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PubMed2002

Descriptive epidemiology of anal atresia in Hawaii, 1986-1999.

BACKGROUND: Anal atresia is one of the more common birth defects affecting the gastrointestinal tract. This study examined the relationship between anal atresia and selected demographic and clinical factors in Hawaii. METHODS: Data were obtained from a population-based birth defects registry and included all cases of anal atresia identified in Hawaii among 1986-1999 deliveries. RESULTS: There were 124 cases of anal atresia, resulting in a rate of 4.38 per 10,000 live births and fetal deaths (95% confidence interval (CI) 3.65-5.23). Cases consisted of 115 (92.7%) live births, 6 (4.8%) fetal deaths, and 3 (2.4%) elective terminations. Chromosomal abnormalities were reported for 10 (8.1%) of the cases, 7 of which were trisomy 21. Family history of anal atresia was reported for 3 (2.4%) of the cases. No secular trend in anal atresia rates was identified (p=0.617). Risk of anal atresia was highest for the 25-29-year maternal age group and lower among younger and older maternal age groups. Risk for anal atresia was lower for females (relative risk (RR) 0.69 95% CI 0.51-0.91) and higher for live births with a birth weight less than 3,000 grams (RR 2.75, 95% CI 2.08-3.56) or less than 38 weeks' gestation (RR 3.90, 95% CI 2.88-5.15) and for multiple births (RR 3.34, 95% CI 1.44-6.57). Anal atresia rates did not vary significantly by maternal race/ethnicity, residence at delivery, gravidity, or prenatal care. CONCLUSIONS: Anal atresia risk was associated with maternal age, infant/fetus sex, birth weight, gestational age, and plurality but not maternal race/ethnicity, residence at delivery, gravidity, or prenatal care. Except for maternal age, these findings are consistent with the literature.

Anus, Imperforate↗
PubMed2005

Assisted reproductive technologies and multiple gestations.

Since the first in vitro fertilization infant was born in England in 1978, the practice of assisted reproductive technology (ART) has steadily increased as the technology and success rates have improved. The incidence of multiple gestations has also increased, primarily owing to the practice of transferring multiple embryos during an ART cycle. Guidelines for infertility clinics have been outlined, along with strategies to limit the number of embryos transferred (depending on the age of the patient) to achieve a lower risk of multiple births. Since 1997, a decrease has occurred in the number of embryos transferred and the percentage of gestations with three or more fetuses, accompanied by a steady increase in the percentage of live births per cycle.

Age Factors↗
PubMedDate not supplied

Outcome and follow-up of children born after IVF-surrogacy.

This study addresses various outcomes and follow-up of children born after IVF-surrogacy. Recent reports on perinatal outcome after IVF-surrogacy and on data generated by the Society of Assisted Reproductive Technology (SART) Registry between 1991 and 1995 were examined. A review of recently published perinatal outcomes of children born after IVF-surrogacy, including the developmental information of 110 children after the first 2 years of life, was undertaken. The birth weights for singleton pregnancies following IVF-surrogacy and IVF were similar, whereas the birth weights of twins and triplets born from the IVF-surrogates were significantly heavier than those delivered from conventional IVF patients. Preterm delivery was increased in twin and triplet gestations in all segments analysed. The incidence of low birth weight was significantly lower in children born after IVF surrogacy than in those born after IVF, for all births recorded. The incidence of congenital abnormalities following IVF and IVF-surrogacy was within the expected range for spontaneous conceptions. Speech delays were predominant in the multiple births, but neither speech nor motor delays persisted at 2 years of age in children born after IVF-surrogacy. These findings would imply that a gestational carrier would provide potential environmental benefits for the infant.

Adult↗
PubMed1997

The Stockholm Neonatal Project: neonatal mortality and morbidity at the Children's Centre, Karolinska Hospital.

Two hundred and ninety-one very-low-birth-weight (VLBW) infants were studied prospectively during the period of 1988-1993. All inborn VLBW infants and most of the VLBW infants born in Greater Stockholm and requiring neonatal intensive care were included in this study. The overall mortality was 17.5% and the mortality in the group with the lowest gestational age at birth, i.e. 23-24 weeks, was 25%. The mortality for boys was higher than for the girls. The mode of delivery, i.e. vaginal versus caesarean section and multiple birth, did not seem to affect the mortality rate. Respiratory insufficiency and/or cerebral complications were the most common cause of neonatal death. Patent ductus arteriosus was found in 35% of the infants, of whom 43% needed surgical ligation. One-third of infants with retinopathy of prematurity (30/92) required cryotherapy.

Cause of Death↗
PubMed2005

Septuplet placenta: a case report.

OBJECTIVE: On November 19, 1997, 7 liveborn infants (4 boys and 3 girls) were delivered by cesarean delivery at 30.5 weeks gestational age. The pregnancy was the result of artificial induction of ovulation. STUDY DESIGN: The septuplet placenta was evaluated with a standard and systematic procedure for placentas of multiple births that revealed a septamnionic, septchorionic architecture with 5 fused and 2 unfused placentas. RESULTS: Each of the 7 umbilical cords contained 3 vessels. Two cords were velamentous; the remaining 5 cords were inserted eccentrically. The ratio of combined birth weights of the 7 infants to total placental weight (7.52:1) correlated with normograms of singleton and twin gestations. CONCLUSION: This ratio and additional calculations were used for comparison and for additional clinicopathologic correlations.

Adult↗
PubMed1999

Breast cancer in relation to some reproductive factors.

Breast cancer is one of the most commonly occurring cancers in females in the Eastern Mediterranean Region. In Egypt women's breast cancer had the highest frequency. The present study was conducted to study the association between breast cancer and some reproductive factors as well as to find out (if possible) predictors for occurrence of breast cancer. A hospital based case control study was carried out in Alexandria Main University Hospital where, 129 histopathologically confirmed incident primary breast cancer cases were included. An equal number of a control group matched by age were selected from the visitors of the same hospital. Data related to women's reproductive period were collected from both cases and controls. The results revealed that there was no statistically significant difference between cases and controls as regards menopausal status, menstruation span, number of births, spontaneous and induced abortion, twin birth, breast feeding and use of oral contraceptives. There was an increasing risk of breast cancer, with the presence of positive family history of breast cancer decreasing age at menarche, increasing age at first full-term pregnancy, widening of the interval between menarche and first full-term pregnancy, increasing age at last full-term pregnancy and shortening of the interval since last birth. Multiple logistic regression analysis revealed that positive family history of breast cancer, young age at menarche, late age at last full-term pregnancy and wide inter-birth interval were significant predictors for occurrence of breast cancer. The results of the study pinpoint that conduction of public health education programmes focusing on the modifiable risk factors are required.

Adolescent↗
PubMedDate not supplied

[Prematurity and prenatal care].

In regard of the constant rate of low birthweight infants in Federal Republic of Germany kinds and relevance of social factors within Low Birthweight are examined. Results of a study based on all births in Berlin (West) during the years 1982-1985 (n = 72201) are presented. It shows a constant rate of low birthweight infants also in Berlin (mean: 6.3%, excluding multiple births). Several social factors (legitimacy, nationality...) with varying intensity played a major role, especially if certain risk situations were cumulating. Since Prenatal Care has particular difficulties in reaching women at higher risks early and consequently, specific approaches of intervention derived from experiences in the US are suggested.

Adolescent↗
PubMed2005

Parenthood in survivors after adulthood cancer and perinatal health in their offspring: a preliminary report.

Cancer survivors may fear infertility, obstetric problems, and genetic alterations in their offspring. After linkage of three registries the probability of post-treatment parenthood and the risk of obstetric and perinatal problems were estimated in cancer survivors compared to individuals without a cancer diagnosis. A total of 1531 of 13,817 patients had 2307 children after one parent's cancer diagnosis: 972 males had 1479 children and 559 females had 828. A total of 1217 patients (784 males and 433 females) became parents > or =9 months after the diagnosis (1899 births: 1221 to male cancer patients and 678 to female patients). The post-diagnosis parenthood probability was 8% at 5 years, and 14% at 10 years without further increase. Female cancer survivors gave birth to post-diagnosis infants with on average 130 grams lower birth weight and 6 days shorter gestations compared with infants in the non-cancer population. Infants fathered by male cancer survivors did not differ from control infants with respect to birth weight or gestational age. There was no increase in the prevalence of major congenital malformations in the offspring of cancer survivors as compared with the offspring of the non-cancer population. Multiple births and deliveries by cesarean sections were increased. Parenthood after cancer is possible in a significant number of patients, more so for males than females. The risk of major congenital malformations was not increased relative to the non-cancer population, nor was perinatal mortality increased. However, female cancer survivors delivered more preterm births and low-birth-weight infants than what was found in the non-cancer population.

Adult↗
PubMed2002

Sudden infant death syndrome in Japan 1995-1998.

This study examined the effects of birth characteristics, which reported on birth certificates, on sudden infant death syndrome (SIDS) based on vital statistics between 1995 and 1998 in Japan. One thousand eight hundred and fifty-nine cases of SIDS and 4,787,537 live births were analyzed. The mortality rate from SIDS was 0.388 SIDS deaths per 1000 live births. Based on multivariate analysis using Poisson regression model, risk factors associated with significantly increased SIDS rates included low birth weight, being a male infant, young maternal age, late birth in multiparity, maternal stillbirth experience, residential region of Kyusyu, Tokai or Hokuriku, and employment status as "unemployed or unknown". However, there was no significant difference between single and multiple birth groups after adjusting other characteristics. A decreasing postnatal age of death was observed as birth weight increased. However, there was no difference in postconceptional age of death between birth weight groups. Preterm infants died of SIDS at a later postnatal age than term infants, but there appeared to be little difference in postconceptional age of death amongst preterm infants. This association between birth characteristics and SIDS were consistent with other studies from western countries, suggesting that recommendations for SIDS in western countries are also applicable for Japan.

Abortion, Induced↗
PubMed2000

Ethnic differences in the growth of low-birthweight infants.

Differences in growth were investigated among ethnic groups in low-birthweight babies (< 2500 g or < 32 weeks gestation) at birth and at 2-3 years. This prospective study was based on data for all 3091 low-birthweight live births in the South East Thames Region, UK, over a 1-year period, surviving to discharge from hospital. Weights were recorded at birth and at 2-3 years for 998 babies, and head circumferences for 859. These were compared with the UK 1990 reference standards. Ethnic differences were adjusted for parity, multiple birth, smoking and alcohol during pregnancy, mother's height, weight and age, marital status, partner's support and social class. At 2-3 years, there was substantial average catch-up growth only for the weight of infants of > or = 32 weeks' gestation. Babies < 32 weeks gestation had fallen behind. Head circumferences had failed to keep up or had fallen behind for both groups. The ethnic groups had similar birthweight standard deviation scores (SDS). At 2-3 years, Black babies of < 32 weeks' gestation had gained in weight and head circumference compared with White babies (adjusted difference in weight SDS: 0.71, [95% CI 0.28, 1.13]). Asian babies of at least 32 weeks' gestation had smaller heads than White, a difference that increased with time. It was concluded that ethnic differences in the growth of low-birthweight infants are related to gestational age. Although most of the babies born at < 28 weeks' gestation were close to their birthweight reference standards, only the Black infants had maintained their position at 2-3 years. Black infants, particularly when born preterm, tend to put on more weight than White.

Black or African American↗
PubMed1988

Law concerning the amendment of the Law on family allowances, 20 December 1988.

This Law amends the Liechtenstein Law on family allowances (see Annual Review of Population Law, Vol. 2, 1985, Section 420) by increasing family allowances to Fr. 140 a month for each child (including orphans) and to Fr. 170 when the child reaches the age of 10. If the person entitled to receive the family allowance has more than two children, the allowance is Fr. 170 per child. The birth allowance for children born alive or dead or who are adopted is set at Fr. 1,200 for each child and at Fr. 1,500 when there are multiple births.

Adoption↗
PubMed2006

Sibship characteristics and risk of multiple sclerosis: a nationwide cohort study in Denmark.

It has been hypothesized that age at infection with a common microbial agent may be associated with the risk of multiple sclerosis (MS). The authors addressed this hypothesis by using number of older siblings and other sibship characteristics as an approximation of age at exposure to common infections. Data on family characteristics and vital status from the Danish Civil Registration System were used to establish a cohort of all Danes whose mothers had been born in Denmark since 1935. Persons diagnosed with MS during the period 1968-1998 were identified through linkage with the Danish Multiple Sclerosis Register. The cohort of 1.9 million Danes was followed for 28.1 million person-years; during that time, 1,036 persons developed MS. Overall, there was no association between number of older siblings, number of younger siblings, total number of siblings, age distance from the nearest younger sibling, or exposure to younger siblings under 2 years of age and risk of MS later in life. There was no association of MS risk with multiple birth (vs. singleton birth) or with the age of the mother or father at birth. These results do not lend support to the hypothesis that number of older siblings or any of the other sibship characteristics studied is associated with risk of MS.

Adolescent↗
PubMed1995

Plasma somatostatin and cholecystokinin levels in preterm infants and their mothers at birth.

Regulatory gut peptides play an important role in regulating the gastrointestinal tract. Our knowledge about the pattern of secretion and function of these peptides is scanty in preterm infants. Therefore, plasma somatostatin (SS) and cholecystokinin (CCK) levels were estimated just after birth in 65 mothers and 73 preterm infants (umbilical cord blood). The gestational age was 32 (24-36 median ranges) wk and birth weight 1900 (475-3350) g. The umbilical cord blood pH was 7.32 +/- 0.10 (mean +/- SD). After Sep-Pak-C18 semichromatography of plasma, SS and CCK were analyzed by RIA. Both plasma SS and CCK levels were significantly higher in infants than in mothers (SS = 14.5 +/- 12.4 versus 9.3 +/- 7.6 pmol/L; CCK = 11.6 +/- 7.4 versus 7.0 +/- 1.9 pmol/L). In appropriate for gestational age and small for gestational age infants' plasma levels of the two peptides were the same. They were also independent of sex, birth weight, gestational age, umbilical cord blood pH, or glucose level. In mothers, but not in infants, plasma SS levels were higher after vaginal delivery than after cesarean section. After multiple birth, newborn plasma SS, but not plasma CCK, was significantly lower than after single birth (9.1 +/- 7.7 versus 16.9 +/- 12.7 pmol/L).

Adolescent↗
PubMed1993

Twinning and cerebral palsy: experience in four northern California counties, births 1983 through 1985.

BACKGROUND: Twinning is associated with heightened risk of cerebral palsy (CP) and is increasing in the United States and elsewhere. METHODS: Twins with moderate or severe congenital CP were identified in a cohort of 155,572 children born 1983 through 1985 in four northern California counties and surviving to 3 years. The prevalence of CP in twins and factors associated with increase in risk were examined. RESULTS: Among 2985 twins, 20 children in 18 pairs had CP. The prevalence of CP was 6.7 per thousand 3-year-old twin children (95% confidence interval [CI], 4.2 to 11), 12 per thousand twin pregnancies (95% CI, 7.2 to 19), and 1.1 per thousand singletons (95% CI, 0.97 to 1.3). Ten percent of all CP was in twins; 22% of CP in infants of less than 1500 g birth weight occurred in twins. Twins were over-represented among very low birth weight infants but their risk of CP was comparable with that of very low birth weight singletons. Twins born weighing 2500 g and more had a CP risk 3.6 times that of singletons of similar weight. In children who survived fetal death of a co-twin, CP was 108 times more prevalent (95% CI, 42 to 273) than in singletons and 13 times more prevalent (95% CI, 4.5 to 37) than in twins whose co-twin was born alive. The CP rate in unlike-sex pairs was 13 per thousand (95% CI, 4.8 to 32), not significantly different from 11 per thousand (95% CI, 5.7 to 19) for like-sex pairs. CONCLUSION: Twin pregnancies produced a child with CP 12 times more often than singleton pregnancies. The heightened risk was largely related to the tendency of twins to be low in birth weight and to a greater risk of CP in twins of normal birth weight compared with singletons of similar weight. Twins of unlike-sex pairs, necessarily dizygotic, were not at lower risk than like-sex pairs. The current increase in multiple births is likely to contribute more children with CP.

California↗
PubMed2001

ACOG Practice Bulletin. Assessment of risk factors for preterm birth. Clinical management guidelines for obstetrician-gynecologists. Number 31, October 2001. (Replaces Technical Bulletin number 206, June 1995; Committee Opinion number 172, May 1996; Committee Opinion number 187, September 1997; Committee Opinion number 198, February 1998; and Committee Opinion number 251, January 2001).

Preterm birth is the second leading cause of neonatal mortality in the United States (1) (second only to birth defects), and preterm labor is the cause of most preterm births (2). Neonatal intensive care has improved the survival rate for babies at the cusp of viability, but it also has increased the proportion of survivors with disabilities. The incidence of multiple births also has increased along with the associated risk of preterm delivery (4). Interventions to delay preterm delivery in these settings have not shown conclusive effectiveness. Because the morbidity of babies born after 34-35 weeks of gestation has diminished, most efforts to identify preterm deliveries have focused on deliveries before this age. This document describes the various methods proposed for predicting preterm birth and the evidence for their roles in clinical practice.

Cervix Uteri↗
PubMed2004

What is the most relevant standard of success in assisted reproduction?: The value of cryopreservation on cumulative pregnancy rates per single oocyte retrieval should not be forgotten.

The most relevant standard of success in IVF has been discussed widely. An optimal standard should reflect both the risk aspects and the effectiveness of the treatment. The most important parameter for the couple is the ultimate cumulative delivery rate per started cycle. Even if the long-term follow-up of the treatment cycles is difficult in practice, we would stress that more emphasis should be given to embryo freezing, in order to maximize the efficiency of the IVF/ICSI cycles. The contribution of embryo cryopreservation in elective single embryo transfer cycle programmes may result in a cumulative delivery rate of >50%. In Finland, the implementation of single embryo transfer has been possible with good cryopreservation programmes. The effect of this strategy has been seen in a decrease in the proportion of twin deliveries after assisted reproduction, being 13.9% for 2002, as well as a reduction of the proportion of multiple births in the nationwide Medical Birth Registry.

Cryopreservation↗
PubMed2006

[Study of 178 ante partum deaths in 2001-2004 in the southern part of Reunion Island].

INTRODUCTION: The perinatal mortality rate is 18.5 in the southern part of the Reunion Island (Indian Ocean), of which 2/3 are due to antepartum fetal deaths (APFD). METHODS: During a 4-year period (2001-2004) all APFD from 22 weeks gestation were recorded and analyzed with placental histology, bacteriological samples and autopsies in 27% of cases. The Australasian and New-Zealand classification PSANZ-PDC (2000) was used. Risk factors of fetal death with monofetal pregnancies are determined in comparison with live births. RESULTS: Out of 21.495 total births, 178 APFD were recorded. The main obstetrical risk factors were primiparity (OR 1.6, p = 0.002), maternal age over 34 years (OR 1.6, p = 0.01), hypertensive disorders of pregnancy (OR 3.0, p < .001) and multiple births (OR 2.5, p < 0.001). The great majority of APFD (76%) involved preterm fetuses, of which 61% of very preterm (<33 weeks), and 25% of fetuses were growth retarded (OR 3.9, p < 0.001). Only 8% of cases were considered unexplained. The main etiologies were infectious causes in 26% of cases, vascular fetal growth restriction (18%), specific perinatal conditions (14%) of which one-third were due to cord anomalies, preeclampsia (10%), maternal conditions (8%), congenital anomalies (8%) and ante-partum hemorrhage (7%). We discuss the interests and the limitations of using the Australian and New-Zealand classification PSANZ 2000. Intra-uterine growth retardation is one of the principal risk factors of fetal death. CONCLUSION: Besides well-known obstetrical risk factors such as diabetes, hypertension, multiple pregnancies, all screening of intra-uterine growth retardation in the second trimester of pregnancy should include a special survey in order to minimize the incidence of APFDs.

Adult↗
PubMed1991

Delivery outcome after infertility--a registry study.

Among a total of 379,779 women with 383,589 infants born in Sweden (1983 to 1986), 7.8% had a recorded period of infertility of at least 1 year. Women with a history of infertility had a higher mean age, a lower parity, had fewer previous induced abortions but more spontaneous abortions, extrauterine pregnancies, and stillbirths than women without a history of infertility. They also smoked more. There was an excess of multiple births. Singleton infants showed an increased percentage of low-birth weight infants, short gestational duration, and signs of intrauterine growth retardation. The rate of major malformations was not increased in the total infertile group but may have been increased in the subgroup with at least 4 years of infertility.

Birth Weight↗