Increasing likelihood of further live births in HIV-infected women in recent years

OBJECTIVE: To examine how the subsequent childbearing of HIV-infected mothers enrolled in the European Collaborative Study (ECS) has changed over time and identify factors predictive of further childbearing. DESIGN: Prospective cohort study. SETTING: Centres in nine European countries included in the ECS, enrolled between end 1986 and November 2003. POPULATION: HIV-infected women (3911): 3693 with only one and 218 with subsequent live births. METHODS: Univariable and multivariable logistic regression analyses to obtain odds ratios (OR) and 95% confidence intervals (CI). Kaplan-Meier (KM) analyses to estimate cumulative proportions of women having a subsequent live birth. MAIN OUTCOME MEASURES: Subsequent live birth. RESULTS: In multivariable analysis adjusting for time period, ethnicity, maternal age and parity, black women were more likely [adjusted odds ratio (AOR) 2.45; 95% CI, 1.75-3.43], and women >30 years less likely (AOR 0.54, 0.37-0.80), to have a subsequent live birth. Time to subsequent live birth significantly shortened over time, with an estimated 2% of women having a subsequent live birth within 24 months of enrollment pre-1989 versus 14% in 2000-2003 (P < 0.001). Estimated time to subsequent live birth was shorter for black than for white women (P < 0.001). CONCLUSIONS: The likelihood of subsequent live births substantially increased after 1995 and birth intervals were shorter in women on HAART and among black women. Numbers are currently too small to address the issue of advantages and disadvantages in the management of subsequent deliveries.     

Perinatal outcomes of immigrant women of Turkish,Middle Eastern and North African origin in Berlin,Germany: a comparison of two time periods

Purpose

Publications based on data from perinatal health registries reported worse perinatal health outcomes among women of Turkish origin. The aim of this study was to compare the perinatal outcomes of women of German and Turkish origin in Berlin in two time periods and to analyze if the situation among the women of Turkish origin has improved over time.

Methods

Datasets of all singleton deliveries from Berlin hospitals for the time periods 1993–1997 (n = 144,600) and 2003–2007 (n = 147,559) were used. Incidence rates resp. prevalences of perinatal health outcomes were computed for women of German and a group of immigrant women mostly of Turkish origin stratified for ‘parity’ and ‘having a partner’. Logistic regression models were computed to test for a change in the odds for adverse perinatal outcomes over time.

Results

The chances for adverse perinatal outcomes were decreasing in the later time period for most measures. For stillbirth, preterm birth and congenital malformations, no differences between women of Turkish and German origin could be found. Differences exist in the utilization of perinatal health care and in the risk for anemia. Among women of Turkish origin, the chance for being anemic is even higher in 2003–2007 compared to 1993–1997.

Conclusions

The perinatal health measures of women of Turkish origin have improved over time. The lower utilization rates of antenatal health care could be the expression of barriers to access the health care for pregnant women with migration background as offered in Germany. A risk group which needs a special focus by health care providers are women without a partner, irrespective of their origin.     

Use of ovarian reserve parameters for predicting live births in women undergoing in vitro fertilization

Objective

To examine common clinical determinants, including patient age; levels of anti-Müllerian hormone (AMH), inhibin B, and follicle-stimulating hormone (FSH); antral follicle count (AFC); and number of oocytes retrieved, to predict live births in women undergoing in vitro fertilization.

Study design

Women undergoing cycles of intracytoplasmic sperm injection (ICSI) for the first time were reviewed retrospectively, and serum levels of AMH, inhibin B, and FSH, as well as AFC (days 1 and 4 of pre-ICSI menstrual period) and patient age were analyzed as determinants of live birth rates.

Results

Of the patients studied, 35.71% (891/2495) became pregnant, with live births achieved in 32.20% (806/2495) of cycles initiated and in 46.37% (806/1738) of embryo transfers. Clinical pregnancy rate was 35.71% (891/2495) for cycles initiated and 51.26% (891/2318) for embryo transfers. Univariate analysis revealed that the odds of live birth significantly decreased with increasing age, declining AMH or inhibin B concentrations, and fewer oocytes retrieved. At AMH levels greater than 5.7 ng/ml, the odds of live birth were 3.18 times greater than for AMH levels less than 1.9 ng/ml [95% confidence interval (CI), 1.89–5.43]. Using multivariate logistic regression, only AMH (OR = 1.89; 95% CI, 1.00–3.60; p < 0.05) and AFC (OR = 1.86; 95% CI, 1.02–3.40; p < 0.05) showed statistically significant associations with live birth. Area under the curve for ROC (ROC_AUC) indicated that AMH (AUC = 0.60) surpassed AFC (AUC = 0.59), number of oocytes retrieved (AUC = 0.59), inhibin B (AUC = 0.55), FSH (ROC_AUC = 0.54) and chronological age (ROC_AUC = 0.53) in predicting live birth.

Conclusions

In this assessment of various indices (i.e., age; levels of AMH, inhibin B, and FSH; AFC; and quantity of oocytes retrieved) for predicting live births for IVF patients, AMH, AFC and the quantity of oocytes retrieved constituted the most reliable determinants.     

Maternal obesity predict isolated birth defects in live births in Eastern Province of Saudi Arabia

Objective: There is no research on the predictors of birth defects in Al Ahsa Governorate in the Eastern Province of Saudi Arabia. The aim of this research was to detect the predictors of isolated structural birth defects in live births. Methods: We conducted this study from April 2006 to 2010. Live births with isolated birth defects represented our sample for this retrospective case control study. Univariate analysis was done for all possible risk factors. Logistic regression analysis was done for all predictors in relation to different birth defects. Results: Out of 37168 live births, isolated structural birth defects were found in 318 cases. Obesity ( body mass index > 30) was a significant predictor for increased nervous system anomalies ( odds ratio (OR): 7.83, CI: 3.9–15.4), facial defects (OR: 5.92, CI: 2.8–12.4), genitourinary anomalies (OR: 4.6 CI: 1.9–11.1), and cardiac malformations (OR: 2.7 CI: 1.3–5.7). Consanguinity increased the risk for cardiac malformations (OR: 3.32, CI: 1.54–7.17). Low socio-economic status increased the risk for nervous system anomalies (OR: 2.09, CI: 1.18–3.7), facial defects (OR: 2.33, CI: 1.25–4.33) and musculoskeletal anomalies (OR: 2.3, CI: 1.29–4.09). Conclusion: Maternal obesity represented the most common predictor for certain categories of isolated structural birth defects including nervous system, facial, genitourinary and cardiac.     

Smoking during pregnancy increases the risk of preterm births among parous women

BACKGROUND: We wanted to study a possible association between smoking during pregnancy and preterm birth. METHODS: A population based prospective study was performed among 7,236 consecutive pregnancies over seven years delivered at one birth clinic. Smoking habits were obtained at a routine ultrasound examination around 18 gestational weeks, and preterm birth was defined as delivery of a child between 24 and 37 gestational weeks. We estimated relative risk (odds ratio) between smoking, possible confounding variables and preterm birth using multiple logistic regression analysis. RESULTS: Overall, 1,769 (25%) women said that they smoked every day during their pregnancy. The smoking women had an increased risk of preterm delivery compared with non-smokers (odds ratio 1.53, 95% confidence interval 1.24, 1.89). However, this association was only demonstrated among the multiparous women (odds ratio 1.88, 95% confidence interval 1.39, 2.54). The association was statistically significant after adjusting for maternal age, diabetes, cervical conization, preeclampsia, placental abruption and placenta previa in a multivariate analysis, and we observed a dose-response effect of maternal smoking on preterm birth among multiparous women. CONCLUSION: For multiparous women smoking during pregnancy increases the risk of preterm delivery, and there seems to be a dose-response effect of smoking.     

Urinary reproductive hormone level differences between African American and Caucasian women of reproductive age

OBJECTIVE: To compare urinary levels of reproductive hormones in African American and Caucasian women. DESIGN: Cross-sectional study. SETTING: Ten United States Air Force (USAF) bases. PATIENT(S): African American (n = 33) and Caucasian (n = 65) women of reproductive age from a larger study of USAF women (n = 170). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Urinary endocrine end points: follicular luteinizing hormone (LH), preovulatory LH, level of LH surge peak, early follicular follicle stimulating hormone (FSH), follicular LH:FSH ratio, midluteal FSH, FSH rise before menses, early follicular estrone 3-glucuronide (E(1)3G), midfollicular E(1)3G, periovulatory E(1)3G peak, midluteal E(1)3G, early follicular pregnanediol 3-glucuronide (Pd3G), follicular Pd3G, rate of periovulatory Pd3G increase, E(1)3G:Pd3G on the day of luteal transition, slope of E(1)3G:Pd3G, and midluteal Pd3G. RESULT(S): Relative to Caucasians, African American women had significantly lower follicular phase LH:FSH ratios (mean +/- SD: 0.7 +/- 0.4 vs. 1.0 +/- 0.6), lower follicular phase Pd3G levels (1.0 +/- 0.5 vs. 1.2 +/- 0.8 microg/mg creatinine), and lower rates of periovulatory Pd3G increase (0.5 +/- 0.7 vs. 1.0 +/- 1.2 microg/mg creatinine). CONCLUSION(S): Findings of this analysis should be considered preliminary evidence of racial differences in hormone levels. Future studies are needed to determine whether these differences have clinical significance.     

Seroprevalence of antibodies to Coxiella burnetti among pregnant women in South Eastern France

OBJECTIVES: To estimate the seroprevalence of antibodies to Coxiella burnetii among pregnant women and to assess the effect of Q fever on pregnancy outcome. STUDY DESIGN: Anonymous seroprevalence survey between March and May 1996 in all gynecological and obstetrical medical departments of South Eastern France. Women were included irrespective of pregnancy outcome (N=12,716, response rate=96.1%). RESULTS: The seroprevalence rate was 0.15% with a global prevalence and a prevalence of recent or chronic infections, respectively, two and three times higher among women who had a spontaneous abortion than among those who delivered although the differences were not statistically significant. The highest proportion of preterm births (6.8%) was found in high prevalence areas (0.57%). CONCLUSION: The seroprevalence was higher than expected but data were not sufficient to confirm the suspected negative impact of Q fever on pregnancy outcome.     

The incidence of pre-eclampsia among couples consisting of Japanese women and Caucasian men

Recent data from Hiby (2004) have suggested that a combination of maternal killer immunoglobulin receptor (KIR) AA genotype and fetal HLA-C2 genotype increases the risk of pre-eclampsia. Different human populations have a reciprocal relationship between KIR AA frequency and HLA-C2 frequency. Japanese people have highest frequency of KIR-AA alleles and lowest frequency of HLA-C2 alleles. However, Caucasians have a moderate frequency of KIR-AA and HLA-C2 alleles. If this hypothesis is correct, the incidence of pre-eclampsia among couples consisting of Japanese women and Caucasian men should be higher than that among couples consisting of Japanese women and Japanese men. Therefore, we investigated the incidence of pre-eclampsia among 324 couples consisting of Japanese women and Caucasian men. The incidence of pre-eclampsia in these couples consisting of Japanese women and Caucasian men was similar to that in Japanese women and Japanese men. Our data do not support that of Hiby et al. [Hiby, S.E., Walker, J.J., O'Shaughnessy, K.M., Redman, C.W.G., Carrington, M., Trowsdale, I., Moffett, A., 2004. Combinations of maternal KIR and fetal HLA-C genes influence the risk of pre-eclampsia and reproductive success. J. Exp. Med. 200, 957–965], although we did not check the haplotypes for HLA-C and KIR.     

Barriers to adoption of family planning among women in Eastern Democratic Republic of Congo

The objectives of this survey were to identify women's level of KAP toward FP; identify possible barriers to using FP; determine pregnancy spacing pattern; and ascertain the level of FP promotion by health workers. This was a 2-weeks cross-sectional survey at all maternity units in Butembo of post-partum women. 572 women were interviewed. FP knowledge was high (76%), perception good (80%). Majority used traditional methods (65%), mostly Calendar method (72%). Barriers to using modern FP included lack of knowledge, fear of side effects, religious considerations and husband opposition. Unmet need for spacing and limiting was high (21 & 31%). For majority (56%), pregnancy spacing met WHO's Healthy Timing and Spacing of Pregnancy recommendations. Promotion of FP was poor (42%). Training of health workers, advocating modern contraception, improving FP services in all public health facilities and promoting FP on each contact of women is highly recommended in this city.     

Correlates of weight loss behaviors among low-income African-American, Caucasian, and Latina women

OBJECTIVE: To examine the prevalence and correlates of weight reduction behaviors among low-income women. METHODS: A total of 1,709 Caucasian, African-American, and Latina women aged 12-58 years attending a federally funded family planning clinic reported their weight loss behaviors during the past 30 days, including using diet pills, exercising, purging (vomiting, laxatives, diuretics), and dieting. Approximately 60% (n = 999) had a body mass index of 25 or greater. RESULTS: Overall, 35.3% (n = 603) of women dieted, 43.7% (n = 746) exercised, 15.1% (n = 258) used diet pills, and 4.3% (n = 69) purged. Only 14.8% (n = 253) of the sample reported both dieting and exercising. The odds of exercising for weight loss decreased as parity increased. Those who smoked currently or in the past were more likely than nonsmokers to report purging (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.2, 5.4). African Americans were least likely to diet or exercise compared with Caucasians and Latinas. Exposure to family members using diet pills (OR 4.6; 95% CI 3.2, 6.5), dieting (OR 2.1; 95% CI 1.6, 2.8), or purging (OR 5.6; 95% CI 2.7, 11.9) was associated with increased odds of performing these behaviors oneself. CONCLUSION: This research demonstrates that low-income women frequently use maladaptive strategies, such as diet pills and purging, to lose weight. Obesity and family exposure to these behaviors places women at increased risk of unhealthy behaviors. Interventions designed to reduce obesity must include precautions regarding the dangers of these practices. LEVEL OF EVIDENCE: III     

Angiogenic imbalance as a contributor to the pathophysiology of preeclampsia among black African women

Objective: The pathogenesis of preeclampsia remains unclear despite extensive research. Altered angiogenic balance has been hypothesized to play a significant role in the clinical manifestations of this syndrome. However this imbalance has not been investigated extensively among black African women. The aim of this study was to investigate the maternal levels of the angiogenic factors soluble vascular endothelial growth factor receptor 1 (sFLT1) and placental growth factor (PlGF) among black African women with preeclampsia.

Methods: A case control study was conducted in the Mthatha hospital complex in South Africa including 51 women with preeclampsia and 82 women with uncomplicated pregnancies. Blood samples were drawn from participants and serum was used to assess sFLT1, and PlGF levels quantified using specific enzyme linked immunosorbent assays. Non- parametric statistics were used for analysis.

Results: Black African women with preeclampsia were found to have significantly lower levels of PlGF (90.3?±?8.9?pg/ml versus 172.8?±?20.2?pg/ml; p?p?p?Conclusion: The results support an altered angiogenic balance may contribute to the pathogenesis/pathophysiology of preeclampsia among black African women as reported in other populations.     

Outcomes of hysterectomy in HIV-seropositive women compared to seronegative women

OBJECTIVE: To compare the postoperative complication rates after hysterectomy between HIV-infected patients and HIV-uninfected patients. STUDY DESIGN: We conducted a retrospective study of 24 human immunodeficiency virus-infected patients who underwent hysterectomy between January 1, 2000 and April 2, 2003 at Grady Memorial Hospital. Postoperative complications rates among HIV-infected women were compared to those rates among HIV-uninfected women. Data were analyzed t-tests for continuous variables and chi-squared tests for categorical variables. RESULTS: The HIV-infected women were more likely to report smoking and recreational drug use. In addition, a higher proportion of the HIV-infected women were co-infected with hepatitis, with more than one-quarter of HIV-infected women being hepatitis B or C seropositive. Although the study was limited due to small sample size, no significant differences in complication rates were found among HIV-infected women compared with uninfected women. CONCLUSION: As HIV-infected women are living longer, healthier lives we anticipate that increased numbers of HIV-infected women will be undergoing hysterectomy for benign gynecologic conditions. It will be important, therefore, to carefully document any potential differences in operative risks.     

Replacing single frozen-thawed euploid embryos in a natural cycle in ovulatory women may increase live birth rates compared to medicated cycles in anovulatory women

Purpose

The goal of this study was to compare pregnancy outcomes between natural frozen embryo transfer (FET) cycles in ovulatory women and programmed FET cycles in anovulatory women after undergoing in vitro fertilization with preimplantation genetic screening (IVF-PGS).

Methods

This was a retrospective cohort study performed at an academic medical center. Patients undergoing single FET IVF-PGS cycles between October 2011 and December 2014 were included. Patients were stratified by type of endometrial replacement: programmed cycles with estrogen/progesterone replacement and natural cycles. IVF-PGS with 24-chromosome screening was performed on all included patients. Those patients with euploid embryos had single embryo transfer in a subsequent FET. The primary study outcome was live birth/ongoing pregnancy rate. Secondary outcomes included implantation, biochemical pregnancy, and miscarriage rates.

Results

One hundred thirteen cycles met inclusion criteria: 65 natural cycles and 48 programmed cycles. The programmed FET group was younger (35.9 ± 4.5 vs. 37.5 ± 3.7, P = 0.03) and had a higher AMH (3.95 ± 4.2 vs. 2.37 ± 2.4, P = 0.045). The groups were similar for BMI, gravidity, parity, history of uterine surgery, and incidence of Asherman’s syndrome. There was also no difference in embryo grade at biopsy or transfer, and proportion of day 5 and day 6 transfers. Implantation rates were higher in the natural FET group (0.66 ± 0.48 vs. 0.44 ± 0.50, P = 0.02). There was no difference in the rates of biochemical pregnancy or miscarriage. After controlling for age, live birth/ongoing pregnancy rate was higher in natural FETs with an adjusted odds ratio of 2.68 (95% CI 1.22–5.87).

Conclusions

Natural FET in ovulatory women after IVF-PGS is associated with increased implantation and live birth rates compared to programmed FET in anovulatory women. Further investigation is needed to determine whether these findings hold true in other patient cohorts.

     

Effect of short-term hormone therapy on oxidative stress and endothelial function in African American and Caucasian postmenopausal women

In postmenopausal women (PMW), the effect of a short-term course of estrogen/progestin HT on free radical oxidative stress was evaluated. In addition, HT's effect on plasma nitric oxide (NO) activity was determined as a measure of vascular endothelial function. We investigated the relationship of these markers and HT across race and the cardiovascular risk factors of smoking, diabetes and hypertension.A prospective, observational study comparing preintervention and postintervention.Academic research center.Twenty-seven (14 African American and 13 Caucasian) PMW volunteers.Six weeks of continuous, combined estrogen/progestin HT.Plasma concentrations of free 8-epi-prostaglandin F(2alpha) (8-isoprostane) before and after HT were compared as a measure of oxidative stress. Nitrite, the stable oxidation metabolite of NO, was measured by the Greiss reaction after nitrate reduction to nitrite with cadmium.Plasma levels of free 8-isoprostane decreased significantly after 6 weeks of HT. Although almost all subjects benefited from the reduction in free 8-isoprostane, PMW with at least one cardiovascular risk factor (n = 19) demonstrated higher free 8-isoprostane than did subjects with no risk factors. Plasma levels of nitrite increased after 6 weeks of HT, but the difference was not statistically significant. Caucasian PMW demonstrated a greater increase in plasma levels of nitrite after 6 weeks of HT as compared with African American subjects, who exhibited almost no change.Short-term administration of HT significantly reduces oxidative stress in PMW and is consistent across race. However, there was an observed racial difference in endothelial NO response to HT between African American and Caucasian PMW.