Cigarette,alcohol, and caffeine consumption: risk factors for spontaneous abortion

OBJECTIVE: To study the association between cigarette, alcohol, and caffeine consumption and the occurrence of spontaneous abortion. METHODS: The study population consisted of 330 women with spontaneous abortion and 1168 pregnant women receiving antenatal care. A case-control design was utilized; cases were defined as women with a spontaneous abortion in gestational week 6-16 and controls as women with a live fetus in gestational week 6-16. The variables studied comprise age, parity, occupational situation, cigarette, alcohol, and caffeine consumption. The association between cigarette, alcohol, and caffeine consumption was studied using logistic regression analyzes while controlling for confounding variables. In addition stratified analyzes of the association between caffeine consumption and spontaneous abortion on the basis of cigarette and alcohol consumption were performed. RESULTS: Women who had given birth twice or more previously had increased odds ratio (OR), 1.78 (1.27-2.49), whereas women who were students had decreased OR, 0.55 (0.34-0.91) for having spontaneous abortions. Regarding lifestyle factors, the adjusted ORs among women who consumed 5 units or more alcohol per week or 375 mg or more caffeine per day were 4.84 (2.87-8.16) and 2.21 (1.53-3.18), respectively. Women who smoked 10-19 cigarettes and 20 or more cigarettes per day did not have significantly increased ORs for having spontaneous abortions, after adjusting for other risk factors. CONCLUSION: Consumption of 5 or more units alcohol per week and 375 mg or more caffeine per day during pregnancy may increase the risk of spontaneous abortion.     

Serum levels of anticardiolipin antibodies are pathologically increased after active immunization of patients with recurrent spontaneous abortion

Although the pathophysiological mechanisms leading to recurrent spontaneous abortion are still not fully understood, treatment schemes based on immunological principles have been advocated in recent years claiming that the production of the so-called blocking factor is being specifically stimulated. We investigated, retrospectively, whether active immunization can affect the production of immunoglobulin (Ig)G and IgM anticardiolipin antibodies. In a group of untreated recurrent spontaneous abortion patients (n = 9), the range of variation of cardiolipin antibodies, during consecutive controls taken at the same time interval as after immunization, was not statistically significant. In contrast to this, significant increases of both IgG and IgM antibodies occurred after active immunization with paternal leucocytes in 10 of 15, and in 6 of 15 cases, respectively. The mean basal and posttransfusion levels were: 7.26 +/- 2.53 and 30.15 +/- 23 U/mL for IgG and 2.26 +/- 1.2 and 6.82 +/- 5.6 U/mL for IgM, respectively. We conclude that active immunization with human lymphocytes leads to the production of antibodies against cardiolipin. This effect is exerted on both IgM and IgG antibodies.     

Caffeine consumption during pregnancy and association with late spontaneous abortion

In a prospective cohort study, 3135 pregnant women were followed to evaluate the association of caffeine consumption during pregnancy with late first- and second-trimester spontaneous abortion. Almost 80% of pregnant women used some caffeine; among users the average daily intake was 99.3 mg from all sources. Sources of caffeine were nonherbal tea (used by 49.4% of women), coffee (41.2%), colas (35.0%), and drugs (6.6%). In all, 28% of pregnant women consumed greater than or equal to 151 mg of caffeine daily, and these "moderate-to-heavy" caffeine users were significantly more likely to experience late first- or second-trimester spontaneous abortion when compared with nonusers and light users (0 to 150 mg). Demographic characteristics, reproductive and medical history, contraceptive use, and smoking and drinking habits were taken into consideration. The adjusted relative risk of miscarriage after moderate-to-heavy caffeine consumption was 1.73 (p = 0.03). Light caffeine use (1 to 150 mg daily) was associated with increased risk for spontaneous abortion only among women who aborted in their last pregnancy (RR = 4.18, p = 0.04). Replicative studies are necessary before the association of caffeine with spontaneous abortion can be confirmed.     

Cardiovascular mortality in men with erectile dysfunction: increased risk but not inevitable

IntroductionIt is unclear whether men with erectile dysfunction (ED) ultimately die of cardiovascular (CV) causes.AimThis study examined the causes of death in men with ED and their risk of CV death.MethodsBased on statutory death registrations and hospital morbidity data, the risk of CV death in men with ED in a linked-data study was assessed against the CV mortality risk in a reference male population.Main Outcome MeasuresDeaths from CV causes as proportions of all deaths. Age-specific rate, mortality rate ratio (MRR), standardized mortality rate ratio (SMRR), and adjusted hazard ratio (HR).ResultsCV mortality was 4.0%. Compared with the reference population, the risk of CV death was higher in men with ED (SMRR 2.2; 95% confidence interval [CI] 1.6, 3.0). Risk of CV mortality was higher in men with CV disease prior to ED (adjusted HR 1.7; 95% CI 1.1, 2.6) or with history of hospital admissions for CV events (adjusted HR 2.2; 95% CI 1.3, 3.8), compared with those without the respective history. MRR was significantly increased in the 40–69 years age group (MRR 4.1; 95% CI 3.2, 5.2). The median time interval between manifestation of ED and CV death was 10.0 years. A greater proportion of deaths from oncological than from CV causes (25.0% vs. 10.8%) occurred within the first 5 years of the manifestation of ED.ConclusionsAlthough the risk of CV mortality is greater in men with ED, almost as many men die of oncological as of CV causes, with a higher proportion of oncological deaths occurring sooner subsequent to the first manifestation of ED. Chew K-K, Gibson N, Sanfilippo F, Stuckey B, and Bremner A. Cardiovascular mortality in men with erectile dysfunction: Increased risk but not inevitable.     

Risk of spontaneous abortion following induced abortion is only increased with short interpregnancy interval.

We set out to study the risk of spontaneous abortion following a first trimester induced abortion as a function of the interpregnancy interval between two pregnancies. The cohort study is based on the following databases: Danish national registries: the Medical Birth Registry (MBR), the Hospital Discharge Registry (HDR), and the induced Abortion Registry (IAR). All primigravid women in the time period from 1980 to 1982 were identified in the MBR, the HDR and the IAR. A total of 15 727 women who terminated the pregnancy with a first trimester induced abortion were selected as the induced abortion cohort, and 46 026 women who did not terminate the pregnancy with an induced abortion constituted the control cohort. By register linkage all subsequent pregnancies which were not terminated by induced abortion were identified from 1980 to 1994. Only women who had a non-terminated pregnancy following the index pregnancy were selected. Women whose first pregnancy was terminated following a first trimester induced abortion had a risk of spontaneous abortion of 11.0% vs. 9.4% in the control cohort. This relative difference of 1.17 was not statistically significant in logistic regression analyses. An increased risk was only found for women who had an interpregnancy interval of less than 3 months (OR=4.06, 95% C.I.=1.98-8.31). The abortion method, vacuum aspiration with dilatation or evacuation with dilatation did not modify this elevated risk. Overall the study did not show an increased risk of spontaneous abortion following one or more induced abortions, except for women with a short interpregnancy interval between an induced abortion and a subsequent pregnancy. We recommend women who have a first trimester induced abortion be advised to wait at least 3-6 months before trying to become pregnant again.     

Dietary factors and risk of spontaneous abortion

OBJECTIVE: This study examines the association between dietary habits and risk of spontaneous abortion. DESIGN: Hospital-based case-control study. SETTING: Obstetric hospitals in Milan, Italy. SUBJECTS: Cases were: 912 women admitted for spontaneous abortion (within the 12th week of gestation). Controls were: women who gave birth at term to healthy infants on randomly selected days at the same hospitals where cases had been identified. RESULTS: The risk of spontaneous abortion was inversely and significantly related to green vegetables, fruit, milk, cheese, eggs and fish consumption. The multivariate odds ratios (OR), for highest versus lowest levels of intake, were 0.3 for fruit, 0.5 for cheese, 0.6 for green vegetables and milk and 0.7 for fish and eggs. The major type of seasoning fats have showed a direct association with risk of miscarriage. Comparing the highest with the lowest intake, the ORs were 2.0 (95% confidence interval, CI 1.1-3.6) and 1.6 (95% CI 1.1-2.3) for butter and oil, respectively. No consistent association emerged between meat, liver, ham and carrots intake and the risk of spontaneous abortion. CONCLUSIONS: This result suggests that a diet poor in several aspects, including vegetables and fruit, milk and dairy products, but rich in fats, may be a determinant or a correlate of increased risk of spontaneous abortion.