Maternal Vitamin D Status During Pregnancy and Bone Mass in Offspring at 20 Years of Age: A Prospective Cohort Study

It is uncertain whether the vitamin D status of pregnant women influences bone mass of their children. Cohort studies have yielded conflicting results; none have examined offspring at skeletal maturity. This longitudinal, prospective study investigated the association between maternal vitamin D status and peak bone mass of offspring in 341 mother and offspring pairs in the Western Australian Pregnancy Cohort (Raine) Study. Maternal serum samples collected at 18 weeks gestation were assayed for 25‐hydroxyvitamin D (25OHD). Outcomes were total body bone mineral content (BMC) and bone mineral density (BMD) measured by dual‐energy X‐ray absorptiometry in offspring at 20 years of age. The mean (± SD) maternal serum 25OHD concentration was 57.2 ± 19.2 nmol/L; 132 women (38.7%) were vitamin D‐deficient (25OHD <50 nmol/L). After adjustment for season of sample collection, maternal factors, and offspring factors (sex, birth weight, and age, height, lean mass, and fat mass at 20 years), maternal 25OHD concentration was positively associated with total body BMC and BMD in offspring, with a mean difference of 19.2 (95% confidence interval [CI], 5.6–32.7) g for BMC and 4.6 (95% CI, 0.1–9.1) mg/cm² for BMD per 10.0 nmol/L of maternal 25OHD. Maternal vitamin D deficiency was associated with 2.7% lower total body BMC (mean ± SE) (2846 ± 20 versus 2924 ± 16 g, p = 0.004) and 1.7% lower total body BMD (1053 ± 7 versus 1071 ± 5 mg/cm², p = 0.043) in the offspring. We conclude that vitamin D deficiency in pregnant women is associated with lower peak bone mass in their children. This may increase fracture risk in the offspring in later life. © 2014 American Society for Bone and Mineral Research.     

Outcome of pregnancy in women treated with all-trans retinoic acid; A case report and review of literature

Abstract

All-trans-retinoic acid (ATRA) has been proved to be an effective treatment for acute promyelocytic leukemia (APL), inducing remission in more than 90% of cases. Treatment of APL in pregnancy is controversial as the use of ATRA has been questioned due to the teratogenic effect of retinoids. We report a case of pregnancy in a woman exposed to ATRA during the first trimester. The baby was born healthy, without any anomalies. Review of all reported cases of the use of ATRA in pregnancy revealed no serious adverse outcomes or congenital anomalies although only very few cases had exposure in the first trimester.     

短串联重复序列聚合酶链反应产前诊断多胎妊娠合子性质及常见染色体三体

目的 产前诊断多胎妊娠的合子性质并检测染色体21三体、18三体、13三体和性染色体三体异常。方法 选择因各种指征产前诊断或拟行选择性减胎的多胎妊娠17例38个胎儿,抽取羊水或脐血及其父母外周血,采用短串联重复序列聚合酶链反应(short tandem repeat and polymerase chain reaction,STR-PCR)技术检查胎儿的合子性质,同时检查有无上述染色体异常;选择18个单胎妊娠产前诊断胎儿及其父母的样本,作为染色体三体检测的对照组。结果 7例体外受精胚胎移植的多胎妊娠均为多合子;7例伴有1胎畸形的多胎妊娠,仅1例为双合子双胎。本组多胎妊娠胎儿未发现有上述染色体三体异常。对4例多合子多胎于妊娠中期行减胎术,预后良好。结论 STR-PCR技术可快速、准确鉴定多胎合子性质,同时诊断胎儿染色体三体,有助于多胎妊娠的产前监测;当出现1胎畸形和拟行减胎术时,有助于选择处理方式。     

Chlamydia trachomatis infections – a major concern for reproductive health. Where do we stand regarding epidemiology,pathogenesis, diagnosis and therapy?

The current article deals with the problem of distinguishing between relapse and reinfection of genital chlamydial infections due to the chronic character of such infections. The problem of detecting and treating chlamydial pelvic inflammatory disease is considered. Factors that may affect the clinical presentation of such infections, such as hormonal therapy, are also highlighted. Observations on novel manifestations of Chlamydia trachomatis infections, such as spontaneous abortion, prematurity and intrauterine infections as well as a statistical correlation of a certain serovar to cervical cancer, are described. The representivity of the data on infections with C. trachomatis monitored in national surveillance programs is questioned. The paper also elaborates on which type of sample, sample site and detection method may be optimal for the diagnosis of such infections in women. Whether to screen at clinics and self-sampling at home of specimens from an index case and a sexual partner to be mailed to a laboratory for testing is discussed. Whether or not females are more susceptible to genital chlamydial infections and their sequelae than males is also discussed. The effectiveness of recommended antibiotic regimens is considered, e.g. in relation to the recent detection of the existence of strains of C. trachomatis that show heterotypic resistance to drugs commonly used for their treatment.     

Knowledge and use of emergency contraception in a tertiary referral unit in a developing country

Background: The promotion and availability of emergency contraception have the possibility of reducing the number of unwanted pregnancies, leading to fewer pregnancy terminations and possibly to reduced maternal morbidity and mortality.Methods: The aims of the study were to determine the knowledge and use of emergency contraception in two groups of women: those requesting emergency contraception after sexual misadventure and another group of women requesting termination of pregnancy. A retrospective analysis was performed on all files of patients who requested emergency contraception over a 12-month period. Telephone interviews were conducted 1 year later. Structured questionnaires regarding knowledge and usage of emergency contraception were also administered to patients requesting termination of pregnancy. Results: Seventy-six women requested emergency contraception over the 12-month period. Forty-one (53.9%) did not attend the follow-up visit. Only two patients used condoms. A total of 39 patients were contacted by telephone after 1 year. Of these, 18 did not use any contraception, although five were sexually active. In the group of women who requested termination of pregnancy, 44% had not previously used contraception. In all, 40% did not know about emergency contraception, 36% had not used it previously and 24% had used it previously. Conclusions: Lack of knowledge concerning emergency contraception can contribute to the number of legal abortions requested. There is an urgent need to address current education for users and providers on the use of emergency contraception.     

Limb–body wall complex: a case series

Objective: Limb-body wall complex (LBWC) is a rare fetal polymalformation of uncertain etiology, but it has been regarded as sporadic in nature with a low recurrence risk. We review a case series in light of recent evidence about possible genetic and environmental associations. Methods: All abortions or births coded as limb-body wall defect or fetal acrania/exencephaly or with unclassified polymalformation between January 1996 and January 2001 were audited. Results: During the 5-year period there were 33 286 live births in our region. Eleven cases met the criteria of LBWC giving an incidence of 0.33/1000 live births. In 50%, 50% and 30% of women a history of cigarette, alcohol and marijuana use, respectively, was noted. Furthermore, 40% of the women had a history of a previous infant with a congenital anomaly. One patient delivered two consecutive male infants with LBWC. Conclusions: Whilst the majority of cases of LBWC are sporadic, some women may have an underlying genetic predisposition. It may be prudent to advise against the use of alcohol, cigarettes and other drugs and to offer an ultrasound scan in a tertiary referral center in a subsequent pregnancy.     

Obstetric morbidity and socio-demographic factors in rural West Bengal,India

The impact of selected socio-demographic factors on reported obstetric morbidity during antepartum and postpartum periods was studied through a cross-sectional retrospective survey carried out in rural areas of three districts of West Bengal, India. During their most recent live births, 56.6% of mothers reported at least one morbid condition. Mothers with higher levels of education reported fewer overall problems. Factors such as age and pregnancy order affect obstetric morbidity differently in different religious groups. More mothers reported postpartum than antepartum problems, and very few sought treatment. The present study provides an insight into various factors affecting obstetric morbidity in a developing country.     

Associations of Fertility and Pregnancy Outcomes with Leather Tannery Work in Mongolia

Abstract

To our knowledge, reproductive health effects among male leather tannery workers have not been previously investigated. Tannery work involves exposure to chromium, solvents, and other chemicals, which has been associated with adverse pregnancy and fertility outcomes in animals or humans in some studies. This study retrospectively investigates the association of male leather tannery work with preterm delivery, spontaneous abortion, time to pregnancy, and infertility by comparing tannery employees to other workers in Ulaanbaatar, Mongolia. Participants were randomly selected from current employee rosters at eight tanneries and two bread-making companies. The results of this research suggest that tannery work may be associated with reduced fertility in males. The study had limited statistical power, and some factors are likely to have biased findings toward the null hypothesis; other limitations and possible sources of undetermined bias give reason for cautious interpretation. Additional studies should be conducted to further examine fertility among tannery workers.     

Placenta increta; conservative management – a successful outcome. Case report and literature review

Placenta increta, a rare complication of pregnancy, is associated with significant postpartum hemorrhage often requiring emergency hysterectomy. We report a case of conservative management, with a combination of parenteral methotrexate, serial ultrasound and Doppler assessment, followed by interval manual removal of placenta.     

安胎清肝法治疗妊娠期慢性乙型病毒性肝炎的临床研究

目的 观察安胎清肝方药治疗妊娠期慢性乙型病毒性肝炎的疗效。方法 选择胎药菟丝子，黄芪，黄芩等和清肝药叶下珠，蒲公英等组成安胎清肝方治疗妊娠期慢性乙型病毒性肝炎50例，观察治疗后妊娠情况，肝功能，乙肝病毒标志物和肝纤维化指标的变化。结果 经治疗后无1例出现流产，谷丙转氨酶，血清胆红素，血清透明质酸等均明显降低，与治疗前比较，差异均有显著性（P＜0．01）；HBeAg和HBV－DNA的阴转率分别达到30％和32．5％。结论 安胎清肝法对妊娠期慢性乙型病毒性肝炎有较好的保胎，护肝作用。