consequences of central nervous system (CNS) dysfunction without mention of brain or eye abnormalities (0.17). During January 15-September 22, 2016, the U.S. Zika Pregnancy Registry (USZPR) reported 26 infants and fetuses with these same defects among 442 completed pregnancies (58.8 per 1,000) born to mothers with laboratory evidence of possible Zika virus infection during pregnancy (2). Although the ascertainment methods differed, this finding was approximately 20 times higher than the proportion of one or more of the same birth defects among pregnancies during the pre-Zika years. These data demonstrate the importance of population-based surveillance for interpreting data about birth defects potentially related to Zika virus infection.
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227
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Castillo-Cadena J, Mejia-Sanchez F, López-Arriaga JA. Congenital malformations according to etiology in newborns from the floricultural zone of Mexico state. Environ Sci Pollut Res Int 2017; 24:7662-7667. [PMID: 28124266 DOI: 10.1007/s11356-017-8429-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/09/2017] [Indexed: 06/06/2023]
Abstract
Birth defects are the number one cause of child mortality worldwide and in 2010 it was the second cause in Mexico. Congenital malformations are a public health issue, because they cause infant mortality, chronic disease and disability. The origin can be genetic, environmental or unknown causes. Among environmental contaminants, pesticides stand out. In this study, we determine the frequency and etiology of congenital malformations in newborns (NBs) of a floricultural community and we compare it with that in the urban community. For 18 months, the NBs were monitored at the Tenancingo General Hospital and the Mother and Child Gynecology and Obstetrics Hospital (IMIEM) in Toluca. The identification of these malformations was carried out in accordance with the WHO. In Tenancingo, 1149 NBs were viewed, where 20% had some kind of congenital malformations. While in the IMIEM, 5069 were reviewed and 6% had some malformation. According to the etiology, in Tenancingo, 69% were multifactorial, 28% were monogenetic and 2% were chromosomal. In the IMIEM, 47% were multifactorial, then 18.3% were monogenetic and 2.8% were chromosomal. There was a significant difference between the global frequency of malformations and the multifactorial etiology of both institutions. Our results show that congenital malformations in the NBs occurred more frequently in the floricultural zone and that because the percentage of multifactorial etiology is higher, it is likely there is an association with exposure to pesticides.
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Affiliation(s)
- Julieta Castillo-Cadena
- Centro de Investigación en Ciencias Médicas, Universidad Autónoma del Estado de México, Jesús Carranza No.205, Col. Universidad, C.P. 50130, Toluca de Lerdo, Mexico.
| | - Fernando Mejia-Sanchez
- Centro de Investigación en Ciencias Médicas, Universidad Autónoma del Estado de México, Jesús Carranza No.205, Col. Universidad, C.P. 50130, Toluca de Lerdo, Mexico
| | - Jerónimo Amado López-Arriaga
- Centro de Investigación en Ciencias Médicas, Universidad Autónoma del Estado de México, Jesús Carranza No.205, Col. Universidad, C.P. 50130, Toluca de Lerdo, Mexico
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228
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Abstract
Every year, approximately 3%-6% of infants worldwide are born with a serious birth defect (1-5). Birth defects can affect an infant regardless of birthplace, race, or ethnicity. In many countries, birth defects are among the leading causes of death for infants and young children (6). Those who survive and live with these conditions are at an increased risk for lifelong disabilities.
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229
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Chong LA, Khalid F, Khoo TB, Teh SH, Kuan GL, Aina Mariana AM, Alias E, Chieng CH, Razali H, Ong GB, Zainah SH, Shukor INC, Wong JJ. Clinical spectrum of children receiving palliative care in Malaysian Hospitals. Med J Malaysia 2017; 72:32-36. [PMID: 28255137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Awareness for paediatric palliative care has resulted in the impetus for paediatrician-led palliative care services across Malaysia. However, there is paucity of local data on patients receiving hospital-based paediatric palliative care. We aim to review the clinical spectrum of patients referred to these services. METHODS An observational study of children aged between 0-18 years receiving palliative care at 13 hospitals between 1st January and 31st December 2014 was carried out. RESULTS There were 315 patients analysed, 90 (28.6%) and 46 (14.6%) were neonates and adolescents respectively. The main ICD-10 diagnostic categories for all patients were identified to be 'Congenital malformations, deformations and chromosomal abnormalities' 117 (37.1%), 'Diseases of nervous system' 76 (24.1%) and 'Neoplasms' 60 (19.0%). At referral 156 (50%) patients had holistic needs assessments. Patients with 'Diseases of nervous system' were assessed to have significantly more physical needs than the other two diagnostic categories. Majority of patients who knew of their diagnosis and prognosis were those with malignancy. Over a fifth of referrals were at their terminal admission. Of 144 who died, 111 (77.1%) had advanced care plans. There was bereavement follow-up in 98 (68.1%) patients. CONCLUSION Patients referred for palliative care have varied diagnoses and needs. To ensure all paediatricians are competent to deliver quality care to all children, further education and training initiatives is imperative.
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Affiliation(s)
- L A Chong
- Hospis Malaysia, Cheras, Kuala Lumpur, Malaysia.
| | - F Khalid
- Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Selangor, Malaysia
| | - T B Khoo
- Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - S H Teh
- Hospital Miri, Miri, Sarawak, Malaysia
| | - G L Kuan
- Malacca Hospital, Malacca, Malaysia
| | | | - E Alias
- Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | | | - H Razali
- Hospital Sultan Ismail, Johor Bahru, Johor, Malaysia
| | - G B Ong
- Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - S H Zainah
- Hospital Sultanah Nora Ismail, Batu Pahat, Johor, Malaysia
| | | | - J J Wong
- Hospital Pakar Sultanah Fatimah, Muar, Johor, Malaysia
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230
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Kasdallah N, Ben Salem H, Kbaier H, Bouguerra C, Blibech S, Douagi M. Premature Birth, low Birth Weight and Birth Defects after assisted reproductive therapies. a 18-year comparative study. Tunis Med 2017; 95:103-108. [PMID: 29424868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND As assisted reproductive therapies (ART) become more common in Tunisia, it was relevant to define the associated perinatal risks. The risk of multiple births and its correlate after ART were well admitted. We aimed to disclose whether ART were associated with increased perinatal risks in singletons and twins from ART comparatively with spontaneous conception. METHODS A retrospective descriptive and comparative study including all newborns conceived by ART and admitted between 1998 and 2015 and spontaneous newborns selected randomly. We compared separately singletons and twins from ART and natural conception for premature birth (PB) and low birth weight (LBW). For birth defects (BD), we compared the two groups condensed. RESULTS We identified 425 ART newborns and 322 controls. The risk of PB was statistically higher, in both ART singletons and twins than in controls. Among singletons, the use of ART was associated with statistically significant increased rates of LBW and VLBW. Among twins, this result was valuable only for VLBW. Newborns conceived with ART had a risk of BD that was three times higher than in controls. BD risk was statistically higher with ICSI (Intra Cytoplasm Sperm Injection), ovulation inductor and in vitro fertilization. BD risks were 2.4 times higher with ICSI than with all others therapies condensed. CONCLUSIONS This study highlighted the increased perinatal risks even in singleton from ART comparatively with natural conception. The exact mechanisms underlying all these risks remain unclear. Further studies are required to prove the part of ART underlying parental factors, and sterility itself.
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231
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Wemaux-Denis C, Garabedian C, Huc A, Cailleret O, Depoortere MH, Hammou Y, Subtil D. [Pregnancy and delivery of teenagers: Is the obstetrical prognosis worst between 13-15years old?]. ACTA ACUST UNITED AC 2017; 45:5-8. [PMID: 28238317 DOI: 10.1016/j.gofs.2016.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/14/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the prognosis of pregnancy and delivery of 13-15years old patients compared to teenagers aged of 16-17. METHODS Single-center retrospective study of a continuous series of 13-15 teenagers followed in a public maternity between 1996 and 2012 compared to a series of patients aged of 16-17 matched on the day of the delivery (two controls for a case). RESULTS Seventy-three teens 13-15 were followed during the study period, and 146 adolescents aged 16-17 were included and matched. The two groups did not differ regarding size, weight or medical history. Younger patients were more often educated than older ones (46.6 vs 27.4%, P<0.01). The incidence of congenital malformations was high but substantially identical in the two groups (9.6 vs 11.0%, NS), as well as prematurity concerned that almost one third of patients (27.4 vs 30.1%, NS). The Caesarean section rate was low (11.0 vs 10.3%, NS). The frequency of birth weight below the 10th percentile did not differ between groups (15.1 vs 19.9%, NS). CONCLUSION Teenage girls of 13-15years old have high perinatal risk (prematurity, congenital malformation), and frequently delivery vaginally. These risks do not seem superior to those of adolescent girls aged of 16-17years old.
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Affiliation(s)
- C Wemaux-Denis
- Département obstétrique et gynécologie, hôpital Jeanne-de-Flandre, pôle Femme-Mère Nouveau-né, université Lille Nord de France, 1, rue Eugène-Avinée, 59037 Lille cedex, France; Service de protection maternelle et infantile, 106, rue Pierre-Legrand, 59000 Lille, France.
| | - C Garabedian
- Département obstétrique et gynécologie, hôpital Jeanne-de-Flandre, pôle Femme-Mère Nouveau-né, université Lille Nord de France, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - A Huc
- Service de protection maternelle et infantile, 106, rue Pierre-Legrand, 59000 Lille, France
| | - O Cailleret
- Service de protection maternelle et infantile hôpital Jeanne-de-Flandre, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - M-H Depoortere
- Département obstétrique et gynécologie, hôpital Jeanne-de-Flandre, pôle Femme-Mère Nouveau-né, université Lille Nord de France, 1, rue Eugène-Avinée, 59037 Lille cedex, France; Service de protection maternelle et infantile hôpital Jeanne-de-Flandre, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - Y Hammou
- Département obstétrique et gynécologie, hôpital Jeanne-de-Flandre, pôle Femme-Mère Nouveau-né, université Lille Nord de France, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - D Subtil
- Département obstétrique et gynécologie, hôpital Jeanne-de-Flandre, pôle Femme-Mère Nouveau-né, université Lille Nord de France, 1, rue Eugène-Avinée, 59037 Lille cedex, France; EA 2694, PRES université Lille Nord de France, 59000 Lille, France
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232
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Bérard A, Zhao JP, Sheehy O. Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort. BMJ Open 2017; 7:e013372. [PMID: 28082367 PMCID: PMC5278249 DOI: 10.1136/bmjopen-2016-013372] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Antidepressant use during gestation has been associated with risk of major congenital malformations but estimates can lack statistical power or be confounded by maternal depression. We aimed to determine the association between first-trimester exposure to antidepressants and the risk of major congenital malformations in a cohort of depressed/anxious women. SETTING AND PARTICIPANTS Data were obtained from the Quebec Pregnancy Cohort (QPC). All pregnancies with a diagnosis of depression or anxiety, or exposed to antidepressants in the 12 months before pregnancy, and ending with a live-born singleton were included. OUTCOME MEASURES Antidepressant classes (selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), tricyclic antidepressants (TCA) and other antidepressants) and types were individually compared with non-exposure during the first trimester (depressed untreated). Major congenital malformations overall and organ-specific malformations in the first year of life were identified. RESULTS 18 487 pregnant women were included. When looking at the specific types of antidepressant used during the first trimester, only citalopram was increasing the risk of major congenital malformations (adjusted OR, (aOR) 1.36, 95% CI 1.08 to 1.73; 88 exposed cases), although there was a trend towards increased risk for the most frequently used antidepressants. Antidepressants with serotonin reuptake inhibition effect (SSRI, SNRI, amitriptyline (the most used TCA)) increased the risk of certain organ-specific defects: paroxetine increased the risk of cardiac defects (aOR 1.45, 95% CI 1.12 to 1.88), and ventricular/atrial septal defects (aOR 1.39, 95% CI 1.00 to 1.93); citalopram increased the risk of musculoskeletal defects (aOR 1.92, 95% CI 1.40 to 2.62), and craniosynostosis (aOR 3.95, 95% CI 2.08 to 7.52); TCA was associated with eye, ear, face and neck defects (aOR 2.45, 95% CI 1.05 to 5.72), and digestive defects (aOR 2.55, 95% CI 1.40 to 4.66); and venlafaxine was associated with respiratory defects (aOR 2.17, 95% CI 1.07 to 4.38). CONCLUSIONS Antidepressants with effects on serotonin reuptake during embryogenesis increased the risk of some organ-specific malformations in a cohort of pregnant women with depression.
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Affiliation(s)
- Anick Bérard
- Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Jin-Ping Zhao
- Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Odile Sheehy
- Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
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Schaefer F, Doyon A, Azukaitis K, Bayazit A, Canpolat N, Duzova A, Niemirska A, Sözeri B, Thurn D, Anarat A, Ranchin B, Litwin M, Caliskan S, Candan C, Baskin E, Yilmaz E, Mir S, Kirchner M, Sander A, Haffner D, Melk A, Wühl E, Shroff R, Querfeld U. Cardiovascular Phenotypes in Children with CKD: The 4C Study. Clin J Am Soc Nephrol 2017; 12:19-28. [PMID: 27827310 PMCID: PMC5220645 DOI: 10.2215/cjn.01090216] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 09/26/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Cardiovascular disease is the most important comorbidity affecting long-term survival in children with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Cardiovascular Comorbidity in Children with CKD Study is a multicenter, prospective, observational study in children ages 6-17 years old with initial GFR of 10-60 ml/min per 1.73 m2. The cardiovascular status is monitored annually, and subclinical cardiovascular disease is assessed by noninvasive measurements of surrogate markers, including the left ventricular mass index, carotid intima-media thickness, and central pulse wave velocity. We here report baseline data at study entry and an explorative analysis of variables associated with surrogate markers. RESULTS A total of 737 patients were screened from October of 2009 to August of 2011 in 55 centers in 12 European countries, and baseline data were analyzed in 688 patients. Sixty-four percent had congenital anomalies of the kidney and urinary tract; 26.1% of children had uncontrolled hypertension (24-hour ambulatory BP monitoring; n=545), and the prevalence increased from 24.4% in CKD stage 3 to 47.4% in CKD stage 5. The prevalence of left ventricular hypertrophy was higher with each CKD stage, from 10.6% in CKD stage 3a to 48% in CKD stage 5. Carotid intima-media thickness was elevated in 41.6%, with only 10.8% of patients displaying measurements below the 50th percentile. Pulse wave velocity was increased in 20.1%. The office systolic BP SD score was the single independent factor significantly associated with all surrogate markers of cardiovascular disease. The intermediate end point score (derived from the number of surrogate marker measurements >95th percentile) was independently associated with a diagnosis of congenital anomalies of the kidney and urinary tract, time since diagnosis of CKD, body mass index, office systolic BP, serum phosphorus, and the hemoglobin level. CONCLUSIONS The baseline data of this large pediatric cohort show that surrogate markers for cardiovascular disease are closely associated with systolic hypertension and stage of CKD.
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Affiliation(s)
- Franz Schaefer
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Honein MA, Dawson AL, Petersen EE, Jones AM, Lee EH, Yazdy MM, Ahmad N, Macdonald J, Evert N, Bingham A, Ellington SR, Shapiro-Mendoza CK, Oduyebo T, Fine AD, Brown CM, Sommer JN, Gupta J, Cavicchia P, Slavinski S, White JL, Owen SM, Petersen LR, Boyle C, Meaney-Delman D, Jamieson DJ. Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy. JAMA 2017; 317:59-68. [PMID: 27960197 DOI: 10.1001/jama.2016.19006] [Citation(s) in RCA: 419] [Impact Index Per Article: 59.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Understanding the risk of birth defects associated with Zika virus infection during pregnancy may help guide communication, prevention, and planning efforts. In the absence of Zika virus, microcephaly occurs in approximately 7 per 10 000 live births. OBJECTIVE To estimate the preliminary proportion of fetuses or infants with birth defects after maternal Zika virus infection by trimester of infection and maternal symptoms. DESIGN, SETTING, AND PARTICIPANTS Completed pregnancies with maternal, fetal, or infant laboratory evidence of possible recent Zika virus infection and outcomes reported in the continental United States and Hawaii from January 15 to September 22, 2016, in the US Zika Pregnancy Registry, a collaboration between the CDC and state and local health departments. EXPOSURES Laboratory evidence of possible recent Zika virus infection in a maternal, placental, fetal, or infant sample. MAIN OUTCOMES AND MEASURES Birth defects potentially Zika associated: brain abnormalities with or without microcephaly, neural tube defects and other early brain malformations, eye abnormalities, and other central nervous system consequences. RESULTS Among 442 completed pregnancies in women (median age, 28 years; range, 15-50 years) with laboratory evidence of possible recent Zika virus infection, birth defects potentially related to Zika virus were identified in 26 (6%; 95% CI, 4%-8%) fetuses or infants. There were 21 infants with birth defects among 395 live births and 5 fetuses with birth defects among 47 pregnancy losses. Birth defects were reported for 16 of 271 (6%; 95% CI, 4%-9%) pregnant asymptomatic women and 10 of 167 (6%; 95% CI, 3%-11%) symptomatic pregnant women. Of the 26 affected fetuses or infants, 4 had microcephaly and no reported neuroimaging, 14 had microcephaly and brain abnormalities, and 4 had brain abnormalities without microcephaly; reported brain abnormalities included intracranial calcifications, corpus callosum abnormalities, abnormal cortical formation, cerebral atrophy, ventriculomegaly, hydrocephaly, and cerebellar abnormalities. Infants with microcephaly (18/442) represent 4% of completed pregnancies. Birth defects were reported in 9 of 85 (11%; 95% CI, 6%-19%) completed pregnancies with maternal symptoms or exposure exclusively in the first trimester (or first trimester and periconceptional period), with no reports of birth defects among fetuses or infants with prenatal exposure to Zika virus infection only in the second or third trimesters. CONCLUSIONS AND RELEVANCE Among pregnant women in the United States with completed pregnancies and laboratory evidence of possible recent Zika infection, 6% of fetuses or infants had evidence of Zika-associated birth defects, primarily brain abnormalities and microcephaly, whereas among women with first-trimester Zika infection, 11% of fetuses or infants had evidence of Zika-associated birth defects. These findings support the importance of screening pregnant women for Zika virus exposure.
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Affiliation(s)
| | - April L Dawson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Abbey M Jones
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ellen H Lee
- New York City Department of Health and Mental Hygiene, Queens, New York
| | | | - Nina Ahmad
- New York State Department of Health, Albany
| | | | - Nicole Evert
- Texas Department of State Health Services, Austin
| | | | | | | | | | - Anne D Fine
- New York City Department of Health and Mental Hygiene, Queens, New York
| | | | | | | | | | - Sally Slavinski
- New York City Department of Health and Mental Hygiene, Queens, New York
| | | | - S Michele Owen
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyle R Petersen
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Coleen Boyle
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Babchishin KM, Seto MC, Sariaslan A, Lichtenstein P, Fazel S, Långström N. Parental and perinatal risk factors for sexual offending in men: a nationwide case-control study. Psychol Med 2017; 47:305-315. [PMID: 27733213 PMCID: PMC5217130 DOI: 10.1017/s003329171600249x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Prior studies suggest parental and perinatal risk factors are associated with later offending. It remains uncertain, however, if such risk factors are similarly related to sexual offending. METHOD We linked socio-demographic, family relations, and perinatal (obtained at birth) data from the nationwide Swedish registers from 1973 to 2009 with information on criminal convictions of cases and control subjects. Male sex offenders (n = 13 773) were matched 1:5 on birth year and county of birth in Sweden to male controls without sexual or non-sexual violent convictions. To examine risk-factor specificity for sexual offending, we also compared male violent, non-sexual offenders (n = 135 953) to controls without sexual or non-sexual violent convictions. Predictors included parental (young maternal or paternal age at son's birth, educational attainment, violent crime, psychiatric disorder, substance misuse, suicide attempt) and perinatal (number of older brothers, low Apgar score, low birth weight, being small for gestational age, congenital malformations, small head size) variables. RESULTS Conditional logistic regression models found consistent patterns of statistically significant, small to moderate independent associations of parental risk factors with sons' sexual offending and non-sexual violent offending. For perinatal risk factors, patterns varied more; small for gestational age and small head size exhibited similar risk effects for both offence types whereas a higher number of older biological brothers and any congenital malformation were small, independent risk factors only for non-sexual violence. CONCLUSIONS This nationwide study suggests substantial commonalities in parental and perinatal risk factors for the onset of sexual and non-sexual violent offending.
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Affiliation(s)
- K. M. Babchishin
- Royal's Institute of Mental Health
Research, University of Ottawa,
Ottawa, Canada
- Department of Medical Epidemiology and
Biostatistics, Karolinska Institutet,
Stockholm, Sweden
| | - M. C. Seto
- Royal's Institute of Mental Health
Research, University of Ottawa,
Ottawa, Canada
| | - A. Sariaslan
- Department of Psychiatry,
University of Oxford, Oxford,
UK
| | - P. Lichtenstein
- Department of Medical Epidemiology and
Biostatistics, Karolinska Institutet,
Stockholm, Sweden
| | - S. Fazel
- Department of Psychiatry,
University of Oxford, Oxford,
UK
| | - N. Långström
- Department of Medical Epidemiology and
Biostatistics, Karolinska Institutet,
Stockholm, Sweden
- Department of Neuroscience,
Uppsala University, Sweden
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236
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Kaartinen N, Tinkanen H. Do in vitro fertilization treatments result in healthy babies? Duodecim 2017; 133:728-734. [PMID: 29240334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In Finland, the proportion of children born as a result of in vitro fertilization treatments is annually approximately 3.3%, and the percentage proportion of the population is growing. Their general somatic health status and cognitive development do not differ from spontaneously fertilized children. In vitro fertilization treatments are, however, associated with a slightly elevated risk of preterm delivery, low birth weight and structural abnormalities. The risk of childhood cancer does not appear to be increased in IVF children. The in vitro fertilization process affects the embryonic epigenome, which organizes itself during early embryonic development. These changes may influence the phenotype and health profile of the unborn child. The effect of in vitro fertilization treatments on an individual's long-term health is poorly understood, requiring prospective follow-up studies with sufficiently large datasets. In vitro fertilization treatments are the most effective way to treat infertility, and the treatments are generally safe both for the future mother and the baby being born.
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237
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Buckley PF. Clinical News. Clin Schizophr Relat Psychoses 2017; 10:187-190. [PMID: 28075172 DOI: 10.3371/csrp.bu.123016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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238
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Cohen E, Horváth-Puhó E, Ray JG, Pedersen L, Adler N, Ording AG, Wise PH, Milstein A, Sørensen HT. Association Between the Birth of an Infant With Major Congenital Anomalies and Subsequent Risk of Mortality in Their Mothers. JAMA 2016; 316:2515-2524. [PMID: 27997654 DOI: 10.1001/jama.2016.18425] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Giving birth to a child with a major birth defect is a serious life event for a woman, yet little is known about the long-term health consequences for the mother. OBJECTIVE To assess whether birth of an infant born with a major congenital anomaly was associated with higher maternal risk of mortality. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study (n = 455 250 women) used individual-level linked Danish registry data for mothers who gave birth to an infant with a major congenital anomaly (41 508) between 1979 and 2010, with follow-up until December 31, 2014. A comparison cohort (413 742) was constructed by randomly sampling, for each mother with an affected infant, up to 10 mothers matched on maternal age, parity, and year of infant's birth. EXPOSURE Live birth of an infant with a major congenital anomaly as defined by the European Surveillance of Congenital Anomalies classification system. MAIN OUTCOMES AND MEASURES Primary outcome was all-cause mortality. Secondary outcomes included cause-specific mortality. Hazard ratios (HRs) were adjusted for marital status, immigration status, income quartile (since 1980), educational level (since 1981), diabetes mellitus, modified Charlson comorbidity index score, hypertension, depression, history of alcohol-related disease, previous spontaneous abortion, pregnancy complications, smoking (since 1991), and body mass index (since 2004). RESULTS Mothers in both groups were a mean (SD) age of 28.9 (5.1) years at delivery. After a median (IQR) follow-up of 21 (12-28) years, there were 1275 deaths (1.60 per 1000 person-years) among 41 508 mothers of a child with a major congenital anomaly vs 10 112 deaths (1.27 per 1000 person-years) among 413 742 mothers in the comparison cohort, corresponding to an absolute mortality rate difference of 0.33 per 1000 person-years (95% CI, 0.24-0.42), an unadjusted HR of 1.27 (95% CI, 1.20-1.35), and an adjusted HR of 1.22 (95% CI, 1.15-1.29). Mothers with affected infants were more likely to die of cardiovascular disease (rate difference, 0.05 per 1000 person-years [95% CI, 0.02-0.08]; adjusted HR, 1.26 [95% CI, 1.04-1.53]), respiratory disease (rate difference, 0.02 per 1000 person-years [95% CI, 0.00-0.04]; adjusted HR, 1.45 [95% CI, 1.01-2.08]), and other natural causes (rate difference, 0.11 per 1000 person-years [95% CI, 0.07-0.15]; adjusted HR, 1.50 [95% CI, 1.27-1.76]). CONCLUSIONS AND RELEVANCE In Denmark, having a child with a major congenital anomaly was associated with a small but statistically significantly increased mortality risk in the mother compared with women without an affected child. However, the clinical importance of this association is uncertain.
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Affiliation(s)
- Eyal Cohen
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark3Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada4Center for Primary Care and Outcomes Research, Stanford University, Stanford, California5Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, California
| | | | - Joel G Ray
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada6St Michael's Hospital Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Nancy Adler
- Center for Health and Community, University of California-San Francisco School of Medicine
| | - Anne Gulbech Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Paul H Wise
- Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
| | - Arnold Milstein
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, California
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark8Division of Epidemiology, Department of Health Research and Policy, Stanford University, Stanford, California
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Kirby RS. Birth certificates are an inappropriate source for identifying cases of birth defects in epidemiologic studies. Int J Circumpolar Health 2016; 66:4; author reply 5-6. [PMID: 17451129 DOI: 10.3402/ijch.v66i1.18215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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240
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Werler MM, Parker SE, Hedman K, Gissler M, Ritvanen A, Surcel HM. Maternal Antibodies to Herpes Virus Antigens and Risk of Gastroschisis in Offspring. Am J Epidemiol 2016; 184:902-912. [PMID: 27856447 DOI: 10.1093/aje/kww114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 11/08/2016] [Indexed: 12/16/2022] Open
Abstract
Gastroschisis risk is highest in offspring of young women and is increasing in prevalence, suggesting that exposures that are increasingly common among younger females may be causal. Some infections by viruses in the herpes family are more common in the earlier childbearing years and have been increasing in prevalence over time. Data from the Finnish Maternity Cohort were linked to Finnish malformation and birth registers (1987-2012) for this study, a nested case-control study of mothers of offspring with gastroschisis and age-matched controls. Maternal antibody responses in early pregnancy (mean gestational age = 11.1 weeks) to Epstein Barr virus (EBV), herpes simplex virus types 1 and 2 (HSV-1 and HSV-2), and cytomegalovirus were measured. Conditional logistic regression models were used to estimate odds ratios (and 95% confidence intervals) for high immunoglobulin reactivity. Odds ratios for high immunoglobulin M (IgM) reactivity to EBV-viral capsid antigen and HSV-1 or HSV-2 (as indicators of recent infection) were 2.16 (95% confidence interval (CI): 0.97, 4.79) and 1.94 (95% CI: 0.74, 5.12), respectively. For higher immunoglobulin G (IgG) reactivity to EBV-viral capsid antigen and HSV-2 IgG, odds ratios were 2.16 (95% CI: 0.82, 5.70) and 2.48 (95% CI: 1.50, 4.10), respectively. Reactivities to HSV-1 IgG, cytomegalovirus IgM, or cytomegalovirus IgG did not appear to increase gastroschisis risk. Primary EBV infection was not associated with gastroschisis, but observed associations with both IgM and IgG reactivities to EBV and HSV suggest that reactivations may be risk factors for it.
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Porras-Hurtado GL, León-Castañeda OM, Molano-Hurtado J, Quiceno SL, Pachajoa H, Montoya JJ. [Prevalence of birth defects in Risaralda, 2010-2013]. Biomedica 2016; 36:556-563. [PMID: 27992982 DOI: 10.7705/biomedica.v36i4.2771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 03/16/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The data regarding birth defects at local levels in developing countries like Colombia are scarce. OBJECTIVE To describe the profile of congenital abnormalities in the province of Risaralda, Colombia. MATERIALS AND METHODS We included the information on infants with structural and functional abnormalities at birth between June, 2010, and December, 2013, from records of the Instituto Nacional de Salud, and compared it with those of children born in the same period in a local clinic participating in the Collaborative Study of Congenital Malformations. We analyzed the data using Stata 10®. RESULTS We found a prevalence of nine defects per 1,000 newborns from the total live births in Risaralda. The local clinic registered in the Collaborative Study of Congenital Malformations registered a prevalence of 34 defects per 1,000 births. Most frequent defects were heart defects, followed by cleft lip and palate, abdominal wall defects, skeletal dysplasia, hydrocephalus, polydactyly and Down syndrome. CONCLUSIONS Having a baseline on the prevalence of congenital defects in Risaralda is very useful in the design of prevention policies oriented to decrease congenital defects incidence and severity. Inclusion of maternity hospitals in the Collaborative Study of Congenital Malformations strengthens national recording and reporting of birth defects.
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Affiliation(s)
- Gloria Liliana Porras-Hurtado
- Grupo Salud Comfamiliar, Clínica Comfamiliar, Pereira, Colombia Estudio Colaborativo Latinoamericano de Malformaciones Congénitas, ECLAMC, Bogotá, D.C., Colombia.
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242
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Bhide P, Gund P, Kar A. Prevalence of Congenital Anomalies in an Indian Maternal Cohort: Healthcare, Prevention, and Surveillance Implications. PLoS One 2016; 11:e0166408. [PMID: 27832123 PMCID: PMC5104451 DOI: 10.1371/journal.pone.0166408] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/30/2016] [Indexed: 01/02/2023] Open
Abstract
Background India lacks a national birth defects surveillance. Data on the prevalence of congenital anomalies are available mostly from hospital-based, cross-sectional studies. This is the first cohort study from India, where 2107 women were followed till pregnancy outcome, in order to measure the prevalence and types of congenital anomalies, their contribution to neonatal mortality, implications for surveillance, and the health service needs for prevention and management. Methods The study followed a cohort of 2107 pregnant women till outcome which was miscarriage, termination of pregnancy, live or stillbirth, neonatal and post-neonatal mortality. Case ascertainment of congenital anomalies was done through visual examination, followed by various investigations. Rates of congenital anomaly affected births were reported per 10 000 births. Health service needs were described through retrospective analysis of events surrounding the diagnosis of a congenital anomaly. Results Among 1822 births, the total prevalence of major congenital anomalies was 230.51 (170.99–310.11) per 10 000 births. Congenital heart defects were the most commonly reported anomalies in the cohort with a prevalence of 65.86 (37.72–114.77) per 10 000 births. Although neural tube defects were two and a half times less as compared to congenital heart defects, they were nevertheless significant at a prevalence of 27.44 (11.73–64.08) per 10 000 births. In this cohort, congenital anomalies were the second largest cause of neonatal deaths. The congenital anomaly prenatal diagnosis prevalence was 10.98 per 1000 births and the congenital anomaly termination of pregnancy rate was 4.39 per 1000 births. Conclusions This first cohort study from India establishes that the congenital anomaly rates were high, affecting one in forty four births in the cohort. The prevalence of congenital anomalies was identical to the stillbirth prevalence in the cohort, highlighting their public health importance. The results of this study identify the need for a well defined national programme with components of prevention, care and surveillance.
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Affiliation(s)
- Prajkta Bhide
- School of Health Sciences, Savitribai Phule Pune University, Pune, 411 007, India
| | - Pooja Gund
- School of Health Sciences, Savitribai Phule Pune University, Pune, 411 007, India
| | - Anita Kar
- School of Health Sciences, Savitribai Phule Pune University, Pune, 411 007, India
- * E-mail:
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243
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Eperon I, Vouga M, Schibler M, Baud D, Eperon G. [Zika virus : a review]. Rev Med Suisse 2016; 12:1789-1793. [PMID: 28692228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Since early 2015, the Zika virus epidemic has spread rapidly through South America and the Caribbean and the first cases of local transmission have just been reported in Florida. Maternal infection during pregnancy can cause serious birth defects. Pregnant women and their partners should avoid travelling to areas of Zika epidemic.
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Affiliation(s)
- Isabelle Eperon
- Département de gynécologie et obstétrique, HUG, 1211 Genève 14
| | - Manon Vouga
- Obstétrique, Département « Femme-Mère-Enfant », CHUV, 1011 Lausanne
| | - Manuel Schibler
- Service des maladies infectieuses, Département de médecine interne, HUG, 1211 Genève 14
| | - David Baud
- Obstétrique, Département « Femme-Mère-Enfant », CHUV, 1011 Lausanne
| | - Gilles Eperon
- Service de médecine tropicale et humanitaire, Département de médecine de premier recours et des urgences, HUG, 1211 Genève 14
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244
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Taye M, Afework M, Fantaye W, Diro E, Worku A. Magnitude of Birth Defects in Central and Northwest Ethiopia from 2010-2014: A Descriptive Retrospective Study. PLoS One 2016; 11:e0161998. [PMID: 27706169 PMCID: PMC5051902 DOI: 10.1371/journal.pone.0161998] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 08/16/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Birth defects are defined as structural and functional defects that develop during the organogenesis period and present at birth or detected later in life. They are one of the leading causes of infant and child mortality, morbidity, and long term disability. The magnitude of birth defects varies from country to country and from race/ethnicity to race/ethnicity, and about 40-60% of their causes are unknown. The known causes of birth defects are genetic and environmental factors which may be prevented. For various reasons, there is lack of data and research on birth defects in Ethiopia. OBJECTIVE The major objective of this study is to estimate the magnitude of birth defects in Ethiopia. SUBJECT AND METHODS A hospital based, retrospective, cross sectional, descriptive study was conducted. The subjects were babies/children aged 0-17years who visited selected hospitals between 2010 and 2014. Fourteen hospitals (8 in Addis Ababa, 6 in Amhara Region) were selected purposively based on case load. A data retrieving form was developed to extract relevant information from record books. RESULTS In the hospitals mentioned, 319,776 various medical records of children aged 0-17years were found. Of these, 6,076 (1.9% with 95% CI: 1.85%-1.95%) children were diagnosed as having birth defects. The majority (58.5%) of the children were male and 41.5% female. A slightly more than half (51.1%) of the children were urban dwellers, while 48.9% were from rural areas. Among the participants of the study the proportion of birth defects ranged as follows: orofacial (34.2%), neural tube (30.8%), upper and lower limb (12.8%), cardiovascular system (10.3%), digestive system and abdominal wall (4.8%), unspecified congenital malformations (2.5%), Down syndrome (2%), genitourinary system (2%), head, face, and neck defects (0.4%), and others (0.3%). The trend of birth defects increased linearly over time [Extended Mantel-Haenszel chi square for linear trend = 356.7 (P<0.0001)]. About 275 (4.5%) of the cases had multiple (associated) birth defects and 5,801 (95.5%) isolated (single) birth defects. Out of the total birth defects, 6,018 (99%) were major and 58 (1%) minor. CONCLUSION The magnitude of birth defects increased from 2010-2014. Orofacial and neural tube defects contributed about two thirds of the birth defects. There is an urgent need for registry and surveillance system strategies for intervention and control of birth defects in Ethiopia.
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Affiliation(s)
- Molla Taye
- Department of Anatomy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Mekbeb Afework
- Department of Anatomy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondwossen Fantaye
- School of Dentistry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ermias Diro
- Internal medicine, School of Medicine, College of Medicine and Health Sciences, the University of Gondar, Gondar, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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245
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Given JE, Loane M, Luteijn JM, Morris JK, de Jong van den Berg LTW, Garne E, Addor MC, Barisic I, de Walle H, Gatt M, Klungsoyr K, Khoshnood B, Latos-Bielenska A, Nelen V, Neville AJ, O'Mahony M, Pierini A, Tucker D, Wiesel A, Dolk H. EUROmediCAT signal detection: an evaluation of selected congenital anomaly-medication associations. Br J Clin Pharmacol 2016; 82:1094-109. [PMID: 27028286 PMCID: PMC5137835 DOI: 10.1111/bcp.12947] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 12/30/2022] Open
Abstract
AIMS To evaluate congenital anomaly (CA)-medication exposure associations produced by the new EUROmediCAT signal detection system and determine which require further investigation. METHODS Data from 15 EUROCAT registries (1995-2011) with medication exposures at the chemical substance (5th level of Anatomic Therapeutic Chemical classification) and chemical subgroup (4th level) were analysed using a 50% false detection rate. After excluding antiepileptics, antidiabetics, antiasthmatics and SSRIs/psycholeptics already under investigation, 27 associations were evaluated. If evidence for a signal persisted after data validation, a literature review was conducted for prior evidence of human teratogenicity. RESULTS Thirteen out of 27 CA-medication exposure signals, based on 389 exposed cases, passed data validation. There was some prior evidence in the literature to support six signals (gastroschisis and levonorgestrel/ethinylestradiol (OR 4.10, 95% CI 1.70-8.53; congenital heart disease/pulmonary valve stenosis and nucleoside/tide reverse transcriptase inhibitors (OR 5.01, 95% CI 1.99-14.20/OR 28.20, 95% CI 4.63-122.24); complete absence of a limb and pregnen (4) derivatives (OR 6.60, 95% CI 1.70-22.93); hypospadias and pregnadien derivatives (OR 1.40, 95% CI 1.10-1.76); hypospadias and synthetic ovulation stimulants (OR 1.89, 95% CI 1.28-2.70). Antipropulsives produced a signal for syndactyly while the literature revealed a signal for hypospadias. There was no prior evidence to support the remaining six signals involving the ordinary salt combinations, propulsives, bulk-forming laxatives, hydrazinophthalazine derivatives, gonadotropin releasing hormone analogues and selective serotonin agonists. CONCLUSION Signals which strengthened prior evidence should be prioritized for further investigation, and independent evidence sought to confirm the remaining signals. Some chance associations are expected and confounding by indication is possible.
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Affiliation(s)
- Joanne E Given
- Centre for Maternal, Fetal and Infant Research, Institute of Nursing and Health Research, Ulster University, United Kingdom
| | - Maria Loane
- Centre for Maternal, Fetal and Infant Research, Institute of Nursing and Health Research, Ulster University, United Kingdom
| | - Johannes M Luteijn
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom
| | - Joan K Morris
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom
| | | | - Ester Garne
- Paediatric Department, Hospital Lillebaelt, Kolding, Denmark
| | | | - Ingeborg Barisic
- Department of Medical Genetics and Reproductive Health, Children's University Hospital Zagreb, Croatia
| | - Hermien de Walle
- Eurocat Northern Netherlands, University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, the Netherlands
| | - Miriam Gatt
- Department of Health Information and Research, Guardamangia, Malta
| | - Kari Klungsoyr
- Medical Birth Registry of Norway, the Norwegian Institute of Public Health and Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Babak Khoshnood
- Paris Registry of Congenital Anomalies, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Biostatistics and Epidemiology, INSERM U1153, Maternité de Port-Royal, PARIS, France
| | - Anna Latos-Bielenska
- Polish Registry of Congenital Malformations, Department of Medical Genetics, Poznan, Poland
| | - Vera Nelen
- Provinciaal Instituut voor Hygiene (PIH), Antwerp, Belgium
| | - Amanda J Neville
- IMER Registry (Emilia Romagna Registry of Birth Defects), Centre for Clinical and Epidemiological Research, University of Ferrara and Azienda Ospedaliero Univerisitarion di Ferrara, Italy
| | | | - Anna Pierini
- Epidemiology and Health Promotion Macro-Area Working Group, Unit of Environmental Epidemiology and Disease Registries, CNR Institute of Clinical Physiology, Pisa, Italy
| | - David Tucker
- CARIS - Congenital Anomaly Register and Information Service for Wales, Public Health Wales, Swansea, United Kingdom
| | - Awi Wiesel
- Mainz Model Birth Registry, University Children's Hospital Mainz, Germany
| | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, Institute of Nursing and Health Research, Ulster University, United Kingdom.
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246
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Abstract
BACKGROUND Data regarding pregnancy outcomes in sickle cell disease are conflicting. Previous studies are limited by small sample size, narrow geographic area, and a wide range of resource availability. OBJECTIVE The purpose of this study was to examine the association between maternal sickle cell disease and adverse pregnancy outcomes in a contemporary North American cohort. STUDY DESIGN We performed a retrospective cohort study of 2,027,323 women with singleton pregnancies delivered in California from 2005-2008. Deliveries at <24 or >42 6/7 weeks of gestation were excluded. Women with sickle cell disease were compared with control subjects. Maternal outcomes of interest included preeclampsia, preterm delivery, placental abruption, oligohydramnios, and cesarean delivery; neonatal outcomes included small for gestational age, anomalies, stillbirth, neonatal death, and infant death. RESULTS The prevalence of sickle cell disease was 0.017%. Compared with control subjects, women with sickle cell disease were more likely to have limited prenatal care (7.4 vs 3.8%; P=.001), underlying chronic hypertension (2.3% vs 1.1%; P=.038), and fetal anomalies (14.0 vs 6.4%; P<.001). The increased odds of fetal anomalies persisted after adjustment for multiple confounders (odds ratio, 1.73; 95% confidence interval, 1.26-2.38). Women with sickle cell disease also had higher odds of severe preeclampsia (odds ratio, 3.75; 95% confidence interval, 2.21-6.38), preterm delivery (odds ratio, 2.50; 95% confidence interval, 1.93-3.21), small for gestational age (odds ratio, 1.96; 95% confidence interval, 1.18-3.25), and cesarean delivery (odds ratio, 1.93; 95% confidence interval, 1.40-2.67). CONCLUSION Women with sickle cell disease are at high risk of maternal and neonatal morbidity. Low rates of fetal and neonatal death may reflect improved antenatal surveillance and management as compared with previous studies. The association between sickle cell disease and fetal anomalies warrants further investigation.
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Affiliation(s)
- Kelly Kuo
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR.
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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247
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Canavan TP, Hill LM. Neonatal Outcomes in Fetuses With a Persistent Intrahepatic Right Umbilical Vein. J Ultrasound Med 2016; 35:2237-2241. [PMID: 27582531 DOI: 10.7863/ultra.15.10015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/19/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES A fetal persistent intrahepatic right umbilical vein has been linked to anomalies and genetic disorders but can be a normal variant. We conducted a retrospective review to determine other sonographic findings that can stratify fetuses for further evaluation. METHODS A total of 313 fetuses had a persistent intrahepatic right umbilical vein identified on 17- to 24-week sonography. The outcome was any major congenital anomaly or an adverse neonatal outcome, which was defined as aneuploidy, fetal demise, or neonatal death. RESULTS A total of 217 patients (69.3%) had a normal neonatal outcome. Sixty-nine patients (22.0%) were lost to follow-up. Five fetuses (2.1%) had aneuploidy; 4 of the 5 had additional sonographic findings, and 1 had an isolated persistent intrahepatic right umbilical vein. Twenty-four fetuses had a major anomaly in association with the persistent right umbilical vein; 26 additional fetuses had soft sonographic markers associated with karyotypic abnormalities but were chromosomally normal. Of those with adverse neonatal outcomes, 12 had a congenital heart defect (57%). An additional sonographic finding with a persistent intrahepatic right umbilical vein was predictive of a congenital anomaly or an adverse neonatal outcome (P < .001), with a positive predictive value of 44.0% (95% confidence interval, 30.0%-58.7%). An isolated persistent intrahepatic right umbilical vein had a 0.4% risk for a congenital anomaly or an adverse neonatal outcome. CONCLUSIONS A persistent intrahepatic right umbilical vein should prompt an extended anatomic survey and a fetal cardiac evaluation. If the survey and cardiac anatomy are reassuring, no further follow-up is needed. If additional findings are identified, genetic counseling and invasive testing should be considered.
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Affiliation(s)
- Timothy P Canavan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Ultrasound, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania USA, Center for Advanced Fetal Diagnosis, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania USA
| | - Lyndon M Hill
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Ultrasound, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania USA
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248
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Savabieasfahani M, Ali SS, Bacho R, Savabi O, Alsabbak M. Prenatal metal exposure in the Middle East: imprint of war in deciduous teeth of children. Environ Monit Assess 2016; 188:505. [PMID: 27491948 PMCID: PMC4975756 DOI: 10.1007/s10661-016-5491-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/28/2016] [Indexed: 06/06/2023]
Abstract
In war zones, the explosion of bombs, bullets, and other ammunition releases multiple neurotoxicants into the environment. The Middle East is currently the site of heavy environmental disruption by massive bombardments. A very large number of US military bases, which release highly toxic environmental contaminants, have also been erected since 2003. Current knowledge supports the hypothesis that war-created pollution is a major cause of rising birth defects and cancers in Iraq. We created elemental bio-imaging of trace elements in deciduous teeth of children with birth defects from Iraq. Healthy and naturally shed teeth from Lebanon and Iran were also analyzed for trace elements. Lead (Pb) was highest in teeth from children with birth defects who donated their teeth from Basra, Iraq (mean 0.73-16.74 (208)Pb/(43)Ca ppm, n = 3). Pb in healthy Lebanese and Iranian teeth were 0.038-0.382 (208)Pb/(43)Ca ppm (n = 4) and 0.041-0.31 (208)Pb/(43)Ca ppm (n = 2), respectively. Our hypothesis that increased war activity coincides with increased metal levels in deciduous teeth is confirmed by this research. Lead levels were similar in Lebanese and Iranian deciduous teeth. Deciduous teeth from Iraqi children with birth defects had remarkably higher levels of Pb. Two Iraqi teeth had four times more Pb, and one tooth had as much as 50 times more Pb than samples from Lebanon and Iran.
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Affiliation(s)
| | - S. Sadik Ali
- Department of Obstetrics and Gynecology, Basra Maternity Hospital, Basra Medical School, P.O. Box 1633 Basra, Iraq
| | - R. Bacho
- Department of Pediatric Dentistry, School of Dentistry, Lebanese University in Beirut, Beirut, Lebanon
| | - O. Savabi
- Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M. Alsabbak
- Department of Obstetrics and Gynecology, Basra Maternity Hospital, Basra Medical School, P.O. Box 1633 Basra, Iraq
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249
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Sebastin SJ, Puhaindran ME, Lim AYT, Lim IJ, Bee WH. The Prevalence of Absence of the Palmaris Longus – A Study in a Chinese Population and a Review of the Literature. ACTA ACUST UNITED AC 2016; 30:525-7. [PMID: 16006020 DOI: 10.1016/j.jhsb.2005.05.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Accepted: 01/25/2005] [Indexed: 11/30/2022]
Abstract
Most standard textbooks of hand surgery quote the prevalence of absence of palmaris longus at around 15%. However, this figure varies considerably in reports from different ethnic groups. We studied 329 Chinese men and women and found palmaris longus to be absent unilaterally in 3.3%, and bilaterally in 1.2%, with an overall prevalence of absence of 4.6%. There was no significant difference in its absence with regard to the body side or the sex. Our literature review revealed a low prevalence of absence in Asian, Black and Native American populations and a much higher prevalence of absence in Caucasian populations. It is clear that a standard prevalence of absence of the palmaris longus cannot be applied to all populations.
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Affiliation(s)
- S J Sebastin
- Department of Hand & Reconstructive Microsurgery, National University Hospital, Singapore
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250
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Sharma R, Lohiya S, Rajabi P, Nguyen K, Ngo A, Lee E, Rad AS, Chen H, Lacruz RS, White SN. Prevalence of Enamel Markings on Third Molars. J Calif Dent Assoc 2016; 44:499-505. [PMID: 28737850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to measure the prevalence of enamel markings in routinely extracted third molars. One hundred donated third molars were examined. All had some marking(s). Caries was almost universal; white snowcapping of cusps and ridges was extremely common; pit and valley defects were very common; spots and bands were very common, most were white; horizontal grooves were common; linear enamel hypoplasia, considered to be a true developmental defect, was rare.
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