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PubMed2002

Safety issues in assisted reproduction technology: the children of assisted reproduction confront the responsible conduct of assisted reproductive technologies.

Neurological sequelae and multiple birth defects have been observed in children conceived by IVF and ICSI. Multiple pregnancy is the most important risk factor. These health problems challenge the responsible practice of medicine. The core values of medicine and the deontology of the profession have been reviewed to define the responsible conduct of research and clinical practice. Professional associations have proposed guidelines to reduce health problems in assisted reproductive technology. Although these health problems could have been prevented, this response by the medical community is nonetheless an important step towards improving responsible medical practices that have become questionable over the years. Professional associations must find out means, not only to implement their guidelines, but also to prevent the recurrence of such episodes in the history of medicine.

Congenital Abnormalities↗
PubMed1981

Blood transfusion: a possible risk factor in retrolental fibroplasia.

The effect of blood transfusion on the occurrence of RLF was evaluated in 58 infants who weighed less than 1001 g at birth (Group I) and 70 oxygen treated infants of various birth weights (Group II). Although there was no significant difference between Group I infants with or without exchange transfusion as to birth weight, gestational age, duration of oxygen therapy, peak Pa02's, or multiple births, there was a significantly increased incidence of pre-retrolental fibroplasia in transfused over non-transfused Group II infants. When Group II infants were stratified for prematurity and oxygen duration, this difference persisted in those not already at risk for RLF. This increased incidence of retinopathy in transfused infants suggests that blood transfusion may be a risk factor in the pathogenesis of RLF.

Apnea↗
PubMed1991

Trends in prevalence and survival of very low birthweight infants, England and Wales: 1983-7.

Between 1983 and 1987 over 99% of all infants born in England and Wales had their birth weights recorded when the birth was registered. Trends in occurrence and one year survival of those who weighed under 1500 g at birth have been calculated in 100 g groups, separately for single and multiple births. By 1987 singleton live births in England and Wales who weighed between 700 and 799 g had a 43% chance of surviving to 1 year compared with a 32% chance five years earlier; those who weighed 800 to 899 g had a 55% chance compared with 46%. The absolute number of survivors weighing between 500 and 999 g at birth increased by nearly 50% between 1983 and 1987, and there was a 30% increase overall in survivors weighing less than 1500 g.

Age Factors↗
PubMed2006

Annual summary of vital statistics: 2004.

The crude birth rate in 2004 was 14.0 births per 1000 population, the second lowest ever reported for the United States. The number of births and the fertility rate (66.3) increased slightly (by <1%) from 2003 to 2004. Fertility rates were highest for Hispanic women (97.7), followed by Asian or Pacific Islander (67.2), non-Hispanic black (66.7), Native American (58.9), and non-Hispanic white (58.5) women. The birth rate for teen mothers continued to fall, dropping 1% from 2003 to 2004 to 41.2 births per 1000 women aged 15 to 19 years, which is another record low. The teen birth rate has fallen 33% since 1991; declines were more rapid for younger teens aged 15 to 17 (43%) than for older teens aged 18 to 19 (26%). The proportion of all births to unmarried women is now slightly higher than one third. Smoking during pregnancy declined slightly from 2003 to 2004. In 2004, 29.1% of births were delivered by cesarean delivery, up 6% since 2003 and 41% since 1996 (20.7%). The primary cesarean delivery rate has risen 41% since 1996, whereas the rate of vaginal birth after a previous cesarean delivery has fallen 67%. The use of timely prenatal care was 84.0% in both 2003 and 2004. The percentage of preterm births rose to 12.5% in 2004 from 10.6% in 1990 and 9.4% in 1981. The percentage of low birth weight births also increased to 8.1% in 2004, up from 6.7% in 1984. Twin birth rate and triplet/+ birth rates increased by 1% and <1%, respectively, from 2002 to 2003. Multiple births accounted for 3.3% of all births in 2003. The infant mortality rate was 7.0 per 1000 live births in 2002 compared with 6.8 in 2001. The ratio of the infant mortality rate among non-Hispanic black infants to that for non-Hispanic white infants was 2.4 in 2002, the same as in 2001. The United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth reached a record high of 77.6 years for all gender and race groups combined. Death rates in the United States continue to decline, with death rates decreasing for 8 of the 15 leading causes. Death rates for children < or =19 years of age declined for 7 of the 10 leading causes in 2003. The death rates did not increase for any cause, and rates for heart disease, influenza, and pneumonia and septicemia did not change significantly for children as a group. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.

Birth Rate↗
PubMed1992

[Rate of intrauterine growth retardation at the Leipzig Perinatal Center comparing the years 1982 to 1984 with 1987 to 1989].

Referring to the number of all live-born children, hypotrophic newborn (IUGR) were classified at the Centre for Perinatal Care in Leipzig into two periods of time. Based on the 5th Kyank-percentile 6.5% hypotrophic newborn were classified into period A (1982-1984) and 5.0% hypotrophic newborn were classified in period B (1987-1989). The proportion of hypotrophic newborn with a birth weight < 2500 g amounted to one quarter of all infants (except multiple birth) with low birth weight in period A and to one fifth (20.7%) in period B. The decrease in the rate of hypotrophy in these infants affected nearly exclusively the mature ones. The number of infants with extreme intra-uterine growth retardation amounted to 29% (99 in 329) in period A and to 24% (58 in 238) in period B. The rate of hypotrophy in stillbirths decreased from 44% to 33%. In this process the proportion of extremely hypotrophic stillbirths amounted to 47% in period A, whereas it decreased to only 26% in period B.

Cross-Sectional Studies↗
PubMed1984

Multiple sclerosis and birth order.

Studies on the birth order of patients with multiple sclerosis have yielded contradictory conclusions. Most of the sets of data, however, have been tested by biased tests. Data that have been submitted to unbiased tests seem to suggest that cases are more likely to occur in early birth ranks. This should be tested on further samples and some comments are offered on how this should be done.

Birth Order↗
PubMedDate not supplied

Development, pharmacology and clinical experience with clomiphene citrate.

This review describes the development and pharmacology of clomiphene and those specific characteristics of both drug and patients which determine its clinical efficacy. The studies reviewed describe clinical observation of patient characteristics (age, additional infertility diagnosis, semen quality), vaginal ultrasound observations of ovaries (number and size of pre-ovulatory follicles) and endometrial lining (thickness, pattern) in 2841 clomiphene cycles in patients who required intrauterine insemination (IUI) because of poor sperm quality or an unsatisfactory postcoital test. They show that (i) conception in clomiphene cycles is related to the number and size of pre-ovulatory follicles, endometrial thickness, patient age, pelvic adhesions, type of anovulatory disorder and semen quality; (ii) pregnancy rates per clomiphene-IUI cycle are constant through at least six cycles; (iii) multiple births cannot be prevented by withholding human chorionic gonadotrophin or advising against coitus when multiple pre-ovulation follicles are present unless all follicles down to 10-12 mm diameter are counted. We also reviewed pregnancy outcome (number of gestational sacs, babies, preclinical and clinical abortion, ectopic pregnancy and birth sex) in 1744 clomiphene pregnancies from our clinic. We found that (i) preclinical and clinical abortions are increased only slightly by clomiphene use, compared to spontaneous pregnancy; (ii) clinical abortions are decreased in patients with polycystic ovaries and luteal insufficiency who use clomiphene; (iii) conception and preclinical abortions are related to endometrial thickness prior to ovulation; (iv) ectopic pregnancies are not increased by clomiphene and (v) the ratio of male births is not altered by clomiphene, except possibly in timed insemination cycles. These studies repudiate many misconceptions regarding clomiphene. They also show that clinical outcome may be improved by pre-ovulation ultrasound monitoring of ovarian and endometrial response.

Adult↗
PubMed1995

The grand multipara.

Grandmultiparity (GMP) has long been considered an obstetric complication for both mother and fetus, although recent studies indicate that, with proper perinatal care, women with high-parity rates are no longer at high risk. The current study examines the outcome of delivery in 1700 women in their fifth or more delivery, as compared with two control groups: 622 primiparas and 735 multiparas (two to three previous deliveries). Excellent prenatal care was available free of charge to all parturients. Our objectives were to evaluate the management of GMP in contemporary obstetrics and to assess whether grand multiparas are still high-risk patients. The age of the grandmultiparas was significantly higher compared with with the control groups, which may explain the higher incidence among them of antenatal medical disorders, such as diabetes mellitus and hypertensive disease. No significant differences were found among the three groups for preterm or post-term births, small-for-gestational-age infants, polyhydramnios, oligohydramnios, perinatal death, fetal distress, multiple births, placenta previa, abruptio placentae or cord prolapse. Macrosomia was markedly higher in the grandmultiparas and multiparas than in nulliparas. Thus, our results indicate that good perinatal care can ensure better results in grandmultiparas, and that grandmultiparity no longer needs to be considered a high-risk obstetric category in our population.

Adult↗
PubMed1983

The 24-hour rhythmicity of birth. A populational study.

The incidence of birth has been determined for each hour of the day for all births in Norway in 1968-1977 of fetuses of 16 weeks of gestation or older, with resident mothers. The 24-hour incidence variations of births (A) with spontaneous onset and parturition, (B) with spontaneous onset, but delivery intervention, (C) with induced onset, but spontaneous birth, and (D) with induced onset and delivery intervention, are all different. It is shown that the curve for the hourly incidence of birth category A coincides very well with previous results of other workers. When multiple births are excluded and category A is split into first and later births in Northern and Southern Norway, dissimilarities arise between the respective 24-hour incidence curves. The results indicate that the 24-hour birth incidence variation has an underlying endogenous, circadian rhythmicity - possibly synchronized by the sun. The 24-hour rhythmicities of birth categories B, C and D seem to be purely exogenous - reflecting the working activity rhythms of hospital obstetricians and midwives.

Circadian Rhythm↗
PubMed2005

[Lowering incidence of cerebral palsy of premature infants through early intervention].

OBJECTIVE: In recent years, the survival rate of premature infants is increased, but the incidence of cerebral palsy did not decrease, instead, there was a tendency of increase. The incidence of cerebral palsy of premature infants was 29.13 per thousand in 7 provinces in China in an investigation of over 30,000 children 1 - 6 years of age in 1997, which is 25.16 times higher than that of full term infants. Each year, about 1 million premature infants are born in China, which may include an increase of approximately 29,000 cerebral palsy infants. The rehabilitation expense of cerebral palsy infants is high, older patients cannot be cured; only improved life quality is possible. Therefore, we carried out this research from March 1, 2000 to the end of February 2003 to explore the effects of early intervention in lowering the incidence of cerebral palsy among premature infants. METHODS: A total of 1053 cases of survived premature infants, gestational age under 37 weeks, excluding those with congenital deformity and hereditary metabolic diseases, born or treated in all collaborative units were classified into 2 groups: early intervention group (551 cases) and routine care group (502 cases). Method of classification: all premature infants born within 1 year before beginning of the study and premature infants born after beginning of the study whose parents did not want to receive early intervention were included in the routine care group; all premature infants born after beginning of the study whose family intended to actively participate in early intervention were included in the intervention group. The numbers of infants in the two groups were quite close in each collaborative unit. In the intervention group, the premature infants received early intervention after discharge from hospital, in addition to routine care, once a month before corrected age of 6 months and once every two months after 6 months. The parents were instructed to cultivate the infant's cognition, language, emotion and communication ability, and the infants were given massage, subjected to exercise and received active motor training. All infants with abnormal motor manifestations were given appropriate rehabilitation training. In the routine care group, infants received similar routine care only. RESULTS: In the 2 groups, no significant differences (P > 0.05) were found in complications of pregnant mothers, average gestational age and birth weight, proportion of small for gestational age (SGA), proportion of single and multiple births, fetal stress, postnatal asphyxia, incidence of neonatal hypoxic inschemic encephalopathy (HIE) and intracranial hemorrhage, Apgar Score and Neonatal Behavioral Neurological Assessment Score at 40 weeks of gestational age. These indicate that the two groups were comparable. At 1 year of age, the incidence of cerebral palsy was 0.91% (5/551) in the intervention group and 3.19% (16/502) in the routine care group (P < 0.01). Of the 5 cases with cerebral palsy in the interventional group, 3 were mild and 2 severe. Of the 16 cases in the routine care group, 7 were moderate and 9 severe. CONCLUSION: Early intervention can reduce the incidence of cerebral palsy of premature infants. This conclusion awaits confirmation from studies with larger sample size.

Apgar Score↗
PubMed2006

Pregnancy outcomes among female hairdressers who participated in the Danish National Birth Cohort.

OBJECTIVES: The Danish National Birth Cohort (DNBC) was used to examine pregnancy outcomes among female hairdressers and neurodevelopment in their offspring. METHODS: A population-based cohort study was conducted of 550 hairdressers and 3216 shop assistants (reference group) by using data from the Danish National Birth Cohort between 1997 and 2003. Information on job characteristics was reported by the women in the first interview (around 17 weeks of gestation). Pregnancy outcomes were obtained by linkage to the national registers. Developmental milestones were reported by the mother at the fourth interview, when the child was approximately 19 months old. Cox regression was applied to analyze fetal loss and congenital malformation. Logistic regression was used to analyze other pregnancy outcomes and developmental milestones. RESULTS: We found no significant differences in fetal loss, multiple births, gender ratio, preterm birth, small-for-gestational age, congenital malformations, or achievement of developmental milestones among the children of hairdressers and shop assistants. CONCLUSIONS: The results do not indicate that children of hairdressers in Denmark currently have a high risk of fetal impairment or delayed psychomotor development.

Abortion, Spontaneous↗
PubMed2006

Intra-uterine insemination for unexplained subfertility.

BACKGROUND: Intra-uterine insemination (IUI) is a widely used fertility treatment for couples with unexplained subfertility. Although IUI is less invasive and less expensive than in vitro fertilisation (IVF), the safety of IUI in combination with ovarian hyperstimulation (OH) is debated. The main concern about IUI treatment with OH is the increase in multiple pregnancy rates. OBJECTIVES: To determine whether for couples with unexplained subfertility IUI improves the live birth rate compared with timed intercourse (TI), both with and without ovarian hyperstimulation. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorder and Subfertility Group Trials Register (searched March 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 4), MEDLINE (1966 to November 2005), EMBASE (1980 to November 2005), SCIsearch and reference lists of articles. Authors of identified studies were contacted for missing or unpublished data. SELECTION CRITERIA: Truly randomised controlled trials (RCTs) with at least one of the following comparisons were included: --IUI versus TI, both in a natural cycle; --IUI versus TI, both in a stimulated cycle; --IUI in a natural cycle versus IUI in a stimulated cycle; --IUI with OH versus TI in natural cycle; --IUI in a natural cycle versus TI with OH. Only couples with unexplained subfertility were included. DATA COLLECTION AND ANALYSIS: Quality assessment and data extraction were performed independently by two review authors. Outcomes were extracted and the data were pooled. Subgroup analyses and sensitivity analyses were done where possible. MAIN RESULTS: In the six trials where IUI was compared with TI, both in stimulated cycles, there was evidence of an increased chance of pregnancy (six RCTs, 517 women: OR 1.68, 95% CI 1.13 to 2.50). A significant increase in pregnancy rate was also found for women where IUI with OH was compared with IUI in a natural cycle (three RCTs, 415 women: OR 2.33, 95% CI 1.46 to 3.71). However, the trials provided insufficient data to investigate the impact of IUI with or without OH on several important outcomes including live birth, multiple pregnancies, miscarriage and risk of ovarian hyperstimulation. There was no evidence of a difference in pregnancy rate for IUI with OH compared with TI in a natural cycle (one RCT, 51 women: OR 4.05, 95% CI 0.39 to 41.87). No RCTs were found for the other two comparisons. AUTHORS' CONCLUSIONS: There is evidence that IUI with OH increases the live birth rate compared to IUI alone. The likelihood of pregnancy was also increased for treatment with IUI compared to TI both in stimulated cycles. There is insufficient data on multiple pregnancies and other adverse events for treatment with OH. Therefore, couples should be fully informed about the risks of IUI and OH as well as alternative treatment options.

Female↗
PubMed2006

Spontaneous preterm delivery in primiparous women at low risk in Denmark: population based study.

OBJECTIVES: To analyse trends in preterm delivery and the factors contributing to preterm delivery in Denmark. To construct a standard population at low risk (white European, 20-40 years of age, with a singleton spontaneous pregnancy) and describe the changes in this population so that time trends can be compared internationally. DESIGN: Population based study. PARTICIPANTS: 99.8% of all deliveries in Denmark, 1995-2004. MAIN OUTCOME MEASURES: Proportion of babies born at less than 37 weeks' completed gestation for each year in the overall population and in a standard population at low risk. RESULTS: Overall, the proportion of preterm deliveries increased by 22% from 1995 to 2004. During the same period, known risk factors for preterm delivery such as in vitro fertilisation, multiple pregnancies, and elective deliveries also increased, and logistic regression analyses showed that these factors were associated with an increased risk of preterm delivery. Spontaneous preterm deliveries in primiparous women at low risk rose 51% (from 3.8% to 5.7%) during this time compared with 20% (2.7% to 3.2%) in multiparous women at low risk. CONCLUSIONS: The overall proportion of preterm deliveries increased significantly from 1995 to 2004 and primiparity and multiple birth were the most important contributing factors. The rise in spontaneous preterm deliveries in the standard population of primiparous women at low risk was greater than in the total population.

Adult↗
PubMed1995

Population-based study of tracheoesophageal fistula and esophageal atresia.

From a multiracial population of 1,035,384 births monitored by the California Birth Defects Monitoring Program (CBDMP) from 1983 to 1988, we ascertained 34 cases of esophageal atresia (EA), 204 cases of tracheoesophageal fistula (TEF) with an EA (TEF/EA), and 54 cases of TEF without EA. The total prevalence rate was 2.82 per 10,000 live births and stillbirths and showed no secular trend nor marked seasonal variation. Rates of multiple birth were high for each defect (TEF 3.7%, TEF/EA 4.9%, EA 8.8%; population 1.1%). Non-Hispanic whites were overrepresented for TEF and TEF/EA, but not for EA. Excluding trisomies, mean maternal age was above the population mean (26.8 years) for TEF (27.9 years) and TEF/EA (28.0 years), but not for EA (26.2 years). The proportion of trisomies was significantly higher for EA (23.5%) than for TEF (9.3%; P < 0.02) or for TEF/EA (7.4%; P < 0.003). We subdivided each defect into five mutually exclusive types: isolated, multiple, syndromic, chromosomal, and trisomic. Male-to-female (M/F) ratios varied considerably between types, both within and between defects. The highest M/F ratios within each defect were for the multiple type (TEF 2.29, TEF/EA 1.44, EA 1.33; population 1.05), and the lowest for trisomies (TEF 0.25; TEF/EA 0.25, and EA 0.60). All types except trisomies were significantly associated with a single umbilical artery. We found an association of EA and TEF/EA with dextrocardia (3.1% of cases), and confirmed the association of primary hydrocephalus with TEF and TEF/EA (2.7% of cases). The proportion of cases with additional midline defects or VATER or VACTERL type anomalies was similar for all three defects, suggesting a common developmental pathogenesis. Epidemiologic differences between defects, and between types within defects, may reflect differences in timing of the pathological process or differences in susceptibilities (e.g., by sex or aneuploidy) and emphasize the need to evaluate each defect and its types separately in epidemiologic studies.

Adult↗
PubMed2002

Neonatal outcome and congenital malformations in children born after in-vitro fertilization.

BACKGROUND: To evaluate the neonatal outcome and the prevalence of congenital malformations in children born after IVF in northern Finland we carried out a population-based study with matched controls. METHODS: Firstly, 304 IVF children born in 1990-1995 were compared with 569 controls, representing the general population in proportion of multiple births, randomly chosen from the Finnish Medical Birth Register (FMBR) and matched for sex, year of birth, area of residence, parity, maternal age and social class. Secondly, plurality matched controls (n = 103) for IVF twins (n =103) were randomly chosen from the FMBR and analysed separately. Additionally, IVF singletons (n = 153) were compared with singleton controls (n = 287). Mortality rates were compared with national figures from FMBR. RESULTS: Most mortality rates were twice as high as national figures in the general population. When compared with the control group representing the general population, the incidences of preterm birth [odds ratio (OR) 5.6, 95% confidence interval (CI) 3.7-8.6], very low birth weight (OR 6.2, 95% CI 2.0-19.0), low birth weight (OR 9.8, 95% CI 5.6-17.3), neonatal morbidity (OR 2.4, 95% CI 1.7-3.4) and hospitalization (OR 3.2, 95% CI 2.2-4.6) were significantly higher in the IVF group. The prevalence of heart malformations was four-fold in the IVF population than in the controls representing the general population (OR 4.0, 95% CI 1.4-11.7). CONCLUSIONS: Neonatal outcome after IVF is worse than in the general population with similar maternal age, parity and social standing, mainly due to the large proportion of multifetal births after IVF. The higher prevalence of heart malformations does not solely arise from multiplicity but from other causes. In order to improve neonatal outcome after IVF, the number of embryos transferred should be limited to a minimum.

Cohort Studies↗
PubMed2003

Risk factors for intrapair birth weight discordance in twins.

OBJECTIVES: To determine the risk factors for birth weight discordance in twins. METHODS: We used the United States (1995-97) Matched Multiple Birth File (n = 294 568) to assess the association between birth weight discordance and maternal sociodemographic, pregnancy and infant characteristics. RESULTS: Eighty-four per cent of the twins were 0-19% discordant, 11.1% were 20-29% discordant, 3.4% were 30-39% discordant, and 1.8% were > or = 2 40% discordant. The risk factors for birth weight discordance for same-sex twins were eclampsia (odds ratio (OR) 1.39,95% confidence interval (CI) 1.20, 1.61), pre-eclampsia (OR 1.31, 95% CI 1.24, 1.38), pre-existing hypertension (OR 1.32, 95% CI 1.12, 1.56), diabetes (OR 1.13, 95% CI 1.04, 1.24) and certain congenital anomalies. For opposite-sex twins, the risk factors for birth weight discordance were pre-eclampsia (OR 1.17, 95% CI 1.09, 1.27), pre-existing hypertension (OR 1.59,95% CI 1.32, 1.91), and certain congenital anomalies. Also, smoking and increased maternal age were associated with birth weight discordance in both same-sex and opposite-sex twins. CONCLUSIONS: Maternal hypertensive disorders, smoking and delayed childbearing were associated with intrapair birth weight discordance. The mechanisms of these associations deserve further investigation.

Adolescent↗
PubMed2005

Safety of the Stockholm Birth Center study: a critical review.

This paper critically appraised the validity and generalizability of the safety of the Stockholm Birth Center care study to determine if it can be relied on to answer the question, "Is primiparous labor and birth in a birth center as safe for babies as standard medical care?" The retrospective cohort study is summarized, and statistical and methodological aspects are evaluated. Errors that were identified include selection bias and two forms of performance bias, both involving the independent variable. Nondefinition and lack of control of the independent variable and minor statistical errors were also noted. More serious concerns relate to the validity of an intention-to-treat analysis. Some methodological problems reduced validity of the study and ability to generalize the findings to other birth centers. Birth center care is a desirable and established birth option. A more useful approach to improving maternity care provision could involve comparing multiple birth center sites with each other to find best practice so that it can be analyzed and duplicated.

Birthing Centers↗