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PubMed2007

High prevalence of glucose intolerance even among young adults in south India.

India is experiencing an epidemic of Type 2 diabetes mellitus (DM) in young adults. This study reports the prevalence of glucose intolerance, and insulin profiles, and their relationship to lifestyle factors in 2218 young adults (aged 26-32 years; 997 urban, 1221 rural) in south India. They were drawn from a cohort of 10,691 individuals born during 1969-1973 in Vellore and nearby villages. Family history, socio-economic status, physical activity and tobacco and alcohol use were recorded. Oral glucose tolerance tests were performed for diagnosis (WHO recommendations). Insulin resistance and secretion were derived from plasma insulin concentrations. Median BMI was 20.0kg/m(2). The prevalence of Type 2 DM and impaired glucose tolerance (IGT) was higher in urban than in rural subjects (3.7% versus 2.1%, p=0.02; 18.9% versus 14.3%, p=0.002, respectively), while prevalence of impaired fasting glycaemia (IFG) was similar in urban and rural populations (3.8% versus 3.4%, p=0.04). Type 2 DM, IGT, IFG or higher insulin resistance and increment were associated with higher socio-economic status (more household possessions) and higher percentage body fat, body mass index and waist/hip ratio. Insulin increment was lower in men with higher alcohol consumption. Our data suggest high levels of glucose intolerance in young rural and urban adults highlighting an urgent need for preventive action to avert a public health catastrophe in India.

Adult↗
PubMed2006

Preparation for parenting multiple birth children.

The experience of expecting and parenting multiples is decidedly different from that of a singleton pregnancy and parenthood. Multiple births are associated with substantial medical, health care, socio-emotional, developmental, educational and economic consequences for both families and society. This paper aims to advise health professionals on how best to help families prepare for and successfully respond to the demands of multiple pregnancy and the first 5 years of parenthood after the births of twins, triplets or more. Four inter-related principles of good practice are vital to the care of multiple birth families: the involvement of a range of disciplines, of the family and of the multiple birth community; the provision of specialised care; coordinated services; and the building of family competency including the capacity to make informed decisions. Preparation should include education on the special aspects of multiple pregnancy and parenting using multiples-focused resources, health promotion and risk modification strategies, infant care and feeding, child development and advice on securing help and support while ensuring family participation in all care decisions.

Adult↗
PubMed2006

Meeting the educational needs of multiple birth children.

There has been a significant increase in the number of twins and higher multiples so that one child in 33 is now a multiple. It is therefore not unusual for schools to have several sets of twins, as well as triplets and even higher multiples. By being the same age and in the same school year if not class, twins and higher multiples are not like brothers and sisters born closely together. Teachers and parents need to be aware of particular issues that may affect the physical, intellectual, personal, social and emotional development of multiple birth children, and to ensure that school policy and practice include this special group of children and parents. These issues include: preterm birth catch-up and implications for starting school; the balance of competition and cooperation among multiples; separation in school and the evidence from recent longitudinal studies; legislative and other initiatives on the development of school policy; the particular needs of higher multiples.

Child↗
PubMed2007

Early prediction of preterm birth for singleton, twin, and triplet pregnancies.

OBJECTIVES: To create prediction models of early preterm birth for singletons, twin, and triplet pregnancies. STUDY DESIGN: We used a historical cohort study with the 1996 birth registration data for singletons and the 1995-1997 linked birth/infant death dataset for multiple births of the United States. Preterm birth was defined as gestational age <32 completed weeks. Eligible study subjects were randomly allocated to two groups: one group (80% subjects) for the creation of the prediction models, and the other group (20% subjects) for the validation of the established prediction models. Multivariate logistic regressions were used to establish the prediction models. We further assessed the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the established prediction models with different cut-off values in the validation group. RESULTS: The sensitivity, specificity, PPV, and NPV of the established model were 24.58, 93.54, 5.91, and 98.69%, respectively for singletons, 64.66, 57.04, 16.29, and 92.59%, respectively for twins, and 63.57, 53.58, 42.96, and 72.78%, respectively for triplets. CONCLUSION: The prediction models of early preterm birth for singleton, twin, and triplet pregnancies created by this study could be useful for obstetricians to identify women being at high risk of preterm birth at early gestation.

Adult↗
PubMed2005

Psychosocial risks associated with multiple births resulting from assisted reproduction.

OBJECTIVE: To determine if increased psychosocial risks are associated with each increase in birth multiplicity (i.e., singleton, twin, triplet) resulting from assisted reproduction. DESIGN: Stratified random sample (n = 249). SETTING: An academic teaching hospital and private practice infertility center. PATIENT(S): Mothers raising 1- to 4-year-old children (n = 128 singletons, n = 111 twins, and n = 10 triplets) conceived through assisted reproduction. INTERVENTION(S): Self-administered, mailed survey. MAIN OUTCOME MEASURE(S): Scales measuring material needs, quality of life, social stigma, depression, stress, and marital satisfaction. RESULT(S): Using multivariate logistic regression models, for each additional multiple birth child, the odds of having difficulty meeting basic material needs more than tripled and the odds of lower quality of life and increased social stigma more than doubled. Each increase in multiplicity was also associated with increased risks of maternal depression. CONCLUSION(S): To increase patients' informed decision-making, assisted reproduction providers might consider incorporating a discussion of these risks with all patients before they begin fertility treatment, and holding the discussion again if the treatment results in a multiple gestation. These data may also help providers to identify appropriate counseling, depression screening, and supports for patients with multiple births.

Adult↗
PubMed2006

World collaborative report on in vitro fertilization, 2000.

The International Committee for Monitoring Assisted Reproductive Technology's 7th World Report for the year 2000 analyzes wide variations in live and multiple birth rates from 49 countries and six regions by type of assisted reproductive technology, age, number of embryos transferred, and multiple births. More than 460,157 procedures resulted in delivery rate per aspiration for conventional in vitro fertilization (IVF) of 18.6%; for intracytoplasmic sperm injection (ICSI), 20.4%; for egg donation, 32.3% per transfer; and for frozen ET, 12.0% per transfer. Conventional IVF and ICSI twin rates were 26.9% and 26.2%, respectively, and triplet rates were 2.8% and 2.9%, respectively, for an estimated total of approximately 197,000 to 220,000 babies worldwide.

Adult↗
PubMed2005

Improved outcome for very low birth weight multiple births.

This study describes time trends for very low birth weight multiple births in relation to very low birth weight singletons. Two cohorts of very low birth weight (less than 1250 gm) children recruited between 1983-85 (cohort 1, n = 115) and 1992-94 (cohort 2, n = 144) were compared. The Bayley Scales of Infant Development and a standardized neurologic examination were administered at 2 years corrected age. Neurodevelopmental outcome did not change between cohort 1 and 2 for singletons. For multiple births, mean Mental Developmental Index increased after adjustment for neonatal risk factors [adjusted mean (standard deviation) 81.8 (11.7) to 96.5 (18.6), analysis of covariance P = 0.007]. The prevalence of cerebral palsy decreased, however not significantly [adjusted odds ratio (95% confidence interval) 0.3 (0.1-1.5), P = 0.14]. The proportion of disease-free survival (no cerebral palsy and no developmental delay) increased for multiple births (7-37%, P = 0.002), but not for singletons. In cohort 2, neurodevelopmental outcome of multiple births was similar to that of singletons. The cognitive outcome of very low birth weight multiple births improved, possibly because of changes in perinatal practice. However, neurodevelopmental outcome was similar to that of very low birth weight singletons who were unaffected by changes in neonatal care with high proportions of motor delay and cerebral palsy.

Case-Control Studies↗
PubMed2005

Epidemiology of oesophageal atresia and tracheo-oesophageal fistula in Hawaii, 1986-2000.

The most common major birth defects affecting the oesophagus and trachea are oesophageal atresia (OA) and tracheo-oesophageal fistula (TOF). Epidemiological information on OA and/or TOF in the USA has been derived from only a few populations. Sixty-one cases of OA or TOF were identified through a population-based birth defects registry in Hawaii during 1986-2000. The relationship between various clinical and demographic factors and OA or TOF were examined. The rate of OA or TOF was 2.2 per 10,000 live births. The cases were 67.2% OA with TOF, 21.3% TOF alone, and 11.5% OA alone. Risk of OA or TOF was significantly higher among multiple births and live births with low birth weight and gestational age. The risk of OA or TOF was significantly higher for whites. The rate of OA or TOF was consistent with that reported elsewhere. The risk of the defects differed significantly between the major racial/ethnic groups in Hawaii. The impact of many factors on OA or TOF in Hawaii was similar to that reported elsewhere.

Adult↗
PubMed2006

Observed frequency of monozygotic twinning in Holstein dairy cattle.

Bonnier's equation is used to mathematically estimate the frequency of monozygotic (MZ) twinning in epidemiologic studies of twinning in dairy cattle; however, no empirical determination of MZ twinning has been reported in the literature. Our objectives were to empirically determine the frequency of MZ twinning in lactating Holstein cows and to compare this result with published estimates predicted using Bonnier's equation. Ear biopsies were collected from 107 sets of Holstein twins from six Wisconsin dairies resulting in 40 opposite-sex twins, 29 same-sex male twins, and 38 same-sex female twins. To empirically determine the frequency of MZ twinning, DNA extracted from ear biopsies collected from the 67 same-sex twins was PCR amplified using primers for a minimum of 5 polymorphic microsatellite DNA markers. Opposite-sex twins were classified as dizygotic (DZ) as well as same-sex twins differing in at least one microsatellite DNA marker. Same-sex twins were classified as MZ when all genotypes for a minimum of five markers were identical. Of the 67 same-sex twins, 62 were classified as DZ and 5 MZ resulting in a MZ twinning frequency of 7.5% of same-sex twins and 4.7% of all twins. The estimated frequency of MZ twinning in this population of twin calves using Bonnier's equation was 39.5% of same-sex twins and 24.7% of all twins. We concluded that MZ twinning occurred infrequently in Holstein cattle and perhaps less frequently than that reported in studies using Bonnier's equation to estimate MZ twinning.

Animals↗
PubMed2004

On stochastic logistic population growth models with immigration and multiple births.

This paper develops a stochastic logistic population growth model with immigration and multiple births. The differential equations for the low-order cumulant functions (i.e., mean, variance, and skewness) of the single birth model are reviewed, and the corresponding equations for the multiple birth model are derived. Accurate approximate solutions for the cumulant functions are obtained using moment closure methods for two families of model parameterizations, one for badger and the other for fox population growth. For both model families, the equilibrium size distribution may be approximated well using the Normal approximation, and even more accurately using the saddlepoint approximation. It is shown that in comparison with the corresponding single birth model, the multiple birth mechanism increases the skewness and the variance of the equilibrium distribution, but slightly reduces its mean. Moreover, the type of density-dependent population control is shown to influence the sign of the skewness and the size of the variance.

Animal Migration↗
PubMed2001

Relationship of follicle numbers and estradiol levels to multiple implantation in 3,608 intrauterine insemination cycles.

OBJECTIVE: To determine the relationship of follicle numbers and estradiol (E(2)) levels to multiple implantations in human menopausal gonadotropin (hMG) and clomiphene citrate (CC) cycles. DESIGN: Fifteen-year prospective study. SETTING: Private infertility clinic. PATIENT(S): Women who underwent 3608 cycles of husband or donor intrauterine insemination (IUI). INTERVENTION(S): Ovulation induction (OI) with CC, hMG, or CC+hMG. MAIN OUTCOME MEASURE(S): Pregnancy and multiple implantations. RESULT(S): Triplet and higher-order implantations-but not twin implantations-were related to age, E(2) levels, and number of follicles > or = 12 mm and > or = 15 mm, but not number of follicles > or = 18 mm, in hMG and CC+hMG cycles. For patients less than 35 years old, three or more implantations tripled when six or more follicles were > or = 12 mm, in CC, hMG, and CC+hMG cycles, and when E(2) was > or = 1000 pg mL in hMG and CC+hMG cycles. For patients 35 or older, pregnancy rates in hMG and CC+hMG cycles doubled when six or more follicles were > or = 12 mm, or E(2) levels were >1000 pg mL, whereas 3 or more implantations were not significantly increased. CONCLUSIONS: Withholding hCG or IUI in CC, hMG, and CC+hMG cycles when six or more follicles are > or = 12 mm may reduce triplet and higher-order implantations by 67% without significantly reducing pregnancy rates for patients under 35 years of age.

Adult↗
PubMed2003

Social stigma and compounded losses: quality-of-life issues for multiple-birth families.

OBJECTIVE: To determine the quality-of-life domains most impacted by multiple births. DESIGN: Focus groups, qualitative research. SETTING: Human volunteers in a medical research environment.Forty-three mothers, 29 raising multiple-birth children, 13 raising singletons, identified from random and convenience samples. INTERVENTION: None. MAIN OUTCOME MEASURE(S): Maternal self-reports of the psychosocial sequelae of multiple or singleton births, based on qualitative data analysis of transcribed group discussions. RESULT(S): The quality-of-life domains that were most impacted by raising multiple birth children were social stigma, pregnancy loss, marital satisfaction, children's health, unmet family needs, parenting stress, maternal depression, and the infertility experience. CONCLUSION(S): Qualitative methods identified two novel quality-of-life domains in iatrogenic multiple birth families: social stigma and compounded losses. An unexpected finding was the potential for increased marital solidification as parents coped with the inordinate stresses of multiple births. As anticipated, children's health, unmet family needs, maternal depression, and parental stress were key areas of concern. In addition, the infertility experience had a lasting impact. These findings are significant, given that at least 38% of all assisted conceptions result in a multiple birth. This study lays the groundwork for further research on the impact of iatrogenic multiple births.

Abortion, Spontaneous↗
PubMedDate not supplied

Concordance of strabismic phenotypes in monozygotic versus multizygotic twins and other multiple births.

PURPOSE: The concordance of strabismic phenotypes was examined in monozygotic versus multizygotic twins and other multiple births to study the role of genetic background in different types of commitant strabismus. METHODS: Medical charts of 45 consecutive pairs of twins (16 monozygotic and 18 dizygotic twins, and 11 with unknown zygosity), 3 sets of triplets (one monozygotic and 2 trizygotic triplets), and one set of quadruzygotic quadruplets examined at 6 institutions between 1973 and 1999 were reviewed retrospectively. The concordance was defined as both or all members having either esotropia or exotropia in common. RESULTS: The concordance of strabismic phenotypes was noted in 33 of 49 pairs or sets (67.3%): 14 of 17 monozygotic twins or triplets (82.4%), 10 of 21 multizygotic twins, triplets, or quadruplets (47.6%), and 9 of 11 twins with unknown zygosity (81.8%). The concordance rate was significantly higher in monozygosity than in multizygosity (P =.043, Fisher exact probability test). The predominant concordant phenotypes in monozygosity were accommodative esotropia and intermittent exotropia. CONCLUSION: A high concordance rate of strabismic phenotypes, predominantly of accommodative esotropia and intermittent exotropia in monozygosity, suggests the genetic background for these types of strabismus.

Diseases in Twins↗
PubMed1999

Cord blood concentrations of vitamin A in preterm infants.

Plasma vitamin A concentrations were measured in cord blood samples from 56 infants of gestational ages < 33 weeks. Outcome was followed prospectively. Mothers' dietary habits and use of multivitamins during pregnancy were evaluated by means of a questionnaire. Vitamin A concentrations less than 1.05 micromol/l (low) were measured in 22, but levels below 0.7 micromol/l (deficient) only in two cases. The concentrations were not correlated with the infants' gestational ages. Infants with low concentrations were significantly more often multiplets compared to those with normal levels and the vitamin A concentrations of the multiplets were significantly lower than those of the singletons. The outcome measures used and the mothers' dietary habits and multivitamin use were similar in cases with low and normal vitamin A concentrations. Multiple gestation seems to be correlated with low plasma vitamin A concentrations in preterm infants at birth, and a complete assessment of vitamin A status to detect possible deficiency might be indicated in these cases.

Adult↗
PubMed2000

The interpretation and use of statistics in assisted reproductive technologies.

This article has discussed some of the uses and limitations of currently available statistics for ART programs. A well-known example from statistics states that flipping a coin will produce "heads" 50% of the time and "tails" 50% of the time, provided that the coin is flipped enough times. Experience also shows that the result of individual flips cannot be predicted. Similarly, in ART, statistics can only give general probabilities and not meaningful predictions of the outcome of any particular cycle. Patients should be aware of the limits of statistical analysis as it applies to their individual treatment.

Adult↗
PubMed2003

Cryopreservation as a tool to reduce multiple birth.

The potential role of embryo cryopreservation from the point of view of prevention of multiple pregnancies is analysed. Cryopreservation is an unavoidable option in stimulated IVF/intracytoplasmic sperm injection (ICSI), but at the same time an underestimated tool in the prevention of twins. There is a need for an evaluation system not only of the cryotechnology process per se, but also of the true augmenting effect of cryopreservation on the total reproductive potential of a single oocyte harvest. Only cryopregnancies occurring after an unsuccessful fresh cycle (possibly followed by one or more unsuccessful freeze-thaw cycles with embryos from the same harvest) truly reflect the augmentation potential of cryopreservation. This potential is greater than generally thought. First, the efficacy of cryopreservation is suboptimal with survival rates between 30 and 70%. Second, if single-embryo transfer were applied in a much larger proportion of cycles than is presently the case, more embryos would be available for cryopreservation, resulting in more and more successful freeze-thaw cycles. In the future, the combination of elective single-embryo transfer with an optimized cryopreservation programme is likely to become the standard of care for routine IVF/ICSI treatment.

Cryopreservation↗
PubMed2003

Cerebral palsy rates among low-birthweight infants fell in the 1990s.

Using a population-based register, this study sought to ascertain changes in the rate and severity of cerebral palsy (CP) in a geographically defined area of the UK among infants weighing less than 1500 g and born between 1984 and 1995. There were 417414 live births in the area, which included Berkshire, Buckinghamshire, Northamptonshire, and Oxfordshire. Of the 898 children with CP (526 males, 372 females), 194 (21.6%) weighed less than 1500 g at birth. The overall CP rate for neonatal survivors fell from 2.5 out of every 1000 in 1984 to 1986 to 1.7 in 1993 to 1995. The rate for those weighing less than 1000 g rose to 90 out of every 1000 neonatal survivors in 1987 to 1989 and then fell to 57 in 1993 to 1995. A similar pattern is seen among infants weighing 1000 to 1499 g at birth, the rate rising to 77 in 1987 to 1988 and then falling to 40 in 1993 to 1995. The rate of severe motor disability among infants weighing less than 1500 g also decreased (24.6 in 1984-1986 to 12.5 in 1993-1995). The relation of these findings to changes in perinatal care in the early 1990s is not known.

Cerebral Palsy↗