Analysis of Infants Based on Data from the German Perinatal Survey of the Years 1994-2011 in Mecklenburg-Pomerania, Germany. Classification of Infants with regard to their Gestation Duration and Birth Weight

BACKGROUND

The demographic change in -Germany describes an ongoing process of population development of which the eastern German states tend to be more affected. These ongoing changes have an influence on the reproductive behavior of the population. After twenty-three years of German reunification, the present study has investigated the question to what extent the somatic classification of newborns in Mecklenburg-Pomerania (M-P), Germany, is affected.

MATERIAL AND METHODS

Newborn singleton births (n=174,084) were classified from the existing data of the German Perinatal Survey between 1994 and 2011. The rate of premature birth, SGA, and LGA rate as well as the rate of low birth weight ≤2,499 g were determined both gender-dependently and independently. In addition, a combined analysis of the rates has been taken into account. The obtained data material from M-P made it possible for the first time to compare by values. National and international reference studies were considered in this comparison.

RESULTS

In M-P, the premature birth rate is 5.2%; the rate of newborns with low birth weight ≤ 2,499 g is 4.4%. Among newborns of ≤2,499 g and SGA newborns, girls compose a higher percentage (4.7%, 12.5%) compared to boys (4.0%, 7.4%). The premature birth rate and LGA newborns appear conversely. For these, the percentage of boys (5.6%, 12.6%) is higher than that of girls (4.8%, 7.0%). 60.6% of the gender non-specific newborns ≤2,499 g are simultaneously premature newborn infants. Only a very small percentage of 0.5% of SGA newborns is at the same time premature infants and newborns with low birth weight.

CONCLUSIONS

By getting nationwide country-specific figures, a detailed analysis of the newborns in M-P can be performed. The analysis supports the existing national values and is a helpful addition for practice-oriented advice.

Analysis of infants based on data from the German Perinatal Survey of the years 1994-2011 in Mecklenburg-Pomerania, Germany: new percentile values for anthropometric measures of infants

BACKGROUND

This communication presents precise percentile values for birth weight, birth length and cranial circumference of infants in Mecklenburg-Pomerania, Germany.

MATERIAL AND METHODS

Based on data from the German Perinatal Survey of the years 1994-2011 in Mecklenburg-Pomerania, the 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentile values for birth weight, birth length and head circumference are specified. The measurements of a total of 174,084 infants from non-multiple births are shown.

RESULTS

The statistically calculated percentile values are presented in tabular and graph forms. The mean birth weight of the infants was 3,437.8 g. The average age of the mothers was 27.9 years. The average duration of pregnancy was 39.4 complete weeks.

CONCLUSIONS

The insights gained from many years of data collection are presented as standardised, regional percentile values and curves for Mecklenburg-Pomerania for the first time. The differentiated presentation for the federal state opens the possibility for individually tailored consultations in clinical practice and may provide support for recognised national curves for these values.

A retrospective in vitro study of the impact of anti-diabetics and cardioselective pharmaceuticals on breast cancer

BACKGROUND

In a retrospective controlled study, a tumor-protective effect, regarding breast cancer, was determined for the medicines metformin and glitazone (anti-diabetics), bisoprolol, and propranolol (cardioselective β1 adrenoceptor antagonists). Our main goal was to provide evidence, showing the tumor-protective effects of beta-blockers and of antidiabetics via investigations in vitro.

MATERIALS AND METHODS

Four different medicines were tested in cell cultures: Propranolol: 2.4 mg/ml and 0.3 mg/ml; bisoprolol: 0.1 mg/ml and 0.05 mg/ml; metformin: 7.5 mg/ml, 2.5 mg/ml, and 0.15 mg/ml; and glitazone: 2.5 mg/ml, 0.15 mg/ml, and 0.05 mg/ml. The human breast cancer cell lines MCF7 and BT20 (estrogen receptor-positive and -negative; ATCC; cell density: 5×10(5) cells/ml) were used. Both cell lines were cultured under sterile conditions in incubators at 37°C, with a humidified atmosphere of 5% CO(2). The influences of the drugs were determined through cytotoxicity and proliferation assays and performance of a hydrogen peroxide assay. Morphological observations (light microscopy) and metabolic investigations (pH value, glucose) were also performed.

RESULTS

The application of the beta-blocker propranolol resulted in highly cytotoxic effects (>90%) in both cell lines. In contrast, bisoprolol did not have any effects, neither in cytotoxicity tests nor in cell proliferation assays. The anti-diabetic metformin had a higher cytotoxic influence on the BT20 than did on the MCF7 cell line. The cell proliferation of BT20 was significantly inhibited after the addition of 2.5 mg/ml metformin and of 2.5 mg/ml glitazone. The application of glitazone also resulted in an increase of hydrogen peroxide and a decrease of the pH value.

CONCLUSION

The strongest cytotoxic effect was observed with propranolol suggesting that, in clinical practice, this pharmaceutical can be used in patients with breast cancer who have hypertension. A specific clinical recommendation for anti-diabetics is not yet possible.

Previous extrauterine pregnancies and neonatal outcomes in primiparous women--an analysis of the German Perinatal Survey

AIM

The aim of this study was to compare neonatal outcomes in primiparous women with and without previous extrauterine pregnancies.

MATERIAL AND METHODS

We analysed data from 207 171 singleton pregnancies in primiparous women from the German Perinatal Survey of 1998-2000. To minimise confounding factors, we only included women without previous miscarriages or terminations of pregnancy and performed comparisons separately for 3 maternal age groups as well as for all cases together.

RESULTS

Women with and without previous extrauterine pregnancies were of comparable height and weight but women with previous extrauterine pregnancies were on average older (29.2 vs. 26.6 years). The preterm birth rate was higher in women with previous extrauterine pregnancies (9.4% vs. 6.8%, odds ratio 1.42 [95% confidence interval 1.18-1.69], p<0.001; analysing all cases together) as was the rate of neonates with a low birth weight ≤ 2 499 g (7.9% vs. 5.7%, odds ratio 1.43 [95% confidence interval 1.17-1.72], p>0.001; analysing all cases together). The proportions of neonates classified as small, appropriate, or large for gestational age were rather similar in women with and without previous extrauterine pregnancies; likewise Apgar scores differed only slightly, although for some comparisons statistical significance was reached in spite of the small magnitude of differences.

CONCLUSIONS

Previous extrauterine pregnancies are associated with higher rates of preterm birth and infants of low birth weight in subsequent pregnancies.

[Congenital malformations--a systematic cohort study from Mecklenburg-Western Pomerania (Germany)]

AIM

We aimed to set-up a passive malformations registry for 2002-2004 for the German Federal State of Mecklenburg-Western Pomerania in order to estimate the prevalence of congenital malformations among live births, stillbirths, miscarriages, and induced abortions. POPULATION AND STUDY DESIGN: Under the guidance of the working group "Neonatology Mecklenburg-Vorpommern" a standardised malformations record form modelled after the Mainz registry was developed and used to record malformations among live births, stillbirths, miscarriages, and induced abortions in all 21 obstetric departments in Mecklenburg-Western Pomerania between 2002 and 2004. We compared the population of neonates with malformations with a general population sample from the German Perinatal Survey of 1995-1997.

RESULTS

There were 768 neonates with at least one major malformation among a total of 37 634 neonates in Mecklenburg-Western Pomerania; this means that the prevalence of major malformations was 203.53 per 10 000 neonates. The prevalence of major malformations in liveborn infants was 178.61 per 10 000. The most common malformations in the total study population were ventricular septal defect (prevalence: 37.2 per 10 000), hydronephrosis (16.7 per 10 000), hypospadias (14.8 per 10 000), Down syndrome (10.1 per 10 000), and cleft lip and palate (9.0 per 10 000). Among the induced abortions the most common diagnoses were Down syndrome, anencephalus, Edwards syndrome, and congenital hydrocephalus. The preterm birth rate among the 637 liveborn and stillborn infants with malformations was 19.6%; 5.6% were born before 32 completed weeks of gestation. The small for gestational age rate for infants with malformations was 14.2% for girls and 14.5% for boys, thus increased compared with the general population sample (9.7%).

CONCLUSIONS

Congenital malformations are important determinants of childhood morbidity and mortality. Malformation prevalence and types of malformations, along with morbidity and mortality, are important parameters in perinatal medicine. The establishment of active malformation registries is therefore an important task.

Effects of phytoestrogen extracts isolated from flax on estradiol production and ER/PR expression in MCF7 breast cancer cells

BACKGROUND

In this study, we tested the effects of crude extracts from flax (Linum usitatissimum) on the production of estradiol and expression of estrogen receptor (ER) and progesterone receptor (PR) in human breast cancer MCF7 cells.

MATERIALS AND METHODS

Isoflavone and lignan extracts from flax plant Linum usitatissimum were obtained, using different extraction methods. Breast carcinoma cells (MCF7) were incubated with various concentrations of the isolated extracts. Untreated MCF7 cells were used as controls. Supernatants were removed at designated times and tested for estradiol with an ELISA method. Furthermore, the effect of phytoestrogen extracts on the production of ERa and ERbeta as well as on PR was examined.

RESULTS AND CONCLUSION

Production of estradiol is elevated in MCF7 cells in a concentration-dependent manner after stimulation with isoflavone and lignan extracts from Linum usitatissimum. Expression of ERalpha is up-regulated after stimulation with lower concentrations of lignan extracts from flax plants, unchanged at median concentrations and down-regulated at high concentrations. Expression of ERbeta is down-regulated in a concentration-dependent manner.

Online monitoring of cellular metabolism in the MCF-7 carcinoma cell line treated with phytoestrogen extracts

BACKGROUND

Phytoestrogens are naturally occurring, plant-derived, nonsteroidal phytochemicals with anticarcinogenic potential. The aim of this study was to isolate phytoestrogens from the flax root of Linum usitatissimum and to test their effect on cellular metabolism in the human mammalian carcinoma cell line MCF-7 using the Bionas 2500 analysis system.

MATERIALS AND METHODS

Metabolically relevant parameters such as acidification, oxygen consumption and cell adhesion were registered continuously over 8 and 24 hours on six sensor chips in parallel at different concentrations of flax root extracts.

RESULTS

The extracts from flax roots of L. usitatissimum reduced extracellular acidification, respiration and adhesion in a concentration-dependent manner.

CONCLUSION

The Bionas 2500 analysis system allows multiparametric online monitoring of cellular processes and can be used to detect the mode of action of anticarcinogenic compounds in cellular metabolism.

The influence of smoking during pregnancy on fetal growth. Considering daily cigarette consumption and the SGA rate according to length of gestation

BACKGROUND

Smoking is the most important risk factor for adverse pregnancy outcomes in industrialized nations and is associated with, amongst other adverse effects, a higher rate of small-for-gestational-age (SGA) neonates. The rate of SGA neonates born before 32 weeks and its association with smoking have so far not been the focus of attention.

MATERIAL AND METHODS

Using data of 643,288 primiparous women from the German perinatal statistics of 1995-2000, we aimed to investigate this relationship. We also analyzed our data according to daily cigarette consumption.

RESULTS

We found that smoking during pregnancy was strongly associated with lower birth weight and higher SGA rates. This effect was especially pronounced in women >or=31 years. There was clear dose dependence with regard to daily cigarette consumption. An increase in SGA rates in smokers versus non-smokers can already be seen for very early preterm deliveries (31 weeks of gestation or less).

CONCLUSIONS

Our results allow the definition of groups of women who are at higher risk of SGA births. We show that especially older primiparous women (aged >or=31 years) who smoke >10 cigarettes a day are at increased risk of experiencing fetal growth restriction.

Obesity and pregnancy--a risk profile

AIM

We aimed to illustrate the relationship between maternal obesity during pregnancy and maternal and fetal outcomes. We examined the influence of maternal BMI at the beginning of pregnancy on risks of pregnancy and birth, and on the somatic classification of the neonates.

MATERIAL AND METHODS

In our retrospective cohort study we included 499,267 singleton pregnancies taken from the German perinatal statistics of 1998-2000. 51,506 obese pregnant women (BMI >or= 30) were compared to 320,148 pregnant women of normal weight (BMI 18.50-24.99). We divided obesity into 3 BMI-categories: BMI = 30.00-34.99, BMI = 35.00-39.99, and BMI >or= 40.00. We defined small-for-gestational-age (SGA), appropriate-for-gestational-age (AGA), and large-for-gestational-age (LGA) status by birth weight percentiles.

RESULTS

10.3 % of all pregnant women had a BMI >or= 30.00 and 0.8 % had a BMI >or= 40.00. The frequency of hypertension increased with the extent of obesity: 7.1 % (BMI = 30.00-34.99), 12.5 % (BMI = 35.00-39.99) and 18.3 % (BMI >or= 40.00) compared to 1.2 % (BMI 18.50-24.99). Cephalopelvic disproportion was found in 6.8 % (BMI >or= 40.00) compared to 2.8 % (BMI 18.50-24.99). Fetal macrosomia occurred in 24.8 % (BMI >or= 40.00) compared to 7.9 % in the control group. Rates of pre-eclampsia, gestational diabetes, and fetal structural anomalies also increased with maternal BMI. Women with different BMIs differed in parity but not in age.

CONCLUSIONS

Obesity during pregnancy is associated with a range of maternal and fetal adverse outcomes. Pregnancy in obese women therefore calls for close monitoring and careful planning of delivery. Pre-conceptional weight reduction should be considered.

Transection of vaginal cuff is an independent prognostic factor in stage I endometrial cancer

AIMS

The objective was to identify prognostic factors of disease-free and overall survival in stage I endometrial carcinoma, thereby potentially facilitating the selection of patients who are on high risk for recurrence and who may benefit from transection of a vaginal cuff.

METHODS

In a retrospective review between 1994 and 2004, 340 patients with stage I endometrial carcinoma were managed surgically at two different hospitals in Rostock. The median follow-up was 79 (range 12-161) months. Clinical and histological parameters were compared using the SPSS software package.

RESULTS

In the univariate analysis the factors associated with poor disease-free survival in stage I carcinoma were higher tumor grade (P=0.013), and no removed vaginal cuff (P=0.025). The corresponding factor for impaired overall survival was no removed vaginal cuff (P=0.003). All parameters with a P-value<0.25 in the univariate setting were entered into a multivariate analysis. The factors that maintained associated with poor disease-free and overall survival were higher tumor grade and lack of vaginal cuff.

CONCLUSIONS

The removal of a vaginal cuff during abdominal hysterectomy was found to be an independent prognostic factor in stage I endometrial carcinomas. A prospective surgical trial is needed to validate our results before changing current clinical practice.

Expression of the glycodelin A gene and the detection of its protein in tissues and serum of ovarian carcinoma patients

BACKGROUND

Glycodelin A (GdA), also known as placental protein 14 (PP14), has been detected in endometrial, cervical and ovarian carcinoma cells. It is suspected to be a marker of human ovarian cancer tissues.

MATERIALS AND METHODS

We investigated serum, tissue and cyst fluid samples of patients with an ovarian carcinoma in contrast to patients with benign and malignant diseases such as uterine myoma, endometriosis, cervical, uterine and breast cancer, and metastases of bladder and colon carcinoma. Used methods were enzyme-immunoassay, immunohistochemistry (IHC) and polymerase chain reaction (PCR).

RESULTS

In 81% of the control group the GdA-expression was negative, which was confirmed by IHC and PCR. Of the ovarian carcinoma group only 52% showed correspondence between IHC and PCR.

CONCLUSION

These results indicate that determination of GdA is not sensitive or specific enough for use as a tumour marker.

Effects of phytoestrogen extracts from Linum usitatissimum on the Jeg3 human trophoblast tumour cell line

BACKGROUND

Phytoestrogens are a diverse group of nonsteroidal plant compounds which have similar effects to endogenous estrogens in humans and have been ascribed potential anticarcinogenic activities. We tested the effects of phytoestrogen extracts from different plant organs of flax, Linum usitatissimum, on cell proliferation in trophoblast tumour cells of the cell line Jeg3.

MATERIALS AND METHODS

Phytoestrogen extracts were prepared from leaves, stems and roots of L. usitatissimum using different extraction methods. The isolated phytoestrogens were identified using HPLC-MS analysis. The influence on cell proliferation (MTT test) was determined in the trophoblast tumour cells, Jeg3.

RESULTS

Cell proliferation of trophoblast tumour Jeg3 cells was significantly affected by the phytoestrogens isolated from leaves, stems and roots of L. usitatissimum. Root extracts inhibited Jeg3 cell growth significantly.

CONCLUSION

A cell culture model system of the human trophoblast tumour cell line, Jeg3, was established to test the effect of potential phytoestrogens on cell proliferation. It was shown that the roots of L. usitatissimum contain measurable concentrations of lignans and isoflavones.

Expression of the pantumour Thomsen-Friedenreich antigen in the human placenta with the diagnosis of hydatidiform mole

BACKGROUND

The Thomsen-Friedenreich (TF) antigen (or, more precisely, epitope, Galbeta1-3GalNAc) has long been known as a pancarcinoma antigen. Specific carrier proteins of the TF-antigen are the mucins, in particular Mucin 1. Here, we present our results of immunohistochemical identification of this carbohydrate antigen in human placenta.

MATERIALS AND METHODS

Paraffin-embedded placental and decidual tissues from patients with the diagnosis hydatidiform mole were incubated with different monoclonal antibodies directed against TF-epitope (CD 176, IgM) and against Mucin 1 (CD 227, IgG).

RESULTS

No expression of the TF-antigen or of Mucin 1 (Muc 1) was found in the decidual tissues, but the samples of chorionic tissues were TF- and Muc 1-antigen positive. As positive control, placental samples of the first trimester were investigated.

CONCLUSION

A disorder of the extravillous trophoblast cells is present in hydatidiform mole.

Maternal serum corticotropin-releasing hormone and ACTH levels as predictive markers of premature labor

OBJECTIVE

To investigate whether corticotropin-releasing hormone (CRH) and corticotropin (ACTH) plasma concentrations in women diagnosed with preterm labor are of potential clinical value in the assessment of the risk of preterm birth.

METHOD

Plasma samples of 79 women diagnosed with preterm labor were used in this study. Samples were divided into three groups based on the week of gestation (24th-28th, 29th-32nd, 33rd-37th). CRH and ACTH values were determined by ELISA.

RESULT

Mean maternal peripheral plasma values of CRH and ACTH were significantly higher (p<0.001) in women who were initially diagnosed with preterm labor and finally delivered a preterm birth, compared to women with the same diagnosis but with term birth.

CONCLUSION

CRH and ACTH serum levels in women diagnosed with preterm labor could be used as predictors for the timing of parturition.