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PubMed2006

Paternal age as a risk factor for low birthweight.

OBJECTIVES: We examined associations between paternal age and low birth-weight in the US urban population. METHODS: Using a population-based sample of 4621 births, we used multiple logistic regression analysis to estimate associations between paternal age and low birthweight, controlling for maternal age, other demographic factors, and the child's gender. RESULTS: When the child's gender and the mother's race/ethnicity, birthplace, parity, marital status, and health insurance type were controlled, teenaged fathers were 20% less likely and fathers older than 34 years were 90% more likely than fathers aged 20 to 34 years to have low-birthweight babies. The associations were significant when maternal age was also controlled. No racial/ethnic differences in associations between paternal age and low birthweight were found. CONCLUSIONS: We identified paternal age as an independent risk factor for low birthweight in the US urban population, suggesting that more attention needs to be paid to paternal influences on birth outcomes and to the interactive effects of urban environments and individual risk factors on health.

Adolescent↗
PubMed2001

Delayed interval delivery in multiple pregnancies.

Preterm delivery remains the most important complication of multiple pregnancies. We describe six cases of successful delay of the subsequent child(ren) after very preterm birth of the first-born, with intervals ranging between 14 and 117 days. Based on our findings and on the available literature, we propose a set of guidelines for the management of early preterm multiple birth deliveries, including tocolysis, antimicrobial therapy and corticosteroids.

Adult↗
PubMed1992

A review of premature birth and subclinical infection.

Premature birth causes high rates of neonatal morbidity and mortality. There are multiple causes of preterm birth. This article reviews the evidence linking subclinical infection and premature birth. Although maternal genital tract colonization with specific organisms has been inconsistently associated with preterm birth and/or premature rupture of membranes, some infections have been consistently associated with preterm delivery. The association of histologic chorioamnionitis with prematurity is a consistent finding, but the mechanisms require further study. The relationship between histologic chorioamnionitis infection and the chorioamnionitis of prematurity requires additional research. A varying number of patients in "idiopathic" preterm labor have positive amniotic fluid cultures (0% to 30%), but it is not clear whether infection preceded labor or occurred as a result of labor. Evidence of subclinical infection as a cause of preterm labor is raised by finding elevated maternal serum C-reactive protein and abnormal amniotic fluid organic acid levels in some patients in preterm labor. Biochemical mechanisms for preterm labor in the setting of infection are suggested by both in vitro and in vivo studies of prostaglandins and their metabolites, endotoxin and cytokines. Some, but by no means all, antibiotic trials conducted to date have reported decreases in prematurity. These results support the hypothesis that premature birth results in part from infection caused by genital tract bacteria. In the next few years, research efforts must be prioritized to determine the role of infection and the appropriate prevention of this cause of prematurity.

Anti-Bacterial Agents↗
PubMed1995

Factors associated with preterm birth in Cardiff, Wales. II. Indicated and spontaneous preterm birth.

OBJECTIVE: Our purpose was to examine and contrast associations of risk factors with spontaneous preterm birth and indicated preterm birth. STUDY DESIGN: Separate multiple logistic regression analyses were performed of indicated and spontaneous preterm births in a large database of births in Cardiff, Wales. RESULTS: Spontaneous preterm births were associated with young maternal age, low maternal weight, low or high parity, previous abortion, smoking, and early pregnancy bleeding. Indicated preterm births were associated with older age, low weight, previous stillbirth, bacteriuria, and early pregnancy bleeding. CONCLUSION: Spontaneous and indicated preterm births have different overall profiles of association with pregnancy risk factors.

Abortion, Induced↗
PubMed2006

Examining the intergenerational transmission of violence in a New Zealand birth cohort.

OBJECTIVE: This paper examines whether exposure to interparental violence in childhood predicts subsequent involvement in interpartner violence and violent crime after controlling for potentially confounding factors. METHOD: The investigation analyses data from the Christchurch Health and Development Study, a prospective, longitudinal study of a birth cohort of over 1000 New Zealand young adults studied at multiple assessment points from birth to the age of 25. RESULTS: After controlling for potentially confounding risk factors, observed associations between exposure to interparental violence in childhood and increased risks of both (a) psychological interpartner violence perpetration and victimization and (b) violent crime, were reduced to statistical non-significance. No statistically significant associations were observed between exposure to interparental violence in childhood and increased risk of physical interpartner violence perpetration or victimization. CONCLUSIONS: It is concluded that the effects of childhood exposure to interparental violence on subsequent interpartner violence are weak and largely explained by the psychosocial context within which childhood exposure to interparental violence occurs.

Adolescent↗
PubMed1996

The behavioral and emotional well-being of school-age children with different birth weights.

OBJECTIVE: To describe the mental and emotional well-being of children born at different birth weights assessed at school age and to identify neonatal, intervening health, and sociodemographic and environmental factors associated with mental and emotional well-being. METHODS: To address this issue, we used a prospective cohort study involving two previously studied cohorts, which were recontacted at 8 to 10 years of age to provide a multisite sample of 247 children weighing 1000 g or less at birth, 364 weighing 1001 to 1500 g, 724 weighing 1501 to 2500 g, and 533 weighing more than 2500 g. Maternal reports were obtained on three standardized measures of mental and emotional well-being (the Rand General Well-being Scale, the Behavior Problem Index, and the Harter Scale of Child Competence) and on intervening health, sociodemographic, and environmental variables. Neonatal variables were derived from records at birth. Statistical techniques included analysis of variance and ordinary least squares multiple regression. RESULTS: Lower birth weight children did not differ on the General Well-being Scale but were more likely to have behavior problems and to be considered less competent. Other important correlates of mental and emotional well-being included childhood illness, maternal mental health, home environment score, and exposure to household cigarette smoking. CONCLUSION: Although lower birth weight children have poorer mental and emotional well-being, a substantial portion of this adverse outcome reflects modifiable environmental factors.

Analysis of Variance↗
PubMed2005

Excess soluble fms-like tyrosine kinase 1 and low platelet counts in premature neonates of preeclamptic mothers.

OBJECTIVE: To investigate the relationship of neonatal platelet count and preeclampsia to levels of soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF), and vascular endothelial growth factor (VEGF) in the cord blood of preterm infants. METHODS: Sixty-nine preterm infants with a gestational age between 26 and 37 weeks at birth were enrolled. sFlt-1, PlGF, and VEGF levels in the cord blood of preterm neonates, with or without maternal preeclampsia, were measured using a standardized sandwich enzyme-linked immunosorbent assay method. RESULTS: Infants with maternal preeclampsia had higher cord blood sFlt-1 but lower PlGF and VEGF levels. There was a significantly positive relationship between neonatal platelet count and birth weight and a significantly negative relationship between neonatal platelet count and cord blood sFlt-1 levels. Multiple regression analysis revealed that only birth weight and cord blood sFlt-1 levels were independently related to neonatal platelet count, whereas maternal preeclampsia, gestational age (GA), and small for GA (SGA) were not related. Neonates with thrombocytopenia had higher cord blood sFlt-1 levels but lower birth weight. A significant correlation was also found between birth weight and cord blood sFlt-1 levels. Multiple regression with birth weight as the dependent variable found that only GA and cord blood sFlt-1 levels were independently related. Furthermore, infants with high cord blood sFlt-1 were more likely to have lower platelet count and maternal preeclampsia, be SGA, and have a trend toward lower birth weight. CONCLUSION: Excess sFlt-1 may play an important role in the development of maternal preeclampsia- induced neonatal thrombocytopenia, and SGA.

Birth Weight↗
PubMed2002

Multiple versus single courses of antenatal corticosteroids for preterm birth: a pilot study.

OBJECTIVES: (1) To determine the feasibility of a multicentre, randomized, double-masked, placebo-controlled trial to investigate the effects of multiple courses of antenatal corticosteroids (ACS), more than 7 days following the initial course of ACS therapy, on perinatal or neonatal mortality or neonatal morbidity. (2) To determine the risk of complications that would require discontinuation of ACS therapy. (3) To determine if multiple courses of ACS have an effect on the concentrations of plasma cortisol and adrenocorticotropin hormone (ACTH) in cord blood and in maternal blood immediately following delivery, compared to a single course of ACS. METHODS: Women at 24 to 30 weeks' gestation, at continued increased risk of preterm birth 7 or more days following a single course of ACS, were randomized to receive weekly courses of betamethasone or placebo until 33 weeks' gestation or delivery. RESULTS: Women were recruited at two hospitals in Toronto from 01 September 1999 to 31 August 2000. Of the 78 women who were approached and were eligible for the study, 12 (15%) were recruited and 66 (85%) refused to participate. Of the 66 refusals, 38 (58%) did not feel their physicians were supportive of the study, 10 (15%) did not want to be randomized, and 4 (6%) had other personal reasons for refusing to enter the trial. Fourteen women (21%) had physicians who did not allow them to join the study. The lack of physician support was due to concerns related to the potential adverse effects of multiple courses of ACS. There were no complications requiring discontinuation of ACS. Plasma cortisol and ACTH concentrations in cord and maternal blood taken after delivery were not significantly different between ACS and placebo groups. CONCLUSION: A multicentre randomized controlled trial is required to determine the benefits and risks of multiple versus a single course of ACS. If the study protocols are supported by physicians and their patients, a multicentre randomized controlled trial is feasible.

Adrenocorticotropic Hormone↗
PubMed2000

Risk factors associated with feed intolerance in very low birthweight infants following initiation of enteral feeds during the first 72 hours of life.

An observational study was carried out in the Kuala Lumpur Maternity Hospital to determine the risk factors associated with feed intolerance in very low birthweight (VLBW, <1501 g) infants given intermittent 3-hourly enteral feeds within 72h after birth. Feed intolerance developed in 85 (64.4 per cent) of 132 infants. Logistic regression analysis showed that the only significant risk factor associated with feed intolerance was the age when the first feed was commenced. For each hour delay in the age of the infants when the first feed was given, the adjusted odds ratios of feed intolerance was 1.03 (95 per cent confidence intervals: 1.01-1.05; p = 0.01). Other factors (modes of delivery, Apgar score at 1 min, sex, ethnicity, history of resuscitation at birth, birthweight, gestation, multiple pregnancy, perinatal asphyxia, types of milk, hypothermia before first feed, hypotension before first feed, respiratory distress syndrome, patent ductus arteriosus, septicaemia, theophylline therapy, indomethacin therapy, ventilatory support, continuous positive airway pressure, umbilical catheterization, and surfactant therapy) were not significantly associated with feed intolerance. Our study suggests that to promote tolerance of enteral feeds in VLBW infants, intermittent orogastric feeds should be commenced as soon as possible during the first 72 h of life.

Adult↗
PubMed1997

The neonatal consequences and neonatal cost of reducing the number of embryos transferred following IVF.

This clinical audit project examined the effects of change of policy between 1990 and 1993 transferring an average two (maximum three for particular cases) embryos to women undergoing IVF in the West of Scotland programme. All women who achieved clinical pregnancy in 1990 (92 women) and 1993 (93 women) as a result of the IVF programme were included in the study. The hospital records of women via the programme were analysed. The results of the study showed that there was a significant reduction in the rate of multiple pregnancy, preterm birth and low birth weight babies in the 1993 group (new policy). The cost of neonatal intensive care in 1993 for babies born following IVF was about nine times lower than that in 1990 (old policy). This study concluded that a policy of transferring two embryos (or three for particular cases) to women in an IVF programme, had improved the perinatal outcome and reduced the cost of the neonatal service for those babies.

Chi-Square Distribution↗
PubMed2026

Early-Onset Colorectal Cancer: Clinical and Molecular Features with Emerging Insights from Comprehensive Genomic Profiling.

Early&#x2011;onset colorectal cancer (EOCRC), defined as colorectal cancer (CRC) diagnosed before 50 years of age, is increasing globally. Colorectal cancer is currently the third most commonly diagnosed cancer and the second leading cause of cancer-related death worldwide, with GLOBOCAN 2024 estimating approximately 2.04 million new cases and 917,895 deaths in 2024. Recent studies indicate a sustained rise in EOCRC incidence across multiple regions and birth cohorts, with the greatest increases observed among younger adults. Although hereditary cancer syndromes account for 20-25% of EOCRC cases, most occur in the absence of known genetic predispositions or established risk factors. Emerging evidence implicates the gut microbiome as a potential contributor to EOCRC, with distinct microbial signatures differentiating it from late&#x2011;onset colorectal cancer (LOCRC) diagnosed after 50 years of age. This review synthesizes current evidence on clinical, molecular, and diagnostic features distinguishing EOCRC from LOCRC, including differences in anatomical distribution, histopathology, genomic and epigenetic alterations, microbiome composition, and immune landscape, and discusses their implications for personalised screening and therapeutic strategies. We performed a retrospective secondary analysis of comprehensive genomic and immune profiling data from 1737 patients with colorectal cancer tested between June 2021 and June 2023. The analysis showed that tumours arising in patients with EOCRC had lower tumour mutational burden than tumours diagnosed as LOCRC, whereas other immune-related biomarkers, including tumour immunogenicity score, did not remain significantly different after correction for multiple testing. Despite these emerging biological differences, current screening strategies remain largely dependent on an age threshold of 50 years, and EOCRC is not addressed by age&#x2011;specific treatment approaches. We therefore review the translational potential of emerging biomarkers, including microbial signatures and liquid biopsy approaches, and propose a framework for integrating molecular profiling into clinical practice. Finally, we highlight the unmet need for coordinated efforts to improve screening in younger populations, address fertility preservation considerations, and ensure adequate psychosocial support for patients with EOCRC.

Early-onset colorectal cancer↗
PubMed1999

Properties of the melatonin-generating system of the sailfin molly, Poecilia velifera.

The properties of the melatonin-generating system of a tropical teleost, the sailfin molly (Poecilia velifera), were investigated in vitro in a series of experiments using static or perifusion culture techniques. The properties examined included photic entrainment, circadian rhythmicity under continuous light (LL) and continuous darkness (DD), functionality of the melatonin-generating system at birth, and presence of multiple circadian oscillators in the molly pineal. Pineal glands or skull caps with the pineal gland firmly attached were dissected from adult and new-born fishes, respectively, and placed into static or perifusion culture at constant temperature (27 degrees C) depending upon the experiment. Melatonin release in samples was quantified by RIA. Rhythmic melatonin release was observed from isolated adult pineals under 12L:12D and 14L:10D, with low amounts of melatonin released during the light and high amounts during the dark. Melatonin release was inhibited by LL. However, under DD, melatonin release was robust and rhythmic with a circadian period (Tau) that ranged between 21.3 and 27.0 h (n = 21). Pineals from new-born (1-day old) mollies released melatonin rhythmically under a light:dark cycle and DD in both static and perifusion culture. Melatonin release from half and quarter pineals of adult mollies under DD was robust and rhythmic with circadian periods that ranged between 22.5 and 29.0 h (n = 19). Taken together, these data show that the molly pineal is photosensitive, fully functional from birth, and contains multiple circadian oscillators (at least four) regulating melatonin production.

Analysis of Variance↗
PubMed1985

Long-term morbidity of infants with bronchopulmonary dysplasia.

Bronchopulmonary dysplasia occurred in 179 infants discharged from a regional neonatal intensive care unit between 1975 and 1982. Perinatal and outcome factors were compared for these study infants and a group of 112 controls matched for birth weight category and year of birth. There were multiple differences between study infants and controls in demographic, diagnostic, and therapeutic items, all of which were categorized as pulmonary items occurring before and after the development of bronchopulmonary dysplasia, and nonpulmonary items. The postdischarge death rate was 11.2% in infants and 0.9% in control infants (P less than .001). Ongoing morbidity was most marked in the areas of health history, physical examination, growth, and vision. Neurodevelopmental abnormalities and hearing abnormalities occurred slightly more frequently in study infants than in controls but not significantly so. Major developmental abnormalities were less frequent in this population than has been the case in other follow-up studies in this area. This group of infants requires close postdischarge observation because ongoing morbidity and postdischarge mortality, part of which may be preventable, are frequent.

Birth Weight↗
PubMed1997

Racial variation in retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group.

OBJECTIVES: To determine and compare the incidence of severe, vision-threatening retinopathy of prematurity (ROP) in black and white low-birth-weight infants. DESIGN: Prospective cohort study. SETTING: Seventy neonatal intensive care units in 23 US participating centers in the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity. PATIENTS: A total of 4099 premature infants weighing less than 1251 g at birth were enrolled to evaluate the natural history of ROP. This 'Natural History' cohort included 2158 white infants and 1584 black infants who were followed up prospectively according to a Natural History protocol. MAIN OUTCOME MEASURES: Incidence and severity of acute ROP. RESULTS: While ROP occurred with similar frequency in all racial subgroups, severe ROP was less common in black infants. One hundred sixty (7.4%) of 2158 white infants reached threshold ROP (defined as at least 5 contiguous or 8 cumulative clock-hours of stage 3 retinopathy in zone 1 or zone 2 in the presence of "plus disease" [dilation and tortuosity of the posterior pole blood vessels]), but only 51 (3.2%) of 1584 black infants progressed to threshold ROP. Using multiple logistic regression analysis, race emerged as a highly significant factor (P < .001) in the development of threshold disease, even when birth weight, gestational age status at delivery, sex, multiple births, and transport status were considered. CONCLUSIONS: Severe, vision-threatening ROP occurs with greater frequency in low-birth-weight white infants than in low-birth-weight black infants who are seemingly at equivalent risk. The reason for this disparity is unknown. We speculate that differences in retinal pigmentation may confer relative protection against free radical-mediated phototoxic injury in black infants.

Birth Weight↗
PubMed1993

First-trimester transabdominal multifetal pregnancy reduction: a report of two hundred completed cases.

OBJECTIVE: Multifetal pregnancy reduction has been proposed as a way to reduce the risk of preterm delivery in women who conceive three or more fetuses. This communication presents the outcome of 200 consecutive multifetal pregnancies in which reduction to a smaller number of fetuses was accomplished. STUDY DESIGN: All of the procedures were performed in the first trimester by the transabdominal injection of potassium chloride into the thoraces of those fetuses that underwent feticide. All of the pregnancies have been completed and outcome data have been obtained in every case. RESULTS: At the time of the procedure 88 women had triplets, 89 had quadruplets, 16 had quintuplets, and 7 had from 6 to 9 fetuses. These pregnancies were reduced to 189 sets of twins, 5 sets of triplets, and 6 singletons. Reductions to triplets were done at the patient's request, and reductions to singletons were only done for medical indications. There were no cases of chorioamnionitis or other maternal complications attributable to the procedure. A total of 181 women were delivered of one or more live infants after 24 weeks' gestation, and 19 (9.5%) lost all of their fetuses before that time. The mean gestational age for all women delivered after 24 weeks was 35.7 weeks. The mean gestational age at delivery varied inversely with the initial number of fetuses, from 36.1 weeks for women who presented with triplets to 33.8 weeks for those who had 6 or more fetuses, and this trend was statistically significant. Sixteen of the 19 complete pregnancy losses occurred > 4 weeks after the reduction procedure had been performed. The loss rates were 7.9% for those who presented with 3 or 4 fetuses, 12.5% for those with 5, and 42.9% for those with > or = 6. This trend was statistically significant. Two neonates died in the first week of life and one died at 10 months of age as a consequence of the sequelae of severe prematurity. Only two surviving infants have shown evidence of chronic morbidity related to early delivery, and all of the others are developing normally. CONCLUSION: The incidence of intrauterine growth retardation was not increased over that anticipated in a population of twins.

Abortion, Induced↗
PubMed1999

Antenatal steroids to prevent respiratory distress syndrome: multiple gestation as an effect modifier.

BACKGROUND: To determine the effect of antenatal steroids on the incidence of respiratory distress syndrome and the need for surfactant in low-birth-weight infants (501-1500 grams). METHODS: A 6 year cohort of 946 infants (396 received complete steroids and 550 received no steroids) was studied for the occurrence of respiratory distress syndrome and the need for surfactant following antenatal steroid therapy. A stratified analysis identified confounding baseline characteristics or effect modifiers. The covariates used were multiple birth, maternal race, sex, mode of delivery, Apgar score <7 at 5 minutes, birth weight and gestational age. A multivariate logistic regression model was used to adjust odds ratios simultaneously for all statistically significant covariates. RESULTS: Multiple gestation and race were effect modifiers. The reduction in RDS was greatest among singleton infants of black mothers with no significant reduction for multiple gestation white infants. The need for surfactant following steroids was reduced only in the group of singletons of other race (not black or white). CONCLUSION: In this retrospective analysis of cohort data collected prospectively antenatal steroid therapy did not reduce the incidence of RDS in multiple gestation white infants.

Betamethasone↗
PubMed1999

Delayed interval delivery in multiple pregnancies. Is optimism justified?

OBJECTIVE: Evaluation of the success of delayed interval delivery in multiple pregnancies. METHOD: Retrospective analyses of all multiple pregnancies with the birth of one child at a gestational age of 16-31 weeks (n=80). Three groups were defined: group I, unsuccessful attempt to temporize delivery, group II, interval between the first child and the other child or children 3 hours or more, with delivery of the remaining children before 28 weeks and group III, prolongation of pregnancy beyond 28 weeks. RESULTS: In 15 multiple pregnancies (ten sets of twins, five sets of triplets), the aim was to postpone the delivery of the second (and third) child. The mean gestational age at admittance was 25 weeks. Delay of the delivery of the second child was achieved in ten cases, five in group II and five in group III. In groups II and III, the mean interval of delivery was 12 days; the gestational age at the delivery of the remaining children in these ten patients was 27 5/7 weeks. No relation could be found between the reason for admittance and the interval in delivery between the first and the other children. The only severe maternal complication was blood loss exceeding 2 liters. In the neonatal outcome of first and second children (with a gestational age of 28 weeks or more) no striking differences were observed. CONCLUSION: Delayed delivery in multiple pregnancies after the birth of the first child is only successful in a minority of patients and should be considered prior to the birth of the first child.

Birth Intervals↗