Search PubMed⌕ Search

Biomedical subjects

Isaac Blickstein

Publications and source records attributed to Isaac Blickstein.

At least 37 records · Page 2Linked to original sources
PubMed2005

En route to an "instant family": psychosocial considerations.

Societal and cultural norms require that a worthwhile person engage in reproduction and formation of a family. Young adults who postpone childbearing may presume that fertility is granted. When all other measures fail, the use of assisted reproductive technologies is considered the ultimate salvation for these couples. It is highly stressful and may lead to significant negative psychological consequences (loss of self-esteem, confidence, health, close relationships, security, and hope). Assisted reproductive technology may produce multiple pregnancy, which is frequently overlooked or underappreciated by infertile couples. Despite the real risks associated with a multiple pregnancy and birth, infertile patients often express a desperate wish to have twins or triplets, thereby accomplishing an instant family. It is necessary to provide these couples with detailed information on the risks of multiple pregnancy and birth.

Female↗
PubMed2005

Characteristics of mothers who delivered the heaviest, average-weight, and lightest triplet sets.

We analyzed a cohort of 2850 live-born triplet sets to compare age, parity, stature, pre-gravid body mass index (BMI), and weekly weight gain in mothers who delivered triplets with a total weight in the 10th, 5th, and 1st deciles corresponding to the heaviest, average-weight, and lightest triplet sets, respectively. Mothers who delivered the heaviest triplets were significantly older, multiparous, taller, heavily built, and gained more weight compared with mothers of average-weight triplets. In contrast, except for higher parity, mothers of average-weight sets were not significantly different compared with mothers who delivered the lightest triplet sets. We concluded that parity was the only significant factor for increased total triplet weight in the first five deciles. However, the presence of other factors in addition to parity is needed for a triplet pregnancy to be included in the 10th decile.

Adolescent↗
PubMed2005

Gestational age-specific distribution of twin birth weight discordance.

AIM: To examine the gestational age-specific distribution of twin birth weight discordance. METHODS: We analyzed all liveborn twin sets between 28 and 40 weeks' gestation from the United States 1995-1998 Multiple Matched Birth Data Set compiled by the National Center for Health Statistics. We calculated the 50th and 95th percentiles of birth weight discordance at each gestational age. Neonatal mortality rates were calculated for discordant twins at the 95th percentile of birth weight discordance for each gestational age. RESULTS: At older gestational ages, the 95th percentile of birth weight discordance resulted in an inter-twin birth weight difference of approximately 25%, a value often used to define twins as birth weight discordant. However, at earlier gestational ages, the 95th percentile of birth weight discordance was greater, reaching nearly 50% at 28 weeks. CONCLUSIONS: The inter-twin birth weight difference at the 95th percentile is greater at lower gestational ages, possibly illustrating the different nature or severity of twin birth weight discordance at an earlier gestational age.

Birth Weight↗
PubMed2005

Early adequate maternal weight gain is associated with fewer small for gestational age triplets.

OBJECTIVE: To examine whether the recommended weight gain during the first 24 weeks reduces the frequency of SGA triplets. STUDY DESIGN: We used data collected by the Women's Health Division of Matria Healthcare, Inc (Marietta, GA). We studied the frequency of SGA triplets (birth weight <10th percentile by triplet standards) by weight gain, parity, and pregravid BMI category. Adequate weight gain was defined as >16.2 kg at 24 weeks and BMI categories were defined as underweight (<19.8), normal (19.8-26), and obese (BMI>26). RESULTS: We studied 2890 triplet sets. Adequate weight gain reduces the frequency of SGA triplets, irrespective of pregravid BMI category and parity, except for obese nulliparous women. However, the reduced frequency of SGA infants was significant only in underweight nulli-paras (OR 0.3, 95% CI 0.1, 0.9). CONCLUSION: Higher pregravid BMI and parity seem to reduce the occurrence of SGA triplets. However, lean mothers, especially nulliparas, may be the most important target population for nutritional intervention in triplet pregnancies.

Adult↗
PubMed2005

[Psychosocial aspects of the direct path from infertility to the "instant family": are all risks known].

Infertility is invariably described as a crisis event. Couples who encounter infertility are further challenged with the accompanied sense of profound losses: loss of health, sexuality, status and prestige, relationship, self-confidence, self-esteem, security, and the fantasy for biological parenthood. Fertility treatments (ART) create hope and cure for the problem on one hand, but place a tremendous burden on the couple's resources on the other. Assisted Reproductive Technologies (ART), carry potential risks for both the infant and for the mother, in addition to diverse negative psychosocial consequences for the couple. However, it seems that couples either ignore these risks or are unaware of them, and therefore, wish to accomplish the "instant family" (more than one child) via a shortcut (one pregnancy). Although it is impossible to ignore the numerous children born with the aid of ART, it is crucial that professionals inform the couple about the medical as well as the psychological consequences that accompany fertility treatments, to enable couples to make more realistic decisions.

Family↗
PubMed2004

Neonatal mortality rates among growth-discordant twins, classified according to the birth weight of the smaller twin.

OBJECTIVE: The purpose of this study was to evaluate neonatal mortality rates among discordant twins, classified according to the birth weight of the smaller twin. STUDY DESIGN: We compared neonatal mortality rates among three groups of discordant twins (>25%), distinguished by the birth weight of the smaller twin being <10th, 10th to 50th, or >50th percentile. RESULTS: Among the 10,683 pairs of twins who were studied, the respective proportions of the three groups were 62.4%, 32.9%, and 4.7%. The neonatal mortality rate was significantly higher among pairs in which the smaller twin weighed <10th birth weight percentile (29. vs 11.1 and 11 per 1000; odds ratio, 2.7; 95% CI, 1.3, 5.7). This difference results from the higher mortality rates among the smaller but not among the larger twins. CONCLUSION: Severely discordant twin pairs in whom the smaller twin is also small for gestational age are at an increased risk of neonatal death. Identification of this group is an imperative step in the management of birth weight discordance in twin gestations.

Birth Weight↗
PubMed2004

Spontaneous embryonic loss following in vitro fertilization: incidence and effect on outcomes.

OBJECTIVES: The purpose of this study was to determine the early spontaneous loss rate in multiple pregnancies following assisted reproductive technology (ART). STUDY DESIGN: Analysis of pregnancies following ART as related to the initial number of embryos and maternal age was performed. RESULTS: At least one spontaneous loss was observed in 47.0% (95% CI 29.8-64.9) of quadruplets, 59.3% (95% CI 48.2-69.8) of triplets, and 35.2% (95% CI 29.6-41.2) of twins. The increased loss rates in mothers > or =35 years was related to early twin pregnancies, but not to early triplet and quadruplet gestations. We could not find an effect of the starting number of embryos on either gestational age or birth weight characteristics. CONCLUSION: Our observations did not identify a clear relation between early spontaneous loss of multiple gestations and either initial number of embryos or maternal age. Other factors might be involved in the outcome of ART multiple pregnancies.

Abortion, Spontaneous↗
PubMed2004

Is it normal for multiples to be smaller than singletons?

This section discusses fetal growth in multiple pregnancy from various perspectives. Whereas the entire 'fetal mass' of a multiple pregnancy can exceed the 90th birth weight percentile of a singleton of the same gestational age, the individual fetuses might exhibit growth patterns compatible with adaptation to the limited uterine environment. Adaptation can take the form of relative growth restriction (i.e. discordance), whereby not all fetuses show a decelerating growth pattern. When adaptation fails, fetal growth is genuinely restricted. However, even in cases with significant discordance, about 40% of the smaller twins weigh above the 10th birth weight percentile. The key in these circumstances might be found in the ability to recognize the transition from the physiologic adaptation into the pathologic process of growth restriction.

Embryonic and Fetal Development↗
PubMed2004

How and why are triplets disadvantaged compared to twins?

The current epidemic of triplets, a result of the widespread use of assisted reproduction, started less than two decades ago. Its full impact has been appreciated only recently. Triplets are disadvantaged from every perinatal perspective compared to twins--preterm birth, low birth weight, morbidity and mortality--because the human uterus probably is better equipped to carry twins than triplets. Although modern neonatal care has improved survival rates of preterm as well as low-birth-weight triplets, other complications remain and are of great clinical importance. The alternative to carrying triplets--multifetal pregnancy reduction--is associated with improved outcomes, as expected from comparing twin to higher-order multiples. However, the improved outcomes of triplets in recent years might call for second thoughts about the frequent recommendation of multifetal pregnancy reduction of triplets to twins.

Abortion, Spontaneous↗
PubMed2004

Do multiple gestations raise the risk of cerebral palsy?

There is an increased risk of CP in multiple as compared with singleton pregnancies, and the higher the number of fetuses the greater is the prevalence of CP. Although LBW and preterm birth are the most significant risk factors for CP, the disadvantage of twins is apparent near term. Moreover, the excessive risk is not only the result of over-representation of multiples among premature babies, but seems to be associated with circumstances that are unique to the twinning process. The risk of CP should be acknowledged not only when a multiple pregnancy is diagnosed, but also when counseling infertility patients in whom iatrogenic multiple pregnancies are an actual risk.

Birth Weight↗
PubMed2004

The likelihood of adverse outcomes in triplet pregnancies estimated by pregravid maternal characteristics.

OBJECTIVE: To estimate the likelihood of adverse outcomes in triplet pregnancies by a score comprising pregravid maternal characteristics. DESIGN: A cross-sectional study. SETTING: Triplets database collected by Matria Healthcare, Inc. PATIENT(S): A scoring system was constructed, assigning 1 point for the presence of a risk factor (nulliparity, stature <165 cm, and age <35 years) and 0 for the absence of a risk factor. Data related to 2,887 triplet sets were analyzed. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Total triplet birth weight <4,500 and delivery at 27-32 weeks. RESULT(S): We identified 18% of triplets' mothers (score 3) in whom the likelihood for adverse results is 50%-90% higher and the likelihood for optimal results is 40% to 70% lower than background rates. CONCLUSION(S): A pregravid maternal profile could estimate the likelihood of adverse outcomes and be used for consulting patients at risk of having or carrying a triplet pregnancy.

Birth Weight↗
PubMed2004

Spontaneous embryonic loss after in vitro fertilization with and without intracytoplasmic sperm injection.

OBJECTIVE: To determine whether pregnancies after IVF, with and without intracytoplasmic sperm injection (ICSI), have different early spontaneous loss rates. DESIGN: Retrospective analysis of IVF/ICSI dataset. SETTING: The Center of Reproductive Medicine, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. PATIENT(S): Women undergoing IVF with or without ICSI. INTERVENTION(S): First-trimester sonography at 6-7 weeks to count the number of embryos with positive heartbeat. The number of embryos lost was calculated from a second-trimester sonogram. MAIN OUTCOME MEASURE(S): Embryonic loss rates related to the initial number of embryos, maternal age <35 or > or =35 years, and IVF procedure. RESULT(S): In vitro fertilization and ICSI had similar embryonic loss rates (odds ratio [OR] 1.2, 95% confidence interval [CI] 0.9-1.7, and OR 1.3, 95% CI 0.9-1.8 for women aged <35 years and > or =35 years, respectively). Younger women had fewer losses after IVF (OR 0.7, 95% CI 0.5-0.9). Multiples had lower loss rates compared with singleton pregnancies. CONCLUSION(S): In vitro fertilization and ICSI have similar spontaneous embryonic loss rates. Factors other than the initial number of embryos, maternal age, and IVF technique, such as embryo quality or uterine environment, might be involved in the outcome of multiple pregnancies in assisted reproductive technology procedures.

Abortion, Spontaneous↗
PubMed2004

The ponderal index in triplets: I. Relationship to small for gestational age neonates.

The aim of the study was to examine the ponderal index in small for gestational age (SGA) triplets. Prospectively collected data from a cohort of triplets born at 28 to 37 weeks were analyzed. A low neonatal ponderal index (birth weight/[length]3) was defined as less than 1 SD below the mean (2.0), and SGA was considered as birth weight below the 10th percentile by triplet standards. We studied 2181 sets of triplets. Triplets delivered at < or = 33 weeks have a lower mean ponderal index compared with those delivered at > 33 weeks. About 70% of SGA triplets do not have a low ponderal index, whereas 79.2% of infants with a low ponderal index are not SGA by triplet standards. Both the frequency of a low ponderal index and the frequency of infants with a low ponderal index who are not SGA decrease with increasing gestational age. We conclude that the majority of triplets with a low ponderal index might not be considered growth restricted, supporting the concept that reduced fetal weight of triplets is more likely a physiological rather than a pathological phenomenon.

Anthropometry↗
PubMed2004

The ponderal index in triplets: II. Gestational age-related patterns of neonatal weights and lengths.

In order to evaluate the determinants of high and low ponderal indices in triplets, we analyzed prospectively collected data from a cohort of 2181 triplet births. Low and high neonatal ponderal indices (birth weight/[length]3) were defined as below or above 1 SD from the mean. The mean ponderal index was of 2.4 +/- 0.4. At 30-31 weeks, there were significantly more infants with a low ponderal index; after 33 weeks, more infants were born with a high index. Birth weights of infants with a high index were significantly higher throughout the entire range of gestational ages, whereas their lengths were significantly smaller. Both birth weights and infant length had significant correlations with gestational ages for infants with a low (R2=0.97 and R2=0.94, respectively) as well as with high ponderal indices (R2=0.95 and R2=0.94, respectively). The regression analyses suggest, however, different patterns for infants with low or high ponderal indices.

Anthropometry↗
PubMed2004

The ponderal index in triplets: III. Association with birth weight discordance.

Our objective was to determine the association of the ponderal index with birth weight discordance in triplets. We analyzed data from triplets delivered at 28-37 weeks for birth weight discordance (>25% difference between the heaviest and lightest triplet). Three categories of discordance (low skew, symmetrical, and high skew) were classified according to the relative position of the middle triplet. Birth weights and the ponderal index (birth weight/[length]3) of all concordant and discordant triplet groups were compared. Of 752 triplet sets included, 184 (24.5%) were discordant. Total triplet birth weight was higher in the concordant compared to all discordant categories. As opposed to birth weight, where only the middle triplet differed according to discordance pattern, the ponderal index for the largest triplet was significantly higher in the low skew discordant group compared to the concordant and other discordant triplet groups. In contrast, the ponderal index for the smallest and middle triplets were similar among the discordant groups. We concluded that discordance in triplet pregnancies exhibits different patterns of mass (birth weight) versus size (ponderal index). Our findings suggest that it may be the size of largest triplet that determines the presence or absence or discordance in triplet gestations.

Adult↗
PubMed2004

The ponderal index in triplets: IV. Relationship with maternal height.

The purpose of the study was to further evaluate the relationship between maternal height and neonatal ponderal index and length. A total of 774 triplet sets with matched maternal stature was available for analyses. We found a significant correlation between maternal height and infant length for both nulliparas (R2=0.70, p=0.04) and multiparas (R2=0.99, p=0.00005). The slopes of the regressions were different than zero, but the difference between the respective regressions was not significant (p=0.83). The analysis revealed a significant correlation between infant ponderal index and maternal stature for nulliparas (R2=0.68, p=0.04) but not for the multiparas (R2=0.08, p=0.6). The slope of the regression for nulliparas was different than zero, but that for the nulliparas was not. The difference between the respective regressions was significant (p=0.03). We conclude that taller mothers deliver longer infants, irrespective of parity, whereas the effect of maternal height on the ponderal index is parity-dependent.

Anthropometry↗