bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of T‐helper cell subsets and crossregulation in hepatitis B virus infection
Authors: Milich D. R.
Published: April 2008

Summary. Serological and biochemical studies indicate that acute HBV infection is resolved in the context of an efficient cell‐mediated immune (CMI) response, whereas, chronic infection is characterized by weak to undetectable CMI responses and relatively efficient humoral immunity. Because humoral immunity and CMI are regulated by different TH subsets, factors which influence the induction of TH1 vs TH2 cells specific for the HBV nucleocapsid antigens (HBcAg, HBeAg) were examined in a murine model system. The factors which affected the HBc/HBeAg‐specific TH1/TH2‐cell balance included: (1) the structure of the antigen (i.e. HBcAg vs HBeAg); (2) the host MHC and T‐cell site recognized; (3) crossregulation between TH1 and TH2 cells; (4) T‐cell tolerance, which is more complete in TH1 than in TH2 cells; (5) secreted HBeAg, which preferentially depletes TH1 cells; (6) the HBV‐specific subset response could be skewed towards either TH1 or TH2 predominance by cytokine treatment in vivo. The results suggest that the balance between TH1 and TH2 cells specific for the HBc/HBeAgs may be relevant in acute and chronic HBV infections. Importantly, HBeAg‐specific TH2 cells preferentially evade tolerance induction as compared to their TH1‐cell counterparts. Because HBeAg may act as a tolerogen during the vertical transmission of chronic HBV infection and preferentially depletes TH1 cells in the circulation, the predominance of HBeAg‐specific TH2 cells may influence the initiation or maintenance of the chronic carrier state. In this case, cytokine therapy designed to shift a TH2‐like response toward TH1 predominance (i.e. IL‐12) may be beneficial in the treatment of chronic HBV infection.
The epidemiology of childhood eczema: I. A population based study of associations
Authors: Golding Jean , Peters Tim J.
Published: April 2008

Summary. Information on whether they thought their child had ever had eczema was obtained from the mothers of 12 555 children in a national cohort of five‐year‐olds born in 1970. This question was part of a multiple battery of questions concerning the medical, social, environmental and behavioural background of the child. These data were linked to the information that had been collected on the cohort at birth, and a profile of characteristics of the children with reported eczema was produced.

A large proportion (46/135) of associations were statistically significant at the 1% level. The major associations were with socio‐economic indicators and characteristics of parental health behaviour, with the most advantaged socio‐economic groups and those with more positive health behaviour having increased rates of reported eczema. The patterns of associations form an interesting profile of the backgrounds of children reported to have had eczema. Identification of these factors was necessary before more advanced statistical techniques were employed to investigate which of these variables predominate when they are considered simultaneously, and to generate hypotheses as to which factors may be causally associated with the disorder.
Follow‐up of the first national birth cohort: Findings from the Medical Research Council National Survey of Health and Development
Authors: Wadsworth M.E.J.
Published: April 2008

Summary. The medical work of a 40 year birth cohort study is described in order to show the continuing associations of childhood factors with later life health, behaviour, illness and survival. Comparisons with the health of children born at later times show the importance of a sensitive monitoring of changes in child health. A summary of work on social and psychological topics is also given, together with a complete list of publications from the study.
HIV infection in children: sizing up the paediatric problem
Authors: Senturia Y.D. , Peckham C.S.
Published: April 2008

Summary. Cases of paediatric AIDS have increased each year in the USA, as the disease has spread to the heterosexual community. In the USA the geographic distribution of perinatal AIDS cases mirrors the distribution of cases in women. To date, 503 HIV antibody positive women have been reported in the UK. It is likely that the increasing number of seropositive women will be reflected in an increase in the number of reports of perinatal HIV infection and AIDS. Although screening of blood donors and blood products has stopped further increase in infections from this route, as transfusion‐infected children become symptomatic the burden on paediatric services will increase.
Pregnant women at work: rest periods to prevent preterm birth?
Authors: Mamelle N. , Bertucat I. , Munoz F.
Published: April 2008

Summary. The aim of this study is to identify social preventive measures in an attempt to prevent pre‐term birth in pregnant women who work under strenuous conditions. A study carried out in 50 factories allowed us to gather data on 1168 pregnancies that occurred during 1 year and to study the modifications in working conditions now granted to pregnant women in many firms in France. We observed a significant relationship between ‘episodes of sick leave’ prescribed especially for fatigue (without any pathological reason) and a lower preterm birth rate. The potential benefit of rest‐periods, granted to pregnant women working in strenuous conditions, is discussed.
The Greek National Perinatal Survey. II: Socioeconomic factors and perinatal mortality in Greece
Authors: Tzoumaka‐Bakoula Chryssa , Lekea‐Karanika Vasso , Matsaniotis N.S. , Golding Jean
Published: April 2008

Summary. Information concerning all 10 859 singleton deliveries in Greece in April 1983, were analysed to assess the contribution of socioeconomic factors to the perinatal mortality rate. Statistically significant associations were initially found with parental eduction, parental ages, duration of marriage, paternal occupation and parity. There was no association with maternal smoking habit, maternal occupation during pregnancy, type of health insurance or housing conditions. Once logistic regression analyses had taken account of the strong parity effect (P<0.0001), only a moderate association with maternal age (P<0.05) remained statistically significant, together with a marginally significant (P<0.05) association with maternal education level. Mothers who were moderately well educated had the lowest risk of loosing their baby. It is concluded that traditional measures of social deprivation appeared to have little effect on perinatal mortality in Greece in 1983.
Assessment of in utero hypoxia and risk of sudden infant death syndrome
Authors: Buck Germaine M. , Cookfair Diane L. , Michalek Arthur M. , Nasca Philip C. , Standfast Susan J. , Sever Lowell E.
Published: April 2008

Summary. Few data are available on the role of hypoxia in sudden infant death syndrome (SIDS). The purpose of this study was to assess whether 10 antenatal factors consistent with in utero hypoxia were associated with an increased risk of SIDS. Cases and two sets of controls were chosen from the Upstate New York Live Birth Cohort for 1974 (n= 132 948). One hundred and forty‐eight SIDS cases were identified, along with 114 dead controls made up of all other sudden deaths. Randomly selected live controls were frequency‐matched to cases on mother's age, race, residence, parity, and infant's birthdate (n=355). Data were collected from vital certificates (97% response), hospital delivery records (89%), and autopsy reports (100%). Odds ratios and 95% confidence intervals were calculated using Mantel‐Haenszel techniques and logistic regression. Abnormal uterine bleeding was the only statistically significant (P<0.05) risk factor observed when dead controls were used (OR=5.4). When live controls were used, statistically significant increases in risk were found for: placenta praevia (OR=21.8), abruptio placentae (OR=3.7), multiple birth (OR=29.6), pregnancy interval ≤12 months (OR=3.8), sexually transmitted disease (OR=6.4), and eclampsia (OR=17.7). These results lend support to a possible hypoxic aetiology of SIDS; however, differences by control group suggest that some factors are not specific to SIDS alone but may be risk factors for infant mortality in general.
Growing up in the inner city: findings from the inner London longitudinal study
Authors: Maughan Barbara
Published: April 2008

Summary. In the late 1960s, a series of epidemiological studies of educational and behavioural problems in middle childhood was undertaken on the Isle of Wight. In 1970, similar methods were used with an inner London sample of 10‐year‐olds to explore area differences in prevalence rates and correlates. Members of the London cohort have since been followed‐up through their teens, to assess the longer‐term implications of such problems for educational attainments, early employment prospects, and adolescent behavioural difficulties. School influences on children's development also constituted a central focus of these later stages of the work. This paper draws together the main findings of the London studies to date, and includes a full list of the main publications.
Maternal thyroid disease and risk of birth defects in offspring: a population‐based case‐control study
Authors: Khoury Muin J. , Becerra José E. , D'Almada Philip J.
Published: April 2008

Summary. We investigated the relationship between maternal thyroid disease and the risk of birth defects in offspring using data from a large population‐based, case‐control study. Cases included 4904 stillborn and liveborn infants with major anomalies diagnosed in the first year of life and born to residents of metropolitan Atlanta between 1968 and 1980. Controls included 3027 normal babies, frequency‐matched to cases by race, hospital of birth and quarter of birth. We compared mothers of cases and controls regarding history of physician‐diagnosed hypothyroidism and hyperthyroidism before the infant's birth, age at diagnosis of thyroid condition, duration of illness, and intake of thyroid medications before and during pregnancy. Information obtained from maternal interviews was evaluated for concordance with hospital records. We adjusted for potentially confounding factors using conditional logistic regression analysis. Overall, there was no relationship between the risk of total birth defects and history of maternal hypothyroidism (odds ratio (OR)=1.05, 95% C.I. 0.84–1.31), maternal hyperthyroidism (OR = 1.00, 95% C.I. 0.66–1.53), and intake of thyroid hormone and antithyroid drugs before and during pregnancy. In an analysis of 66 specific birth defects and defect groups, we found two statistically significant associations with hypothyroidism and three with hyperthyroidism which may reflect chance findings. In an evaluation of babies with multiple anomalies, we observed a two‐fold increased risk with hypothyroidism but no discernible pattern of defects. The absolute risk of major birth defects in offspring of women with history of hypothyroidism can be estimated as 2.1%, a finding at odds with the 10–20% risk cited in the literature.
Associations of excessive irritability with common illnesses and food intolerance
Authors: Price Charles E. , Rona Roberto J. , Chinn Susan
Published: April 2008

Summary. In a national study of almost 7000 primary school children, parents' perceptions were used to test the hypothesis that the child's irritability was associated with food intolerance independently of other symptoms. After adjustment in a multiple regression analysis for asthma or wheeze, cough, eczema, hives, diarrhoea and vomiting, rhinitis, hay fever and headache, and the social factors of father's social class, maternal education and maternal age, a highly significant association between perception of food intolerance and irritability (P<0.001) remained. Though we cannot rule out that irritable children's parents could be biased towards diagnosing food intolerance the possibility that some children do have behavioural disturbance associated with reactions to food needs to be explored further, preferably with a double blind challenge assessment.
The growth chart – a road to health chart? Maternal comprehension of the growth chart in two Somali villages
Authors: Aden Abdulaziz Sharif , Brännstrom Inger , Mohamud Kadigia Ali , Persson Lars Ake , Wall Stig
Published: April 2008

Summary. Growth monitoring is so far not implemented on a large scale in the Somali health services. Available reports indicate that growth faltering is common. However, the use of growth charts as a tool for health education has been questioned. This study examines the ability of 199, predominantly illiterate, rural Somali mothers to understand the growth chart message after an intensive period of growth chart use and education. During a home‐based interview the mothers were asked to combine a set of four growth curves with a set of four pictures, showing the corresponding developments of four children. The mothers managed significantly better to interpret the charts than could be expected by chance alone. Maternal age, number of children and literacy did not differ much between those who correctly and incorrectly combined pictures and charts. Almost all mothers recognised the value of the growth chart as being good for the control and promotion of their children's health and/or growth. We conclude that the growth chart may be an applicable and appropriate tool even with illiterate mothers, provided that other prerequisites for successful growth monitoring, e.g. appropriate health services, are available.
Antenatal and perinatal care in southern Italy. II. The clinicians' reactions
Authors: Mazzarella Gianfranco , Scarpellino Benedetto , Coppola Angelo , Cafiero Maurizio , Quagliata Luigi , Pisacane Alfredo
Published: April 2008

Summary. One hundred obstetricians and 50 paediatricians engaged in public antenatal and perinatal care in southern Italy were interviewed about the provision of care in their facilities: 93% of the obstetricians judged the coverage of the target population to be insufficient and 53% of them considered the use of the risk approach to be unsatisfactory in public clinics. For example, no initiative was taken by 60% of public clinics when a woman at high risk failed to attend a booked antenatal visit. Bed rest during labour was prescribed by 72% of the obstetricians, a supporting relative was admitted to only 18% of the births and routine episiotomy was performed in 77% of primigravidae. Only 56% of the paediatricians interviewed allowed early contact between mother and baby. In public hospitals, 80% of paediatricians were present in the delivery room for the births. Screening for congenital hypothyroidism and phenylketonuria was executed in only 37% of the public hospitals. Newborn transport system adequate to national standards was available in only 33% of the hospitals. Antenatal and perinatal care need to be rapidly improved to meet population needs in southern Italy.
Government statistics of certified causes of perinatal mortality in Moscow and certain problems with its improvement
Authors: Ignatyeva R.K. , Kaderkaeva N.I. , Jarkovska S.V.
Published: April 2008

Summary. While preparing the Ninth Revision of the International Classification of Diseases, Injuries and Causes of Death (1970–1975), the World Health Organisation sought ways of improving the accuracy of statistics of perinatal mortality. A new Certificate of Cause of Perinatal Death, developed for use in all regions of the USSR and introduced there in 1974, was recommended for introduction in other countries. This was based on the reorganised and more clear‐cut coding outlined in Chapter XV of ICD‐9. Comparison of the perinatal death rates in 1975 with those in 1986 showed a fall from 25 to 20 per 1000 births, with changes in causes related to changes on classification. Cross‐tabulation of multiple‐cause perinatal death was made possible by coding maternal conditions affecting the fetus or newborn separately from fetal conditions originating in the perinatal period. Analysis of the results of tabulation of multiple‐cause perinatal death in Moscow in 1986 proceeded to a proposed structure for a Basic Tabulation List allowing comparisons of the statistics of perinatal mortality.
From our own correspondents
Authors: GAFFIN JEAN
Published: April 2008

Fumes from the spleen

A tale is told of a man in Paris during the upheaval in 1848, who saw a friend marching after a crowd toward the barricades. Warning him that these could not be held against the troops, that he had better keep away, and asking why he followed these people, he received the reply, ‘I must follow them. I am their leader.’
Antenatal care received and its association with preterm birth in Greece
Authors: Lekea‐Karanika Vasso , Tzoumaka‐Bakoula Chryssa , Golding Jean
Published: April 2008

Summary A total population sample of singleton births to mothers with certain dates of last menstrual period (LMP) was identified from the Greek National Perinatal Survey of April 1983. Two groups of mothers were considered separately, 3116 primigravidae and 6524 multigravidae, with preterm birth rates of 5.9% and 8.4% respectively. Of all the antenatal care factors tested, primigravidae showed significant associations (unadjusted) with haematocrit level and with drugs taken during pregnancy. The logistic regression analysis which followed showed that the only factor independently associated with preterm delivery for that group of mothers was drugs taken during this period: women taking no drugs (including vitamins and iron) had the highest risk of preterm delivery. In contrast, multigravidae showed significant unadjusted associations with a great variety of parameters of antenatal care. Nevertheless, in the logistic regression analysis only three proved to have independent significant associations: drugs taken during pregnancy (reduced risk among mothers taking vitamins and iron), hospital admission during pregnancy (mainly for cervical cerclage) and the pattern of antenatal care during the first two trimesters (those attending the recommended number of times having least risk).
Retinopathy of prematurity: risk factors in a prospective population‐based study
Authors: Darlow Brian A. , Horwood L. John , Clemett Richard S.
Published: April 2008

Summary. A prospective study of risk factors for retinopathy of prematurity (ROP) in all very low birthweight (< 1500 g) infants born in New Zealand in 1986 is reported. Of 413 liveborn infants admitted to neonatal units, 338 (81.2%) survived to be discharged home. Of surviving infants, 313 (93%) were examined by indirect ophthalmoscopy, as were eight infants who died before discharge. Sixty‐nine infants (21.5% of 321) had acute retinopathy. On multiple logistic regression analysis, three variables made statistically significant independent contributions to the risk of any acute retinopathy; gestational age (P < 0.0001), principal hospital caring for the infant (P<0.01) and treatment with indomethacin (P < 0.01). Only two variables, gestational age (P < 0.0001) and hospital (P < 0.01), made significant contributions to the risk of stage 2 or more ROP. For both categories of ROP, timing of the examination also had a statistically significant effect (P < 0.001). After adjustment for other significant predictor variables, it was estimated that approximately 70% of infants of less than 26 weeks' gestation were at risk of ROP and nearly 50% of stage 2 or more ROP, in comparison with less than 2% of infants of 32 weeks' gestation or more; infants treated with indomethacin were over 1.5 times more likely to have ROP than infants not so treated. Failure to enforce uniform timing of examination was the most serious defect in the study; only 205 (64%) of the 321 infants were examined at the recommended time. However, reanalysis of the model with information limited to these 205 infants yielded similar risk factors. The incidence of ROP, both observed (P < 0.05) and adjusted for other significant variables in the regression model (P < 0.01) was lowest in the two largest level III hospitals. These hospitals also had the best survival rates after adjustment for birthweight, gestation and gender (P < 0.01). We speculate that the larger level III units obtained better results because their size and experience enabled them to provide a better overall quality of care.
The epidemiology of severe injuries to children in northern Manhattan: methods and incidence rates
Authors: Davidson Leslie L. , Durkin Maureen S. , O'Connor Patricia , Barlow Barbara , Heagarty Margaret C.
Published: April 2008

Summary. The epidemiology of injury incidence in inner‐city children has not previously been described. This study presents the methods used and the incidence rates found for severe injury (causing hospitalisation or death) in a population of 89 000 children under age 17 years in northern Manhattan, a largely poor area of New York City. The average annual incidence rate (measured from 1983 to 1987) for severe injuries to children under 17 was 846/100 000 a year. The vast majority (79%) were classified as unintentional. Nine per cent were due to assault, 3% were self‐inflicted and in an additional 9% the intention was unclear. Classified by cause, the highest incidence (per 100 000/year) was found for falls (218), vehicle‐related (141, primarily pedestrian), ingestion (119) and burns (110). Guns caused 3% of the injuries (27). The death rate from injury was 18.7/100 000, 36% of which was due to homicide. In an additional 28%, intentional injury was suspected. The suicide rate was 0.4/100 000. The leading causes of injury death included guns and burns (both 2.7/100 000). Compared with childhood injury rates in predominantly rural and suburban populations, the rates reported here for northern Manhattan are higher for overall injury incidence (fatal and non‐fatal) and for homicide, but lower for injury mortality not due to homicide.
Genetic risk factors for perinatally acquired HIV‐1 infection
Authors: Just Jeanette , Louie Leslie , Abrams Elaine , Nicholas Stephen W. , Wara Diane , Stein Zena , King Mary‐Claire
Published: April 2008

Summary. This study evaluates genetic influence on susceptibility to perinatal HIV‐1 infection among 106 Black infants from New York and San Francisco born to mothers infected with HIV‐1. Genes tested by molecular techniques are HLA class II loci DRB1, DPB1 and DQA1; HLA class III loci complement C4A and C4B; α and β interferons; and the constant region of the T‐cell receptor β chain. Of the 106 infants analysed, 54 are infected with HIV and 52 remain uninfected at age 15 months and older. Genotypes in the HLA region appear to influence risk of HIV infection. Specifically, infants with the amino acid sequence ‐asp‐glu‐ala‐val‐ at DPB1 positions #84–87 are more likely to be infected (P= 0.001) and infants with the allele DQA1*0102 are less likely to be infected (P= 0.031). Combinations of these two risk factors show a strong dose response (P= 0.0005). HLA DPB1 and DQA1 may play a direct role in immune response associated with HIV‐1 infection, or the critical region may be located between these two genes. Characterisation of other class II HLA genes in these infants will allow more precise determination of the role of HLA loci in susceptibility to HIV‐1 infection.
The contribution of maternal depressive symptoms and life events to child behaviour problems
Authors: O'Connor Patricia , Neugebauer Richard
Published: April 2008

Summary. The effect of maternal depressive symptoms and stressful life events on child behaviour problems has been the focus of clinical and epidemiological research for some years. We interviewed 80 women drawn from the New York City area regarding their life events in the preceding 6 months, current levels of depressive symptoms and behaviour problems in their children. For each woman, one child between the ages of 3 to 8 was selected for study analysis. Maternal depressive symptoms and maternal life events in general, as well as undesirable events in particular, contributed independently to child behaviour problems in multivariable analyses controlling for maternal education. This association did not vary by maternal marital status, or gender or age of the child. Events judged on common sense grounds to be especially disruptive of the child's routine did not contribute to child behaviour problems, independently of maternal depressive symptoms. Future research should devote more attention to specification of the life events under study and of factors that may buffer both the mother and the child from their pathogenic effects.
Genetic and developmental influences on susceptibility to epilepsy: evidence from twins
Authors: Ottman Ruth
Published: April 2008

Summary. This study evaluated genetic and developmental contributions to epilepsy, using data on epilepsy and multiple births in the sibships of 1981 probands with epilepsy. Prevalence of a history of epilepsy was much higher in monozygotic (MZ) than in dizygotic (DZ) co‐twins of probands (35.0% vs. 3.7%), but prevalence was not significantly higher in DZ co‐twins than in singleton siblings. The proportion of individuals who were MZ twins was higher among probands with epilepsy than among their non‐co‐twin siblings without epilepsy (odds ratio 2.5, 95% CI 1.31–4.85). However, the proportion who were DZ twins was similar among probands and unaffected siblings (odds ratio 1.0, 95% CI 0.67–1.60). These findings suggest that the increased prevalence of epilepsy in MZ co‐twins of probands may be partly explained by developmental factors related to MZ twinning, rather than by their genetic identity with the probands.
Risk factors in limb reduction defects
Authors: Stoll C. , Alembik Y. , Dott B. , Roth M.P.
Published: April 2008

Summary. Risk factors were studied in 123 children with limb reduction defects (LRD) from 118265 consecutive births of known outcome during the period from 1979 to 1987 in the area which is covered by our registry of congenital malformations. For each case a control was studied. The LRD was localised and classified according to the EUROCAT guide for the description and classification of limb defects. The prevalence of LRD was 1.04 per thousand: 82.9% of the babies were liveborn, 13.0% were late spontaneous abortion or stillborn and termination was performed in 4.0% of the cases. The proportion of males was 0.55. The most common malformations in the 51.2% of children who had at least one other anomaly than LRD were associated cardiac, digestive and renal anomalies. The pregnancy with limb anomalies was more often complicated by oligohydramnios, polyhydramnios and threatened abortion but there were no differences in parental characteristics. However, 9.7% of marriages were consanguineous (P<0.01) and the incidence of LRD in first‐degree relatives of the children with LRD was high. First‐degree relatives also had more non‐limb malformations than did those of controls.
A case‐control study to investigate the role of recent spontaneous abortion in the aetiology of neural tube defects
Authors: Kurinczuk Jennifer J. , Clarke Michael
Published: April 2008

Summary. Clarke et al.1 suggested that women who have had a spontaneous abortion are at an increased risk in their next pregnancy of producing an offspring with a neural tube defect (NTD). A matched case‐control study was carried out to test the related hypothesis that a spontaneous abortion occurring in the 6‐month period prior to the conception of a pregnancy (recent spontaneous abortion) is a risk factor for the development of an NTD in that pregnancy. The cases were 177 singleton pregnancies to non‐primigravida Leicestershire women, which were affected by non‐syndromal NTDs between 1976 and 1989. Two control pregnancies were matched with each case on intended place of delivery and date of maternal last normal menstrual period (LNMP). After adjusting for potential confounders, recent spontaneous abortion was found to be associated with a decreased relative risk of neural tube defect, odds ratio 0.46, 95% confidence interval 0.20, 1.07. The result provided little evidence in favour of the hypothesis, suggesting instead that prior spontaneous abortion has a protective effect in relation to subsequent NTD development rather than being a major risk factor in the aetiology of NTDs.
Different effects of maternal and paternal education on early mortality in Norway
Authors: Arntzen Annett , Magnus Per , Bakketeig Leiv S.
Published: April 2008

Summary. In order to separate the effects of maternal and paternal education on pregnancy outcome, a total population of 97526 single, firstborn infants and their parents was studied. Census information from 1980 was linked to the Medical Birth Registry for 1978–82. Children of parents with high education (> 12 years) were the most likely to survive the first year of life. There was a linear association between parental education and infant mortality. Examining parental education jointly, it was found that the father's educational level had the greatest impact on stillbirth. Mother's educational level seemed to be more closely associated with postneonatal mortality. Possible mechanism to explain the association between educational level and infant mortality are discussed.
Amniotic band syndrome: a population‐based study in two Australian states
Authors: Bower Carol , Norwood Fiona , Knowles Simon , Chambers Helen , Haan Eric , Chan Annabelle
Published: April 2008

Summary. A search for cases of amniotic band syndrome was made in two population‐based Australian birth defects registries, using defined selection criteria. Over a period of 4 years in Western Australia and 5 years in South Australia, 25 cases of amniotic band syndrome had been identified as such by the two registries, and an additional 15 new cases were identified by the study selection process, giving an annual prevalence of amniotic band syndrome over the study period of 2.03 per 10000 births. Similar proportions of male and female infants were affected, although the syndrome was more common in mothers younger than 25 years of age, and in first births. Limb defects only (upper and/or lower) were found in 24 cases, limb‐body‐wall defects in four cases, and complex craniofacial and other malformations in 12 cases. A heightened awareness of the syndrome should enhance the identification of amniotic band syndrome, which has implications for genetic counselling, and our understanding of the aetiology and pathogenesis of this condition.
Ethnic differences in the incidence of the sudden infant death syndrome (SIDS) in Victoria, Australia 1985–1989
Authors: Kilkenny Monique , Lumley Judith
Published: April 2008

Summary. In order to describe ethnic differences in the incidence of the sudden infant death syndrome (SIDS) records of all livebirths in the State of Victoria, Australia, 1985–1989, excluding those who died in the first month of life, were linked to death certificates. Cases were defined as infants dying with a diagnosis of SIDS between 1 month and 1 year of age (n= 601) from the cohort of 308052 neonatal survivors. Ethnicity was defined by the mother's country of birth. The SIDS incidence was 2.04/1000 in infants of Australian‐born mothers. The relative risk of SIDS was 0.28 (95% confidence interval (CI) 0.15,0.55) in infants whose mothers had been born in Southern Europe and 0.48 (95% CI 0.29, 0.78) in infants whose mothers had been born in Asia. SIDS in infants of Australian‐born mothers was associated with low maternal age, high parity, marital status other than married, male sex, multiple birth, low birthweight and preterm birth. After adjustment for those factors in a case‐control analysis using a logistic regression model the adjusted odds ratio for SIDS was 0.34 (95% CI 0.17, 0.69) comparing infants whose mothers were born in Southern Europe with infants of Australian‐born mothers, and 0.60 (95% CI 0.35, 1.04) for infants whose mothers were born in Asia, compared with infants of the Australian‐born. Thus there are substantial ethnic differences in SIDS which are not explained by the classic social and perinatal risk factors.
Perinatal mortality in single and multiple births in Japan, 1980–1991
Authors: Imaizumi Yoko
Published: April 2008

Summary. Perinatal mortality rates (PMR) decreased significantly per year in single, twin, triplet, quadruplet and quintuplet births during the period 1980–1991. The PMRs were 7.7 per 1000 livebirths for singletons, 45.6 for twins, 89.0 for triplets, 116.8 for quadruplets, and 476.2 for quintuplets during the 12 years. The relative risks of perinatal death in multiplets vs. singletons were 6 for twins, 12 for triplets, 15 for quadruplets and 62 for quintuplets. The PMR was significantly higher in males than females for singletons and twins, but there was no sex differential in PMRs for higher order of multiple births. The PMR increased with birth order in twins and triplets, whereas there was no birth order effect on the PMR for quadruplets. An increasing proportion of multiple births among perinatal deaths may be related to the increasing multiple birth rate in Japan.
Meconium staining of the liquor in a low‐risk population
Authors: Mahomed Kassam , Nyoni Rose , Masona Daisy
Published: April 2008

Summary. Although the significance of meconium‐stained amniotic fluid as a sign of fetal distress remains controversial, its presence remains a concern to both obstetricians and neonatologists since signs of asphyxia and meconium staining are associated with an increase in perinatal morbidity and mortality. The aim of this study was to evaluate the role of meconium staining of the liquor in the low‐risk obstetric population in terms of fetal distress and perinatal morbidity and mortality. In a prospective cohort study at a referral hospital and at one of two municipal clinics, women with a singleton pregnancy of 37 to 42 weeks gestation and with no pre‐defined risk factor were recruited into the study. Study patients comprised those with meconium staining of the liquor and controls comprised similar women but with clear liquor. Meconium staining of the liquor was associated with poor outcome in all the outcome measures assessed. Fetal heart rate (FHR) abnormality was more closely associated with adverse outcome than meconium staining, and thin meconium alone was not associated with any adverse outcome except respiratory distress. Women with thin meconium in the presence of normal FHR can therefore be safely managed at the clinic level. Thick meconium itself was a risk factor for poor outcome, more so if associated with FHR abnormality, and should be an indicator for early referral.
Medical conditions present during pregnancy and risk of perinatal death in Jamaica
Authors: Ashley Deanna , Greenwood Rosemary , McCaw‐Binns Affette , Thomas Peter , Golding Jean
Published: April 2008

Summary. In an attempt to identify causes of perinatal mortality and thence devise preventative strategies on the island of Jamaica, a study was made of the 1847 singleton perinatal deaths occurring over the 12‐month period between 1 September 1986 and 31 August 1987. Complications of the pregnancy were elicited by questioning the mother as well as abstracting data from the antenatal and clinical obstetric records. The deaths were classified using the Wigglesworth categorisation and the three largest groups were chosen for special study: antepartum fetal deaths, deaths of live births from immaturity and deaths from intrapartum asphyxia. The medical features of the pregnancies' were compared with data similarly obtained from 9919 women delivering singletons in the 2 months of September and October 1986 and who survived the first week of life.

Unadjusted statistically significant associations were found with maternal syphilis, vaginal infection or discharge, bleeding in the first two trimesters, bleeding in the third trimester, lowest haemoglobin, highest diastolic and first diastolic blood pressures, highest level of proteinuria, diabetes and antenatal eclampsia. Logistic regression taking account of social, environmental and health behaviour variables showed the following significant relationships. Antepartum fetal death was associated with adjusted odds ratio (AOR) for syphilis 2.88 [95% confidence interval (CI): 1.91, 4.32], bleeding in third trimester 3.86 [2.73, 5.44], highest diastolic blood pressure (P < 0.0001), highest level of proteinuria (P < 0.0001), lowest Hb (P < 0.0001) and antenatal eclamptic fits AOR 4.62 [1.47, 14.50]. Deaths from immaturity were independently associated with bleeding <28 weeks AOR 3.50 [2.39, 5.13], bleeding 28+ weeks AOR 1.93 [1.16, 3.22], highest diastolic blood pressure (P < 0.01) and highest level of proteinuria (P < 0.0001).

Infection featured in deaths associated with intrapartum asphyxia, with syphilis AOR 2.17 [1.44, 3.26] and vaginal infection/discharge (P < 0.01) independently associated; other strong associations were bleeding <28 weeks AOR 2.10 [1.57, 2.81], bleeding 28+ weeks AOR 2.32 [1.62, 3.33], highest diastolic blood pressure (P < 0.0001), first diastolic blood pressure (P < 0.0001) and antenatal eclampsia AOR 6.70 [2.63, 17.13].

For all perinatal deaths combined, independent features were syphilis AOR 2.06 [1.49, 2.85], vaginal infection/discharge (P < 0.001), bleeding <28 weeks AOR 2.01 [1.60, 2.53], bleeding 28+ weeks AOR 2.65 [2.02, 3.48], highest diastolic blood pressure (P < 0.0001), first diastolic blood pressure (P < 0.0001), proteinuria (P < 0.0001) and antenatal eclampsia AOR 4.22 [1.76, 10.14]. The results help identify areas for monitoring and identifying pregnancies at highest risk.
Deaths associated with intrapartum asphyxia in Jamaica
Authors: Escoffery Carlos , Greenwood Rosemary , Ashley Deanna , Coard Kathleen , Keeling Jean , Golding Jean
Published: April 2008

Summary. The Jamaican Perinatal Mortality Survey compared all 2069 perinatal deaths occurring during the 12 months between 1 September 1986 and 31 August 1987 with 10086 survivors born in the 2 months of September and October 1986. The Wigglesworth classification identified 44% of the deaths as attributable to intrapartum asphyxia (IPA), and this grouping was largely confirmed by post‐mortem examination where it had been carried out. About half of these babies weighed 2500 g + and death should have been largely preventable.

Comparison of the 813 IPA singleton deaths with 9919 singleton survivors using logistic regression showed independent associations with maternal employment status, the number of children in the household, maternal height, whether or not the mother was trying to get pregnant, or had ever used an intrauterine contraceptive device. Medical conditions such as syphilis, untreated vaginal infection, bleeding < 28 weeks, bleeding 28+ weeks, highest diastolic and first diastolic blood pressures and eclamptic fits antenatally were all strongly associated. Mothers who commenced antenatal care in the first trimester were at reduced risk as were those who took iron during pregnancy. There were substantial reductions in mortality in areas where better medical facilities were available.

To this model, features of previous obstetric history were offered, but the only variables which entered were those relating to prior perinatal deaths and immediately preceding miscarriage and termination.

Examination of specific features in the management of labour and delivery is a logical basis for the introduction of changes in practice. Caesarean section is unlikely to be appropriate but it is suggested that more active interventions in terms of use of forceps and/or vacuum extraction may be useful.
The epidemiology of perinatal death in Jamaica
Authors: Greenwood Rosemary , Golding Jean , McCaw‐Binns Affette , Keeling Jean , Ashley Deanna
Published: April 2008

Summary. Information from the Jamaican Perinatal Mortality Survey was used to identify features of mothers and their pregnancies that were independently associated with perinatal death. Social, biological, environmental, life style and medical aspects of mothers and their pregnancies were collected on two inter‐locking subsamples: (1) all births on the island of Jamaica in the 2 months of September and October 1986, the ‘cohort months’, and (2) all fetal deaths of weight 500 g or more, together with all neonatal deaths, in the 12‐month period from 1 September 1986 to 31 August 1987.

Singleton survivors from the cohort months were compared with all perinatal deaths in the 12‐month period using logistic regression. The first model omitted items concerning past obstetric history, but these were included in the second model. In total, 21 variables entered the first model and 24 the second. The only item that became non‐significant when past obstetric history was included was maternal age.

The final model compared 1017 perinatal deaths with 7672 survivors. It consisted of the following: union (marital) status (married being at lower risk, P < 0.01), maternal employment status (housewives at lowest risk, P < 0.001), number of adults in household (the more the higher the risk, P < 0.05), the number of children aged < 11 (the more the lower the risk, P < 0.0001), use of toilet facilities (shared with other households increased risk, P < 0.001), maternal height (tall women at reduced risk, P < 0.001), mother's report that she was trying to get pregnant (P < 0.001), maternal alcohol consumption (drinkers had lower risk, P < 0.05), maternal syphilis (higher risk, P < 0.0001), bleeding before 28 weeks (higher risk, P < 0.0001), bleeding at 28 weeks or more (higher risk, P < 0.0001), first diastolic blood pressure (80mm + at higher risk, P < 0.0001), highest diastolic blood pressure (100mm + at increased risk, P < 0.0001), highest proteinuria (++ or more at increased risk, P < 0.0001), vaginal discharge/infection (untreated at increased risk, P < 0.001), pre‐eclampsia diagnosed in antenatal period (increased risk, P < 0.01), maternal diabetes (increased risk, P < 0.05), start of antenatal care (first trimester at reduced risk, P < 0.01), iron taken (reduced risk, P < 0.0001), type of perinatal care available in parish of residence (reduced risk if consultant obstetricians and paediatricians available at all times, P < 0.0001), number of miscarriages and terminations (the more the higher the risk, P < 0.0001), previous stillbirth (higher risk, P < 0.0001), previous early neonatal death (higher risk, P < 0.001), previous Caesarean section (higher risk, P < 0.01). The implications for reduction in perinatal mortality rates are discussed.
Reproductive history and the risk of neonatal sepsis
Authors: Germain Marc , Krohn Marijane A. , Daling Janet R.
Published: April 2008

Summary. It was recently suggested that a previous abortion increases the risk of intrapartum infection in a following pregnancy. The authors hypothesised that abortion also could be associated with a higher risk of neonatal sepsis. A case‐control study of neonatal sepsis was conducted using the Washington State Birth Registry. Cases of sepsis were selected among singleton livebirths during the period 1984‐90, and compared with a control group for the occurrence of spontaneous or induced abortion in previous pregnancies. The risk estimates were calculated using a stratified analysis. After exclusion of primigravidae, the age‐adjusted odds ratio (OR) was 1.68, with a 95% confidence interval (CI) 1.33,2.11 for previous spontaneous abortion, and 2.20 (95% CI 1.73, 2.79) for induced abortion, compared with previous livebirth. After exclusion of nullipa‐rous women, the OR decreased to 1.19 (95% CI 0.90,1.58) for spontaneous abortion and 1.45 (95% CI 1.03, 2.04) for induced abortion. After controlling for the effect of parity, induced abortion is associated with an increased risk of neonatal sepsis in a subsequent pregnancy, but the association between spontaneous abortion and sepsis is small and nonsignificant. The authors suggest that the procedures involved in a therapeutic abortion might produce a latent, sub‐clinical infection that persists until the next pregnancy, and is then transmitted to the newborn.
Case‐control study on maternal residential proximity to high voltage power lines and congenital anomalies in France
Authors: Robert Elisabeth , Harris John A. , Robertt Olivier , Selvin Steve
Published: April 2008

Summary. .The literature indicates that exposure to electro‐magnetic fields (EMF) may result in an increased incidence of cancer and spontaneous abortion. The aim of the present study was to determine whether living closer to high voltage power lines (HVPL) increased the risk of congenital anomalies. We studied residential exposure in any municipality in the Central‐East Region of France where there was at least one residence within 500 metres of a HVPL. This was a matched case‐control design. The cases consisted of all children with congenital anomalies, identified to the population‐based registry in Central‐East France between 1988‐91. We chose two random controls, matched for birth year and municipality, for each case. For every case and control, we measured the distance from the HVPL to the maternal residence at the time of birth of the child as a surrogate for EMF exposure. Using 100 metres from an HVPL as the cut‐point between exposure and non‐exposure to electromagnetic fields produced by HVPL, yielded an odds ratio of 0.95 (95% (confidence interval) CI: 0.45‐2.03). Using 50 metres as the cut‐point, yielded an OR of 1.25 (95% CI: 0.49‐3.22). Among the 11 cases within 100 metres, there were 2 children with chromosomal anomalies, but otherwise there was no pattern in the occurrence of specific anomalies. These data indicate a lack of association between distance to HVPL and the total
A review of perinatal autopsy rates worldwide, 1960s to 1990s
Authors: Khong T.Y.
Published: April 2008

Summary. Epidemiological data derived from death certification in the absence of a necropsy can be erroneous. Despite concern over adult hospital necropsy rates, which have fallen dramatically in the last 40 years, relatively less has been published regarding perinatal necropsy rates. A literature review of necropsy rates for neonatal deaths, stillbirths and perinatal losses was undertaken. There is a wide variation in the perinatal necropsy rates worldwide but the numbers appear to be higher than adult hospital rates. The necropsy rate for neonatal deaths appears to be lower than that for stillbirths. It is hoped that the review will serve to alert readers to remain vigilant against any fall in the perinatal necropsy rates.
Analysing the relationship between maternal weight gain and birthweight: exploration of four statistical issues
Authors: Selvin Steve , Abrams Barbara
Published: April 2008

Summary. Four statistical issues concerning the analysis of birthweight and maternal weight gain during pregnancy are discussed: (1) Part‐whole correlation is described (e.g. the correlation between total maternal weight gain and her infant's birthweight). (2) The choice between a ratio or two separate explanatory variables is explored (e.g. body mass index or using maternal weight and height separately). (3) Two statistical properties (bias and power) when a binary variable replaces a continuous variable are discussed (e.g. consequences of using low birthweight instead of reported birthweight). (4) A model selection procedure is presented to provide a way to select a useful subset of variables from a large number of available explanatory variables to model an outcome variable (e.g. birthweight). These issues are illustrated with a set of 4017 births from Moffitt Hospital at the University of California, San Francisco. Furthermore, these four issues arise in a number of applications of statistical methods to data collected to study the epidemiology of newborn infants.
The effect of the pregnancy‐induced hypertension on fetal growth: a review of the literature
Authors: Misra Dawn P.
Published: April 2008

Summary. Understanding how pregnancy‐induced hypertension affects fetal growth could suggest a particular biological mechanism leading to intrauterine growth retardation (IUGR) and improve our understanding about how other exposures affect the risk of IUGR. It is hypothesised that hypertension reduces uteroplacental perfusion and through this route inhibits fetal growth.1‐2 Definitions and associated incidence rates are given. The findings from the epidemiological literature on hypertension in pregnancy and fetal growth are then critically discussed and summarised. Finally, the steps to be taken next in this area of research are outlined.