Hillary Klonoff-Cohen

A prospective study of stress among women undergoing in vitro fertilization or gamete intrafallopian transfer

OBJECTIVE To evaluate whether baseline or procedural stress during in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT) affects pregnancy or live birth delivery rates. DESIGN Prospective study. SETTING Seven clinics in Southern California between 1993 and 1998. PATIENT(S) One hundred and fifty-one women completed two questionnaires. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The number of oocytes aspirated and fertilized, the number of embryos transferred, the achievement of a pregnancy, live birth delivery, and infant outcomes. RESULT(S) Positive-affect negative-affect score at baseline negatively influenced the number of oocytes retrieved and embryos transferred. A higher expectation of pregnancy was associated with greater numbers of oocytes fertilized and embryos transferred. At baseline, the risk of no live birth was 93% lower for women who had the highest positive-affect score compared to those with the lowest score. Furthermore, the score on the Infertility Reaction Scale was related to negative outcomes in live birth delivery, infant birth weight, and multiple births. During the time of the procedure, the PANAS and Bipolar Profile of Moods States results were related to the number of oocytes fertilized and embryos transferred; stress did not affect pregnancy or delivery. CONCLUSION(S) Baseline (acute and chronic) stress affected biologic end points (i.e., number of oocytes retrieved and fertilized), as well as pregnancy, live birth delivery, birth weight, and multiple gestations, whereas (procedural) stress only influenced biologic end points.

Albumin levels as a predictor of mortality in the healthy elderly

Serum albumin levels probably predict subsequent mortality in the elderly, but it is not clear whether this is independent of disease. A 3 year prospective study of 2342 healthy non-institutionalized men and women aged 50-89 years old, residing in Rancho Bernardo, California, confirmed the following findings. Serum albumin levels decreased with increasing age in both men and women, and this association was independent of health status. In addition, for every standard deviation decrease in albumin, the relative odds of dying was 1.24 (p = 0.04), after adjusting for age, sex and lifestyle factors such as smoking, exercise and alcohol consumption. Separating the study sample into those who did and did not report disease at baseline did not appreciably alter these findings. Most of the albumin levels of the older adults (70-89) fall within the normal and narrow range of the younger adults (50-69), nevertheless, albumin levels predict outcome independent of known disease. The albumin-early mortality association suggests that serum albumin levels are a predictor for subclinical disease in the healthy elderly.

Effects of maternal and paternal alcohol consumption on the success rates of in vitro fertilization and gamete intrafallopian transfer

OBJECTIVE To determine whether the amount and timing of female and male alcohol use during IVF and GIFT affect reproductive endpoints. DESIGN Multicenter prospective study. SETTING Clinics in southern California. PATIENT(S) Two hundred twenty-one couples with female infertility. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Egg retrieval, transfer, fertilization, pregnancy, miscarriage, live birth, and multiple gestations. RESULT(S) Female alcohol consumption was associated with: (1) a 13% decrease in the number of eggs aspirated (adjusted 95% confidence interval [CI]: -2% to -23%, for one additional drink per day, 1 year before the IVF or GIFT attempt); (2) an increase in risk of not achieving pregnancy by 2.86 times (0.99-8.24, 1 month prior); and (3) an increase in risk of miscarriage by 2.21 times (1.09-4.49, 1 week before the procedure). For men, one additional drink per day increased the risk of not achieving a live birth by 2.28 (1.08-4.80) to 8.32 (1.82-37.97) times, depending on the time period; beer also affected live births (ORs = 5.49-45.64). This outcome may be due partially to increased risk of miscarriage by 2.70 to 38.04 times for men who drank <or=1 month before and during IVF and GIFT. CONCLUSION(S) This is the first study to report an association between alcohol use and reproductive endpoints of IVF and GIFT. Because alcohol use is ubiquitous, modifying drinking habits may increase assisted reproductive technology success rates.

job Stress and Preeclampsia

&NA; We conducted a case‐control study to determine whether job strain (or stress) during pregnancy resulted in an increased risk of preeclampsia. We compared 110 nulliparous Caucasian and African‐American women who had preeclampsia with 115 healthy nulliparous controls. All subjects gave birth between 1984 and 1987 in Chapel Hill, NC. Occupation was ascertained during a telephone interview. We assigned each job title a strain (or stress) score in accordance with the occupational database developed by Karasek. Overall, 54 (49%) of the control women worked during pregnancy, 14 in high‐stress jobs. Logistic regression analysis indicated a 3.1‐fold [95% confidence interval (CI) = 1.2–7.8] increased risk of preeclampsia for women employed in high‐stress jobs (high psychological demand, low decision latitude) and an odds ratio of 2.0 (95% CI = 1.0–4.3) for low‐stress jobs compared with nonworking women, while simultaneously adjusting for age, race, family history of preeclampsia, history of hypertension in the subjects mother, gravidity, smoking during pregnancy, timing of the first prenatal visit, and type of birth control used by the couple before the pregnancy. Furthermore, working women had 2.3 times the risk of developing preeclampsia (95% CI = 1.2–4.6) compared with nonworking women. Workrelated psychosocial strain increased the risk of preeclampsia in our study.

Prenatal Alcohol Exposure Patterns and Alcohol-Related Birth Defects and Growth Deficiencies: A Prospective Study

BACKGROUND The physical features of fetal alcohol syndrome include smooth philtrum, thin vermillion border, short palpebral fissures, microcephaly, and growth deficiencies on weight and height. However, little is known about the specific quantities of alcohol exposure, pattern of drinking, timing of exposure, and magnitude of risk for each of these features. METHODS Using data on 992 subjects collected prospectively in California between 1978 and 2005, we examined the patterns and timing of alcohol exposure in relation to these features. Structural features were assessed by a dysmorphologist who performed a blinded physical examination of all infants. Patterns of drinking were evaluated by drinks per day, number of binge episodes, and maximum number of drinks. Timing of exposure was evaluated 0 to 6 weeks postconception, 6 to 12 weeks postconception, first trimester, second trimester, and third trimester. RESULTS Higher prenatal alcohol exposure in every pattern was significantly associated with the incidence of smooth philtrum but not with short palpebral fissures. The strongest associations were with timing of exposure in the second half of the first trimester (RR 1.25, 95% CI 1.14 to 1.36 for average number of drinks per day; RR 1.17, 95% CI 1.09 to 1.26 for maximum number of drinks in 1 episode). Similarly, thin vermillion border was most strongly associated with exposure in the second half of the first trimester. Findings with respect to timing of exposure were similar for microcephaly and reduced birth weight. However, reduced birth length was increased with exposure in any trimester. These associations were linear, and there was no evidence of a threshold. CONCLUSIONS Reduced birth length and weight, microcephaly, smooth philtrum, and thin vermillion border are associated with specific gestational timing of prenatal alcohol exposure and are dose-related without evidence of a threshold. Women should continue to be advised to abstain from alcohol consumption from conception throughout pregnancy.

Breastfeeding, infant formula supplementation, and Autistic Disorder: the results of a parent survey

BackgroundAlthough Autistic Disorder is associated with several congenital conditions, the cause for most cases is unknown. The present study was undertaken to determine whether breastfeeding or the use of infant formula supplemented with docosahexaenoic acid and arachidonic acid is associated with Autistic Disorder. The hypothesis is that breastfeeding and use of infant formula supplemented with docosahexaenoic acid/arachidonic acid are protective for Autistic Disorder.MethodsThis is a case-control study using data from the Autism Internet Research Survey, an online parental survey conducted from February to April 2005 with results for 861 children with Autistic Disorder and 123 control children. The analyses were performed using logistic regression.ResultsAbsence of breastfeeding when compared to breastfeeding for more than six months was significantly associated with an increase in the odds of having autistic disorder when all cases were considered (OR 2.48, 95% CI 1.42, 4.35) and after limiting cases to children with regression in development (OR 1.95, 95% CI 1.01, 3.78). Use of infant formula without docosahexaenoic acid and arachidonic acid supplementation versus exclusive breastfeeding was associated with a significant increase in the odds of autistic disorder when all cases were considered (OR 4.41, 95% CI 1.24, 15.7) and after limiting cases to children with regression in development (OR 12.96, 95% CI 1.27, 132).ConclusionThe results of this preliminary study indicate that children who were not breastfed or were fed infant formula without docosahexaenoic acid/arachidonic acid supplementation were significantly more likely to have autistic disorder.

Acetaminophen (paracetamol) use, measles-mumps-rubella vaccination, and autistic disorder: The results of a parent survey

The present study was performed to determine whether acetaminophen (paracetamol) use after the measles-mumps-rubella vaccination could be associated with autistic disorder. This case-control study used the results of an online parental survey conducted from 16 July 2005 to 30 January 2006, consisting of 83 children with autistic disorder and 80 control children. Acetaminophen use after measles-mumps-rubella vaccination was significantly associated with autistic disorder when considering children 5 years of age or less (OR 6.11, 95% CI 1.42—26.3), after limiting cases to children with regression in development (OR 3.97, 95% CI 1.11—14.3), and when considering only children who had post-vaccination sequelae (OR 8.23, 95% CI 1.56—43.3), adjusting for age, gender, mothers ethnicity, and the presence of illness concurrent with measles-mumps-rubella vaccination. Ibuprofen use after measles-mumps-rubella vaccination was not associated with autistic disorder. This preliminary study found that acetaminophen use after measles-mumps-rubella vaccination was associated with autistic disorder.

Fetal sex and maternal asthma control in pregnancy

Asthma is a prevalent chronic disorder that might substantially complicate pregnancy. Some recent reports suggest that the presence of a female fetus might be associated with worse maternal asthma symptoms during pregnancy. We tested this hypothesis using the sample of 719 pregnant women with asthma prospectively enrolled in the OTIS study. The presence of a female fetus was associated with a higher incidence of hospitalizations for asthma during pregnancy (OR = 1.84; 95% CI: 1.05; 3.21) independent of maternal age, BMI, ethnicity, smoking, and socioeconomic status. The current study suggests that pregnant asthmatic women carrying a girl might be more susceptible to asthma exacerbations.

Outdoor carbon monoxide, nitrogen dioxide, and sudden infant death syndrome

Aims: To investigate whether infants who died of SIDS were more likely to have higher acute and lifetime average exposures to outdoor carbon monoxide (CO) and nitrogen dioxide (NO2) than comparison healthy infants. Methods: A total of 169 case and 169 matched control infants born between 1988 and 1992, were studied. CO and NO2 concentrations, averaged for all days within the infant’s lifespan, and the last 30 days, 7 days, 3 days, and 1 day of life were obtained from air pollutant data provided by the California Air Resources Board. Results: Based on monthly aggregated data, average CO and particularly NO2 were associated with SIDS count, even after adjustment for seasonal trends. SIDS outcome was not significantly associated with high average outdoor CO levels for any time period. However, high average outdoor NO2 levels on the last day of the infant’s exposure period were significantly associated with SIDS; the adjusted odds ratio was 2.34 (95% CI 1.13 to 4.87). Conclusions: SIDS may be related to high levels of acute outdoor NO2 exposure during the last day of life. Further studies are needed to replicate this finding.

Breast cancer histology in Caucasians, African Americans, Hispanics, Asians, and Pacific Islanders.

STUDY OBJECTIVES To investigate the association between race/ethnicity and histologic types of breast cancer. DESIGN Cross-sectional study. SETTING Population-based data from the Northern California Tumor Registry, which is part of the National Cancer Institutes Surveillance, Epidemiology and End Results Program. PARTICIPANTS A total of 2759 breast cancer cases diagnosed in 1988. MAIN RESULTS Tumors were classified as ductal, lobular, and mixed/unspecified carcinoma. Ductal carcinoma was the most common (83.6%) and lobular carcinoma was the rarest. Most cases were diagnosed in the localized stage (56.3%). Caucasian women had the highest rates of total breast cancer (240.9/100,000), ductal and lobular. In African-American women, the odds of ductal carcinoma were twice that of lobular carcinoma, compared with Caucasian women (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.0-3.9) after adjusting for age, site, and stage at diagnosis. Similarly, Asian and Hispanic women also had higher, non-statistically significant odds of ductal versus lobular carcinoma compared with Caucasians (OR = 1.8 [95% CI 0.9-3.7] and 1.6 [95% CI 0.8-3.4], respectively). CONCLUSIONS Future studies should investigate how racial/ethnic differences in histology among breast cancer patients will influence life expectancy, against a backdrop of health care access, sociocultural issues, lifestyle habits, reproductive history, family history, and tumor characteristics.