Angela Iasci

Interaction between fetal gender and risk factors for fetal growth retardation.

OBJECTIVE Our purpose was to evaluate the interactions between fetal gender and recognized risk factors of fetal growth retardation. STUDY DESIGN A case-control study of 530 singleton pregnancies complicated by fetal growth retardation and 782 control pregnancies with appropriately grown fetuses was conducted. Interactions were evaluated by logistic regression analysis. RESULTS In logistic regression analysis fetal growth retardation was more frequent in female than male fetuses (odds ratio 1.39, 95% confidence interval 1.06 to 1.82). In female fetuses hypertension-related fetal growth retardation was three times more common than in males. On the other hand, a low (< 50 kg) maternal prepregnancy weight and a low (< 18) body mass index (kg/m2) were significant risk factors for fetal growth retardation in male fetuses only. Although maternal smoking in pregnancy was a significant risk factor for growth retardation in both male and female fetuses, its effect was significantly stronger in male fetuses. CONCLUSION Fetal gender can affect the magnitude of the classic risk factors for fetal growth retardation.

The effect of work activity in pregnancy on the risk of fetal growth retardation

Background. The relationship between physical activity at work and risk of fetal growth restriction is controversial. For the most part, previous studies investigated the effect of work activity on birthweight alone. We evaluated the impact of type of occupation and physical effort at work on the risk of ultrasonographically confirmed fetal growth retardation among nulliparous women.

Epidemiologic association between maternal smoking during pregnancy and intracranial hemorrhage in preterm infants

The objective of this study was to evaluate the effect of maternal smoking during pregnancy on the risk of intracranial hemorrhage in preterm infants (born at 24 to 33 weeks of gestation). We conducted a case-control study of 96 preterm infants with intracranial hemorrhage and 96 gestational age-matched control subjects with negative cranial ultrasonographic findings. In conditional multiple logistic regression models, heavy maternal smoking ( > 10 cigarettes per day) during the latter half of pregnancy was associated with an increased risk of mild (grade I or II) intracranial hemorrhage (odds ratio = 5.96, 95% confidence interval 1.72 to 20.76; p = 0.005). After adjustment for the confounding effect of birth weight and respiratory distress syndrome, the risk of any intracranial hemorrhage (grade I to IV) was three times higher (adjusted odds ratio = 3.63, 95% confidence interval 1.37 to 9.63; p = 0.009) in infants of heavy smokers ( > 10 cigarettes per day) than in control subjects. The results of this study indicate that cigarette smoking during the latter half of pregnancy increases the risk of intracranial hemorrhage in preterm infants. The deleterious effect of smoking was greater for mild hemorrhages (grade I or II) and was confined to infants of heavy smokers.

Antenatal risk factors for germinal matrix hemorrhage and intraventricular hemorrhage in preterm infants.

OBJECTIVES This study was designed to evaluate the effect of antenatal risk factors on the occurrence of germinal matrix hemorrhage or intraventricular hemorrhage in preterm infants. STUDY DESIGN Antenatal factors were evaluated in 302 infants delivered between 24 and 33 completed weeks gestation. Ultrasonographic screening of intracranial hemorrhage was carried out in all the infants. The association between risk factors and neonatal intracranial hemorrhage was evaluated with both univariate and multivariate models. RESULTS In stepwise logistic regression analysis, birthweight was a better predictor of neonatal germinal matrix hemorrhage than gestational age. Conversely, gestational age better predicted intraventricular hemorrhage than did birthweight. Risk factors for neonatal germinal matrix hemorrhage and intraventricular hemorrhage were dissimilar. A history of heavy (> 10 cigarettes/day) maternal smoking on admission increased the risk of germinal matrix hemorrhage three-fold (odds ratio = 3.35; 95% C.I. 1.24-9.07). Antenatal corticosteroid use reduced the risk of intraventricular hemorrhage by 76% (odds ratio = 0.24; 95% C.I. 0.09-0.61). Among patients with spontaneous preterm delivery or premature rupture of fetal membranes, the presence of labor was a significant effect modifier of the gestational-age associated risk of germinal matrix hemorrhage-intraventricular hemorrhage. CONCLUSIONS Risk factors for neonatal germinal matrix hemorrhage are different from those for intraventricular hemorrhage. Most antenatal factors, especially those affecting fetal maturity, could influence the progression rather than the onset of intracranial hemorrhage.

The influence of presentation and method of delivery on neonatal mortality and infant neurodevelopmental outcome in nondiscordant low-birthweight (<2500 g) twin gestations

The effects of birth order, presentation and method of delivery on neonatal mortality and neurodevelopmental outcome in nondiscordant low birthweight ( < 2500 g) twin gestations were evaluated. Sixty-four sets of twins were included in the study; 29 sets were in vertex/vertex presentation (Group I), 25 sets in vertex/breech (Group II) and in 10 pregnancies the first twin was nonvertex (Group III). The rate of favorable neonatal outcome (survival and normal neurodevelopmental outcome after a 2-year follow-up) was lower in pregnancies in which at least one twin was in nonvertex presentation (50/70 vs. 52/58 P = 0.02). However, after adjustment by multiple logistic regression analysis for the effects of gestational age, birthweight, birth order and educational level of the mother, this difference was not statistically significant (odds ratio = 0.6; 95% confidence interval 0.44 to 5.9; P = 0.5). In pregnancies in which at least one of the twins was in nonvertex presentation, delivery by cesarean section did not affect the rate of favorable neonatal outcome (odds ratio = 1.8; 95% confidence interval 0.48 to 12.9; P = 0.8). The results of this study suggest that in low birthweight twin gestations, method of delivery in relation to fetal presentation has little or no effect on neonatal mortality and subsequent neonatal neurodevelopmental outcome.

The effect of fetal infection with human immunodeficiency virus type 1 on birthweight and length of gestation

We sought to evaluate the effect of vertical transmission of human immunodeficiency virus type 1 (HIV-1) on birthweight and length of gestation. For this purpose we used maternal and pregnancy data of 559 HIV-1-seropositive pregnant women delivered at 13 Italian centers from 1985 to 1991. The mother-to-child transmission rate of HIV infection was 18.2% (84/461). After adjustment for potential confounders with multiple linear regression analysis, there were no differences in birthweight, gestational age, and proportion of expected birthweight (observed birthweight/expected birthweight) between infected and uninfected children. Intravenous drug abuse during current pregnancy was the factor which correlated best with a reduction in birthweight (mean reduction, 214.4 g; 95% confidence interval (CI), 61.7-367.1), length of gestation (mean reduction, 9.3 days; 95% CI, 3.9-14.7) and proportion of expected birthweight (mean reduction, 12.1%; 95% CI, 4.7-19.5%). In our population, HIV-1 infection of the fetus has little effect on length of gestation and birthweight.

Sociodemographic and clinical variables modifying the smoking-related risk of low birth weight

Objective: The purpose of the study was to evaluate the sociodemographic and clinical variables modifying the smoking‐related risk of low birth weight (<2500 g). Method: This case‐control study included a population of 967 singleton low birth weight deliveries and 967 selected controls. Unconditional logistic regression analysis was used to test statistical significance of the interactions between smoking in pregnancy and other risk factors for low birth weight. Results: Increasing maternal age and parity potentiate the smoking‐related risk of a low birth weight infant. The effect of maternal smoking on the risk of low birth weight was significantly increased in patients with a history of previous spontaneous abortion (excess risk 2.30, 95% C.I. 1.24–4.27) and in patients of high compared with patients of intermediate or low social class (excess risk 1.97, 95% C.I. 1.1–3.57). Smokers with less than two prenatal visits per trimester were at significantly greater risk of delivering a low birth weight infant (excess risk 2.36, 95% C.I. 1.14–4.87) than their counterparts with more frequent prenatal visits. Among clinical variables, the effect of maternal smoking on the risk of low birth weight was significantly increased in women with a history of first trimester hemorrhage during the current pregnancy (excess risk 2.67, 95% C.I. 1.30–5.49). Conclusions: The smoking‐related risk of low birth weight is very high in some subgroups of women. Identification of these subgroups could be important for prenatal counseling.

Fetal neural tube defects in pregnant women previously submitted to bariatric surgery: more attention to a new emerging entity

Department of Pediatric Surgery, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy Department of Obstetrics and Gynecology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Italy Department of Public Health, Neurosciences, Experimental and Forensics Medicine-Section of Human Nutrition, University of Pavia, Italy Department of Neurosurgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy Clinic of Orthopaedics and Traumatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy Department of Neuradiology, IRCCS Policlinico San Matteo Foundation Pavia, Italy Department of Internal Medicine University of Pavia and Department of Pediatrics, IRCCS Policlinico San Matteo Foundation Pavia, Italy *Correspondence to: Gloria Pelizzo. E-mail: g.pelizzo@smatteo.pv.it

Cervical intraepithelial neoplasia in pregnant intravenous drug users infected with human immunodeficiency virus type 1

OBJECTIVE The purpose of this study was to evaluate the frequency and natural history of cervical intraepithelial neoplasia (CIN) during pregnancy in past or current intravenous drug users infected with human immunodeficiency virus type 1 (HIV-1). STUDY DESIGN We prospectively evaluated 48 pregnant HIV-1 seropositive patients and 38 HIV seronegative controls. All the subjects were current or past intravenous drug users. Follow-up visits were carried out each trimester of pregnancy and 8-12 weeks post-partum with Papanicolau smears, colposcopic examinations and, when necessary, colposcopically directed cervical biopsies. RESULTS Thirteen of 48 HIV-seropositive women (27.1%) and three of 38 HIV-seronegative controls (7.9%) (P = 0.027 by Fisher exact test) had biopsy-proven CIN at the beginning of pregnancy. High-grade CIN was detected in 10 cases (20.8%) and in two (5.3%) controls (P = 0.058 by Fisher exact test). None of the cervical squamous intraepithelial lesions progressed throughout pregnancy, in both cases and controls. Post-partum cold-knife cervical conization was performed on seven patients with CIN III and examination of the cone biopsy specimens demonstrated persistence of CIN III. CONCLUSIONS HIV-infected intravenous drug users are at high risk of CIN during pregnancy, thus requiring adequate screening programs. Our preliminary data suggest that the progression rate of CIN during gestation is low in this high-risk group.

A prenatal case of duplication with terminal deletion of 5p not identified by conventional cytogenetics

A 4-year long prospective study referring to secondtrimester termination of pregnancy due to fetal malformation revealed chromosomal anomalies in about 16% of the 57 cases with congenital malformation diagnosed by ultrasound examination and confirmed by fetal autopsy (Akgun et al., 2007). It is possible that many of the fetuses thought to have a normal karyotype, have instead cryptic chromosomal deletions or duplications that cannot be detected by conventional cytogenetic techniques. In fact, Mefford et al. (2007) found that 6% of autopsy samples from 155 fetuses (128 with normal karyotype, and 27 without any karyotype information) with well-defined developmental pathologies had cryptic imbalances detected through an array-based comparative genomic hybridization (array-CGH) containing bacterial artificial chromosomes (BACs) targeted to rearrangement hotspots. Here we report a 24-year-old woman who underwent chorionic villus sampling, after a diagnosis of cystic hygroma in the first trimester of pregnancy. Although chromosome analysis on cells from both short and long term cultures preparation at a resolution of about 320–400 bands did not reveal any numerical or structural rearrangement (Figure 1), array-CGH analysis on fetal blood after termination of pregnancy revealed a de novo large rearrangement on the short arm of one chromosome 5 with a deletion of at least 25 Mb of the short arm of the chromosome 5 and a contiguous duplication of 20.3 Mb (Figure 1). Thus, the karyotype of the fetus was 46,XY,del(5)(pter-p14.1),dup(5)(p14.1p11). Microsatellite analysis demonstrated the paternal origin of the rearranged chromosome 5 with maternal alleles present only in the deletion region. The area of paternal allelic peaks in the duplication region was double in respect to the maternal alleles (Table 1). The woman was referred for cytogenetic evaluation between the 12th and the 13th week of pregnancy