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PubMed1991

Multifetal pregnancy reduction: a Belgian experience.

Multifetal pregnancy reductions were performed during the first trimester of pregnancy in 26 patients. Transabdominal intrathoracic KC1 injections were performed in 23 cases, and transcervical aspirations in 3 cases. There were 4 miscarriages (15%) during the second trimester, 18 pregnancies ended in 33 births, 4 pregnancies are going on uneventfully and are beyond 32 weeks. There was no maternal morbidity related to the procedure; fetal morbidity has been mild.

Abortion, Induced↗
PubMedDate not supplied

Higher multiple births: socio-economic implications in a developing nation.

A case of successful quadruplet pregnancy followed from date of diagnosis, through delivery, and to the third year of life is presented. The emotional, social, and economic problems encountered by the parents and hospital personnel are examined with a detailed analysis of the financial burden placed on all parties. Individual, voluntary donations made at the time of delivery have proved insufficient to cover the care involved before, during, and after the birth of multiples. A more concrete commitment on the part of government in the form of legislation or subvention is suggested in order to ease some of the stress on the parents of multiples.

Adult↗
PubMed1988

Multiple pregnancy as a risk factor in rural Tanzania.

The prevalence of twin pregnancies in two rural hospitals in the South Western Highlands of Tanzania ranged from 15 to 20 per 1,000 births. The literature on the generally assumed high twinning rates in the whole of Africa is reviewed. High prevalence figures can be the result of hospital selection, as most African studies are hospital-based. Only from Nigeria, one population-based study revealed a rate of 45 per 1,000. In both hospitals perinatal mortality in twin births was strikingly low, especially when birthweight was at least 1,500 g: between 30 and 40 per 1,000 births. It is argued that there is no place for a more liberal use of caesarean section to further reduce perinatal mortality.

Birth Weight↗
PubMed2003

Obstetric complications correlate with neurobehavioral and brain structural alterations in young relatives at risk for schizophrenia.

As complications of pregnancy and birth may be important risk factors for the development of schizophrenia, studying the "roots" of schizophrenia in high-risk offspring may better elucidate the interface between biology, environment, and susceptibility to illness. Using magnetic resonance imaging (MRI), neurobehavioral assessments and obstetric histories, we found several significant correlations between these multiple factors, suggesting that birth complications may be a nonspecific etiopathogenic risk factor for psychopathology in young relatives at risk for schizophrenia.

Adolescent↗
PubMed2001

Epidemiology of autism in Singapore: findings of the first autism survey.

The report describes the results of a survey conducted on 176 parents of children with autism in Singapore. The ages of the children ranged from 3 to 12 years. The survey focused on the child's background, behaviour problems and skill profile, the home and school situation as well as the linguistic and social background. It was noted that the Singapore population confirms the international distribution regarding a predominance of boys over girls and a low incidence of birth complications. A positive trend noted was the fact that 60% of the children were diagnosed before the age of 3 years. Discussion focuses on possible risk factors and psychosocial adversities for autism such as a high frequency of caregivers who are foreign maids, the use of multiple languages and the high level of punitive educational practices. The possible influence of psychosocial deprivation on child development is discussed.

Autistic Disorder↗
PubMed1989

Computerised tomography in schizophrenia. Familial versus non-familial forms of illness.

Findings on CT and demographical or clinical data in 80 patients with DSM-III schizophrenia and 45 medical controls were evaluated. Multiple-discriminant analysis showed that the enlargement of the third ventricle and frontal and parietal atrophy could significantly predict the diagnosis of schizophrenia. Widening of Sylvian fissures and parietal atrophy differentiated familial schizophrenics of both horizontal transmission (who had affected siblings) and vertical transmission (who had affected parents or/and offspring) from non-familial patients. Parietal atrophy and a history of birth complications differentiated horizontal from vertical transmission. The CT findings together with some clinical characteristics could differentiate the three subgroups classified by the hereditary form; thus each of these subgroup may belong to a different disease entity, of a different pathophysiology.

Adult↗
PubMed1984

The role of parental attitudes in the development of temperament in twins at home, school and in test situations.

In the La Trobe Twin Study, data are collected on temperament and social development in 3-15 year old twins and singletons from four different sources: questionnaires to parents covering development from birth to the present plus the Bristol Social Adjustment Guide completed by the teacher, Sattler's Behavior and Attitude Checklist completed by the tester, and the Qualitative Score on the Porteus Maze Test. Particular stresses are identified which the parents perceive as distinguishing a multiple from a singleton birth. Whereas they perceive no differences between the first and second-born in birth complications, the second-born is judged less favourably particularly in MZ pairs. The distinction continues in the later assessments by the teacher and tester, where in addition the male twins are seen as being different from other children both in cognition and in temperament. It is proposed that social and cognitive development of twins are interrelated and have two unique components, one related to the greater problems accompanying a multiple birth and the other to comparisons between cotwins.

Adolescent↗
PubMed2006

Predictors of attention problems for the period from pre-teen to early teen years.

OBJECTIVE: This longitudinal study investigated the scope, persistence, and predictors of attention problems (AP) over a period of time from pre-teen (7-12 years) to early teen years (13-17 years). METHOD: AP evaluations used the Child Behavior Checklist (CBCL) and a semi-structured interview (C-SSAGA-P) with the parents. In addition, data relating to birth complications, family histories of affective disorders and alcohol-use disorders, home supervision, emotional, social and behavioral problems, school performance and school activities at two different measurement points were also collected. RESULTS: The findings indicate a high degree of comorbidity between AP and emotional and behavioral problems, difficulties in school, social problems and peer rejection. Furthermore, a cross-sectional association between childhood AP and parental affective disorders was also evident. Longitudinally, there was no increase in AP over the age span covered by the study, and symptoms often did not persist over time. Multiple regression analyses confirmed poorer school performance, problems with peers and AP at time point 15 as predictors for subsequent AP. CONCLUSION: The findings indicate that AP symptoms do not occur more frequently in early teen than in pre-teen years, and tend to be temporary phenomena. Difficulties in school and with peers were noted as particularly strong predictors of subsequent AP.

Adolescent↗
PubMed2003

High rates of behavioral problems in perinatally HIV-infected children are not linked to HIV disease.

OBJECTIVE: Descriptive studies and clinical reports have suggested that human immunodeficiency virus (HIV)-positive children are at risk for behavioral problems. Inadequate control groups and sample sizes have limited the ability of investigators to consider multiple influences that place HIV-positive children at risk for poor behavioral outcomes. We examined the unique and combined influences of HIV, prenatal drug exposure, and environmental factors on behavior in children who were perinatally exposed to HIV. METHODS: Participants included 307 children who were born to HIV-positive mothers (96 HIV infected and 211 seroreverters) and enrolled in a natural history, longitudinal study of women to infant HIV transmission. Caregivers completed parent behavioral rating scales, beginning when the children were 3 years old. Data were also collected on prenatal drug exposure; child age, gender, and ethnicity; caregiver relationship to child; and birth complications. RESULTS: Multivariate analyses comparing the HIV-infected children with perinatally exposed but uninfected children from similar backgrounds failed to find an association between either HIV status or prenatal drug exposure and poor behavioral outcomes. The strongest correlates of increased behavioral symptoms were demographic characteristics. CONCLUSIONS: This study suggests that although a high prevalence of behavioral problems does exist among HIV-infected children, neither HIV infection nor prenatal drug exposure is the underlying cause. Rather, other biological and environmental factors are likely contributors toward poor behavioral outcomes.

Adolescent↗
PubMed2006

Prenatal and birth complications in autism.

OBJECTIVES: Prenatal and birth history as potential sources of risk factors in relation to the onset of autism were examined. METHODS: A cohort of 164 families of autistic children referred to The Autism Center at New Jersey Medical School-UMDNJ, Newark, New Jersey, over a two-year period was studied. Intake prenatal and birth history information was obtained from each family and reviewed by a clinician. RESULTS: Prevalence rates in this cohort for vaginal bleeding, prolonged labor and prematurity were higher than comparable rates reported nationally and in New Jersey. Clustering of multiple prenatal risk factors was observed. This clustering was associated with the age of the mother, but uncorrelated with birth order. CONCLUSIONS: These findings support the general hypothesis that systemic problems at the prenatal stage may form a distinct dimension of risk associated with autism.

Adolescent↗
PubMed2005

The effect of the lunar cycle on frequency of births and birth complications.

OBJECTIVE: The purpose of this study was to examine the influence of the lunar cycle on the frequency of deliveries and/or delivery complications. STUDY DESIGN: This was a retrospective cohort, secondary analysis of 564,039 births across 62 lunar cycles that were identified from North Carolina birth certificate data from 1997 to 2001. RESULTS: Using analysis of variance and t-tests, we found no significant differences in the frequency of births, route of delivery, births to multigravid women, or birth complications across the 8 phases of the moon or between documented high- and low-volume intervals of the lunar cycle. CONCLUSION: An analysis of 5 years of data demonstrated no predictable influence of the lunar cycle on deliveries or complications. As expected, this pervasive myth is not evidence based.

Analysis of Variance↗
PubMed2005

Periviable birth at 20 to 26 weeks of gestation: proximate causes, previous obstetric history and recurrence risk.

OBJECTIVE: Early preterm birth at 20 to 26 weeks of gestation (periviable birth) carries extreme risks of infant death and morbidities. Prevention of periviable birth could improve infant outcomes significantly. We sought to characterize the causes of periviable birth and to determine whether periviable birth can be predicted by previous pregnancy outcome. STUDY DESIGN: We evaluated 104,921 pregnancies (1974-2004) and assessed the frequency and causes of periviable birth. Women who were delivered of both their first and second pregnancies at >20 weeks of gestation at our institution were identified. Predictive values of the first pregnancy outcomes for second pregnancy outcomes were determined. RESULTS: Periviable birth complicated 1981 deliveries (1.9%). Seventy-nine percent of the women with periviable births had no history of periviable births; 44% of the women had no previous deliveries, and 35% of the women had previous term deliveries only. Causes of periviable birth were labor (36%), premature rupture of membranes (34%), bleeding (10%), and preeclampsia (4%). Four percent of the gestations were multiple gestations. Among 7970 pregnancies at >20 weeks of gestation, periviable birth in the first pregnancy was associated with preterm birth and periviable birth in the second pregnancy (35.6%, 6.9%; relative risk, 3.3 and 8.6; P < .0001). Periviable birth and preterm birth in the first pregnancy were insensitive for periviable birth in the second pregnancy (8.8%, 36.8%, respectively). CONCLUSION: Although periviable birth is associated with subsequent periviable birth and preterm birth, preterm birth and periviable birth are insensitive markers for recurrences in the next pregnancy. Early pregnancy or preconceptional markers for prediction of periviable birth are needed.

Female↗
PubMed1999

Perinatal outcome in hospital and birth center obstetric care.

OBJECTIVE: Our purpose was to compare birth complications and fetal outcome in hospitals and birth centers. METHOD: We retrospectively compared all 801 deliveries between 1992 and 1994 from two free-standing birth centers against 3271 hospital deliveries in Berlin. The hospital collective was selected according to the same risk criteria of the birth centers. RESULTS: The birth center group had significantly fewer medical interventions, with a similar cesarean section rate (3.0% vs. 4.6%, P = 0.057) and occurrence of severe perineal lesions. The episiotomy rate was significantly higher (P < 0.001) in the clinics for first-time and multiple births. The perinatal mortality was not significantly different ( < 0.1 per 1000). One-minute Apgar scores less than 7 were found significantly more often in the birth center group. CONCLUSION: When birth centers employ thorough risk selection and significant early referral rates to nearby hospitals, there is no evidence of increased maternal or perinatal risk compared to hospital deliveries.

Birthing Centers↗
PubMed1985

Birth stress and self-reported sleep difficulty.

Difficulty in falling asleep and frequency of night wakenings were assessed in 1,272 college-aged individuals for whom birth histories (based on retrospective maternal reports) were available. A history of birth complications was associated with reports of sleep difficulties as an infant. Birth stressors, such as breech birth, prolonged labor, low birth weight, and multiple births, were predictive of disrupted sleep patterns in the young adult.

Adolescent↗
PubMed2002

Pregnancy and birth complications in autism and liability to the broader autism phenotype.

OBJECTIVE: To understand better the relationship between pregnancy and birth complications and genetic factors in autism. METHOD: The sample included 78 children with an autism spectrum disorder and 88 unaffected siblings. A standardized interview was used to ask mothers about the pregnancy and birth of each child, and an overall index reflecting freedom from complications (termed "optimality") was determined. The presence of autism-like traits (termed the "broader autism phenotype") in second- and third-degree relatives was ascertained by reports from multiple informants. The pro-. portion of relatives with the broader autism phenotype, corrected for degree of relation, was used as an index of family loading. RESULTS: Children with autism spectrum disorders have lower optimality (higher rates of complications) than unaffected siblings. High family loading for the broader autism phenotype is associated with higher rates of complications in unaffected siblings. Family loading was not significantly associated with complications in affected siblings in this sample. Overall, these findings argue against complications being a direct cause of autism, as one would expect to find the most complications in sporadic cases (i.e., in children without a positive family history). CONCLUSION: Increased rates of birth and pregnancy complications are likely secondary to familial factors associated with autism.

Autistic Disorder↗
PubMed2005

Paternal age and intelligence: implications for age-related genomic changes in male germ cells.

BACKGROUND: A robust association between advancing paternal age and schizophrenia risk is reported, and genetic changes in the germ cells of older men are presumed to underlie the effect. If that is so, then the pathway may include effects on cognition, as those with premorbid schizophrenia are reported to have lower intelligence. There are also substantial genetic influences on intelligence, so de novo genetic events in male germ cells, which accompany advancing paternal age, may plausibly influence offspring intelligence. OBJECTIVE: An association of paternal age with IQ in healthy adolescents may illuminate the mechanisms that link it to schizophrenia. METHOD: We examined the association of paternal age and IQ scores using the Israeli Army Board data on 44 175 individuals from a richly described birth cohort, along with maternal age and other potential modifiers. RESULTS: A significant inverted U-shaped relationship was observed between paternal age and IQ scores, which was independent from a similar association of IQ scores with maternal age. These relationships were not significantly attenuated by controlling for multiple possible confounding factors, including the other parent's age, parental education, social class, sex and birth order, birth weight and birth complications. Overall, parental age accounted for approximately 2% of the total variance in IQ scores, with later paternal age lowering non-verbal IQ scores more than verbal IQ scores. CONCLUSION: We found independent effects of maternal and paternal age on offspring IQ scores. The paternal age effect may be explained by de novo mutations or abnormal methylation of paternally imprinted genes, whereas maternal age may affect fetal neurodevelopment through age-related alterations in the in-utero environment. The influence of late paternal age to modify non-verbal IQ may be related to the pathways that increase the risk for schizophrenia in the offspring of older fathers.

Cohort Studies↗
PubMed1995

Preterm labor: emerging role of genital tract infections.

Preterm birth complicates 8-10% of all pregnancies in the United States and is the leading cause of infant morbidity and mortality. Neonatal morbidity and mortality is concentrated among very low-birthweight and extremely premature infants, particularly those delivered prior to 30 weeks' gestational age. In addition to the contribution of preterm birth to neonatal morbidity and mortality, the economic costs associated with this pregnancy complication are staggering. Efforts to reduce the preterm birth rate have been largely focused on prevention and early intervention with treatment for preterm labor. Mixed results regarding the success of prematurity prevention programs have been reported, and controversy continues to surround the efficacy of tocolytic therapy in the treatment of preterm labor. Although neonatal survival for infants born at early gestational ages has steadily improved in recent years, survival of infants delivered prior to 24 weeks' gestation remains very poor. Additionally, despite this decline in neonatal mortality, the United States still lags behind most industrialized nations in infant mortality, and no change in the rate of low birthweight has occurred in recent decades. Multiple lines of evidence support a role for infection as an etiologic factor in preterm labor. Although this association has been well known for many years, a wealth of new data is emerging, linking subclinical genital tract infection with spontaneous preterm birth, particularly among pregnancies that result in birth prior to 30 weeks' gestational age as a result of spontaneous preterm labor or preterm, premature rupture of membranes. Conversely, preterm birth that occurs closer to term is less likely to be associated with genital tract infection. Improved understanding of the link between genital tract infection and preterm birth now provides an exciting potential for the development of sensitive new markers to identify women at risk and effective interventions to prevent preterm birth. A review and comment on this growing literature is provided.

Biomarkers↗