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Biomedical subjects

Z Stein

Publications and source records attributed to Z Stein.

At least 73 records · Page 4Linked to original sources
PubMed1986

Characteristics of women with recurrent spontaneous abortions and women with favorable reproductive histories.

Women with a history of recurrent spontaneous abortions (repeaters) are compared with women who have had live births and no spontaneous abortions (multiparae) and women who have had live births and only one spontaneous abortion (sporadics) to identify characteristics of the women and their abortuses that might predict subsequent fetal loss. A number of risk factors for recurrent spontaneous abortion have been identified: the loss of a chromosomally normal conception, loss after the first trimester of pregnancy, a delay in conceiving prior to the study pregnancy, a diagnosis of cervical incompetence, and a history of very low birthweight deliveries. The odds ratios associated with being a repeater vary from 1.4 to 5.6 depending on the number of characteristics present.

Abortion, Habitual↗
PubMed1986

The relationship between maternal age and chromosome size in autosomal trisomy.

The pattern of maternal age-specific incidence of autosomal trisomy in spontaneous abortions was examined for each chromosome for which a sufficient number of trisomies was observed. This included chromosomes 2, 4, 7-10, 13-16, 18, and 20-22. The rate of increase after age 30 for each of the small chromosomes (groups D-G) was similar, with the exception of chromosome 16, which showed a significantly shallower rate. The C group chromosomes tended to have an intermediate rate of increase after age 30, with the exception of chromosome 7, which had a pattern similar to the smaller chromosomes. The larger chromosomes (2 and 4) had the smallest rate of increase. There was a significant relationship between chromosome size and rate of increase after age 30 (after excluding chromosome 16), but not with rate of increase before age 30. The results suggest that autosomal trisomies may be of heterogeneous origin, with a maternal age-related factor associated with chromosome size and other sources unrelated to chromosome size. Additional evidence for and against this hypothesis is discussed.

Abortion, Spontaneous↗
PubMed1985

Morphology of early fetal deaths and their chromosomal characteristics.

The morphologic features of a consecutive series of 3,472 singleton spontaneous abortions are described. Of the total, 21% consisted of well-formed fetuses (over 30 mm long), 27.9% had no identifiable fetal tissues, 34.2% consisted of fetal membranes only, and the remainder, 16.8%, consisted of a variety of embryonic types. The rate of focal malformations among embryos over 10 mm in length and among fetuses was 16.4%. The overall rate of chromosome anomalies in the 1,356 karyotyped specimens was 39.8%. The vast majority, 94%, occurred in embryos less than 30 mm, and in specimens whose development had not proceeded beyond differentiation of fetal membranes. The rate of chromosome anomalies among nonmalformed fetuses (greater than 30 mm) was only 1.7%. However, the presence of limited embryonic development was not a good predictor of the presence of a chromosome anomaly. Slightly over half (56%) of all specimens less than 30 mm long had chromosome anomalies; for individual classes of such specimens the rate ranged from 45% to 81%. The morphologic category with the highest rate of karyotypic anomalies had an excess of monosomy X abortuses. A gradient of developmental level could be associated with the degree of intrauterine mortality of each chromosome anomaly; i.e., conceptuses with karyotypes that occur at term had a greater degree of embryonic development than karyotypes that are never seen among term births. Thus, trisomies 13, 18, and 21 were more often associated with fetuses, and less often with tissue fragments than other trisomies. Focal malformations were multiple and severe in abortuses with triploidy, trisomies 13 and 18, and monosomy X and mild in trisomy 21. With the exception of monosomy X the malformations were similar to, and not more severe than those reported from, term births with the same anomaly. The high rate of intrauterine mortality in conceptuses with chromosome anomalies could be ascribed to their failure to develop past the embryonic stages. However, the presence of an equally large fraction of chromosomally normal abortions with the same degree of rudimentary development suggests the existence of early and profound developmental problems that are not associated with anomalies of the chromosome complement.

Abortion, Spontaneous↗
PubMed1985

Fever during pregnancy and spontaneous abortion.

The hypothesis that maternal fever during pregnancy is a risk factor for spontaneous abortion was tested in a case-control study by comparing the frequencies and timing of fevers of 100 F (37.78 C) or more among three groups of women: women having euploid abortions, women having aneuploid abortions, and women delivering at 28 weeks gestation or later (controls). Cases and controls were identified in three New York City hospitals between August 1979 and June 1982. It was hypothesized that if fever was an antecedent, rather than a symptom of spontaneous abortion, an association would be detected with euploid but not with aneuploid abortions. Among public patients, reported fevers were significantly more frequent among euploid abortions than among controls (18% vs. 7.1%, odds ratio = 2.96), whereas reported fevers were not more frequent among aneuploid abortions (3.9% vs. 7.1%, odds ratio = 0.52). It was also postulated that variation in the strength of the association of fever with euploid abortion with the duration of the interval between the fever and the abortion might yield insight about mechanisms underlying an association. The odds ratios for fever occurring at three intervals--in the same calendar month as a euploid abortion, one month before, and two or more months before--were 6.04, 3.28, and 1.41, respectively. The findings for private patients--for whom a control group was not recruited--are compatible with those for public patients although not statistically significant: the odds of fever with euploid abortion were 2.18 times those with aneuploid abortion.

Abortion, Spontaneous↗
PubMed1985

Maternal employment and the chromosomal characteristics of spontaneously aborted conceptions.

The employment histories of 1,252 women experiencing a spontaneous abortion and 2,126 controls were compared to examine the relation between maternal employment before and during pregnancy and karyotype of the spontaneously aborted conceptus. Among private patients, there was no evidence of a positive association of work only before pregnancy, only during pregnancy, or both before and during pregnancy (v no work) with either chromosomally normal or abnormal abortions. In contrast, among public patients the odds of working only during pregnancy or both before and during pregnancy were raised for chromosomally abnormal abortions (adjusted odds ratios = 3.11 and 1.86, respectively) and slightly raised for chromosomally normal abortions (adjusted odds ratios = 1.35 and 1.31, respectively). Among workers, the frequencies of work before pregnancy in specific employment circumstances were compared among karyotyped cases and controls. For two work locations--factory and hospital/nursing facility--the data were of sufficient size to suggest that associations of twofold or greater with most types of abortion are unlikely.

Abortion, Spontaneous↗
PubMed1984

Family history as an independent risk factor for coronary artery disease.

The risk of family history of ischemic heart disease independent of other well described risk factors has remained difficult to quantitate. Significant coronary artery disease was determined by coronary arteriography to be present in 223 patients and absent in 57 control subjects. Age, sex, blood pressure, serum cholesterol, cigarette smoking and the presence of diabetes and left ventricular hypertrophy on the electrocardiogram were tabulated for each patient and the data used to assign a risk score based on the American Heart Association multivariate model. Subjects were stratified and matched according to risk score to estimate risk of family history independent of familial aggregation of these seven other risk factors. Angina, myocardial infarction, cardiac death and any ischemic heart disease were ascertained in 1,319 first degree relatives. Odds ratios for overall, stratified and matched comparisons of these end points in relatives of patients and control subjects ranged between 2.0 and 3.9 (p less than 0.01 for all comparisons), indicating a higher frequency of all ischemic heart disease end points in relatives of patients with documented coronary artery disease. Life table comparison of patients at lowest risk with those at higher risk showed significantly greater cumulative frequency and earlier age of onset of all ischemic heart disease end points in relatives of low risk patients. These observations indicate that some of the risk associated with family history is independent of familial aggregation of other known risk factors and suggest that the independent effects of family history may be most important in individuals who otherwise are at low risk.

Adult↗
PubMed1984

The relationship of maternal age and trisomy among trisomic spontaneous abortions.

The relationship between maternal age and trisomy was examined by comparing mean ages of 954 trisomic spontaneous abortions with those of live births ascertained at the same study center. The overall mean for trisomy was highly significantly elevated over that of the newborns. The age effect was most pronounced for trisomies involving the small chromosomes, with trisomies 13, 14, 15, 16, 17, 18, 20, 21, and 22 all having significantly increased ages by comparison with the control population. However, the majority of trisomies involving large or medium-sized chromosomes also had elevated mean maternal ages, suggesting that most, if not all, human trisomies are associated with increasing age of the mother. Additional variation in the age effect was observed among trisomies involving similar-sized chromosomes, indicating that factors other than chromosome size also influence the relationship between increasing age and trisomy.

Abortion, Spontaneous↗
PubMed1983

Maternal smoking and trisomy among spontaneously aborted conceptions.

In a study of spontaneous abortions, we found an apparently robust association of trisomy with smoking that varies with maternal age. Among women under age 30, smoking either before or at the time of conception is less common in women aborting trisomic conceptions than in controls delivering at 28 weeks or later. Among older women, smoking is more common in women aborting trisomic conceptions than in controls. Our results point to an effect of smoking on the frequency of trisomic abortions that varies with age, and they suggest that the causes of recognized trisomic abortions differ in younger and older women.

Abortion, Spontaneous↗
PubMed1982

Prenatal starvation and maternal blood pressure near delivery.

Maternities in cities exposed to the Dutch famine of 1944 to 1945 and in control cities were compared. Systolic blood pressure near the time of delivery was significantly reduced by exposure to famine late in the 2nd trimester and early in the 3rd trimester. Blood pressure correlated best with caloric rations in the 3rd month before delivery, and this relationship holds consistently below a ration level of 1900 cal. Above 1900 cal and up to 2200 cal (the upper limit of rations for the data analyzed) the relationship is inconsistent across cities. Edema, analyzed in one city, varied in a manner similar to blood pressure.

Blood Pressure↗
PubMed1982

Effects of prenatal nutritional supplementation on the placenta: report of a randomized controlled trial.

Protein and nucleic acid content, and RNase levels were measured in placentas collected at birth in a randomized controlled trial of prenatal nutritional supplementation in New York City. These biochemical indices were explored to understand better the effects of nutritional supplementation. (With high-protein supplements, gross measures had shown no improvement in outcome at birth and adverse effects on fetal growth, prematurity, and newborn survival; with balanced protein-calorie supplements, there was a nonsignificant rise in birth weight and longer gestation.) The biochemical indices were in general somewhat weakly related to fetal growth measures. Significant effects of nutritional treatment on the indices were minimal, and added no information that could account for gross effects observed in the fetus.

Birth Weight↗
PubMed1982

Leukemia and other cancers, anomalies and infections as causes of death in Down's syndrome in the United States during 1976.

All 995 persons with Down's syndrome who died in the United States during 1976 and whose death certificates listed Down's syndrome as the underlying or a contributing cause of death were identified. This allowed the underlying causes of death of 793 affected persons to be analysed and compared to deaths in the whole US population for that year. Mortality ratios provided evidence that the excess risk of leukemia mortality continues into adulthood and that deaths from other hematopoietic malignancies also occur excessively among Down's syndrome adults. Congenital anomalies of all kinds in infancy and congenital defects of the heart in infancy and later were also excessive. Respiratory tract infections and pneumonia showed persistently high ratios. Diabetes was raised only at ages 24 to 34 years. Ischemic heart disease, non-hematopoietic cancers, accidents, suicides and violence were under-represented among the causes of death. Methodological limitations of proportional mortality analysis are discussed.

Abnormalities, Multiple↗