Birth outcomes of women with ulcerative colitis: a nationwide Danish cohort study

OBJECTIVE: Our study aimed to compare the birth outcomes in offspring of women with ulcerative colitis with controls without the disease. METHODS: A cohort study of 1531 newborns to mothers with ulcerative colitis, and 9092 controls, based on linkage between the Danish National Registry of Patients and the Danish Birth Registry from 1982 to 1992. RESULTS: Among the births to women with ulcerative colitis, 569 took place before and 962 after the first hospitalization for ulcerative colitis. We found no increased risk of either low birth weight or intrauterine growth retardation for newborns born before or after the mothers' first hospitalization. The risk of preterm birth was increased when birth occurred after the mothers' first hospitalization (odds ratio = 1.4, 95% confidence interval = 1.1-1.9), and particularly when the first hospitalization for ulcerative colitis took place during pregnancy (odds ratio = 3.4, 95% confidence interval = 1.8-6.4). CONCLUSIONS: In the offspring of women with ulcerative colitis, we found no increased risk of low birth weight or signs of intrauterine growth retardation. The risk of preterm birth was increased in the offspring of women with ulcerative colitis, particularly when the first hospitalization for ulcerative colitis occurred during pregnancy.     

Pregnancy outcome for women with Crohn's disease: a follow-up study based on linkage between national registries

Objective: Crohn's disease, characterized by chronic intestinal inflammation, is sometimes followed by malabsorption, which may interfere with embryogenesis and fetal growth. Therefore we examined birthweight, the frequency of preterm birth, and other reproductive outcomes in the offspring of women with Crohn's disease.
Methods: We used a historical registry-based study, with linkage between the Danish National Registry of Patients and the Danish Medical Birth Registry. Included were 510 newborns to mothers with Crohn's disease and 3018 controls in the study period from 1982 to 1992.
Results: The average birthweight of newborns to mothers with Crohn's disease was 185 g, 134 g less than expected for primiparas and multiparas. After adjusting for potential confounders the differences were 142 g (95% confidence interval [CI_95%] = 76, 208) and 105 g (  CI_95%= 37, 173  ), respectively. The risk of low birthweight was increased in Crohn patients (  odds ratio [OR] = 2.4  ;  CI_95%= 1.6–3.7  ), as was the risk of preterm birth (  OR = 1.6  ;  CI_95%= 1.1–2.3  ).
Conclusions: We found a lower birthweight in newborns of patients with Crohn's disease, indicating that Crohn's disease or its treatment may influence fetal growth.     

Celiac disease and risk of adverse fetal outcome: a population-based cohort study

BACKGROUND & AIMS: Studies of maternal celiac disease (CD) and fetal outcome are inconsistent, and low statistical power is likely to have contributed to this inconsistency. We investigated the risk of adverse outcomes in women with CD diagnosed prior to pregnancy and in women who did not receive a diagnosis of CD until after the delivery. METHODS: A national register-based cohort study restricted to women aged 15-44 years with singleton live born infants was used. We identified 2078 offspring to women who had received a diagnosis of CD (1964-2001): 1149 offspring to women diagnosed prior to birth and 929 offspring to women diagnosed after infant birth. Main outcome measures were: intrauterine growth retardation, low birth weight (<2500 g), very low birth weight (<1500 g), preterm birth (<37 gestational weeks), very preterm birth (<30 gestational weeks), and caesarean section. RESULTS: Undiagnosed CD was associated with an increased risk of intrauterine growth retardation (OR = 1.62; 95% CI: 1.22-2.15), low birth weight (OR = 2.13; 95% CI: 1.66-2.75), very low birth weight (OR = 2.45; 95% CI: 1.35-4.43), preterm birth (OR = 1.71; 95% CI: 1.35-2.17), and caesarean section (OR = 1.82; 95% CI: 1.27-2.60). In contrast, a diagnosis of CD made before the birth was not associated with these adverse fetal outcomes. CONCLUSIONS: Undiagnosed maternal CD is a risk factor for unfavorable fetal outcomes, but the risks are reduced when CD has been diagnosed. CD diagnosed prior to pregnancy does not constitute a great a risk as undiagnosed CD.     

The effect of dual infection with HIV and malaria on pregnancy outcome in western Kenya

OBJECTIVE: To determine the effect of dual infection with HIV and malaria on birth outcomes and maternal anaemia among women delivering at a large public hospital in Kisumu, western Kenya. SUBJECTS AND METHODS: Data on obstetric and neonatal characteristics, maternal and placental parasitaemia, and postpartum haemoglobin levels were collected from women enrolled in a cohort study of the interaction between malaria and HIV during pregnancy. RESULTS: Between 1996 and 1999, data were available from 2466 singleton deliveries. The maternal HIV seroprevalence was 24.3%, and at delivery 22.0% of the women had evidence of malaria. Low birthweight, preterm delivery (PTD), intrauterine growth retardation (IUGR) and maternal anaemia (haemoglobin < 8 g/dl) occurred in 4.6, 6.7, 9.8 and 13.8% of deliveries, respectively. Maternal HIV, in the absence of malaria, was associated with a 99 g (95% CI 52-145) reduction in mean birthweight among all gravidae. Malaria was associated with both IUGR and PTD, resulting in a reduction in mean birthweight of 145 g (95% CI 82-209) among HIV-seronegative and 206 g (95% CI 115-298) among HIV-seropositive primigravidae, but not among multigravidae. Both HIV and malaria were significant risk factors for postpartum maternal anaemia, and HIV-seropositive women with malaria were twice as likely to have anaemia than HIV-seronegative women with or without malaria. CONCLUSION: Women with dual infection are at particular risk of adverse birth outcomes. In areas with a moderate or high prevalence of HIV and malaria, all pregnant women should be the focus of malaria and anaemia control efforts to improve birth outcomes.     

Domestic violence during pregnancy and risk of low birthweight and maternal complications: a prospective cohort study at Mulago Hospital, Uganda

OBJECTIVES: To investigate whether domestic violence during pregnancy is a risk factor for antepartum hospitalization or low birthweight (LBW) delivery. METHODS: A prospective cohort study was conducted in Mulago hospital, Kampala, Uganda, among 612 women recruited in the second pregnancy trimester and followed up to delivery, from May 2004 through July 2005. The exposure (physical, sexual or psychological violence during pregnancy) was assessed using the Abuse Assessment Screen. The relative and attributable risks of LBW and antepartum hospitalization were estimated using multivariate logistic regression analysis. RESULTS: The 169 women [27.7% 95% CI (24.3-31.5%)] who reported domestic violence during pregnancy did not differ significantly from the unexposed regarding sociodemographic characteristics, but differed significantly (P < 0.05) regarding domicile variables (had less household decision-making power, more resided in extended families and more had unplanned pregnancy). They delivered babies with a mean birthweight 2647.5 +/- 604 g, on average 186 g [(95% CI 76-296); P = 0.001] lower than those unexposed. After adjusting for age, parity, number of living children, pregnancy planning, domicile and number of years in marriage, the relative risk (RR) of LBW delivery among women exposed to domestic violence was 3.78 (95% CI 2.86-5.00). Such women had a 37% higher risk of obstetric complications (such as hypertension, premature rupture of membranes and anaemia) that necessitated antepartum hospitalization [RR 1.37 (95% CI 1.01-1.84)]. CONCLUSION: In this pregnancy cohort, domestic violence during pregnancy was a risk factor for LBW delivery and antepartum hospitalization.     

Maternal non-diagnosed celiac disease and risk of low birth weight

AIMS: In order to know the prevalence of celiac disease in mothers with newborns weighing less or more than 2,500 g at birth we carried out a case-control study. PATIENTS: mothers of newborns in Cabue?es Hospital. Case group: Mothers with babies weighing less than 2,500 g at birth. Controls: Mothers with babies weighing more than 2,500 g at birth. One control for each case. METHODS: epidemiological and clinical interviews, and celiac disease serology. RESULTS: We studied 1103 women: 577 cases and 526 controls. We diagnosed 4 celiac disease cases, 2 in the case group and 2 in the control group. These 4 mothers had 3 term newborns (1 case in each 235 mothers; prevalence 0.42%) and 1 preterm newborn (1 case in each 389 mothers; prevalence 0.26%). Two cases had babies with adequate birth weight for their gestational age (1 case in each 419 mothers; prevalence 0.24%) and two cases had babies with low birth weight for their gestational age (1 in each 132 mothers; prevalence 0.75%). The odds ratio for low birth weight was 0.91 (95% CI: 0.12-6.49), the odds ratio for preterm birth was 0.61 (95% CI: 0.06-5.89), ad the odds ratio for low birth weight for gestational age was 3.19 (95% CI: 0.44-22.79).CONCLUSIONS: The prevalence of celiac disease in fertile women in our geographic area was 0.36% (1 case in each 275 mothers), and no differences were found between study groups.     

Pregnancy outcomes among patients with sickle cell disease at Korle-Bu Teaching Hospital, Accra, Ghana: retrospective cohort study

Pregnancy in sickle cell disease (SCD) patients is associated with increased risk of maternal and fetal mortality. This study determines pregnancy outcomes among women with SCD delivering at Korle-Bu Teaching Hospital, Accra, Ghana. Nine hundred sixty (960) medical records of pregnant women (131 HbSS, 112 HbSC, and 717 comparison group) from 2007 to 2008 were reviewed. The HbSS women were at increased risk of eclampsia (adjusted odds ratio [AOR] = 10.56, 95% confidence interval [CI] = 3.60-30.96, P < 0.001), intrauterine growth restriction (AOR = 4.00, 95% CI = 1.38-11.64, P = 0.011), and placenta previa (AOR = 22.03, 95% CI = 9.87-49.14, P < 0.001) compared with the comparison group. The HbSC women had increased risk for intrauterine fetal death (AOR = 3.38, 95% CI = 1.15-9.96, P = 0.027) and decreased risk of delivering low birth weight babies (AOR = 0.21, 95% CI = 0.06-0.73, P = 0.014). Women with SCD in Ghana are at a greater risk of morbidity and mortality in pregnancy compared with women without hemoglobinopathies. Improved maternal and fetal outcomes in Ghanaian women with SCD can be achieved through effective intervention by health care providers with thorough knowledge about predisposing factors toward adverse outcomes.     

Cognitive impairment over the age of 85: hospitalization and mortality

The risks of cognitive impairment among hospitalized patients over age 85 are not adequately understood. We used electronically recorded ICD-9 codes of inpatients over 85 years old to identify patients age > or =85 who showed signs of cognitive impairment during hospitalization at our institution. We randomly selected patient records showing cognitive impairment and patient control records matched for age and admission date but without cognitive impairment and obtained mortality information up to 18 months after discharge. Records were further examined to characterize hospital stay including reason for admission. After adjustment for comorbidities and potential confounders, patients over age 85 with ICD-9-defined cognitive impairment had increased risk of death within the hospital (hazard ratio (HR)=3.99; 95% confidence interval (CI) 0.42-37.90; p=0.229), in the first year after hospitalization (HR=2.35; 95% CI 1.15-4.78; p=0.019), and cumulatively (HR=2.46; 95% CI 1.26-4.82; p=0.009). In this matched cohort of hospitalized patients > or =85 years old, cognitive impairment was associated with an increased mortality rate. Because of this additional risk of death, hospitalized geriatric patients who are cognitively impaired may merit closer monitoring.     

Hospitalization for pneumonia in the Cardiovascular Health Study: incidence, mortality, and influence on longer-term survival

OBJECTIVES: To estimate the rate of hospitalization for pneumonia in community-dwelling older adults and to assess its risk factors and contribution to mortality. DESIGN: Prospective observational study. SETTING: The Cardiovascular Health Study (CHS) in four U.S. communities. PARTICIPANTS: Five thousand eight hundred eighty-eight men and women aged 65 and older who were followed for a median 10.7 years. MEASUREMENTS: Participants were interviewed about medical history and demographics; evaluated for lung, physical, and cognitive function; and followed for hospitalizations, cardiovascular disease, and death. RESULTS: Nearly 10% of the cohort was hospitalized for pneumonia, for a rate of 11.1 per 1,000 person-years (95% confidence interval (CI)=10.2-12.0). Risk factors included older age, male sex, current and past smoking, poor physical and lung function, and history of cardiovascular disease and chronic obstructive pulmonary disease. Ten percent of participants died during their incident pneumonia hospitalization, and death rates were high in those who survived to discharge. Compared with participants who had not been hospitalized for pneumonia, the relative risk of total mortality was 4.9 (95% CI=4.1-6.0) during the first year after hospitalization and 2.6 (95% CI=2.2-3.1) thereafter, adjusted for age, sex, and race. The respective relative risks were 3.9 (95% CI=3.1-4.8) and 2.0 (95% CI=1.6-2.4) after further adjustment for baseline history of cardiovascular disease; diabetes mellitus; smoking; and measures of lung, physical, and cognitive function. CONCLUSION: In older people, hospitalization for pneumonia is common and is associated with an elevated risk of death, as shown in this population-based, prospective cohort.     

Causes of death in patients with celiac disease in a population-based Swedish cohort

BACKGROUND: Patients with celiac disease have an increased risk of death from gastrointestinal malignancies and lymphomas, but little is known about mortality from other causes and few studies have assessed long-term outcomes. METHODS: Nationwide data on 10 032 Swedish patients hospitalized from January 1, 1964, through December 31, 1993, with celiac disease and surviving at least 12 months were linked with the national mortality register. Mortality risks were computed as standardized mortality ratios (SMRs), comparing mortality rates of patients with celiac disease with rates in the general Swedish population. RESULTS: A total of 828 patients with celiac disease died during the follow-up period (1965-1994). For all causes of death combined, mortality risks were significantly elevated: 2.0-fold (95% confidence interval [CI], 1.8-2.1) among all patients with celiac disease and 1.4-fold (95% CI, 1.2-1.6) among patients with celiac disease with no other discharge diagnoses at initial hospitalization. The overall SMR did not differ by sex or calendar year of initial hospitalization, whereas mortality risk in patients hospitalized with celiac disease before the age of 2 years was significantly lower by 60% (95% CI, 0.2-0.8) compared with the same age group of the general population. Mortality risks were elevated for a wide array of diseases, including non-Hodgkin lymphoma (SMR, 11.4), cancer of the small intestine (SMR, 17.3), autoimmune diseases (including rheumatoid arthritis [SMR, 7.3] and diffuse diseases of connective tissue [SMR, 17.0]), allergic disorders (such as asthma [SMR, 2.8]), inflammatory bowel diseases (including ulcerative colitis and Crohn disease [SMR, 70.9]), diabetes mellitus (SMR, 3.0), disorders of immune deficiency (SMR, 20.9), tuberculosis (SMR, 5.9), pneumonia (SMR, 2.9), and nephritis (SMR, 5.4). CONCLUSION: The elevated mortality risk for all causes of death combined reflected, for the most part, disorders characterized by immune dysfunction.     

Infection with HIV as a risk factor for adverse obstetrical outcome

We carried out a case-control study to investigate the role of sexually transmitted diseases (STDs), including infection with HIV, as risk factors for adverse outcome of pregnancy. Overall, 1507 women were enrolled within 24 h of delivery. Cases (n = 796) were mothers of low-birthweight infants (less than 2500 g) or of stillborns. Low-birthweight infants were divided into preterms (n = 373) and neonates small for gestational age (n = 234). Stillborns were separated into intrauterine fetal deaths (n = 120), and intrapartum fetal deaths (n = 69). Controls were selected from mothers delivering a live baby of greater than or equal to 2500 g (n = 711). The maternal HIV seroprevalence in the control group was 3.1%. Prematurity was associated with maternal HIV antibody [8.6% seropositive; adjusted odds ratio (OR) 2.1; 95% confidence interval (CI) 1.1-4.0], as was being born small for gestational age (7.7% seropositive; adjusted OR 2.3; 95% CI 1.2-4.2). In mothers who delivered a stillborn baby, both intrauterine fetal death (11.7% seropositive; adjusted OR 2.7; 95% CI 1.3-5.5) and intrapartum fetal death (11.6% seropositive; adjusted OR 2.9; 95% CI 1.3-6.5) were independently associated with HIV seropositivity in the mother. Maternal syphilis was confirmed as an important risk factor for intrauterine fetal death (14.3% positive; adjusted OR 4.8; 95% CI 2.4-9.5). No significant association was found between other STDs, including gonococcal and chlamydial infection, and adverse obstetrical outcome. These results suggest an association between maternal HIV infection and adverse obstetrical outcome, defined as low birthweight and stillbirth.     

Coeliac disease in the father and risk of adverse pregnancy outcome: a population-based cohort study

OBJECTIVE: The risk of adverse foetal outcomes was investigated in offspring to men with coeliac disease (CD) diagnosed prior to infant birth and in offspring to men who did not receive a diagnosis of CD until after the delivery. MATERIAL AND METHODS: A cohort study was based on national registry data restricted to women aged 15-44 years with singleton live-born infants, with linkage between the Swedish national birth registry (1973-2001) and the national inpatient registry (1964-2001). A total of 1059 offspring to men who had received a diagnosis of CD were included: 554 offspring to men diagnosed prior to birth and 505 offspring to men diagnosed after infant birth. RESULTS: Undiagnosed CD in the father was associated with an increased risk of caesarean section (adjusted odds ratio (AOR)=1.83; 95% confidence interval (CI) for AOR=1.13-2.95; p=0.014) but was otherwise not linked to adverse pregnancy outcome: (intrauterine growth retardation (OR=1.37; 95% CI=0.91-2.07), low birth-weight (OR=1.41; 95% CI=0.93-2.12), very low birth-weight (OR=1.21; 95% CI=0.39-3.77), preterm birth (OR=1.10; 95% CI=0.74-1.62), and very preterm (OR=0.62; 95% CI=0.09-4.40)). A paternal diagnosis of CD made before infant birth was not associated with adverse foetal outcome. CONCLUSIONS: CD in the father is not a risk factor for unfavourable foetal outcome. The increased risk for caesarean section in offspring to men with undiagnosed CD in this study may be due to multiple comparisons.     

Autoimmune diseases in women with Turner's Syndrome

Objective

In terms of number of X chromosomes, women with Turner's syndrome cytogenetically resemble men. An increased risk of autoimmune diseases has been observed among women with Turner's syndrome. This study was undertaken to investigate whether the autoimmune disease profile in women with Turner's syndrome is characterized by diseases with a female or male predominance.

Methods

Using the Danish Cytogenetic Central Register, the Danish National Patient Register, and the Danish Civil Registration System, we estimated relative risk of 46 different autoimmune diseases in a cohort of 798 Danish women with Turner's syndrome followed up for 12,461 person‐years between 1980 and 2004. Standardized incidence ratios (SIRs) of first hospitalization for autoimmune disease and 95% confidence intervals (95% CIs) were used as measures of relative risk.

Results

The overall risk of autoimmune disease among women with Turner's syndrome was twice that among Danish women in general (SIR 2.1 [95% CI 1.6–2.7]). For autoimmune diseases with a female predominance, the SIR among women with Turner's syndrome was 1.7 (95% CI 1.2–2.4), whereas the SIR for autoimmune diseases with a male predominance among these women was 3.9 (95% CI 2.5–5.8). Associations were strongest for Hashimoto thyroiditis (SIR 14.6 [95% CI 6.7–27.1]), a strongly female‐predominant condition, and type 1 diabetes mellitus (SIR 4.1 [95% CI 2.5–6.3]).

Conclusion

Women with Turner's syndrome are at excess risk of autoimmune diseases, notably autoimmune diseases characterized by male predominance.

     

First-year blood pressure increase steepest in low birthweight newborns

AIM: The present research has been undertaken prospectively to study the impact of birthweight and growth pattern on blood pressure changes from birth through the first year of life. METHODS: Parents of newborns born at term (gestational age > 37 weeks) after uncomplicated pregnancies and in the absence of perinatal illness were randomly invited to allow their children to participate in the study. One hundred and forty-nine (84 male and 65 female) newborns were included in the present analysis. The newborns were divided into four groups according to birthweight: < 2500 g (n = 23); 2500-2999 g (n = 39); 3000-3500 g (n = 48); and > 3500 g (n = 39). RESULTS: At birth systolic and diastolic blood pressure were significantly lower and heart rate was significantly higher in those children with the lowest birthweight as compared to those in the other groups. During the first month of life a significant trend, inversely related to birthweight, was present for systolic as well as diastolic blood pressure. After the first month of life, at 3, 6, 9 and at 12 months, systolic and diastolic blood pressure were similar across birthweight groups. In a multiple regression analysis, birthweight was a positive independent determinant of systolic blood pressure at birth and an inverse independent determinant of the increment of systolic blood pressure during the first month of life and of the systolic blood pressure at the end of the first year. CONCLUSIONS: In summary, the present study goes further towards understanding blood pressure changes in low birthweight babies. Beginning at birth, both blood pressure values, as well as changes in blood pressure, provide information about the impact of intrauterine life on the risk of developing hypertension later in life.     

Birthweight of offspring and paternal insulin resistance and paternal diabetes in late adulthood: cross sectional survey

Aims/hypothesis It has been proposed that genetic factors involved in insulin action could explain part of the link between low birthweight and risk of cardiovascular disease and diabetes in adulthood. To confirm this we examined the association between offspring birthweight and paternal insulin resistance and diabetes in late adulthood.Methods We did a cross-sectional survey of 4252 men who were 60 to 79 years of age and from 24 British towns. Of these, 2788 men provided details of their offsprings birthweight and sex.Results Offspring birthweight was inversely associated with paternal insulin resistance defined by the homeostasis model assessment (HOMA) score and with Type 2 diabetes in late adulthood. Fathers of offspring in the highest quartile of sex-standardised birthweight SD scores had a 34% reduction in odds of having a high HOMA insulin resistance score (OR=0.66, 95% CI: 0.47 to 0.92) compared with fathers of offspring in the lowest quartile after adjustment for potential confounders. A stronger inverse association was seen between offspring birthweight and risk of paternal diabetes (adjusted OR=0.59, 95% CI: 0.39 to 0.88 top quartile vs lowest quartile). For each increase of offspring-birthweight SD score the odds of high HOMA scores decreased by 13% (OR=0.87, 95% CI: 0.78 to 0.98) and the odds for diabetes by 17% (OR=0.83, 95% CI: 0.72 to 0.95), after full adjustment.Conclusions/interpretation Offspring birthweight is inversely associated with paternal insulin resistance and diabetes in late adulthood, supporting the hypothesis that genetic factors related to insulin action contribute to the association between birthweight and adult cardiovascular disease and diabetes risk.Abbreviations HOMA homeostasis model assessment - OR odds ratio - Q questionnaire     

Association between genetic variation in the gene for insulin-like growth factor-I and low birthweight

Low birthweight is associated with later risk of type 2 diabetes and related disorders. We aimed to show that a polymorphism in the gene for insulin-like growth factor-I, which has proved to raise risk of type 2 diabetes and myocardial infarction, is associated with low birthweight. We recorded birthweight and obtained DNA for 463 adults. Individuals who did not have the wild-type allele of the polymorphism had a 215 g lower birthweight than those homozygous for this allele (95% CI -411 to -10). Our data lend support to the hypothesis that genetic variation affecting fetal growth could account for the association between low birthweight and susceptibility to diabetes and cardiovascular disease in later life.     

Hospitalization and development of dependence in activities of daily living in a cohort of disabled older women: the Women's Health and Aging Study I

BACKGROUND: Changes in self-reported function in older adults are known to occur in the 2 weeks prior to, during, and in the first few months after hospitalization. The long-term outcome of hospitalization on functional status in disabled older adults is not known. The objective of this study was to determine whether hospitalization predicts long-term Activities of Daily Living (ADL) dependence in previously ADL independent, although disabled, older women. METHODS: The Women's Health and Aging Study I is a population-based, prospective cohort study of disabled, community-dwelling women > or =65 years old. We evaluated participants who were independent in ADLs at baseline and excluded women with incident stroke, lower extremity joint surgery, amputation, or hip fracture. We examined the association between self-reported incident hospitalization at three consecutive 6-month intervals and incident dependence in at least one ADL at 18 months (n = 595). RESULTS: Of 595 women evaluated, 32% had at least one hospitalization. Women who were hospitalized were more likely to become dependent in ADLs than were women who were not hospitalized (17% vs 8%, p =.001). In a multivariate model, hospitalization was independently predictive of development of ADL dependence that persisted at 18 months after baseline (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.7-5.8), adjusting for age, race, education, baseline walking speed, difficulty with ADLs, self-reported health status, depressive symptoms, cognitive status, and presence of congestive heart failure, diabetes, or pulmonary disease. Increasing numbers of 6-month intervals with hospitalizations were independently predictive of higher risk in an adjusted model: one (OR, 2.3; 95% CI, 1.1-4.6), two (OR, 5.8; 95% CI, 2.4-14.4), and three (OR, 12.5; 95% CI, 2.7-57.6). CONCLUSIONS: These results suggest that hospitalization has an independent and dose-response effect on loss of ADL independence in disabled older women over an 18-month period.     

Malaria infection during pregnancy: intrauterine growth retardation and preterm delivery in Malawi

In sub-Saharan Africa, malaria infection in pregnancy contributes to low birth weight through intrauterine growth retardation (IUGR) and preterm delivery (PTD). It was hypothesized that malaria-associated PTD and IUGR have differing etiologies due to timing of infection. In a prospective cohort of primigravid women enrolled at the antenatal clinic of Mangochi District Hospital in Malawi, the associations were investigated between antenatal or delivery parasitemias and IUGR or PTD. Among 178 singleton deliveries, 35% of infants were preterm or had IUGR. Cord blood parasitemia (odds ratio [OR]=3.34; 95% confidence interval [CI], 1.3-8.8], placental parasitemia (OR=2.43; 95% CI, 1.2-5.1), and postdelivery maternal peripheral parasitemia (OR=2.78; 95% CI, 1.3-6.1) were associated with PTD. Parasitemia and/or clinically diagnosed malaria in the antenatal period was associated with IUGR (OR=5.13; 95% CI, 1.4-19.4). Delivery parasitemias had borderline associations with IUGR. The risk patterns observed suggest that the timing and severity of infection influences the occurrence of IUGR or PTD.     

Influence of the factor V Leiden mutation on infectious disease susceptibility and outcome: a population-based study

BACKGROUND: The effect of the coagulation factor V Leiden mutation on infectious disease susceptibility and outcome is controversial. METHODS: We genotyped 9253 individuals from the Copenhagen City Heart Study for the factor V Leiden mutation. The risk of hospitalization for any infectious disease during a follow-up period of 7.2 years and subsequent risk of disease progression to death were estimated by Cox proportional-hazards regression analysis. RESULTS: During 66,789 person-years of follow-up, 1093 persons were hospitalized because of infection. The risk of urinary-tract infection was decreased in factor V Leiden heterozygotes, compared with that in noncarriers (adjusted relative risk [aRR], 0.55 [95% confidence interval [CI], 0.31-0.99]), whereas the risk of skin infection was increased (aRR, 1.68 [95% CI, 1.07-2.66]). No associations between carrier status and risk of diarrheal disease, other viral infections, parasitic infections, pneumonia, sepsis, or upper respiratory-tract infection were detected. However, in subjects hospitalized for sepsis, factor V Leiden carriers were at an increased risk of mortality 28 days after admission, compared with noncarriers (aRR, 4.41; 95% CI, 1.42-13.67]). CONCLUSION: In the Danish general population, the factor V Leiden mutation may be associated with infectious disease susceptibility and an increased risk of mortality from sepsis.