Uri Dior

Association between number of children and mortality of mothers: results of a 37-year follow-up study

PURPOSE To examine the association between parity and long-term, all-cause mortality and mortality owing to specific causes in women. METHODS This prospective population-based study included 40,454 mothers who gave birth in Western Jerusalem, Israel, to 125,842 children and were followed for an average of 37 years after the birth of their first child. Cox proportional hazards models were used to evaluate long-term total and specific-cause mortality of women by their parity. RESULTS We found a U-shaped relationship between the number of offspring and risk of all-cause mortality in mothers. After adjustment for sociodemographic characteristics and maternal health and obstetric conditions, higher mortality rates were observed for mothers of 1 child (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.04-1.4), mothers of 5 to 9 children (HR, 1.21; 95% CI, 1.09-1.33), and mothers of 10 or more children (HR, 1.49; 95% CI, 1.12-1.99) compared with mothers of 2 to 4 children. Mortality risk from specific causes including coronary disease, circulatory disease, and cancer were increased for multiparous women. CONCLUSIONS In this long-term follow-up study, there was an association between number of children and mortality risk for mothers. These findings suggest that maternal pregnancies and postnatal characteristics as reflected by number of children may have consequences for long-term maternal health.

Emerging Roles of MicroRNA in the Embryo–Endometrium Cross Talk

Embryo implantation requires a reciprocal interaction between the blastocyst and endometrium and is associated with complex regulatory mechanisms. Since their discovery, microRNAs have become prominent regulatory candidates, providing missing links for many biological pathways. In recent years, microRNAs have been implicated as one of the important players in the regulation of multiple physiological functions of the endometrium. This review aims to present recent knowledge pertaining to the diverse aspects of microRNAs in the embryo-endometrial cross talk. We will focus on the role of microRNAs in decidualization. Next, we will review recent studies investigating the role of microRNAs in recurrent pregnancy loss. Finally, we will discuss the role of microRNAs in the tissue invasion of implantation and compare that with tissue invasion in cancers.

The Association of Maternal Intrapartum Subfebrile Temperature and Adverse Obstetric and Neonatal Outcomes

BACKGROUND Subfebrile intrapartum maternal temperature is very common, yet there is sparse evidence regarding its causes or its effects on perinatal outcomes. We examined whether mild temperature elevation during labour is a risk marker for adverse obstetric and neonatal outcomes. METHODS A retrospective cohort analysis including 42 601 term, singleton live-births in two medical centres between 2003 and 2010 was performed. This study compared women who experienced a maximal intrapartum temperature of ≤37°C with women who experienced subfebrile intrapartum temperature (37.1-37.9°C). Adjusted risks for adverse obstetric and neonatal outcomes were calculated by using multivariable logistic regression models. RESULTS Compared with maternal temperature ≤ 37°C, subfebrile temperature was associated with higher rates of primary caesarean deliveries {adjusted odds ratios [aOR] = 1.36 [95% confidence interval (CI) 1.25, 1.49])} and assisted vaginal deliveries (aOR = 1.20 [95% CI 1.11, 1.30]), as well as with greater risks of early neonatal sepsis (aOR = 2.66 [95% CI 1.88, 3.77]), neonatal intensive care unit admissions (aOR = 1.40 [95% CI 1.08, 1.83]), and neonatal asphyxia or seizures (aOR = 3.18 [95% CI 1.51, 6.70]). Mildly elevated maternal intrapartum temperature (37.1-37.5°C) was also associated with adverse outcomes. CONCLUSIONS Maternal intrapartum subfebrile temperature may be an indicator of operative delivery and neonatal morbidity. Further research is needed to confirm these findings and to reveal underlying mechanisms.

Leukocyte blood count during early puerperium and its relation to puerperal infection

Abstract Objective: To describe the white blood cell (WBC) and neutrophil counts in early puerperium and to investigate their contribution to the diagnosis of puerperal bacterial infection. Methods: A retrospective cohort analysis through which clinical and laboratory data were collected from 67 695 term live births. Total leukocyte and neutrophil blood count percentiles were established for febrile parturients (FP) with puerperal fever (≥38 °C) and for non-FP (NFP), and stratified by mode of delivery. Rates of positive bacterial cultures were compared according to the total leukocyte and neutrophil blood counts. Results: Mean WBC counts of parturients delivering vaginally and by cesarean section were 12.62 × 103 and 12.71 × 103/µL for NFP, and 14.38 × 103 and 12.74 × 103/µL for FP, respectively. The proportions of parturients with a WBC count of ≥15 × 103/µL were 36.4% for FP and 21.8% for NFP (p < 0.001). Neutrophils comprised 80% or more of the leukocyte count in 57.6% of FP and in 30.6% of NFP (p < 0.001). However, no statistically significant differences in the rates of positive bacterial cultures were observed between those with high and low levels of leukocytes and neutrophils. Conclusions: Leukocytosis and non-extreme neutrophilia were not found to reliably associate with bacterial infection, and their value in determining antibiotic therapy is questioned.

Very High Intrapartum Fever in Term Pregnancies and Adverse Obstetric and Neonatal Outcomes

Background: Intrapartum fever is a well-known risk factor for adverse perinatal outcomes. Maternal intrapartum fever ≥39.0°C at term is a rare event during labor, and there is scarce evidence regarding its implications. Objectives: To investigate the association between very high intrapartum maternal fever and perinatal outcomes in term pregnancies. Methods: A retrospective cohort analysis including 43,560 term, singleton live births in two medical centers between the years 2003 and 2011 was performed. We compared parturients who experienced a maximal intrapartum fever of <38.0°C with two subgroups of parturients who experienced respective maximal fevers of 38.0-38.9°C and ≥39°C. Adjusted risks for adverse perinatal outcomes were calculated by using multiple logistic regression models to control for confounders. Results: Compared with normal intrapartum temperature, intrapartum fever ≥39.0°C was associated with an extremely elevated risk for neonatal sepsis 16.08 (95% CI: 2.15, 120.3) as well as with low Apgar scores and neonatal intensive care unit admissions (p < 0.001). Additionally, very high intrapartum fever was related to significantly higher risk for operative delivery (p < 0.001). Conclusions: Extremely elevated intrapartum fever is an important indicator of severe neonatal morbidity and operative delivery.