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PubMed1999

A computerised study on the results of in-vitro-fertilisation.

This project has been concerned with the comparison of children born as a result of fresh embryo transfer (IVF) with children conceived and born via the natural process. The former included children who were the single outcome of the birth (singletons) and children who were the result of a multiple birth (e.g. twins, triplets). A computer database was established into which was put 23 items of data on each child, making a total of 12,788 items overall. There were 278 "normally conceived" children (controls), 150 IVF Singletons, and 128 children from multiple births. The results show interesting differences in the gestational age at birth, the birth weight, the mode of delivery and the degrees of birth abnormalities and malformations.

Birth Weight↗
PubMed2000

Obstetric outcome and follow-up of children born after in vitro fertilization (IVF).

In vitro fertilization (IVF) is a well established and effective method for the treatment of infertility, but there is concern about the health of children born as a result of this procedure. The introduction of new technologies, such as intracytoplasmic sperm injection (ICSI), has increased concern that the offspring from such techniques may be at increased risk, particularly of malformations. Studies on obstetric and neonatal outcome and early infant development after IVF obtained from a Medline search were reviewed. Children born after IVF had a considerably higher risk of being born pre-term and with a lower birth weight than children conceived naturally. A high incidence of multiple births and maternal characteristics were the main factors responsible for the increase in adverse outcome. Novel strategies in assisted reproduction, including the development of single embryo transfer regimens and avoidance of multiple births, are required. There is also a need for further developmental follow-up of children born after assisted conception, especially those born after ICSI.

Journal Article↗
PubMed1996

Coffee and alcohol intake, smoking and risk of multiple pregnancy.

We analysed the relationship between coffee and alcohol intake, smoking and risk of multiple pregnancies using data from a case-control study on risk factors for multiple births conducted in Italy. Cases were 133 women who delivered multiple births not related to treatment for infertility (33 monozygotic and 100 dizygotic twins). Controls were 395 women admitted for normal delivery at the same clinic where cases had been identified. The odds ratios (OR) of multiple pregnancy were 1.5[95% confidence interval (CI) 0.8-2.8] and 2.0 (95% CI 1.0-3.7) for women drinking respectively one to two or three or more cups of coffee per day in comparison with non-coffee drinkers. Considering separately dizygotic and monozygotic pregnancies, the estimated OR were respectively for women drinking three or more cups of coffee, 1.7 and 3.1 for dizygotic and monozygotic pregnancies. The risk of multiple pregnancy tended to be higher in women drinking >or= 15 alcohol drinks per week: in comparison with tea-totallers the estimated OR for drink > or = 15 glasses per week were 2.3 and 2.6 respectively for dizygotic and monozygotic pregnancies. Heavy smokers (> or = 10 cigarettes per day) were at increased risk of multiple pregnancy: in comparison with never smokers, the estimated OR for multiple pregnancy was 1.6 (95% CI 0.9-2.7). Considering separately the two groups of multiple pregnancy, the OR of dizygotic and monozygotic pregnancy were 1.4 (95% CI 0.8-2.5) and 2.4 (95% CI 0.9-6.1) for women smoking > or = 10 cigarettes/day, but the trend in risk with number of cigarettes smoked per day and duration of the habit was not significant.

Adult↗
PubMed1989

Antenatal care and fetal outcome, especially low birthweight, in Port Harcourt, Nigeria.

A total of 820 singleton babies and 73 babies from multiple births were studied, all born in a 7-month period in the University of Port Harcourt Teaching Hospital. At birth, 8.9% of the singleton babies and 70% of those of multiple birth weighed less than 2500 g. Maternal factors significantly associated with increased incidence of low birthweight were antepartum haemorrhage, short stature, age and parity. However, the effects of these were nullified by antenatal care. Amongst the babies, the major contributory factor was intrauterine growth retardation, the cause of which in most cases was not apparent and was not affected by antenatal care. We suggest that a lot more attention be focussed on this category of low-birthweight babies.

Adolescent↗
PubMed1982

Sudden infant death syndrome in infants with bronchopulmonary dysplasia.

The association between bronchopulmonary dysplasia and sudden infant death syndrome was studied retrospectively in low-birth-weight infants discharged from the neonatal program at Harvard Medical School. The incidence of sudden infant death syndrome was seven times greater in infants with bronchopulmonary dysplasia when compared with a group of control infants without bronchopulmonary dysplasia. Confounding factors, including birth weight, sex, multiple birth, socioeconomic status, and apnea were evaluated. The results indicate that there is an association between bronchopulmonary dysplasia and sudden infant death syndrome.

Apnea↗
PubMed1990

Child abuse of one of a pair of twins in Japan.

A nationwide survey in Japan on child abuse and neglect revealed that 10% of the victims were products of multiple births. None of the victims who were singletons had multiple-birth siblings, and only in a few cases were both twins abused. The findings indicated that one rather than both of a pair of twins was likely to be abused in Japan. Abuse of both twins was likely when there were serious parental or family problems, whereas abuse of one twin was associated with the child's medical problems or non-home care. There was no instance of abuse of a pair of twins when both were handicapped. Comparisons of the abused twin with the non-abused co-twin and examination of the abuser's attitude to the victim suggested that the difference between twins in their development or in their response to parents increased the stress of child-rearing and encouraged favouritism, which resulted in abuse of only one twin. Comparison by parents of children with their siblings may be a common factor in general child abuse because it is a natural thing for parents to do.

Adult↗
PubMed2001

[Epipage study: mortality of very premature infants and state of progress at follow up].

OBJECTIVE: To study perinatal and neonatal mortality of very preterm infants and to assess the association with birth weight and multiple births. METHODS: Infants enrolled in the Epipage study born between 22 and 32 weeks gestational age in 9 French regions in 1997 were included in this study. The main outcome measure was stillbirth and death before discharge from hospital. RESULTS: During the study period, 4397 births and therapeutic abortions meeting the inclusion criteria were recorded (including 16% therapeutic abortions and 18% stillbirths). Survival rate for babies born between 22 and 32 weeks was 67% of all births (stillborn + liveborn) and 85% among livebirths. Survival rose with increasing gestational age: survival (livebirths) was 50% at 25 weeks gestation, 78% at 28 weeks and 97% at 32 weeks. Survival was lower for infants with a birthweight below the 10th percentile and for multiple-pregnancy infants. The different stages of the follow-up planned up to 5 years are presented together with the response rate to the postal follow-up questionnaire. CONCLUSION: This cohort provides mortality data on very premature infants during pregnancy, at birth, during hospitalization before discharge. Survival of liveborn infants was stratified by gestational age and was consistent with other geographically based studies of very preterm infants born in the 1990s.

Birth Weight↗
PubMed1999

Natural variation in the human sex ratio.

Analysis of the effect of multiple birth, birth order, age of parents and the sexes of preceding siblings on the secondary sex ratio was performed for 815 891 children, born in Denmark, 1980-1993. The proportion of males was analysed as a function of multiple birth, birth order, age of parents and the sexes of preceding siblings, using contingency tables, chi(2) tests and logistic regression analysis. The secondary sex ratio decreased with increased number of children per plural birth and with paternal age, whereas no independent effect was observed for maternal age, birth order, the sex of the preceding child, or the combination of sexes of previously born children in the family.

Adult↗
PubMed2004

[Incidence and the progression of the acute-phase of the retinopathy of prematurity in infants hospitalized in Neonatology Department of University of Medical Sciences in Poznań].

PURPOSE: The assessment of the epidemiological data of acute-phase of retinopathy of prematurity (ROP). MATERIAL AND METHODS: Infants with birth weights less than 1500g and birth dates between April 1, 2002, and May 30, 2003, admitted to special care baby unit in Department of Neonatology in Poznan, were examined. The incidence of retinopathy of prematurity, infants sex, multiple births, the onset of acute-phase ROP (considering the day of life and postmenstrual age) and also the day of life, at which the treatment was started, were analysed. RESULTS: Among 190 infants enrolled to the study 48.9% were female and 51.1% were male. There were 20.5% infants from multiple births. In the examined group in infants with a birth weight under 1250g the incidence of ROP was 32.6% and in infants with a birth weight above 1250g--7.4%. The ROP was diagnosed earliest in 4th week of life, the latest in 12th week of life (mean time of diagnosis the 8th week of life). The earliest time of performing the treatment with diode laser was 37th day of life, the latest--97th day of life (mean time of treatment the 67.5th day of life). CONCLUSIONS: Presented epidemiological data may be helpful in foreseeing the natural history of acute-phase of ROP in population of Polish premature infants with a birth weight under 1500g.

Age of Onset↗
PubMed2005

Seasonal fluctuation of multiple sclerosis births in Sardinia.

Study results from different geographical areas provide some circumstantial evidence that, when compared with the general population, people who later in life develop multiple sclerosis (MS) have a pattern of birth excess numbers in spring and late summer, which may disclose an association with MS-predisposing environmental agents. To identify the presence of season-related cluster of MS birth in Sardinia we have designed a case-control study in the province of Sassari, Northern Sardinia, insular Italy, an area at very-high and increasing risk for MS. Mean birth incidence rate of people with MS (810 cases) on a three-and six-months basis were compared with that of two control populations: the MS unaffected siblings (1069), sharing genetic material with patients, and a representative number of births (247,612) of the general population of the study area. We found that the birth in months peaking in spring significantly represents one risk factor for future MS development. This seasonal deviation of MS births reveals an intriguing epidemiological overlap with common environmental agents, which may open a new scenario of hypothetical explanations for environmental factors perhaps affecting the CNS at the crucial time of myelination or shaping the newborn immune system.

Adult↗
PubMed2004

The Western Australian Register of Childhood Multiples: effects of questionnaire design and follow-up protocol on response rates and representativeness.

Twin registers have been established worldwide to study the roles of genes and the environment in health and behaviour. While questionnaire surveys are thought to be the most cost-effective way of collecting large amounts of data, low response rates can result in response bias. Many different strategies have been proposed to maximise response rates. A register of all multiple births occurring in Western Australia (WA) from 1980 onwards has been established using probabilistic record linkage techniques. Families who had not experienced the death of one or more of their multiples were invited to participate in the Western Australian Twin Child Health (WATCH) study, which studied the genetic and environmental determinants of childhood asthma and atopy. Several questionnaire designs and follow-up methods were assessed. We have shown that it was feasible to use a population-based register of multiple births to contact families for a questionnaire study. Questionnaire length, mode of follow-up, the number of responses required and the of participants all seemed to affect response.

Follow-Up Studies↗
PubMed1998

Risk factors in premature rupture of membranes.

Objective: This retrospective study was undertaken to investigate risk factors in women who have preterm premature rupture of membranes. This information will aid the clinician in targeting at-risk women for intensified obstetric care and entry into prevention programs.Methods: 28,725 deliveries were analyzed over a 16-month time frame (January 1, 1995-April 30, 1996). These data were collected via a 14 county, 23 hospital population based Perinatal Data System. The associations between premature rupture of membranes and risk factors were analyzed using chi(2) and Fisher's Exact test analyses. Odds ratios show the magnitude of these associations.Results: Risk factors included vaginal bleeding, tobacco usage, multiple births, polyhydramnios, maternal age <20 years and >34 years, congenital malformations, parity, race, in vitro fertilization, sexually transmitted disease, prior preterm delivery, and incompetent cervix. Premature rupture of membranes shows a significant association with prior preterm delivery, prior history of a low birth weight infant, incompetent cervix, tobacco use (12 pack per day), multiple births, parity, in vitro fertilization, sexually transmitted diseases, and viral diseases, P <.001 (for all of these risk factors), polyhydramnios and non-white race, P <.01.Conclusions: These associations help to develop a picture of the patient at risk for premature rupture of membranes. Strategies can be better developed to enter high-risk patients into prevention programs to maximize pregnancy outcomes.

Journal Article↗
PubMed2001

Intrauterine insemination with donor semen. An evaluation of prognostic factors based on a review of 1131 cycles.

OBJECTIVE: To identify prognostic factors influencing the outcome of infertility treatment using intrauterine insemination with donor semen (IUI-D). DESIGN: Retrospective study of all patients undergoing IUI-D between August 1st, 1990 and July 31st, 1998. SETTING: University-affiliated infertility clinic. PATIENTS: Three hundred and five couples undergoing 1131 IUI-D treatment cycles. MAIN OUTCOME MEASURES: Type of hormonal treatment, number of follicles, length of follicular phase, endometrial pattern, female age, infertility diagnosis and semen quality related to clinical pregnancy rate, cumulative birth rate and multiple gestations. RESULTS: Throughout the nine year period the overall clinical pregnancy rate per cycle was 22.3%, with an increase from 12.9% in 1990 to 34.6% in 1998. The multiple birth rate was 20.6%. The birth rate per couple was 61.1% after a mean of 3.2 treatment cycles. The pregnancy rate was highest in the first treatment cycle and the cumulative birth rate rose only slightly after the sixth treatment cycle. The following parameters were positively and significantly correlated to a successful outcome of IUI-D: i) the first treatment cycle - compared to the following up to six treatment cycles; ii) number of mature follicles - more than one - at the time of insemination, however, with an unacceptable high rate of multiple pregnancies when more than 3 mature follicles were present; iii) time of insemination after the 12th day in the cycle; iv) insemination after ovulation has occurred and; v) female age under 30 years. CONCLUSIONS: IUI-D is a simple and inexpensive treatment giving acceptable pregnancy rates for up to six treatment cycles if at least 2 mature follicles have developed at the time of insemination, which implies that hormonal ovarian stimulation and induction of ovulation is used, and ovulation has occurred at the time of insemination, which ought to take place after cycle day (cd) 12 with at least two million motile spermatozoa.

Adult↗
PubMed2001

Homologous intrauterine insemination. An evaluation of prognostic factors based on a review of 2473 cycles.

OBJECTIVE: To identify prognostic factors influencing the outcome of infertility treatment using homologous intrauterine inseminations (IUI-H). DESIGN: Retrospective study of all patients undergoing IUI-H at the Fertility Clinic, Odense University Hospital from August 1st, 1990 to July 31st, 1998. SETTING: University-affiliated infertility clinic. PATIENTS: Eight hundred and ninety-three couples undergoing 2473 IUI-H treatment cycles. MAIN OUTCOME MEASURES: Infertility diagnosis, female age, number of follicles, type of hormonal treatment, length of follicular phase, endometrial pattern, and semen quality related to clinical pregnancy rate, cumulative birth rate and multiple gestations. RESULTS: Throughout the nine year period the overall clinical pregnancy rate per IUI-H cycle was 11.9% with a significant increase from 8.7% in 1990 to 14.8% in 1998. The multiple birth rate was 18.1%. The birth rate per couple was 27.2% after a mean of 2.8 treatment cycles. The pregnancy rate was highest in the first treatment cycle and the cumulative birth rate rose only slightly after the fourth treatment cycle. Of the main outcome measures the following were positively and significantly related to a successful outcome of IUI: i) The first treatment cycle - compared to the following up to six treatment cycles; ii) number of mature follicles up to five - at the time of insemination, however, with an unacceptable high rate of multiple pregnancies with more than 4 mature follicles; iii) use of CC/hMG-FSH as compared to CC only for ovarian stimulation; iv) number of motile sperms inseminated exceeding 5 million; v) time of insemination between the 13th and the 16th day in the cycle and vi) anovulatory or idiopathic infertility. CONCLUSIONS: IUI-H is a simple and inexpensive treatment giving acceptable pregnancy rates for up to four treatment cycles providing that at least 3 to 4 mature follicles have developed at the time of insemination, which implies that hormonal ovarian stimulation and induction of ovulation is used, that insemination occurs between cycle day 13 and 16 and that at least 5 million motile sperms are available for insemination. Our results indicate that in the presence of tubal pathology or less than 5 million motile sperms, the couples should be referred directly to IVF-treatment.

Adult↗
PubMed1998

Is maternal growth hormone essential for a normal pregnancy?

OBJECTIVE: It remains uncertain whether there is any disadvantage imposed upon women with pituitary disease who are GH-deficient and become pregnant. The aim of this study was to determine whether maternal GH deficiency adversely affects the outcome of pregnancy. DESIGN: Retrospective study. METHODS: The case notes of 77 female patients with known GH deficiency were examined. Sixteen patients (a total of 25 pregnancies) were identified who had been pregnant whilst known to be GH-deficient. Peak GH response to provocative testing prior to pregnancy, length of gestation, birth weight, maternal well-being and the incidence of maternal and fetal complications of pregnancy were documented. RESULTS: Peak GH response to insulin tolerance test (n = 21 ) or glucagon stimulation test (n = 4) prior to pregnancy was 8.7 (< 1 to 17.3)mU/l (peak < or =9 mU/l in 14 cases). There were 25 pregnancies resulting in 26 live births (including one set of twins and one set of quins) and 4 spontaneous first trimester abortions. Eight pregnancies were achieved by ovulation induction. Median gestation of live births was 39 (33 to 42) weeks. Median birth weight excluding multiple births (n = 19), uncorrected for gestational age, was 3.09 (1.64 to 4.19) kg, and the numbers with birth weights below the 10th, between the 10th and 90th, and above the 90th centiles were five, nine and five respectively. Preeclampsia occurred in two pregnancies and post-partum haemorrhage after one pregnancy. There were three minor congenital abnormalities. CONCLUSIONS: Our data suggest that pregnancy in GH-deficient females is not detrimental to the fetus and the incidence of maternal morbidity is low. We conclude that GH replacement therapy is probably not essential for GH-deficient females during pregnancy.

Adult↗
PubMed1986

Retinopathy of prematurity: the influence of gestational age and retinal maturity on the statistical behavior of risk factors.

The clinical and laboratory data on 140 premature infants, 74 cases with retinopathy of prematurity (ROP) and 66 control cases without ROP, were correlated with ROP grades of increasing severity. By using multiple linear regression (MLR), it is shown that for predicting ROP grades the importance of certain variables varies considerably depending on the gestational age. Below 32 weeks of gestation, acidosis, hyperoxemia, gestational age, pathologic paCO2 levels, and multiple birth are strong regressors. Above 31 weeks, the most important regressors are multiple birth and acidosis, while gestational age and duration of FiO2 greater than 0.4 are much less influential. Blood transfusions and artificial ventilation do not seem important in the MLR of either group. When ROP is regressed on the number of paO2 values above 100 torr and gestational age or on the number of paCO2 values above 50 torr and gestational age, the regression coefficients of these variables drop to near zero at a gestational age of about 32 weeks. This loss of weight of the two variables paO2 and paCO2 with increasing gestational age coincides with a comparable drop of the relative incidence of ROP and the relative incidence of immature retinal vessels. It is hypothesized that it is the proportion of infants with an immature retinal vasculature in populations of given gestational ages rather than the gestational age itself which is responsible for the widely varying importance of certain factors during the development of ROP.

Gestational Age↗
PubMed2004

Ovulation induction in women with polycystic ovary syndrome: randomized trial of clomiphene citrate versus low-dose recombinant FSH as first line therapy.

This single centre randomized controlled trial was undertaken to compare the efficacy and safety of clomiphene citrate and low-dose recombinant FSH as first line pharmacological therapy for anovulatory infertility associated with polycystic ovary syndrome (PCOS). Seventy-six infertile patients with PCOS were randomized to receive clomiphene citrate (50-150 mg/day for 5 days) (clomiphene citrate group, n = 38) or recombinant human FSH (FSH group, n = 38) in a chronic, low-dose, step-up protocol (daily starting dose 75 IU) for up to three consecutive cycles. Ovarian response was monitored by transvaginal ultrasonography and human chorionic gonadotrophin (HCG) was given to trigger ovulation in all cycles with appropriate follicular development. The primary outcome measure was cumulative pregnancy after undergoing up to three treatment cycles. Secondary outcomes were cycle cancellation rate, ovulation rate per cycle, cumulative ovulation rate, pregnancy rate per cycle, incidence of OHSS, cumulative live birth rate, and multiple birth rate. One hundred and four clomiphene citrate cycles and 91 FSH cycles were evaluable. The relative risk and its 95% confidence interval were 1.17 (0.97-1.46) for HCG cycles with ovulation, 1.78 (0.92-3.54) for the pregnancy rate per woman, and 1.83 (0.79-4.40) for live births per woman in favour of FSH. The cumulative pregnancy rate after three treatment cycles was 43% with FSH and 24% with clomiphene citrate (P = 0.06). By logistic regression analysis, the factors predicting ovulation included female age, serum androstenedione and use of FSH. Predictors of pregnancy were duration of infertility and use of FSH. This randomized controlled trial suggests that low-dose recombinant FSH may be an effective alternative to clomiphene citrate in first-line treatment for anovulatory PCOS patients. Thus, further studies, possibly multi-centre, in order to avoid problems with patient recruitment, are warranted to confirm these results.

Adult↗
PubMed2001

Congenital thyrotoxicosis in premature infants.

OBJECTIVES: Graves' disease (GD) complicates 0.1% to 0.2% of pregnancies, but congenital thyrotoxicosis is rare occurring in one in 70 of these pregnancies independent of maternal disease status. Antenatal prediction of affected infants is imprecise; however, maternal history, coupled with a high maternal serum TSH receptor binding immunoglobulin index (TBII) predict adverse neonatal outcome. Mortality is reported to be as high as 25% in affected infants and would therefore be expected to be higher in premature infants. This study illustrates that in sick, premature, extreme low birth weight (ELBW) or intrauterine growth retarded (IUGR) infants, the diagnosis maybe overlooked especially in the absence of antenatal risk assessment and management of thyrotoxicosis in this setting is complex. DESIGN AND PATIENTS: The records of premature neonates born at the three main maternity units in Brisbane, between January 1996 and July 1998 diagnosed with congenital thyrotoxicosis were reviewed. Data were recorded on gestational age, birth weight (B Wt), maternal thyroid history and current status, and neonatal course. Thyroid function and TBII status was assessed using standard biochemical assays. RESULTS: Seven neonates from five pregnancies were identified (four female, three male). Mean gestational age was 30 week (25--36 week) and median B Wt was 1.96 kg (0.50--2.62 kg). Only one mother received formal antenatal counselling by a paediatric endocrine service and had a TBII (54%) measured prior to delivery. Three of five mothers had elevated TBII measured after diagnosis in their offspring (57%, 65%, 83%) and in one mother, a TBII was not performed. All mothers were biochemically euthyroid at delivery. Mean age at diagnosis was 9 days (1--16 days) and mean age at commencement of treatment was 12 days (7--26 days). Two infants received propylthiouracil and five received a combination of carbimazole and propranolol. Four became biochemically hypothyroid, in three this resolved with cessation of the antithyroid drug (ATD), and one required ongoing T4 supple-mentation. Only one infant required treatment for cardiac failure and there were no deaths in this cohort. CONCLUSIONS: This is a large series of extremely small and premature infants with neonatal thyro-toxicosis. Presentation was nonspecific. The diagnosis was delayed because of low birth weight, prematurity, multiple birth and/or an unrecognized maternal history of Graves' disease. The treatment of neonatal thyrotoxicosis was difficult in these extreme low birth weight infants yet no infant died and significant morbidity was confined to high output cardiac failure in one infant. With antenatal recognition of past or active Graves' disease, assessment of maternal TSH receptor binding immunoglobulin index prior to delivery and postnatal monitoring of cord TSH and venous fT4 and TSH on days 4 and 7 rapid treatment of affected infants may have further reduced neonatal morbidity.

Antithyroid Agents↗