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Prevalence of and Risk Factors for Iron Deficiency in Twin and Singleton Newborns. Nutrients 2022; 14:nu14183854. [PMID: 36145230 PMCID: PMC9500937 DOI: 10.3390/nu14183854] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Iron deficiency (ID) in utero and in infancy can cause irreversible neurocognitive damage. Iron status is not routinely tested at birth, so the burden of neonatal ID in the United States is unknown. Infants born from twin or higher-order pregnancies may be at elevated risk of inadequate nutrient endowment at birth. The present study sought to compare the burden of neonatal ID in cord blood serum samples from twin (n = 54) and singleton pregnancies (n = 24). Iron status (serum ferritin (SF), soluble transferrin receptor (sTfR), hepcidin) and inflammation (C-reactive protein (CRP) and interleukin-6 (IL-6)) biomarker concentrations were measured by immunoassay. The prevalence of ID (SF < 76 ng/mL) among twins was 21% (23/108) and among singletons 20% (5/24). Gestational age at birth, maternal race and infant sex predicted SF levels. Maternal anemia (hemoglobin < 11 g/dL) was observed in 40% of mothers but was not associated with neonatal iron biomarkers. More research is needed to identify risk factors and regulatory mechanisms for inadequate fetal iron accrual to identify higher risk pregnancies and neonates for screening and intervention.
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2
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Kokkinaki T, Markodimitraki M, Vasdekis VG. Maternal speech to singleton and first-born dizygotic twin infants: a four-month longitudinal and naturalistic study. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2022. [DOI: 10.1080/17405629.2022.2092092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Theano Kokkinaki
- Laboratory of Applied Psychology, Department of Psychology, University of Crete, Rethymnon, Greece
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3
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Sellier E, Goldsmith S, McIntyre S, Perra O, Rackauskaite G, Badawi N, Fares A, Smithers-Sheedy H. Cerebral palsy in twins and higher multiple births: a Europe-Australia population-based study. Dev Med Child Neurol 2021; 63:712-720. [PMID: 33533028 DOI: 10.1111/dmcn.14827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 11/26/2022]
Abstract
AIM To describe the birth prevalence, temporal trends, and clinical outcomes of twins, triplets, or quadruplets with cerebral palsy (CP). METHOD This was a cross-sectional study using data for twins, triplets, and quadruplets with prenatally or perinatally acquired CP and pooled from the Surveillance of Cerebral Palsy in Europe network (born 1992-2009) and Australian Cerebral Palsy Register (born 1993-2009). Children were at least 4 years old at time of registration. Children born in regions with population ascertainment and available denominator data were included in prevalence calculations (n=1033 twins, 81 triplets, and 11 quadruplets). Clinical data from children registered in all participating registers were described, including 2163 twins (56% male), 187 triplets (59% male), and 20 quadruplets (45% male). RESULTS The birth prevalence of CP was higher with increasing plurality (twins 6.5 per 1000 live births [95% confidence interval {CI} 6.1-6.9], triplets 17.1 [95% CI 13.6-21.2], quadruplets 50.7 [95% CI 25.6-88.9]); however, prevalence by gestational age was similar across all pluralities. Between 1992-1994 and 2007-2009, prevalence of CP among twins declined (p=0.001) but prevalence of CP among triplets did not change significantly over time (p=0.55). The distributions of Gross Motor Function Classification System, epilepsy, and impairments of intellect, vision, and hearing were similar regardless of plurality. INTERPRETATION The data combined from two CP register networks indicated that triplets and quadruplets had increased risk of CP compared to twins. The higher prevalence of CP in triplets and quadruplets is due to their higher risk of preterm birth. Prevalence of CP among twins significantly declined in Europe and Australia. Clinical outcomes were similar for all multiple births.
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Affiliation(s)
- Elodie Sellier
- Université Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France.,RHEOP, Grenoble, France
| | - Shona Goldsmith
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Gija Rackauskaite
- Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Asma Fares
- Pôle Santé Publique, Département de l'Information Médicale CHU Grenoble Alpes, Grenoble, France
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
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4
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Genetic architecture of reciprocal social behavior in toddlers: Implications for heterogeneity in the early origins of autism spectrum disorder. Dev Psychopathol 2021; 32:1190-1205. [PMID: 33161906 DOI: 10.1017/s0954579420000723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Impairment in reciprocal social behavior (RSB), an essential component of early social competence, clinically defines autism spectrum disorder (ASD). However, the behavioral and genetic architecture of RSB in toddlerhood, when ASD first emerges, has not been fully characterized. We analyzed data from a quantitative video-referenced rating of RSB (vrRSB) in two toddler samples: a community-based volunteer research registry (n = 1,563) and an ethnically diverse, longitudinal twin sample ascertained from two state birth registries (n = 714). Variation in RSB was continuously distributed, temporally stable, significantly associated with ASD risk at age 18 months, and only modestly explained by sociodemographic and medical factors (r2 = 9.4%). Five latent RSB factors were identified and corresponded to aspects of social communication or restricted repetitive behaviors, the two core ASD symptom domains. Quantitative genetic analyses indicated substantial heritability for all factors at age 24 months (h2 ≥ .61). Genetic influences strongly overlapped across all factors, with a social motivation factor showing evidence of newly-emerging genetic influences between the ages of 18 and 24 months. RSB constitutes a heritable, trait-like competency whose factorial and genetic structure is generalized across diverse populations, demonstrating its role as an early, enduring dimension of inherited variation in human social behavior. Substantially overlapping RSB domains, measurable when core ASD features arise and consolidate, may serve as markers of specific pathways to autism and anchors to inform determinants of autism's heterogeneity.
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5
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Wong SW, Cheung H, Zheng M, Yang X, McBride C, Ho CS, Leung JS, Chow BW, Waye MMY. Effect of Twinning on Chinese and English Vocabulary Knowledge. Child Dev 2020; 91:1886-1897. [DOI: 10.1111/cdev.13400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Mo Zheng
- The Chinese University of Hong Kong
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Trombetta T, Brustia P, Curti L, Caldarera AM, Gerino E, Rollè L. Twins' and Singletons' Linguistic Environment: A Systematic Review. Front Psychol 2019; 10:2005. [PMID: 31551866 PMCID: PMC6733883 DOI: 10.3389/fpsyg.2019.02005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 08/16/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Among twins, lower linguistic skills emerged when compared with singletons. Considering the association found between parental linguistic input and children's language development, exploring the differences between twins and singletons' linguistic environments could find variables that are potentially associated with the lower linguistic skills of twins. Aim: The current systematic review aims to analyze and systematize the existing literature focused on the comparison of twins' and singletons' linguistic environments within their first 3 years of life. Methodological issues (i.e., the procedure used to assess the linguistic environment, the coding of the linguistic environment's features, the computational method employed to assess the parental linguistic input, and participant characteristics) and differences found among twins and singletons regarding their linguistic environment (i.e., linguistic input quantity, linguistic input complexity, linguistic features of child-directed speech, parental responsiveness, and directiveness, joint attention, and book reading) were highlighted. Method: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement was followed. Eligible studies were searched through EBSCO, PubMed, and Web of Science. From this search, 1,347 study results emerged, and 8 studies were included. Results: To our knowledge, this is the first systematic review focused on the comparison of twins' and singletons' linguistic environments. Differences between the groups were found in all of the included studies. Data against twins were generally identified regarding all the considered linguistic environment's features. However, conflicting results within and between the included studies emerged, mainly according to the computational method employed (i.e., twin moms value, twin direct dyadic value, twin direct dyadic + both value, and input directed toward both children simultaneously). Conclusion: The disadvantaged linguistic environment of twins is likely due to limited parental resources and demands associated with the management of two children of the same age. However, the limited and conflicting data found did not allow for a firm conclusion to be drawn on the differences in the twins' and singletons' linguistic environments. Further studies on the topic are needed.
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Affiliation(s)
| | - Piera Brustia
- Department of Psychology, University of Torino, Turin, Italy
| | - Lorenzo Curti
- Department of Psychology, University of Torino, Turin, Italy
| | | | - Eva Gerino
- Department of Psychology, University of Torino, Turin, Italy
| | - Luca Rollè
- Department of Psychology, University of Torino, Turin, Italy
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7
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Kuiper D, Bennema A, la Bastide-van Gemert S, Seggers J, Schendelaar P, Mastenbroek S, Hoek A, Heineman MJ, Roseboom TJ, Kok JH, Hadders-Algra M. Developmental outcome of 9-year-old children born after PGS: follow-up of a randomized trial. Hum Reprod 2019; 33:147-155. [PMID: 29136227 DOI: 10.1093/humrep/dex337] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/27/2017] [Indexed: 01/08/2023] Open
Abstract
STUDY QUESTION Does Day-3 cleavage-stage PGS affect neurodevelopment of 9-year-old IVF offspring? SUMMARY ANSWER We did not find evidence of adverse consequences of Day-3 cleavage-stage PGS on neurodevelopment of 9-year-old IVF offspring, although children born after IVF with or without PGS often had a non-optimal neurological condition. WHAT IS KNOWN ALREADY Knowledge on long-term sequelae for development and health of children born following PGS is lacking. This is striking as evidence accumulates that IVF itself is associated with increased risk for impaired health and development in the offspring. STUDY DESIGN SIZE, DURATION This prospective, assessor-blinded, multicentre, follow-up study evaluated development and health of 9-year-old IVF children born to women who were randomly assigned to IVF with PGS (PGS group) or without PGS (control group). The follow-up examination at 9 years took place between March 2014 and May 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 408 women were included and randomly assigned to IVF with or without Day-3 cleavage-stage PGS. This resulted in 52 ongoing pregnancies in the PGS group and 74 in the control group. In the PGS group, 59 children were born alive; in the control group, 85 children were born alive. At the age of 9 years, 43 children born after PGS and 56 control children participated in the study. Our primary outcome was the neurological optimality score, a sensitive measure of neurological condition assessed with a standardized, age-specific test (Touwen test). Secondary outcomes were adverse neurological condition (neurologically abnormal and the complex form of minor neurological dysfunction), cognitive development (intelligence quotient and specific domains), behaviour (parental and teacher's questionnaires), blood pressure and anthropometrics. MAIN RESULTS AND THE ROLE OF CHANCE Neurodevelopmental outcome of PGS children did not differ from that of controls; the neurological optimality scores (mean values [(95% CI]: PGS children 51.5 [49.3; 53.7], control children 53.1 [50.5; 55.7]) were not significantly different. The prevalences of adverse neurological outcome (in all but one child implying the presence of the complex form of minor neurological dysfunction) did not differ between the groups (PGS group 17/43 [40%], control group 19/56 [34%]), although the prevalence of complex minor neurological dysfunction in both groups was rather high. Also intelligence quotient scores of the two groups were not significantly different (PGS group 114 [108; 120]); control group 117 [109; 125]), and the behaviour, blood pressure and anthropometrics of both groups did not differ. Mean blood pressures of both groups were above the 60th percentile. LIMITATIONS REASONS FOR CAUTION The power analysis of the study was not based on the number of children needed for the follow-up study, but on the number of women who were needed to detect an increase in ongoing pregnancy rates after PGS. In addition, our study evaluated embryo biopsy in the form of PGS at cleavage stage (Day-3 embryo biopsy), while currently PGS at blastocyst stage (Day-5 embryo biopsy) is recommended and increasingly being used. WIDER IMPLICATIONS OF THE FINDINGS Our findings indicate that PGS in cleavage stage embryos is not associated with adverse effects on neurological, cognitive and behavioural development, blood pressure and anthropometrics of offspring at 9 years. This is a reassuring finding as embryo biopsy in the forms of PGS and PGD is increasingly applied. However, both groups of IVF offspring showed high prevalences of the clinically relevant form of minor neurological dysfunction, which is a point of concern for the IVF community. In addition, our study confirms findings of others that IVF offspring may be at risk of an unfavourable cardiovascular outcome. These findings are alarming and highlight the importance of research on the underlying mechanisms of unfavourable neurodevelopmental and cardiovascular outcomes in IVF offspring. STUDY FUNDING/COMPETING INTEREST(S) The randomized controlled trial was financially supported by the Organization for Health Research and Development (ZonMw), The Netherlands (Grant number 945-03-013). The follow-up was financially supported by the University Medical Center Groningen (Grant number: 754510), the Cornelia Foundation, and the graduate schools BCN and Share, Groningen, The Netherlands. The sponsors of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. There are no conflicts of interest. TRIAL REGISTRATION NUMBER ISRCTN76355836.
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Affiliation(s)
- Derk Kuiper
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Hanzeplein 1, Groningen GZ 9713, The Netherlands
| | - Anne Bennema
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Hanzeplein 1, Groningen GZ 9713, The Netherlands
| | - Sacha la Bastide-van Gemert
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, Groningen GZ 9713, The Netherlands
| | - Jorien Seggers
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Hanzeplein 1, Groningen GZ 9713, The Netherlands
| | - Pamela Schendelaar
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Hanzeplein 1, Groningen GZ 9713, The Netherlands
| | - Sebastiaan Mastenbroek
- University of Amsterdam, Academic Medical Center, Center for Reproductive Medicine, Meibergdreef 9, Amsterdam AZ 1105, The Netherlands
| | - Annemieke Hoek
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynaecology, Hanzeplein 1, Groningen GZ 9713, The Netherlands
| | - Maas Jan Heineman
- University of Amsterdam, Academic Medical Center, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam AZ 1105, The Netherlands
| | - Tessa J Roseboom
- University of Amsterdam, Academic Medical Center, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam AZ 1105, The Netherlands.,University of Amsterdam, Academic Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef 9, Amsterdam AZ 1105, The Netherlands
| | - Joke H Kok
- University of Amsterdam, Academic Medical Center, Emma Children's Hospita, Department of Neonatology, Meibergdreef 9, Amsterdam AZ 1105, The Netherlands
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Hanzeplein 1, Groningen GZ 9713, The Netherlands
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Bolch C, Fahey M, Reddihough D, Williams K, Reid S, Guzys A, Cole S, Edwards A, Fung A, Hodges R, Palma-Dias R, Teoh M, Walker S. Twin-to-twin transfusion syndrome neurodevelopmental follow-up study (neurodevelopmental outcomes for children whose twin-to-twin transfusion syndrome was treated with placental laser photocoagulation). BMC Pediatr 2018; 18:256. [PMID: 30068295 PMCID: PMC6090765 DOI: 10.1186/s12887-018-1230-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 07/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Twin-to-twin transfusion syndrome (TTTS) is a serious complication of 10–15% of twin or triplet pregnancies in which multiple fetuses share a single placenta. Communicating placental vessels allow one fetus (the donor) to pump blood to the other (the recipient). Mortality rates without intervention are high, approaching 100% in some series, with fetal deaths usually due to cardiac failure. Surgical correction using laser photocoagulation of communicating placental vessels was developed in the 1980s and refined in the 1990s. Since it was introduced in Victoria in 2006, laser surgery has been performed in approximately 120 pregnancies. Survival of one or more fetuses following laser surgery is currently > 90%, however the neurodevelopmental outcomes for survivors remain incompletely understood. Prior to laser therapy, at least one in five survivors of TTTS had serious adverse neurodevelopmental outcomes (usually cerebral palsy). Current estimates of neurological impairment among survivors following laser surgery vary from 4 to 31% and long-term follow-up data are limited. Methods This paper describes the methodology for a retrospective cohort study in which children aged 24 months and over (corrected for prematurity), who were treated with laser placental photocoagulation for TTTS at Monash Health in Victoria, Australia, will undergo comprehensive neurodevelopmental assessment by a multidisciplinary team. Evaluation will include parental completion of pre-assessment questionnaires of social and behavioural development, a standardised medical assessment by a developmental paediatrician or paediatric neurologist, and age-appropriate cognitive and academic, speech and fine and gross motor assessments by psychologists, speech and occupational therapists or physiotherapists. Assessments will be undertaken at the Murdoch Children’s Research Institute/Royal Children’s Hospital, at Monash Health or at another mutually agreed location. Results will be recorded in a secure online database which will facilitate future related research. Discussion This will be the first study to report and evaluate neurodevelopmental outcomes following laser surgery for twin-to-twin transfusion syndrome in Victoria, and will inform clinical practice regarding follow-up of children at risk of adverse outcomes. Electronic supplementary material The online version of this article (10.1186/s12887-018-1230-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christie Bolch
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Australia. .,Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Australia.
| | - Michael Fahey
- Department of Paediatrics, Monash Health, Clayton, Australia.,Department of Paediatrics, Monash University, Clayton, Australia
| | - Dinah Reddihough
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Australia.,Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Katrina Williams
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Australia.,Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Susan Reid
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Australia.,Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Angela Guzys
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Stephen Cole
- Department of Maternity Services, Royal Women's Hospital, Melbourne, Australia
| | - Andrew Edwards
- Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
| | - Alison Fung
- Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Ryan Hodges
- Women's & Newborn Program, Monash Health, Clayton, VIC, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
| | - Ricardo Palma-Dias
- Ultrasound Services, Royal Women's Hospital, Parkville, VIC, Australia.,Pregnancy Research Centre, Department of Maternal-Fetal Medicine, Royal Women's Hospital, Parkville, VIC, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia
| | - Mark Teoh
- Fetal Diagnostic Unit, Monash Health, Clayton, VIC, Australia
| | - Susan Walker
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Australia.,Maternal Fetal Medicine, The University of Melbourne, Melbourne, Australia
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9
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Kokkinaki T, Markodimitraki M. Spontaneous emotional coordination of first-born dizygotic twins and singletons with their mothers in early infancy. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2017. [DOI: 10.1080/17405629.2017.1375909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Theano Kokkinaki
- Laboratory of Applied Psychology, Department of Psychology, University of Crete, Rethymnon, Greece
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10
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Kuiper D, Bennema A, la Bastide-van Gemert S, Seggers J, Schendelaar P, Haadsma M, Hoek A, Heineman MJ, Hadders-Algra M. Neurodevelopmental and cardiometabolic outcome in 4-year-old twins and singletons born after IVF. Reprod Biomed Online 2017; 34:659-667. [DOI: 10.1016/j.rbmo.2017.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 02/20/2017] [Accepted: 02/28/2017] [Indexed: 02/08/2023]
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Razaz N, Avitan T, Ting J, Pressey T, Joseph KS. Perinatal outcomes in multifetal pregnancy following fetal reduction. CMAJ 2017; 189:E652-E658. [PMID: 28483844 DOI: 10.1503/cmaj.160722] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND There is currently insufficient evidence regarding the prognosis of multifetal pregnancy following elective fetal reduction to twin or singleton pregnancy. We compared perinatal outcomes in pregnancies with and without fetal reduction. METHODS We used data on all stillbirths and live births in British Columbia, Canada, from 2009 to 2013. We compared outcomes of multifetal pregnancies with fetal reduction (to twin or singleton pregnancy) with outcomes of pregnancies without fetal reduction. The primary outcome was a composite of serious neonatal morbidity or perinatal death. Other outcomes studied included preterm birth, low birth weight and small-for-gestational-age live birth. RESULTS The rate of serious neonatal morbidity or perinatal death did not differ significantly between pregnancies reduced to twins and unreduced triplet pregnancies (adjusted rate ratio 0.50, 95% confidence interval [CI] 0.24-1.07) or between pregnancies reduced to singletons and unreduced twin pregnancies (adjusted rate ratio 1.57, 95% CI 0.74-3.33). The rate was significantly lower in the fetal reduction group reduced to twins versus unreduced triplet pregnancies when we restricted the analysis to pregnancies conceived following the use of assisted reproduction technologies (adjusted rate ratio 0.35, 95% CI 0.18-0.67). The rates of preterm birth, very preterm birth, low birth weight and very low birth weight were significantly lower among pregnancies reduced to twins than among unreduced triplet pregnancies. Compared with unreduced twin pregnancies, pregnancies reduced to singletons had lower rates of preterm birth and low birth weight. INTERPRETATION Fetal reduction to twins and singletons was not associated with a decreased risk of serious neonatal morbidity or perinatal death. However, such fetal reduction was associated with substantial improvements in several other perinatal outcomes, such as preterm birth and low birth weight. Clinicians discussing the risks associated with multifetal pregnancy should counsel parents on the potential risks and benefits of fetal reduction.
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Affiliation(s)
- Neda Razaz
- Department of Obstetrics and Gynaecology (Razaz, Pressey, Joseph), University of British Columbia, and BC Women's Hospital and Health Centre, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Razaz), Karolinska University Hospital in Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Avitan), Hadassah Medical Centre, Jerusalem, Israel; Department of Pediatrics (Ting) and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC
| | - Tehila Avitan
- Department of Obstetrics and Gynaecology (Razaz, Pressey, Joseph), University of British Columbia, and BC Women's Hospital and Health Centre, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Razaz), Karolinska University Hospital in Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Avitan), Hadassah Medical Centre, Jerusalem, Israel; Department of Pediatrics (Ting) and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC
| | - Joseph Ting
- Department of Obstetrics and Gynaecology (Razaz, Pressey, Joseph), University of British Columbia, and BC Women's Hospital and Health Centre, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Razaz), Karolinska University Hospital in Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Avitan), Hadassah Medical Centre, Jerusalem, Israel; Department of Pediatrics (Ting) and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC
| | - Tracy Pressey
- Department of Obstetrics and Gynaecology (Razaz, Pressey, Joseph), University of British Columbia, and BC Women's Hospital and Health Centre, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Razaz), Karolinska University Hospital in Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Avitan), Hadassah Medical Centre, Jerusalem, Israel; Department of Pediatrics (Ting) and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC
| | - K S Joseph
- Department of Obstetrics and Gynaecology (Razaz, Pressey, Joseph), University of British Columbia, and BC Women's Hospital and Health Centre, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Razaz), Karolinska University Hospital in Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Avitan), Hadassah Medical Centre, Jerusalem, Israel; Department of Pediatrics (Ting) and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC
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12
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Hindmarsh G, Llewellyn G, Emerson E. The Social-Emotional Well-Being of Children of Mothers with Intellectual Impairment: A Population-Based Analysis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:469-481. [PMID: 27878941 DOI: 10.1111/jar.12306] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children of parents with intellectual impairment are thought to be at risk for poor social-emotional well-being. This study investigated the relationship between maternal intellectual impairment and poor child social-emotional well-being. METHOD Secondary analysis of data from waves 2-4 of the Millennium Cohort Study (UK). Social-emotional well-being was measured by maternal report at Waves 2-4, with teacher and child self-report at Wave 4. Bivariate and multivariate analyses were conducted. RESULTS Unadjusted, maternal intellectual impairment was associated with an elevated risk of overall poor social-emotional well-being at ages 3 and 5, but not at age 7. After controlling for individual, family and environmental characteristics, no statistically significant association was found between maternal intellectual impairment and poor child social-emotional well-being. CONCLUSIONS Children of mothers with intellectual impairment are more likely than their peers to be exposed to adverse living conditions. These living conditions may explain, at least in part, why these children face a heightened risk of poor social-emotional well-being at ages 3 and 5. Improving the living conditions of mothers with intellectual impairment may offer a pathway to child social-emotional well-being.
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Affiliation(s)
- Gabrielle Hindmarsh
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Eric Emerson
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
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Campos D, Arias AV, Campos-Zanelli TM, Souza DS, Dos Santos Neto OG, Peralta CFA, Guerreiro MM. Twin-twin transfusion syndrome: neurodevelopment of infants treated with laser surgery. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:307-13. [PMID: 27097004 DOI: 10.1590/0004-282x20160032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/30/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the neurodevelopmental functions of survivors of twin-twin transfusion syndrome (TTTS) treated by fetoscopic laser coagulation (FLC), during the first year of life, comparing them to a control group; and to verify the influence of specific variables on neurodevelopment. METHOD This was a prospective, longitudinal study. The sample comprised 33 monochorionic diamniotic twins who underwent FLC for treatment of TTTS and 22 full-term infants of single-fetus pregnancies. Bayley Scales of Infant and Toddler Development Screening Test were used for evaluation. Prenatal, perinatal and postnatal information were obtained. RESULTS There was an increased frequency of infants in the TTTS group with inadequate performance compared to the control group. The identified variables (fetal donor, low economic income and cardiorespiratory disease) negatively impacted expressive communication and fine motor skills. CONCLUSION Although through follow-up is recommended in all TTTS survivors, particular attention is required for the high-risk group as defined in this study.
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Affiliation(s)
- Denise Campos
- Centro de Investigação em Pediatria, Departamento de Neurologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Amabile V Arias
- Centro de Investigação em Pediatria, Departamento de Neurologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Thatiane M Campos-Zanelli
- Centro de Investigação em Pediatria, Departamento de Neurologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Daniela S Souza
- Centro de Investigação em Pediatria, Departamento de Neurologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Orlando G Dos Santos Neto
- Hospital da Mulher Prof. Dr. José Aristodemo Pinotti, Departamento de Obstetrícia e Ginecologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Cleisson Fabio A Peralta
- Hospital da Mulher Prof. Dr. José Aristodemo Pinotti, Departamento de Obstetrícia e Ginecologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Marilisa M Guerreiro
- Centro de Investigação em Pediatria, Departamento de Neurologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Panagiotopoulou O, Fouzas S, Sinopidis X, Mantagos SP, Dimitriou G, Karatza AA. Congenital heart disease in twins: The contribution of type of conception and chorionicity. Int J Cardiol 2016; 218:144-149. [PMID: 27232926 DOI: 10.1016/j.ijcard.2016.05.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/07/2016] [Accepted: 05/12/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Increased incidence of congenital heart disease (CHD) has been reported in the offspring of monochorionic twin gestations. Assisted reproductive technology (ART), which is related to increased rates of twinning, has also been associated with higher risk of birth defects. We studied the incidence of CHD in a cohort of twins to clarify the contribution of type of conception and chorionicity. METHODS Data concerning 874 live-born twins of which at least one was admitted in our Neonatal Unit during 1995-2012 were analysed. Forty-five % (N=197) of the gestations resulted from ART (in vitro fertilisation or intracytoplasmic sperm insertion). RESULTS In the ART group 32/389 (8.2%) had CHD compared to 21/485 (4.3%) infants conceived naturally (OR 1.90, 95%CI 1.08-3.34, p=0.024). Spontaneous-conception gestations had higher incidence of monochorionic placentation (47/245 versus 4/197, p<0.001), and included younger mothers (29.1±5.2 versus 33.9±5.5years, p<0.001) who had higher parity (median 2 [range 1-7] versus 1 Pinborg (2005), Blondel and Kaminski (2002), Knopman et al. (2014), Kyvik and Derom (2006) ; p<0.001). Multivariable logistic regression analysis showed that ART (OR 2.60, 95% CI 1.24-5.45) and monochorionicity (OR 3.49, 95% CI 1.57-7.77) were significant determinants of CHD, independently of maternal age, parity, and the gender of the offspring. CONCLUSIONS We confirmed that monochorionic twins have increased risk of CHD and we documented a higher incidence of CHD in ART twins independently of chorionicity. We suggest improvement of echocardiographic skills of health care professionals involved in prenatal screening and foetal cardiology referral of ART dichorionic twins with suspicious findings at screening, in addition to all monochorionic gestations.
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Affiliation(s)
- Olga Panagiotopoulou
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Sotirios Fouzas
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Xenophon Sinopidis
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Stefanos P Mantagos
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Gabriel Dimitriou
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Ageliki A Karatza
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece.
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15
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Li X, Eiden RD, Epstein LH, Shenassa ED, Xie C, Wen X. Etiological Subgroups of Small-for-Gestational-Age: Differential Neurodevelopmental Outcomes. PLoS One 2016; 11:e0160677. [PMID: 27501456 PMCID: PMC4976943 DOI: 10.1371/journal.pone.0160677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/24/2016] [Indexed: 11/18/2022] Open
Abstract
Objectives It remains unclear why substantial variations in neurodevelopmental outcomes exist within small-for-gestational-age (SGA) children. We prospectively compared 5-y neurodevelopmental outcomes across SGA etiological subgroups. Methods Children born SGA (N = 1050) from U.S. Early Childhood Longitudinal Study-Birth Cohort (2001–2007) was divided into etiological subgroups by each of 7 well-established prenatal risk factors. We fit linear regression models to compare 5-y reading, math, gross motor and fine motor scores across SGA subgroups, adjusting for socio-demographic confounders. Results Compared to singleton SGA subgroup, multiple-birth SGA subgroup had lower mean reading (adjusted mean difference, -4.08 [95% confidence interval, -6.10, -2.06]) and math (-2.22 [-3.61, -0.84]) scores. These disadvantages in reading and math existed only among multiple-birth SGA subgroup without ovulation stimulation (reading, -4.50 [-6.64, -2.36]; math, -2.91 [-4.37, -1.44]), but not among those with ovulation stimulation (reading, -2.33 [-6.24, 1.57]; math 0.63 [-1.86, 3.12]). Compared to singleton SGA subgroup without maternal smoking and inadequate gestational weight gain, singleton SGA subgroup with co-occurrence of maternal smoking and inadequate gestational weight gain (GWG) had lower mean reading (-4.81 [-8.50, -1.12]) and math (-2.95 [-5.51, -0.38]) scores. These differences were not mediated by Apgar score. Conclusions Multiple-birth SGA subgroups (vs. singleton SGA) or singleton SGA subgroup with co-occurrence of smoking and inadequate GWG (vs. singleton SGA subgroup without maternal smoking and inadequate gestational weight gain) have poorer cognitive development up to 5 y.
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Affiliation(s)
- Xiuhong Li
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.,Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo, State University of New York, Buffalo, NY, 14214, United States of America
| | - Rina D Eiden
- Research Institute on Addictions, University at Buffalo, State University of New York, Buffalo, NY, 14203, United States of America
| | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo, State University of New York, Buffalo, NY, 14214, United States of America
| | - Edmond D Shenassa
- Maternal and Child Health Program, School of Public Health, University of Maryland, College Park, MD, 20742, United States of America.,Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, 20742, United States of America.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, 02912, United States of America
| | - Chuanbo Xie
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo, State University of New York, Buffalo, NY, 14214, United States of America.,Department of Cancer Prevention Research, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province 510060, China
| | - Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo, State University of New York, Buffalo, NY, 14214, United States of America
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Koustas G, Sjoblom C. Minute changes to the culture environment of mouse pre-implantation embryos affect the health of the conceptus. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2016. [DOI: 10.1016/j.apjr.2016.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Ghassabian A, Sundaram R, Bell E, Bello SC, Kus C, Yeung E. Gross Motor Milestones and Subsequent Development. Pediatrics 2016; 138:peds.2015-4372. [PMID: 27354457 PMCID: PMC4925077 DOI: 10.1542/peds.2015-4372] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE We examined the longitudinal associations of age at achieving gross motor milestones and children's development in a US cohort of singletons and twins. METHODS In the Upstate KIDS study, a population-based study of children born between 2008 and 2010, information on age at achievement of motor milestones and developmental skills was available in 599 children (314 singletons, 259 twins, and 26 triplets). Mothers reported their children's major motor milestones at ∼4, 8, 12, 18, and 24 months. At age 4 years, children's development was clinically assessed by using the Battelle Developmental Inventory, Second Edition (BDI-2). Primary analyses by using multivariate linear regressions were conducted in singletons. We also examined the associations in twins. RESULTS Later achievement of standing with assistance predicted lower BDI-2 scores in singletons in adjusted models (B per SD of age at achievement, -21.9 [95% confidence interval (CI), -41.5 to -2.2]). Post hoc analysis on age of standing with assistance showed that associations were driven by differences in adaptive skills (B = -5.3 [95% CI, -9.0 to -1.6]) and cognitive skills (B = -5.9 [95% CI, -11.5 to -0.4]). Analyses restricted to twins suggested no association between the age at achievement of milestones and total BDI-2 score after adjustment for gestational age and birth weight. CONCLUSIONS This study provides evidence that the age of achieving motor milestones may be an important basis for various aspects of later child development. In twins, key predictors of later development (eg, perinatal factors) overshadow the predictive role of milestones in infancy.
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Affiliation(s)
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Erin Bell
- Departments of Environmental Health Sciences and,Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, New York
| | | | - Christopher Kus
- Division of Family Health, New York State Department of Health, Albany, New York
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van den Akker O, Postavaru GI, Purewal S. Maternal psychosocial consequences of twins and multiple births following assisted and natural conception: a meta-analysis. Reprod Biomed Online 2016; 33:1-14. [PMID: 27156004 DOI: 10.1016/j.rbmo.2016.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/14/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
The aim of this meta-analysis is to provide new evidence on the effects on maternal health of multiple births due to assisted reproductive technology (ART). A bibliographic search was undertaken using PubMed, PsycINFO, CINAHL and Science Direct. Data extraction was completed using Cochrane Review recommendations, and the review was performed following PRISMA and MOOSE guidelines. Meta-analytic data were analysed using random effects models. Eight papers (2993 mothers) were included. Mothers of ART multiple births were significantly more likely to experience depression (standardized mean difference [SMD] d = 0.198, 95% CI 0.050 - 0.345, z = 2.623, P = 0.009; heterogeneity I(2) = 36.47%), and stress (SMD d = 0.177, 95% CI 0.049 - 0.305, P = 0.007; heterogeneity I(2) = 0.01%) than mothers of ART singletons. No difference in psychosocial distress (combined stress and depression) (SMD d = 0.371, 95% CI -0.153 - 0.895; I(2) = 86.962%, P = 0.001) or depression (d = 0.152, 95% CI -0.179 - 0.483: z = 0.901; I(2) = 36.918%) were found between mothers of ART and naturally conceived multiple births. In conclusion, mothers of ART multiple births were significantly more likely to have depression and stress than mothers of ART singletons, but were no different from mothers of naturally conceived multiples.
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Affiliation(s)
- Olga van den Akker
- Department of Psychology, School of Science and Technology, Middlesex University, Hendon, London, NW44BT, UK.
| | - Gianina-Ioana Postavaru
- Centre for Sustainable Working Life, Birkbeck, University of London, Malet Street, Bloomsbury, London, WC1E 7HX, UK
| | - Satvinder Purewal
- Institute of Psychology, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, WV1 1AD, UK
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Ahrenfeldt LJ, Skytthe A, Möller S, Czene K, Adami HO, Mucci LA, Kaprio J, Petersen I, Christensen K, Lindahl-Jacobsen R. Risk of Sex-Specific Cancers in Opposite-Sex and Same-Sex Twins in Denmark and Sweden. Cancer Epidemiol Biomarkers Prev 2015; 24:1622-8. [PMID: 26282631 DOI: 10.1158/1055-9965.epi-15-0317] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/29/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Increasing evidence shows that some cancers originate in utero. It is hypothesized that elevated exposure to some steroid hormones might increase cancer risk and that hormone transfer between twin fetuses could result in different prenatal exposure to testosterone. METHODS This large-scale prospective twin study compared opposite-sex (OS) and same-sex (SS) twins to test the impact of intrauterine exposures on cancer risk. On the basis of the Danish and Swedish twin and cancer registries, we calculated incidence rate ratios for OS and SS twins, whereas standardized incidence ratios (SIR) with 95% confidence intervals (CI) were calculated for OS/SS twins compared with the general population. RESULTS A total of 18,001 cancers were identified during 1943-2009. No significant differences were observed between OS and SS twins, neither for the sex-specific cancers nor for cancer at all sites. All-cause cancer was slightly reduced for OS and SS twins compared with the general population, significant for OS males (SIR, 0.95; 95% CI, 0.92-0.98) and for SS males and females (SIR, 0.97; 95% CI, 0.94-0.99). CONCLUSIONS Our data suggest that having a male co-twin-which may entail higher exposure to prenatal testosterone-does not increase the risk of sex-specific cancers in OS females. Furthermore, the study supports that twinning per se is not a risk factor of cancer. IMPACT Findings are reassuring, as they fail to provide evidence for the hypothesis that endocrine or other difference in the in utero milieu affects the risk of sex-specific cancers.
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Affiliation(s)
- Linda J Ahrenfeldt
- The Danish Twin Registry, Department of Public Health, University of Southern Denmark, Odense C, Denmark.
| | - Axel Skytthe
- The Danish Twin Registry, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Sören Möller
- The Danish Twin Registry, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lorelei A Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jaakko Kaprio
- Department of Public Health and Institute for Molecular Medicine, University of Helsinki, Helsinki, Finland. Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Inge Petersen
- The Danish Twin Registry, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Kaare Christensen
- The Danish Twin Registry, Department of Public Health, University of Southern Denmark, Odense C, Denmark. Department of Clinical Biochemistry and Pharmacology and Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- The Danish Twin Registry, Department of Public Health, University of Southern Denmark, Odense C, Denmark. Max-Planck Odense Center on the Biodemography of Aging, University of Southern Denmark, Odense C, Denmark
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Neonatal and infant outcomes in twin gestations with preterm premature rupture of membranes at 24-31 weeks of gestation. Obstet Gynecol 2014; 124:323-331. [PMID: 25004345 DOI: 10.1097/aog.0000000000000369] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the perinatal and infant and early childhood morbidity associated with preterm premature rupture of membranes (PROM) in a cohort of twin pregnancies evaluated prospectively with neonatal follow-up to 2 years of age. METHODS This was a secondary analysis of a randomized controlled trial of magnesium sulfate for prevention of cerebral palsy. Inclusion criteria were twin gestation with preterm PROM diagnosed between 24 0/7 and 31 6/7 weeks of gestation and planned expectant management. Latency (time from membrane rupture to delivery) and perinatal outcomes were evaluated by gestational age at membrane rupture. Long-term neonatal outcomes were also analyzed. RESULTS Among 151 women who met inclusion criteria, the median gestational age at preterm PROM was 28.1 weeks (range 24.1-31.6 weeks). Approximately one-third of women achieved a latency of at least 1 week. Gestational age at preterm PROM (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.63-0.90 for each week after 24 weeks of gestation) and cervical dilation at admission (OR 0.66, 95% CI 0.49-0.90 for each centimeter of dilation) were inversely associated with a latency period of at least 1 week. There were no stillbirths (95% CI 0-1%), but the rate of neonatal mortality was 90 per 1,000 newborns (95% CI 57-112) with a 7.3% cerebral palsy rate among survivors (95% CI 4.4-10.3%). CONCLUSION In twin pregnancies, preterm PROM from 24 to 31 weeks of gestation is associated with a neonatal mortality rate of 9.0% and an overall cerebral palsy rate of 7.3%. A longer latency period is associated with less advanced cervical dilation and later gestational age at PROM. LEVEL OF EVIEDENCE: II.
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Murray SR, Norman JE. Multiple pregnancies following assisted reproductive technologies--a happy consequence or double trouble? Semin Fetal Neonatal Med 2014; 19:222-7. [PMID: 24685368 DOI: 10.1016/j.siny.2014.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The association between assisted reproduction technologies (ART) and multiple pregnancy is well-established, with a multiple birth rate of 24% in ART pregnancies. Multiple pregnancy is associated with significantly increased maternal and perinatal morbidity and mortality, as well as increased costs to the National Health Service. Evidence relating to the obstetric outcomes of ART twins versus naturally conceived twins is discussed in this review. Methods to reduce the risk of multiple births including elective single embryo transfer and multifetal pregnancy reduction are also discussed.
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Affiliation(s)
- S R Murray
- Simpson Centre for Reproductive Health, Royal Infirmary Edinburgh, 47 Little France Crescent, UK.
| | - J E Norman
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, UK
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Gejão MG, Nicolielo AP, Gonçalves BRL, Maximino LP, Lopes-Herrera SA. Evolução comunicativa em gemelares com atraso no desenvolvimento da linguagem. REVISTA CEFAC 2014. [DOI: 10.1590/1982-021620141013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo tem como tema o comportamento comunicativo de gêmeos com alteração de linguagem pré e pós intervenção fonoaudiológica. Foram analisados dados de dois pares de gêmeos do sexo masculino (S1/S2 monozigóticos; S3/S4 dizigóticos), com diagnóstico de Atraso de Linguagem. Os dados foram coletados na avaliação pré e pós intervenção fonoaudiológica, por meio de: entrevista semi-estruturada com os pais; observação do comportamento comunicativo; e teste de linguagem e escala de desenvolvimento. A intervenção fonoaudiológica teve duração de 34 meses para S1/S2 (de dois anos e cinco meses a cinco anos e três meses) e 17 meses para S3/S4 (de três anos e sete meses a cinco anos e quatro meses). Na avaliação pré intervenção fonoaudiológica de S1/S2 foram observadas intercorrências pré, peri e /pós natais mais graves, com maior comprometimento neuropsicomotor e comunicativo. S3/S4 apresentaram intercorrências pré, peri e pós natais menos graves e o atraso no desenvolvimento ocorreu apenas para a linguagem. A idade das crianças na avaliação pós intervenção foi semelhante, porém, o par S1/S2 apresentou desempenho comunicativo e global com maior prejuízo, mesmo tendo recebido maior tempo de intervenção fonoaudiológica. S3 apresentou desempenho aproximado ao desenvolvimento típico e S4 dificuldades apenas quanto à fonologia e pragmática. As experiências de gemelares, diferenciadas em meio a circunstâncias interpessoais, acarretam desenvolvimento de linguagem atípico, devido à menor necessidade objetiva de interação linguística. As intercorrências pós natais em S1/S2 agravaram o atraso no desenvolvimento infantil, englobando o desenvolvimento comunicativo.
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Abstract
OBJECTIVE To assess the association between number of embryos transferred and a measure of assisted reproductive technology success that emphasizes good perinatal outcome. METHODS We analyzed assisted reproductive technology cycles initiated in 2011 that progressed to fresh embryo transfer among women using autologous oocytes and reported to the U.S. National Assisted Reproductive Technology Surveillance System (n=82,508). Percentages of good perinatal outcome (live birth of a term [at or after 37 weeks of gestation], normal birth weight [2,500 g or greater] singleton) were stratified by prognosis (favorable, average, less favorable), age, embryo stage (day 3, day 5), and number of embryos transferred. Differences in the percentages by number of embryos transferred were evaluated using Fisher's exact test with Bonferroni correction. RESULTS Among patients younger than 35 years with a favorable prognosis, chances of a good perinatal outcome were higher with transferring a single (compared with double) day 5 (43% compared with 27%) or day 3 embryo (36% compared with 30%). Likewise, a higher chance of a good perinatal outcome was observed with transferring a single day 5 embryo in patients 35-37 years old with a favorable prognosis (39% compared with 28%) or patients younger than 35 years old with an average prognosis (35% compared with 26%). A higher chance of good perinatal outcome was associated with transferring two (compared with one) day 3 embryos among patients aged 40 years or younger with an average prognosis or patients younger than 35 years old with a less favorable prognosis. CONCLUSION The association between number of embryos transferred and the birth of a term, normal birth weight singleton is described. Among patients younger than 35 years of age undergoing in vitro fertilization with a favorable prognosis, the highest chance of good perinatal outcome is associated with a single embryo transfer. LEVEL OF EVIDENCE II.
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Goodman A, Heshmati A, Malki N, Koupil I. Associations between birth characteristics and eating disorders across the life course: findings from 2 million males and females born in Sweden, 1975-1998. Am J Epidemiol 2014; 179:852-63. [PMID: 24553681 DOI: 10.1093/aje/kwt445] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Birth characteristics predict a range of major physical and mental disorders, but findings regarding eating disorders are inconsistent and inconclusive. This total-population Swedish cohort study identified 2,015,862 individuals born in 1975-1998 and followed them for anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified until the end of 2010. We examined associations with multiple family and birth characteristics and conducted within-family analyses to test for maternal-level confounding. In total, 1,019 males and 15,395 females received an eating disorder diagnosis. Anorexia nervosa was independently predicted by multiple birth (adjusted hazard ratio = 1.33, 95% confidence interval: 1.15, 1.53) for twins or triplets vs. singletons) and lower gestational age (adjusted hazard ratio = 0.96, 95% confidence interval: 0.95, 0.98) per extra week of gestation, with a clear dose-response pattern. Within-family analyses provided no evidence of residual maternal-level confounding. Higher birth weight for gestational age showed a strong, positive dose-response association with bulimia nervosa (adjusted hazard ratio = 1.15, 95% confidence interval: 1.09, 1.22, per each standard-deviation increase), again with no evidence of residual maternal-level confounding. We conclude that some perinatal characteristics may play causal, disease-specific roles in the development of eating disorders, including via perinatal variation within the normal range. Further research into the underlying mechanisms is warranted. Finally, several large population-based studies of anorexia nervosa have been conducted in twins; it is possible that these studies considerably overestimate prevalence.
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Kulkarni AD, Jamieson DJ, Jones HW, Kissin DM, Gallo MF, Macaluso M, Adashi EY. Fertility treatments and multiple births in the United States. N Engl J Med 2013; 369:2218-25. [PMID: 24304051 DOI: 10.1056/nejmoa1301467] [Citation(s) in RCA: 175] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The advent of fertility treatments has led to an increase in the rate of multiple births in the United States. However, the trends in and magnitude of the contribution of fertility treatments to the increase are uncertain. METHODS We derived the rates of multiple births after natural conception from data on distributions of all births from 1962 through 1966 (before fertility treatments were available). Publicly available data on births from 1971 through 2011 were used to determine national multiple birth rates, and data on in vitro fertilization (IVF) from 1997 through 2011 were used to estimate the annual proportion of multiple births that were attributable to IVF and to non-IVF fertility treatments, after adjustment for maternal age. Trends in multiple births were examined starting from 1998, the year when clinical practice guidelines for IVF were developed with an aim toward reducing the incidence of multiple births. RESULTS We estimated that by 2011, a total of 36% of twin births and 77% of triplet and higher-order births resulted from conception assisted by fertility treatments. The observed incidence of twin births increased by a factor of 1.9 from 1971 to 2009. The incidence of triplet and higher-order births increased by a factor of 6.7 from 1971 to 1998 and decreased by 29% from 1998 to 2011. This decrease coincided with a 70% reduction in the transfer of three or more embryos during IVF (P<0.001) and a 33% decrease in the proportion of triplet and higher-order births attributable to IVF (P<0.001). CONCLUSIONS Over the past four decades, the increased use of fertility treatments in the United States has been associated with a substantial rise in the rate of multiple births. The rate of triplet and higher-order births has declined over the past decade in the context of a reduction in the transfer of three or more embryos during IVF. (Funded by the Centers for Disease Control and Prevention.).
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Affiliation(s)
- Aniket D Kulkarni
- From the Women's Health and Fertility Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta (A.D.K., D.J.J., D.M.K., M.F.G.); the Johns Hopkins School of Medicine, Baltimore (H.W.J.); the Eastern Virginia Medical School, Norfolk (H.W.J.); the Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati (M.M.); and the Warren Alpert Medical School, Brown University, Providence, RI (E.Y.A.)
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Nan C, Piek J, Warner C, Mellers D, Krone RE, Barrett T, Zeegers MP. Trajectories and predictors of developmental skills in healthy twins up to 24 months of age. Infant Behav Dev 2013; 36:670-8. [DOI: 10.1016/j.infbeh.2013.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 07/08/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
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Angulo-Barroso RM, Tiernan C, Chen LC, Valentin-Gudiol M, Ulrich D. Treadmill training in moderate risk preterm infants promotes stepping quality--results of a small randomised controlled trial. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3629-3638. [PMID: 24012586 DOI: 10.1016/j.ridd.2013.07.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 07/24/2013] [Accepted: 07/30/2013] [Indexed: 06/02/2023]
Abstract
Infants at risk for neuromotor delay (NMD) are associated with premature birth and low birth weight. These infants frequently exhibit tone, posture, and movement abnormalities. Therefore, it is important to identify potential interventions to facilitate early motor development within this population. The purpose of this study was to examine the potential benefits of treadmill (TM) training in infants at risk for NMD. Furthermore, relationships between TM stepping performance and onset of walking have been suggested, and therefore, were also explored. Twenty-eight infants at moderate risk for NMD were randomly assigned to one of two groups: (1) TM training (experimental) (N=15) or (2) control (N=13). Infants in the experimental group were trained for 8 min/day, five days/week from study entry until walking onset. Monthly, 5 min of TM stepping performance were videotaped and analysed for infants in both groups to obtain frequency and quality of TM stepping. Groups were different in terms of TM stepping performance with experimental group displaying better stepping. However, they did not differ in age of walking onset (experimental=15.1 months, control=14.6 months). In both groups, frequency of TM stepping was significantly related to onset of walking. Findings suggest that TM training as implemented impact the quality of TM stepping, but did not significantly improve walking onset. Given the significant relationship between stepping and walking onset, the moderate affection of the population, the relative low intensity and lack of individualisation of the training, we suggest future research should further explore the impact of TM training on gait-related variables and include individualised, more intense, and prolonged training.
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Affiliation(s)
- R M Angulo-Barroso
- Department of Health and Applied Sciences, INEFC University of Barcelona, Spain; Kinesiology, University of Michigan, Ann Arbor, MI, USA.
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Neurodevelopmental Outcome Among Multiples and Singletons: A Regional Neonatal Intensive Care Unit's Experience in Turkey. Twin Res Hum Genet 2013; 16:614-8. [DOI: 10.1017/thg.2012.155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective: The aim of this study was to compare the neurodevelopmental outcome at 12–18 months’ corrected age between multiples and singleton preterm infants. Methods: We designed a prospective study of preterm infants (≤32 weeks gestation) born and hospitalized in the neonatal intensive care unit between November 2008 and November 2009, whose assessments were performed at 12–18 months’ corrected age. Neurodevelopmental impairment was defined as the presence of any one of the following: moderate or severe cerebral palsy, severe bilateral hearing loss or bilateral blindness, mental developmental index score, or psychomotor developmental index score less than 70. Results were compared for both multiples and singleton infants. Results: One hundred and fifty-nine multiples and 211 singleton infants were assessed at 12–18 months’ corrected age. The neurodevelopmental outcome including all parameters at 12–18 months’ corrected age in multiples was not significantly different from singleton preterm infants. Conclusions: Multiple gestation in preterm infants is not associated with an increased risk of neurodevelopmental impairment at 12–18 months’ corrected age compared with singleton preterm infants. For further information, long term and high participation in neurodevelopmental follow-up and evaluation at pre-school age will be needed.
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Abstract
AbstractThe science of genetics is undergoing a paradigm shift. Recent discoveries, including the activity of retrotransposons, the extent of copy number variations, somatic and chromosomal mosaicism, and the nature of the epigenome as a regulator of DNA expressivity, are challenging a series of dogmas concerning the nature of the genome and the relationship between genotype and phenotype. According to three widely held dogmas, DNA is the unchanging template of heredity, is identical in all the cells and tissues of the body, and is the sole agent of inheritance. Rather than being an unchanging template, DNA appears subject to a good deal of environmentally induced change. Instead of identical DNA in all the cells of the body, somatic mosaicism appears to be the normal human condition. And DNA can no longer be considered the sole agent of inheritance. We now know that the epigenome, which regulates gene expressivity, can be inherited via the germline. These developments are particularly significant for behavior genetics for at least three reasons: First, epigenetic regulation, DNA variability, and somatic mosaicism appear to be particularly prevalent in the human brain and probably are involved in much of human behavior; second, they have important implications for the validity of heritability and gene association studies, the methodologies that largely define the discipline of behavior genetics; and third, they appear to play a critical role in development during the perinatal period and, in particular, in enabling phenotypic plasticity in offspring. I examine one of the central claims to emerge from the use of heritability studies in the behavioral sciences, the principle of minimal shared maternal effects, in light of the growing awareness that the maternal perinatal environment is a critical venue for the exercise of adaptive phenotypic plasticity. This consideration has important implications for both developmental and evolutionary biology.
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Lutz KF, Burnson C, Hane A, Samuelson A, Maleck S, Poehlmann J. Parenting Stress, Social Support, and Mother-Child Interactions in Families of Multiple and Singleton Preterm Toddlers. FAMILY RELATIONS 2012; 61:642-656. [PMID: 23125472 PMCID: PMC3483797 DOI: 10.1111/j.1741-3729.2012.00726.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The study investigated family support as a buffer of stress in 153 mothers and preterm toddlers. Data were collected regarding maternal depressive symptoms, parenting stress, and family support; infant health; and videotaped mother-child interactions. Although more parenting stress related to less optimal child play, only information support functioned as a protective factor. Information support predicted positive play under high, but not low, maternal stress. Mothers of multiples reported more parenting stress than mothers of singletons.
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Dodd JM, Crowther CA, Haslam RR, Robinson JS. Elective birth at 37 weeks of gestation versus standard care for women with an uncomplicated twin pregnancy at term: the Twins Timing of Birth Randomised Trial. BJOG 2012; 119:964-73. [PMID: 22691051 DOI: 10.1111/j.1471-0528.2012.03356.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate whether for women with an uncomplicated twin pregnancy, elective birth at 37 weeks of gestation was associated with reduced risk of death or serious outcomes for babies, without increasing harm. DESIGN Randomised controlled trial. SETTING Maternity hospitals across Australia, New Zealand and Italy. POPULATION A total of 235 women with an uncomplicated twin pregnancy at 36(+6) weeks of gestation, with no contraindication to continuing their pregnancy. METHODS Using a computer-generated, central telephone randomisation service, 235 women were randomised to Elective Birth (birth at 37 weeks; n=116) or Standard Care (continued expectant management, with birth planned from 38 weeks; n=119). Outcome assessors were masked to treatment allocation. MAIN OUTCOME MEASURE A composite of serious adverse outcome for the infant. RESULTS For women with an uncomplicated twin pregnancy, elective birth at 37 weeks of gestation was associated with a significant reduction in risk of serious adverse outcome for the infant (Elective Birth 11/232 [4.7%] versus Standard Care 29/238 [12.2%]; risk ratio [RR] 0.39; 95% CI 0.20-0.75; P=0.005), reflecting a reduction in birthweight less than the third centile using singleton gestational age-specific charts (Elective Birth 7/232 [3.0%] versus Standard Care 24/238 [10.1%]; RR 0.30; 95% CI 0.13-0.67; P=0.004). In a post hoc analysis using twin gestational age-specific charts, there was evidence of a trend towards a reduction in the primary composite of serious adverse infant outcome (Elective Birth Group 4/232 [1.7%] versus Standard Care Group 12/238 [5.0%]; RR 0.34; 95% CI 0.11 to 1.05; P=0.06). CONCLUSION The findings of our study support recommendations for women with an uncomplicated twin pregnancy to birth at 37 weeks of gestation.
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Affiliation(s)
- J M Dodd
- Australian Research Centre for Health of Women and Babies (ARCH), Robinson Institute, The University of Adelaide, Adelaide, SA, Australia.
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Hjern A, Ekeus C, Rasmussen F, Lindblad F. Educational achievement and vocational career in twins - a Swedish national cohort study. Acta Paediatr 2012; 101:591-6. [PMID: 22353254 DOI: 10.1111/j.1651-2227.2012.02636.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To investigate how being born and raised as a twin is associated with IQ, educational achievement and vocational career. METHODS Register study in a national birth cohort, complemented with a siblings study. The study population included 13,368 individuals born and raised as twins and 837,752 singletons, including 3019 siblings of twins, in the Swedish birth cohorts of 1973-1981. Our outcome measures were mean grade points on a five point scale from ninth grade of primary school at 15-16 years, IQ tests on a nine grade point scale from male conscripts at 18-19 years, highest completed education, disability benefits, work income and employment at 27-35 years of age. RESULTS Twins had slightly better mean grade point averages in ninth grade; +0.08 (95% CI 0.04-0.11) and more often had completed a university education in young adulthood; OR 1.16 (1.02-1.21) compared with singleton siblings, despite male twins having a slightly lower IQ at military conscription compared with male singletons. Employment rates, mean income and disability benefits were similar in twins and singletons. CONCLUSIONS Twins have slightly better educational careers and similar vocational careers compared with those born as singletons.
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Affiliation(s)
- Anders Hjern
- Centre for Health Equity Studies, Karolinska Institutet/Stockholm University, Sweden.
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Crinella FM. Does soy-based infant formula cause ADHD? Update and public policy considerations. Expert Rev Neurother 2012; 12:395-407. [PMID: 22449212 DOI: 10.1586/ern.12.2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An earlier article hypothesized a relationship between soy-based infant formulas, manganese (Mn) neurotoxicity and symptoms of ADHD. In this update, more recent literature on ADHD, Mn and Mn neurotoxicity is reviewed, as well as the risks of Mn toxicity that may accompany ingestion of soy-based infant formula. The results of several critical studies are described, including rodent and primate models that demonstrate an association between ingestion of relatively high levels of Mn and: overactivity, disinhibition and inattention; stereotypes and disturbances of social relatedness; and alterations of dopamine D1 and D2 receptors and dopamine transporter in critical brain regions. Similar deficits have been shown in children with ADHD. In addition, ADHD-like symptoms of behavioral disinhibition were found to be correlated with Mn content in tooth enamel, apparently deposited at or before the fifth gestational month. The results are discussed in terms of their weight as a risk factor in ADHD, vis-à-vis compelling evidence of genetic, epigenetic and other environmental risk factors associated with the disorder, as well as the appropriateness of additional public policy decisions regarding the safety of soy formula.
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Affiliation(s)
- Francis M Crinella
- University of California Irvine, Department of Pediatrics, UCI Child Development Center, 19722 MacArthur Blvd, Irvine, CA 92612, USA.
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Heikkilä K, Kelly Y, Renfrew MJ, Sacker A, Quigley MA. Breastfeeding and educational achievement at age 5. MATERNAL AND CHILD NUTRITION 2012; 10:92-101. [PMID: 22462489 DOI: 10.1111/j.1740-8709.2012.00402.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Our aim was to investigate whether the duration of breastfeeding, at all or exclusively, is associated with educational achievement at age 5. We used data from a prospective, population-based UK cohort study, the Millennium Cohort Study (MCS). 5489 children from White ethnic background born at term in 2000-2001, attending school in England in 2006, were included in our analyses. Educational achievement was measured using the Foundation Stage Profile (FSP), a statutory assessment undertaken by teachers at the end of the child's first school year. Breastfeeding duration was ascertained from interviews with the mother when the child was 9 months old. We used modified Poisson's regression to model the association of breastfeeding duration with having reached a good level of achievement overall (≥78 overall points and ≥6 in 'personal, social and emotional development' and 'communication, language and literacy' points) and in specific areas (≥6 points) of development. Children who had been breastfed for up to 2 months were more likely to have reached a good level of overall achievement [adjusted rate ratio (RR): 1.09, 95% confidence interval (CI): 1.01, 1.19] than never breastfed children. This association was more marked in children breastfed for 2-4 months (adjusted RR: 1.17, 95% CI: 1.07, 1.29) and in those breastfed for longer than 4 months (adjusted RR: 1.16, 95% CI: 1.07, 1.26). The associations of exclusive breastfeeding with the educational achievement were similar. Our findings suggest that longer duration of breastfeeding, at all or exclusively, is associated with better educational achievement at age 5.
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Affiliation(s)
- Katriina Heikkilä
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK Institute for Social and Economic Research, University of Essex, Essex, UK Mother and Infant Research Unit, University of York, York, UK
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Palermo GD, Neri QV, Monahan D, Kocent J, Rosenwaks Z. Development and current applications of assisted fertilization. Fertil Steril 2012; 97:248-59. [PMID: 22289284 DOI: 10.1016/j.fertnstert.2011.12.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 12/20/2011] [Accepted: 12/20/2011] [Indexed: 12/17/2022]
Abstract
Since the very early establishment of in vitro insemination, it became clear that one of the limiting steps is the achievement of fertilization. Among the different assisted fertilization methods, intracytoplasmic sperm injection emerged as the ultimate technique to allow fertilization with ejaculated, epididymal, and testicular spermatozoa. This work describes the early steps that brought forth the development of intracytoplasmic sperm injection and its role in assisted reproductive techniques. The current methods to select the preferential male gamete will be elucidated and the concerns related to the offspring of severe male factor couples will be discussed.
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Affiliation(s)
- Gianpiero D Palermo
- The Ronald O. Perelman & Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York 10021, USA.
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Curran S, Dworzynski K, Happé F, Ronald A, Allison C, Baron-Cohen S, Brayne C, Bolton PF. No major effect of twinning on autistic traits. Autism Res 2011; 4:377-82. [PMID: 21766464 DOI: 10.1002/aur.207] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND It has been questioned whether the process of twinning might be a risk factor for autism spectrum conditions (ASC) and autistic traits. AIM We sought to determine whether autistic traits and probable disorder, as measured by the Childhood Autism Spectrum Test (CAST), were more pronounced in twins compared to singletons. SAMPLES Data were analyzed from two large population-based samples of UK children, twins (n = 5,142 twin pairs, aged 8 years) and singletons (n = 2,805, aged 5-9 years). RESULTS Distributions of CAST scores in both groups were negatively skewed and scores for twins were more variable than singletons. Mean CAST total scores and standard errors (SE) were not significantly different for twins (5.1; SE 0.04) compared to singletons (4.9; SE 0.08). Moreover, contrary to expectations, the likelihood of scoring above the threshold for possible ASC was significantly lower in the twins than the singletons (OR = 0.69; P = 0.002). Subsidiary analyses of CAST scores according to sex, twin type, and subscale scores representing the subdomains of autism found a few significant differences (P<0.01), but the effect sizes for these differences were small and none exceeded η(2) = 0.005. The explanation for these small differences remains obscure, but the very small effect sizes mean they are of little importance. CONCLUSIONS Our results do not provide evidence to support twinning as a risk factor in the development of autistic traits.
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Affiliation(s)
- Sarah Curran
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, King's College London, United Kingdom.
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Bridges PJ, Jeoung M, Kim H, Kim JH, Lee DR, Ko C, Baker DJ. Methodology matters: IVF versus ICSI and embryonic gene expression. Reprod Biomed Online 2011; 23:234-44. [PMID: 21665548 DOI: 10.1016/j.rbmo.2011.04.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 03/09/2011] [Accepted: 04/14/2011] [Indexed: 12/20/2022]
Abstract
The use of assisted reproduction treatment, especially intracytoplasmic sperm injection (ICSI), is now linked to a range of adverse consequences, the aetiology of which remains largely undefined. Our objective of this study was to determine differences in gene expression of blastocysts generated by ICSI as well as ICSI with artificial oocyte activation (ICSI-A) versus the less manipulative IVF, providing fundamental genetic information that can be used to aid in the diagnosis or treatment of those adversely affected by assisted reproduction treatment, as well as stimulate research to further refine these techniques. Murine blastocysts were generated by ICSI, ICSI-A and IVF, and processed for a microarray-based analysis of gene expression. Ten blastocysts were pooled for each procedure and three independent replicates generated. The data were then processed to determine differential gene expression and to identify biological pathways affected by the procedures. In blastocysts derived by ICSI versus IVF, the expression of 197 genes differed (P < 0.01). In blastocysts derived by ICSI-A versus IVF and ICSI-A versus ICSI, the expression of 132 and 65 genes differed respectively (P < 0.01). Procedural-induced changes in genes regulating specific biological pathways revealed some consistency to known adverse consequences. Detailed investigation of procedure-specific dysfunction is therefore warranted.
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Affiliation(s)
- Phillip J Bridges
- Division of Clinical and Reproductive Sciences, University of Kentucky, Lexington, KY 40536, USA
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Wadhawan R, Oh W, Vohr BR, Wrage L, Das A, Bell EF, Laptook AR, Shankaran S, Stoll BJ, Walsh MC, Higgins RD. Neurodevelopmental outcomes of triplets or higher-order extremely low birth weight infants. Pediatrics 2011; 127:e654-60. [PMID: 21357334 PMCID: PMC3304548 DOI: 10.1542/peds.2010-2646] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Extremely low birth weight twins have a higher rate of death or neurodevelopmental impairment than singletons. Higher-order extremely low birth weight multiple births may have an even higher rate of death or neurodevelopmental impairment. METHODS Extremely low birth weight (birth weight 401-1000 g) multiple births born in participating centers of the Neonatal Research Network between 1996 and 2005 were assessed for death or neurodevelopmental impairment at 18 to 22 months' corrected age. Neurodevelopmental impairment was defined by the presence of 1 or more of the following: moderate to severe cerebral palsy; mental developmental index score or psychomotor developmental index score less than 70; severe bilateral deafness; or blindness. Infants who died within 12 hours of birth were excluded. Maternal and infant demographic and clinical variables were compared among singleton, twin, and triplet or higher-order infants. Logistic regression analysis was performed to establish the association between singletons, twins, and triplet or higher-order multiples and death or neurodevelopmental impairment, controlling for confounding variables that may affect death or neurodevelopmental impairment. RESULTS Our cohort consisted of 8296 singleton, 2164 twin, and 521 triplet or higher-order infants. The risk of death or neurodevelopmental impairment was increased in triplets or higher-order multiples when compared with singletons (adjusted odds ratio: 1.7 [95% confidence interval: 1.29-2.24]), and there was a trend toward an increased risk when compared with twins (adjusted odds ratio: 1.27 [95% confidence: 0.95-1.71]). CONCLUSIONS Triplet or higher-order births are associated with an increased risk of death or neurodevelopmental impairment at 18 to 22 months' corrected age when compared with extremely low birth weight singleton infants, and there was a trend toward an increased risk when compared with twins.
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Affiliation(s)
- Rajan Wadhawan
- West Coast Neonatology, All Children's Hospital, 601 Fifth Street South, OCC 5th Floor, St Petersburg, FL 33701, USA.
| | - William Oh
- Department of Pediatrics, Women & Infants Hospital, Providence, Rhode Island
| | - Betty R. Vohr
- Department of Pediatrics, Women & Infants Hospital, Providence, Rhode Island
| | - Lisa Wrage
- Statistics and Epidemiology Unit, Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Abhik Das
- Statistics and Epidemiology Unit, Research Triangle Institute International, Rockville, Maryland
| | - Edward F. Bell
- Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | - Abbot R. Laptook
- Department of Pediatrics, Women & Infants Hospital, Providence, Rhode Island
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Barbara J. Stoll
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Michele C. Walsh
- Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio; and
| | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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Abstract
This article discusses the issue of multifetal pregnancy as a result of fertility treatments. Pregnancies with multiple gestations are associated with serious infant and maternal health risks as well as psychological distress and significant financial consequences, and are a far too common consequence of infertility treatments such as assisted reproductive technology (ART) and ovulation induction drugs. Women with multifetal pregnancies are at a higher risk for multiple pregnancy complications and maternal morbidity/mortality as well as stress, depression, and anxiety disorders, especially when there is the threat of a loss of one or more fetuses. The rise in rates of multifetal gestation and the accompanying increased risk to both mother and fetuses have led the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology to develop guidelines to limit the number of transferred embryos during in vitro fertilization. Nurses who work with infertile women are in a position to educate them about the risks, benefits, and alternatives associated with ARTs and multifetal pregnancies, and should endeavor to learn as much as possible about this topic.
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Ross LE, McQueen K, Vigod S, Dennis CL. Risk for postpartum depression associated with assisted reproductive technologies and multiple births: a systematic review. Hum Reprod Update 2010; 17:96-106. [DOI: 10.1093/humupd/dmq025] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Andrade DHLD, Pedruzzi CM, Soares IDA, Azevedo MFD, Camboim ED. Achados audiológicos e linguagem em gêmeas regurgitadoras. REVISTA CEFAC 2009. [DOI: 10.1590/s1516-18462009000300023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
TEMA: achados audiológicos e linguagem em gêmeas regurgitadoras. PROCEDIMENTOS: o estudo consiste no relato dos achados audiológicos e do desenvolvimento da linguagem de duas crianças, irmãs gêmeas regurgitadoras. Para isso, foram realizadas as seguintes etapas: coleta dos dados nos prontuários, relatórios das pacientes e coleta de informações com os familiares. Nos prontuários, além dos achados audiológicos e de linguagem, foi relatado também o tipo de abordagem terapêutica utilizada e os objetivos dos planejamentos diários que nortearam as sessões. RESULTADOS: as crianças apresentaram ausência das emissões otoacústicas evocadas por estímulo transiente e produto de distorção, e potencial evocado auditivo de tronco encefálico via aérea e via óssea com limiar eletrofisiológico em 30 e 35dBNA bilateralmente, tendo sido sugerido no laudo perda auditiva de grau leve. No acompanhamento apresentaram episódios de otite média secretora, confirmada pela avaliação otorrinolaringológica, e curvas timpanométricas do tipo B e C. As crianças iniciaram a terapia fonoaudiológica aos 10 meses de idade. Foram realizadas 32 sessões terapêuticas para o sujeito A.B. e 28 para o sujeito A.E., no período de 11 meses, nas quais as crianças demonstraram evolução, apresentando produções esperadas para a fase linguística do desenvolvimento da linguagem, porém não eram compatíveis com a idade observada na literatura estudada. CONCLUSÃO: as duas crianças com refluxo gastroesofágico apresentaram perda condutiva, audição flutuante nos primeiros dois anos de vida e atraso no desenvolvimento da linguagem. Apesar de suas produções apresentarem atraso, foi possível observar significativa evolução das crianças em relação à aquisição de linguagem dentro do processo terapêutico.
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Hillemeier MM, Farkas G, Morgan PL, Martin MA, Maczuga SA. Disparities in the prevalence of cognitive delay: how early do they appear? Paediatr Perinat Epidemiol 2009; 23:186-98. [PMID: 19775380 PMCID: PMC3439196 DOI: 10.1111/j.1365-3016.2008.01006.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cognitively delayed children are at risk for poor mental and physical health throughout their lives. The economically disadvantaged and some race/ethnic groups are more likely to experience cognitive delay, but the age at which delays first emerge and the underlying mechanisms responsible for disparities are not well understood. The objective of this study was to determine when sociodemographic disparities in cognitive functioning emerge, and identify predictors of low cognitive functioning in early childhood. Data were from 7308 singleton and 1463 multiple births in the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a nationally representative cohort of children born in the USA in 2001. Multiple logistic regression analyses examined associations between sociodemographic characteristics and low cognitive functioning at 9 and 24 months, and tested whether gestational and birth-related factors mediate these associations. Sociodemographic characteristics were statistically significant predictors of low cognitive functioning among singletons at 24 months, including the three lowest quintiles of socio-economic status [lowest quintile, odds ratio (OR) = 2.7, 95% confidence interval [CI][1.7, 4.1]], non-white race/ethnicity (African American OR = 1.8 [95% CI 1.3, 2.5], Hispanic OR = 2.3 [95% CI 1.6, 3.2]), and gender (male OR = 2.1, [95% CI 1.7, 2.5]). Gestational and birth characteristics associated with low cognitive function at 9 months included very low and moderately low birthweight (OR = 55.0 [95% CI 28.3, 107.9] and OR = 3.6 [95% CI 2.6, 5.1]), respectively, and very preterm and moderately preterm delivery (OR = 3.6 [95% CI 2.0, 6.7] and OR = 2.4 [95% CI 1.7, 3.5]), respectively, but they had weaker effects by 24 months (ORs for birthweight: 3.7 [95% CI 2.3, 5.9] and 1.8 [95% CI 1.4, 2.3]; ORs for preterm: 1.8 [95% CI 1.1, 2.9] and 0.9 [95% CI 0.7, 1.3]). Results for multiple births were similar. Sociodemographic disparities in poor cognitive functioning emerged by 24 months of age, but were not mediated by gestational or birth characteristics. Further investigation of processes whereby social disadvantage adversely affects development prior to 24 months is needed.
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Affiliation(s)
- Marianne M Hillemeier
- Department of Health Policy and Administration, Pennsylvania State University, University Park, PA 16802, USA.
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Abstract
PURPOSE To evaluate short-term outcomes associated with discordant twin pairs admitted to the NICU. DESIGN A retrospective descriptive study comparing discordant twin pairs. SUBJECTS Three hundred eighty-four discordant twin pairs were included. Mean gestational age of the twin pairs was 32.6 weeks (range, 24-39). METHODS The ParadigmHealth database was queried for all twin admissions from January 2001 to June 2004 admitted to 453 NICUs across the United States. Discordance was calculated for each twin set as defined as greater than 20% difference in birth weight. Exclusion criteria were death of a twin, congenital anomalies, or extracorporeal life support. MAIN OUTCOME MEASURES Demographics, respiratory needs, feeding characteristics, complications, and discharge needs. RESULTS A total of 384 discordant twin pairs met inclusion criteria. The larger twins required more ventilation/continuous positive airway pressure (55% vs 44%, P < .01) and/or oxygen therapy (50% vs 41%, P = .02) compared with smaller twins. Smaller twins reached full oral (PO) feeds an average of 0.6 weeks later than larger twins (P < .0001) but had more weight gain per day. Smaller twins transitioned to an open crib at lower weights but at slightly greater age. No differences were noted with necrotizing enterocolitis or apnea. Smaller twins had increased nosocomial infections. Mean length of stay was shorter (P = .0036) in the larger twin group. Only 33% of the twin pairs were discharged on the same day. CONCLUSIONS Larger twins had more acute respiratory issues but achieved certain milestones more rapidly with fewer complications, thus leading to earlier discharge compared with their smaller twin counterparts.
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Allen C, Bowdin S, Harrison RF, Sutcliffe AG, Brueton L, Kirby G, Kirkman-Brown J, Barrett C, Reardon W, Maher E. Pregnancy and perinatal outcomes after assisted reproduction: a comparative study. Ir J Med Sci 2008; 177:233-41. [PMID: 18521653 DOI: 10.1007/s11845-008-0172-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Accepted: 04/25/2008] [Indexed: 11/26/2022]
Affiliation(s)
- C Allen
- Human Assisted Reproduction Ireland, Rotunda Hospital, Dublin, Ireland.
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Socio-emotional and language development of 2-year-old children born after PGD/PGS, and parental well-being. Hum Reprod 2008; 23:1849-57. [DOI: 10.1093/humrep/den179] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ferreira AT, Silva MMAD, Silva L, Merighi LBM, Miranda AM, De-Vitto LPM, Lamônica DAC. Desempenho comunicativo em trigêmeos prematuros. REVISTA CEFAC 2008. [DOI: 10.1590/s1516-18462008000100003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: descrever habilidades do desenvolvimento de trigêmeos aos 18 meses e aos 29 meses de vida, enfocando a comunicação. MÉTODOS: irmãos trigêmeos dizigóticos do sexo masculino. Os procedimentos de avaliação englobaram: Anamnese, Observação do Comportamento Comunicativo e Escala de Desenvolvimento de Gesell e Amatruda (2000). As avaliações foram realizadas aos 18 e aos 29 meses. As crianças apresentaram atraso do desenvolvimento neuropsicomotor e eram expostas a multilingüismo. RESULTADOS: foi verificada alteração nos comportamentos comunicativos nas três crianças, tanto na primeira quanto na segunda avaliação, embora tenha sido observada melhora do desempenho, após as orientações recebidas pela família. Na segunda avaliação foi observada criptofasia. Dos comportamentos motor grosseiro, delicado, adaptativo, pessoal-social e de linguagem, o último foi o mais afetado para as três crianças, apesar de todos estarem alterados considerando a idade cronológica dos trigêmeos. CONCLUSÃO: as habilidades do desenvolvimento dos trigêmeos avaliados neste estudo estavam alteradas, acometendo todas as áreas. Ressalta-se maior comprometimento da linguagem tanto aos 18 como aos 29 meses.
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Affiliation(s)
| | | | - Luciana Silva
- Universidade de São Paulo; Universidade de São Paulo
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Kanat-Pektas M, Kunt C, Gungor T, Mollamahmutoglu L. Perinatal and first year outcomes of spontaneous versus assisted twins: a single center experience. Arch Gynecol Obstet 2008; 278:143-7. [DOI: 10.1007/s00404-007-0545-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 12/13/2007] [Indexed: 10/22/2022]
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Moustafa MK, Sheded SA, El Aziz Mousta MA. Elective single embryo transfer versus double embryo transfer in assisted reproduction. Reprod Biomed Online 2008; 17:82-7. [PMID: 18616895 DOI: 10.1016/s1472-6483(10)60297-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Eskandar M, Shafiq H, Almushait MA, Sobande A, Bahar AM. Cervical cerclage for prevention of preterm birth in women with twin pregnancy. Int J Gynaecol Obstet 2007; 99:110-2. [PMID: 17612544 DOI: 10.1016/j.ijgo.2007.05.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Revised: 05/25/2007] [Accepted: 05/29/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the effect of elective cervical cerclage in women with twin pregnancy on gestational age at time of delivery. METHOD In a pragmatic fashion women in Abha Maternity Hospital, Saudi Arabia with twin gestations were allocated to receive either an elective cerclage (group I) or no cerclage (group II). Elective cerclage was performed at 12 to 14 weeks of gestation after sonographic examination of the fetus to confirm gestational age and exclude major congenital anomalies. In all cases, follow up of the pregnancy was continued until delivery. RESULTS Of the 176 twin pregnancies included, cerclage was performed in 76 women, and no cerclage in 100 women. In Group I: 12 pregnancies ended in spontaneous miscarriage, 37 in preterm labor, and 27 women reached full term. There were a total of 106 live births in 62 women. In Group II: 8 women aborted, 44 women ended in preterm labor and 48 women reached full term. There were a total of 160 live births in 89 women. The gestational age at delivery ranged from 20 to 41 weeks. Multiple regression analysis did not show association between cerclage and time of delivery, although a trend was observed (P=0.056). CONCLUSION Elective cerclage contributes little in prolongation of gestational age at the time of delivery in women with twin pregnancy, especially in women of high parity. Those with a previous history of preterm labor may be a subgroup that could benefit from elective cerclage.
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Affiliation(s)
- M Eskandar
- Department of Obstetrics and Gynecology and Reproductive Medicine, King Khalid University, College of Medicine, PO Box 641, Abha, Saudi Arabia.
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