Affective disorders in the aftermath of miscarriage: a comprehensive review

We review the research literature regarding affective symptomatology and disorders following miscarriage, with an emphasis on controlled studies and those that have been published since the last review article in 1996. The current review draws a sharp distinction between controlled and uncontrolled designs and clarifies the proper inferences that may be drawn from each, as only with an appropriate comparison group can it be determined whether the affective reactions following miscarriage are a specific consequence of the reproductive loss or of other life events common in women of reproductive age. In addition to providing an update of the literature on depression in the aftermath of miscarriage and associated risk factors, we also discuss reproductive loss in the context of attachment theory and grief, and present information on topics that were not covered extensively (or at all) by prior reviews, such as issues related to a pregnancy subsequent to miscarriage and the impact of miscarriage on the partners of miscarrying women. In the final section, treatment options relevant to miscarriage are presented.     

Impact of short-term preconceptional exposure to particulate air pollution on treatment outcome in couples undergoing in vitro fertilization and embryo transfer (IVF/ET)

Purpose  

To assess the potential effects of short-term exposure to particulate air pollution during follicular phase on clinical, laboratory, and pregnancy outcomes of women undergoing IVF/ET.     

Examination of gender effect in birth weight and miscarriage associations with childhood cancer (United Kingdom)

Background Higher birth weight and maternal history of miscarriage has been associated with an increased risk of childhood leukemia. The possibility that this association may be sex-specific has not been explored in detail in previous studies. Methods In a retrospective case-control study, 732 childhood (≤14 years) cancer cases from a population-based Registry in Northern England whose hospital birth records could be accessed and 3,723 controls matched for date and hospital of birth to the cases were compared. We examined birth weight for sex-specific associations with childhood cancer. Conditional logistic regression analysis was used for statistical evaluation of associations. Results In acute lymphoblastic leukemia (ALL) (225 cases and 1,163 matched controls), birth weight and sex showed a strong interaction (P = 0.003). In boys with ALL, but not in girls, there was a nonlinear association with birth weight (P for trend = 0.008; OR = 3.05 for the highest quintile compared to the second lowest quintile, 95% CI = 1.40–6.64; P = 0.005). When birth weights were adjusted using UK standards for gestational age and sex, the risk associations were similar in statistical significance and magnitude. Maternal history of miscarriage showed an association with all cancers and individually with ALL. The miscarriage association with ALL was statistically significant in boys only (OR = 1.91, 95% CI = 1.07–3.42; P = 0.03). A multivariable model for ALL containing other examined maternal and reproductive variables confirmed the independence of the birth weight and miscarriage associations. There was no birth weight or miscarriage associations in other cancers. Conclusions This study confirmed the risk associations with birth weight and miscarriages in childhood ALL. Statistically significant association of size at birth suggested marked differences in etiology between girls and boys.     

Smallpox during pregnancy and maternal outcomes

A historical study evaluated maternal outcomes in pregnancy complicated by smallpox. The overall case fatality was estimated to be 34.3% (95% confidence interval [CI] 31.4-37.1), and the proportion of miscarriage or premature birth was estimated to be 39.9% (95% CI 36.5-43.2). Vaccination before pregnancy reduced the risk for death.     

Social and professional support needs of families after perinatal loss

Perinatal loss has been associated with depression, anxiety, obsessive-compulsive disorder, suicide, marital conflict, and post-traumatic stress disorder. Nurses may provide professional support through teaching, role modeling, encouragement, counseling, problem solving, and other interventions. Nurses also may encourage more effective social support by helping significant others to provide willing, well-intentioned action that will produce a positive response in the bereaved couple. Interventions to increase professional and social support after perinatal loss are described.     

高纯度尿促性腺激素对IVF-ET妊娠结局的影响

目的:探讨体外受精-胚胎移植(IVF-ET)超促排卵周期中应用高纯度尿促性腺激素(HP-HMG,贺美奇)对妊娠结局的影响。方法:回顾性分析117个IVF-ET周期,根据超促排卵周期中是否使用HP-HMG将其分为两组,A组(n=63)应用果纳芬(r-FSH,重组卵泡刺激素),B组(n=54)加用贺美奇,比较两组妊娠率、流产率、着床率、持续妊娠率和持续着床率。结果:两组鲜胚移植周期妊娠率、流产率、着床率、持续妊娠率和持续着床率比较差异有统计学意义(P<0.05);两组冻胚移植周期妊娠率和着床率比较差异无统计学意义(P>0.05),而流产率、持续妊娠率和持续着床率比较差异有统计学意义(P<0.05)。结论:长方案超促排卵适时加用HP-HMG可以改善胚胎质量和子宫内膜容受性,提高持续妊娠率和持续着床率,降低流产率。     

Interplay of immune components and their association with recurrent pregnancy loss

Maintenance and progression of pregnancy is an intricate process governed by a variety of developmental cues. Recurrent pregnancy loss (RPL) is a complication experienced by expecting mothers that is defined as three or more consecutive pregnancy losses. This review focuses on the dysfunctions of the immune system as one of the key contributors towards RPL. The current data suggests that the alloimmune and autoimmune factors contribute to the loss of fetus. Such causes despite being recognized as a definitive reason for recurrent pregnancy loss, are still under extensive investigation with new parameters being discovered and scrutinized for their association with RPLs. More in-depth and high throughput studies are required for devising better diagnostic tools and management strategies for the affected female so that they can carry their pregnancy to term.     

Ten new cases of Balanced Reciprocal Translocation Mosaicism (BRTM): Reproductive implications,frequency and mechanism

Chromosomal anomalies are well known to be an important cause of infertility, sterility and pregnancy loss. Balanced Reciprocal Translocation Mosaicism (BRTM) is an extremely rare phenomenon, mainly observed in subjects with a normal phenotype accompanied by reproductive failure. To date the mechanism of origin and the incidence of BRTM are poorly defined.Here we describe 10 new cases of BRTM. In 9 cases chromosome analysis revealed the presence of two different cell lines, one with a normal karyotype and the second with an apparently balanced reciprocal translocation. In the remaining case, both cell lines showed two different, but apparently balanced, reciprocal translocations.We document the clinical implications of BRTM, discuss its frequency in our referred population and suggest that carrier individuals might be more frequent than expected.