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There has been a sharp increase in the number of multiple births, particularly triplets and higher order births, in recent years (Botting et al, 1990). Perinatal mortality and morbidity are more frequent in multiple pregnancies than in singleton pregnancies. Greater understanding of the biological phenomenon of multiple pregnancy and perinatal care strategies directed at specific problems should improve the outcome.
We investigated the impact of maternal anaemia on birth outcomes among adolescent twin pregnancies in the United States using the vital statistics records for matched multiple births covering the years 1995-1997 inclusive. The study group consisted of mothers aged 19 years or younger who had a twin pregnancy. A cohort of women aged 20-29 years with twin pregnancies served as the comparison group. The main birth outcomes of interest were: low and very low birth weight, preterm and very preterm delivery, small-for-gestational age, stillbirth, neonatal and perinatal mortality. Crude and adjusted odds ratios for the above outcomes were calculated using the generalised estimating equation framework (GEE) that captured both intra- and intercluster sources of heterogeneity. Although not statistically significant, we detected an elevated risk for stillbirth among anaemic women (20-30%) in either age cohort, a magnitude that is substantial at the population level as well as warranting further aetiological investigations.
OBJECTIVE: To describe the outcome of pregnancies obtained after intracytoplasmic sperm injection (ICSI) and the impact of the origin and quality of sperm used on this outcome. DESIGN: Retrospective analysis. SETTING: A tertiary referral center for assisted reproduction. PATIENT(S): Pregnant patients conceived after microinjection of ejaculated sperm (n=1,427), epididymal sperm (n=79), and testicular sperm (n=93). INTERVENTION(S): ICSI, epididymal sperm aspiration, and testicular biopsy. MAIN OUTCOME MEASURE(S): Stillbirth, prematurity, and early perinatal mortality. RESULT(S): The delivery rate of multiple births was 31.4%, and the preterm delivery rate was 25.6%. The prematurity rates in singletons, twins, and triplets were 9.9%, 56.7%, and 96.6%, respectively. The early perinatal mortality rate of the entire population was 26.1 per thousand. In the ejaculated-sperm group, when the sperm was severely defective (group 1), 14 intrauterine deaths occurred (3.1%). In the second and third groups, in which sperm was moderately defective, there were 2 deaths and 1 death (0.6% and 0.4%), respectively. The difference between the number of deaths in group 1 vs. groups 2/3 was statistically significant. CONCLUSION(S): The rates of multiple pregnancies, preterm deliveries, low birth weight, and early perinatal mortality were higher after ICSI than after natural conception. In the ejaculated-sperm group, the rate of intrauterine death was higher in the severely defective sperm group than in the better-quality sperm groups.
AIMS/HYPOTHESIS: We investigated the association between type 1 diabetes and birthweight by age at disease onset. METHODS: This population-based case-referent study used data from two nationwide case registers that are linked to the Swedish Medical Birth Registry and cover incident cases of type 1 diabetes in the 0- to 14-year (since 1 July 1977) and 15- to 34-year age groups (since 1 January 1983). Of the cases linked to the Medical Birth Registry, a total of 9,283 cases with onset before 15 years of age was recorded before 1 January 2003, and 1,610 cases were recorded with onset before 30 years of age and born after 1973 (together 95% of eligible cases). Multiple births and babies of diabetic mothers were excluded. Sex-specific birthweight by gestational week is expressed as multiples of the standard deviation (SDS) and adjusted for year of birth, maternal age and parity. RESULTS: Cases with onset before 10 years of age (n = 5,792) showed a significant linear trend in odds ratio (OR) by SDS of adjusted birthweight (OR by SDS: 0.062; 95% CI: 0.037-0.086; p < 0.0001), while cases with onset at the age of 10-29 years showed no significant trend (OR by SDS: 0.004; 95% CI: -0.007 to 0.0014; p = 0.22). CONCLUSIONS/INTERPRETATION: The association between type 1 diabetes risk and birthweight seems to be limited to cases with disease onset in younger years.
OBJECTIVE: To study the prevalence of group B Streptococcus (GBS) colonization in pregnant women and their newborns at Perugia General Hospital. METHODS: The number of mother---child pairs examined was 2300. Vaginal swabs were collected from the mothers at delivery, and auricular and pharyngeal swabs and gastric aspirate from the newborns at birth. Maternal risk factors for GBS disease, including premature delivery, intrapartum fever, prolonged rupture of membranes and multiple births, were evaluated. RESULTS: Maternal and neonatal colonization rates were 11.3% and 4.6%, respectively. GBS was isolated in 41.5% of the neonates born to colonized mothers and in 0.1% of those born to non-colonized mothers. No significant difference was observed in vertical transmission rates in the presence or absence of maternal risk factors. The external auditory canal was the most frequent (93.5%) and heavily colonized body site. Type Ib was the most common serotype among GBS isolates from mothers and babies. C surface protein was not detected in serotype V and VIII isolates, but was frequent in all other serotypes. Early-onset disease was observed in 0.4/1000 live births. CONCLUSIONS: The prevalence of maternal and neonatal colonization at Perugia General Hospital was similar to that obtained in other studies performed in Italy. The external auditory canal was confirmed as the most reliable body site to be sampled for the detection of neonates exposed to maternal GBS colonization.
The birth of twins, triplets or more is usually a reason for great celebration. Evidence suggests, however, that in some circumstances a multiple birth creates serious difficulties for parents and may cause enormous stress within a family. One crude indicator of family breakdown is the reception of children into Local Authority care: during 1988, the author attempted to establish the incidence of twins in care (or on social workers' caseloads where preventive work was being done) by gathering figures from Directors of Social Services in Local Authorities in England, Wales and Northern Ireland. Whilst analysis of the figures at first suggests that there is no over-representation of 'multiples' in Local Authority care, it is suggested that the results of the first survey should be treated with caution. The majority of Local Authorities have not so far identified twins, etc., on their records (nor, indeed, has the Department of Social Services) and so identification had to be done on a 'common surname and date of birth' basis, where that was possible. Many single twins would thus be missed. Only 36% of Local Authorities were able to provide complete figures for sets of twins in care. Reliable data for the incidence of twins on social workers' caseloads (children not in care) proved impossible to collect. Information about multiples should be much easier to obtain in the future. Many Local Authorities are now installing or operating computer systems. Over half of those Directors who could not provide figures at the moment indicated that they would be able to do so on a future occasion.
OBJECTIVE: The purpose of this study was to examine if neonatal mortality rates (NMR) based on birth weight discordance (BWD) differ based on mode of delivery. STUDY DESIGN: The population-based US "matched multiple birth" database (1995 to 1998) was used to examine the effect of vaginal/vaginal (VV) and cesarean/cesarean (CC) modes of delivery (MOD) on neonatal mortality (<28 days after birth). Births at <32 weeks, congenital malformations, chromosomal anomalies, and discordant MOD (vaginal/cesarean) were excluded. The association between MOD (with CC as the reference) and neonatal mortality was expressed as relative risks (RR) with 95% CI, derived from logistic regression models. RESULTS: The NMR increased with increasing degrees of BWD regardless of mode of delivery. CC was associated with decreased NMR when BWD was between 20% and 40%, but this reached significance at BWD > or =40%; VV pairs had a 1.6-fold (95% CI 1.1-2.2) increased NMR compared with CC. CONCLUSION: In twins with BWD <40%, MOD has no effect on NMR. Beyond or equal to 40% discordance, there was lower NMR with cesarean-cesarean delivery.
Atresia and stenosis are some of the most common birth defects affecting the small intestine. Few population-based studies have examined the epidemiology of small intestinal atresia/stenosis. Eighty-two cases of small intestinal atresia/stenosis were identified through a population-based birth defects registry in Hawaii during 1986-2000. The relationships of various clinical and demographic factors with small intestinal atresia/stenosis and duodenal atresia/stenosis were examined. The small intestinal atresia/stenosis and duodenal atresia/stenosis rates were 2.9 per 10,000 live births [95% confidence interval (CI) 2.3-3.6] and 1.3 per 10,000 live births (95% CI 1.0-1.9), respectively. No secular trend was observed (P = 0.067 and 0.090, respectively). Maternal age risk for small intestinal atresia/stenosis was U-shaped, while duodenal atresia/stenosis rates were highest with maternal age of 35 years or more. Small intestinal atresia/stenosis was substantially more common among Far East Asians than Caucasians [rate ratio (RR) 1.96, 95% CI 1.24-2.94]. Duodenal atresia/stenosis risk was higher in Hawaii County than in Honolulu County (RR 2.55, 95% CI 1.10-5.02). Small intestinal atresia/stenosis was also associated with low birth weight (RR 11.50, 95% CI 8.05-15.92), low gestational age (RR 8.60, 95% CI 6.34-11.41) and multiple births (RR 3.79, 95% CI 1.39-8.24). In conclusion, this study found associations between small intestinal atresia/stenosis and maternal age, maternal race/ethnicity, county of residence, birth weight, gestational age and plurality, but not delivery period. Many of the associations between small intestinal atresia/stenosis and other factors noted in this investigation were similar to those reported by other studies.
The data on transfer of mouse eggs microinjected with DNA during production of transgenic mice were analyzed. The transfer of mouse eggs into both oviducts did not lead to a reliably higher birth rate. It did not affect the frequency of recipients' pregnancy and, although somewhat increased the frequency of multiple birth, led, finally, to unjustified loss of the major part of viable DNA-injected eggs. We recommend transferring no less than 15 microinjected eggs only in one oviduct of each recipient. The transfer into another oviduct is acceptable if the transfer into the first oviduct failed or its outcome is doubtful.
OBJECTIVE: The object of this paper was to analyze the epidemiological factors that contribute to congenital dislocation of the hip (CDH) in our setting. PATIENTS AND METHODS: A comparative study of the obstetrical and perinatal risk factors of a series of 72 newborns with CDH was carried out. These newborns were compared with a sample of 973 healthy newborns. The following factors were analyzed: sex, birth weight, fetal posture, type of delivery, duration of the pushing stage of labor, family history, single or multiple birth, age of parents, firstborn status and season of birth using the Pearson Chi-square test for the qualitative variables and the Mann-Whitney U for the quantitative variables. RESULTS: A statistically significant values (p < 0.05) was found for: sex, fetal posture, type of delivery, firstborn status and month of birth. Forty-nine (68%) of the newborns with CDH had two or more of these risk factors. CONCLUSIONS: When encountering a female newborn, with a breech posture or distocic delivery, from a primipara mother and born in November, a more rigorous examination and follow-up of that newborn should be carried out in order to rule out this pathology.
The Multiple-Trait Gibbs Sampler for Animal Models programs were extended to allow analysis of ordered categorical data using a Bayesian threshold model. The algorithm is based on data augmentation, where a value on the unobserved underlying normally distributed variable (liability) is generated in each round of iteration for each categorical observation. The programs allow analysis of several continuous and ordered categorical traits. Categorical traits can have any number of response levels. Models can be different for each trait. The programs were used to analyze twinning and ovulation rates from a herd of cattle selected for twinning rate at the U.S. Meat Animal Research Center. Data included number of calves born at each parturition for the lifetime of a cow and number of eggs ovulated for several estrous cycles before first breeding as heifers. A total of 6,411 calvings was recorded for 2,087 cows with 83.2% single and 16.8% multiple births. A total of 19,849 ovulations was recorded for 2,332 heifers with 85.2% single and 14.8% multiple ovulations. Mean posterior estimates of heritability and fraction of variance accounted for by permanent environmental effects (PE) were .128 and .103 for twinning rate and .168 and .079 for ovulation rate. Mean posterior estimate of genetic correlation was .808, and correlation of PE effects was .517. Use of a threshold model could allow for more rapid genetic improvement of the twinning herd through improved identification and selection of genetically superior animals because of higher heritability on the underlying scale.
Although the incidence of triplet and quadruplet birth has increased in the United States, few research-based guidelines are available for assisting mothers of these multiple births with breastfeeding. The purpose of this case study is to report a successful breastfeeding experience of a mother with preterm quadruplets. The quadruplets were born by cesarean delivery at 34 weeks' gestation and weighed from 1,820 g to 2,240 g. In-hospital breastfeeding experiences were managed by the authors, according to research-based guidelines for breastfeeding preterm neonates and infants. During the first month after discharge of the four newborns, the mother breastfed 12-34 times daily. Mean daily weight gains for the quadruplets during this time varied from 30 g to 54 g, indicative of adequate maternal milk supply. Nurses in maternity and neonatal specialties can apply the findings from this study to similar cases of mothers who want to breastfeed multiple neonates or infants.
The BESST (birth emphasizing a successful singleton at term) statistic per assisted reproductive technolgies (ART) cycle commenced is proposed to help minimize multiple births.
We investigated the association between selected infant and maternal characteristics and autism risk. Children with autism born in California in 1989-1994 were identified through service agency records and compared with the total population of California live births for selected characteristics recorded on the birth certificate. Multivariate models were used to generate adjusted risk estimates. From a live birth population of more than 3.5 million, 4381 children with autism were identified. Increased risks were observed for males, multiple births, and children born to black mothers. Risk increased as maternal age and maternal education increased. Children born to immigrant mothers had similar or decreased risk compared with California-born mothers. Environmental factors associated with these demographic characteristics may interact with genetic vulnerability to increase the risk of autism.
A line of transgenic mice containing the simian virus 40 (SV40) large tumor antigen gene under the control of the viral enhancer-promoter expressed this viral protein in the brains of these mice within the first 2 weeks after birth. Multiple foci of anaplastic cells formed in the choroid plexuses of these mice at 36 to 41 days after birth, and normal tissue coexisted with these transformed foci. Immunoperoxidase staining to detect the SV40 T antigen showed tumor-specific expression of nuclear T antigen at late times in tumor development, approximately 90 to 100 days and thereafter. The level of SV40 T antigen, on a per cell basis, appeared to be lower in the great majority of choroid plexus cells at earlier times in tumor development. These results suggest that low levels of tumor antigen (14 to 36 days) are present before detectable pathology (36 to 41 days) and the level of T antigen per cell is higher in rapidly growing late-stage tumors (older than 90 days).
OBJECTIVES: To explore the impact of a community neonatal service on high risk infant survivors in the first year of life. DESIGN: Retrospective multicentre survey. Postal questionnaires were sent to selected parents. SETTING: Thirty two neonatal units in England and Wales. PATIENTS INCLUSION CRITERIA: infants over 12 months of age with birth weight < or =1500 g, or who received level I intensive care for at least 48 hours. EXCLUSION CRITERIA: multiple births, infants who had died or had severe congenital abnormalities. A total of 3367 eligible infants were selected, and their parents were sent a questionnaire; 65% responded. MAIN OUTCOME MEASURES: Length of stay on the neonatal unit from birth to initial discharge. Readmission to hospital during the first year of life. RESULTS: The median length of stay in units with a community neonatal service was 35 days compared with 37 days in units without. When adjusted for infant and parent characteristics, the median length of stay was reduced by 12.6% where a community neonatal service was provided (95% confidence interval 5.3% to 19.3%). The readmission rates were 44.6% in units with a community neonatal service and 43.5% in units without. There was no significant reduction in the adjusted odds of readmission. CONCLUSIONS: The retrospective nature of this study means that these findings cannot be definitely attributed to the presence of a community neonatal service. However, the results suggest that community neonatal services may reduce the length of stay without any subsequent increase in readmission.
AIM OF THE STUDY: To analyze gastrin and its precursors in plasma from mothers and preterm infants just after birth. PATIENTS AND METHODS: 38 preterm infants, median (range) gestational age 32 wks (25-36 wks) and birth weight 1995 g (538-2764 g), and 29 mothers participated. Thirteen mothers were delivered by Cesarean section. The concentration of the total progastrin product was measured by a new processing-independent analysis (PIA) for progastrin, and the concentration of mature (i.e. alpha-amidated) gastrin was measured by conventional RIA. RESULTS: The median concentration of the progastrin product was significantly higher than that of alpha-amidated gastrin in both mothers and infants (mothers: 40 versus 8 pmol/l; infants: 67 versus 9 pmol/l). The peptide concentrations were not correlated to sex, birth weight, umbilical cord pH, blood glucose concentrations or placenta weight. In mothers, the progastrin product was higher after multiple births than after a single birth. CONCLUSION: As more than 90% of the total progastrin product in healthy nonpregnant adults is alpha-amidated, the results indicate that the biosynthesis of progastrin and its products is increased in mothers and even further in infants. Post-translational maturation is, however, markedly attenuated. Since it was recently suggested that progastrin and some of its non-amidated processing intermediates may act as growth factors for the gastrointestinal mucosa, the results of this study indicate that the gastrointestinal mucosa of pregnant women and infants is subject to gross gastrinergic growth stimulation.
With advances in neonatal and obstetric care over the past few years, the number of premature, multiple-birth neonates entering NICUs has increased. As we have started to recognize the special bond that twins and higher multiples share, cobedding has emerged as an NICU practice. As with any change, the introduction of cobedding presents challenges in the NICU. Both the theoretical benefits anti the potential concerns are many. Although nursing staff and parents may be excited about the prospect of placing these infants in the same crib, careful investigation and planning are necessary for any new procedure. This article discusses the cobedding of multiples as implemented at the University of Michigan. As a new practice, cobedding warrants further research, especially regarding its proposed benefits and implementation in the NICU.