Search

Objective: Ultrasound estimation of amniotic fluid volume (AFI) is a critical component of antenatal surveillance. Alterations in AFI have classically been considered an indication of fetal compromise, but recent studies have called this into question. The present study was undertaken to reevaluate the relationship between AFI and perinatal outcome., Study Design: The perinatal data base of the authors' institution was queried for all patients in a 6-year period who had AFI evaluated. Two groups, 1 high-risk and 1 low-risk, were evaluated to determine the relationship between AFI and gestational age. An additional high-risk group that had AFI determined within 48 hours of delivery was also used to correlate AFI with intrapartum and perinatal outcomes. Statistical analysis was performed using linear regression analysis to evaluate the correlation between AFI and gestational age or birth weight. Additional correlations were done using analysis of variance, chi-square, Fisher exact test, or Student t test. Interaction between variables was analyses using logistic regression analysis., Results: Fourteen thousand seven hundred forty-seven AFI determinations in 4337 high-risk patients, and 1153 AFI determinations in 1153 low-risk patients were evaluated. There were no clinically significant correlations between AFI and gestational age. In the second high-risk group of 454 patients there was a significant correlation between polyhydramnios and large-for-gestational age infants, congenital anomalies, and an increase in cesarean section for delivery. There was an increased risk of nonreassuring fetal heart rate patterns during labor for the oligohydramnios patient, but only in preterm patients. There was no strong relationship between AFI and neonatal complications or length of stay in the neonatal intensive care unit. Logistic regression confirmed that AFI was not significantly correlated with perinatal outcome., Conclusion: The present study suggests that AFI is a weaker predictor of perinatal outcome than has been classically suggested. Although the AFI identification of polyhydramnios was helpful in identifying LGA fetuses and fetuses at risk for congenital abnormalities, oligohydramnios was a rather weak predictor of poor perinatal outcome.

Objective: This study was conducted to identify all risk factors that are associated with microcephaly and to quantify the magnitude of risk that is associated with these factors., Study Design: This population-based case-control study used the Missouri Birth Defects Registry to identify 360 microcephaly cases and 3600 control cases during 1993 through 1999. Logistic regression was used to calculate adjusted odds ratios and 95% CIs., Results: Significant risk factors for isolated microcephaly include alcohol use, inadequate weight gain during pregnancy, inadequate prenatal care, black race, and low education. Mothers with one previous live birth were protected against isolated microcephaly compared with nulliparous women., Conclusion: Our results suggest that microcephaly may arise from some preventable factors. These findings may be useful in aiding clinicians, patients, and policymakers in reducing the risk of microcephaly, a source of high perinatal mortality and morbidity rates.

Objective: The purpose of this study was to evaluate the association between the prevalence of birth defects among maternal and paternal occupation groups in Singapore for live births between January 1, 1994, and December 31, 1998, and to determine whether there are certain demographic risk factors and maternal and/or paternal occupation groups that are associated with an increased risk for birth defects versus chromosomal single birth defect, nonchromosomal single birth defect, and multiple birth defects., Study Design: This was a retrospective study. Information on live births (Singapore National Registry of Births and Deaths) and birth defect cases (National Birth Defects Register) were studied. Other information included the mother's date of birth, ethnic group, highest educational qualification, and the occupation of the mother and the father. Cox regression analysis was used to determine whether certain demographic and occupational factors were associated with the three groups of birth defects., Results: Of a total of 237,755 live births, there were 3276 birth defect cases (nonchromosomal single birth defect, 1869 cases; chromosomal single birth defect, 197 cases; and multiple birth defects, 1210 cases). Increased risks for all types of birth defects were observed with advancing gestational age. Occurrence of nonchromosomal single birth defect and multiple birth defects were significantly higher for multiple births compared to singleton births. Significant associations were found with the use of "legislators, senior officers, and managers" as reference: Maternal occupation of "cleaners, laborers, and related workers" with chromosomal single birth defect anomalies (adjusted risk ratio, 4.86; 95% CI, 1.07-22.14); paternal occupation of "plant and machine operators and assemblers" (adjusted risk ratio, 1.50; 95% CI, 1.14-1.98) with nonchromosomal single birth defect; "production craftsmen and related workers" and "cleaners and laborers and related workers" with nonchromosomal single birth defect (adjusted risk ratio, 1.42; 95% CI, 1.10-1.82; and adjusted risk ratio, 1.43; 95% CI, 1.07-1.91 respectively); and multiple birth defects (adjusted risk ratio, 1.42; 95% CI, 1.03-1.94; and adjusted risk ratio, 1.47; 95% CI, 1.03-2.09, respectively)., Conclusion: Maternal delivery age is an important risk factor for all birth defects. Mothers and fathers who work as "cleaners and laborers and related workers" appear to have a higher risk of giving birth to children with chromosomal single birth defect and nonchromosomal single birth defect and multiple birth defects, respectively. Further in-depth study would be needed to confirm these observations.

Objectives: We sought to determine the types of congenital anomalies affecting infants of women with gestational diabetes mellitus or type 2 diabetes and to examine the relationship between those malformation types and measures of initial glycemia of women at entry into prenatal care with type 2 diabetes or at time of diagnosis in women with gestational diabetes mellitus., Study Design: A total of 4,180 pregnancies complicated by gestational diabetes mellitus (n = 3764) or type 2 diabetes (n = 416) that were delivered after 20 weeks of gestation were reviewed for the presence of congenital malformations diagnosed before hospital discharge. Anomalies were categorized as being absent, minor, major, genetic syndromes, or aneuploidies. Major anomalies were further categorized by the number and type of affected organ systems. In addition to maternal clinical and historical parameters, the initial fasting serum glucose either from the diagnostic glucose tolerance test (gestational diabetes mellitus) or at entry to prenatal care (type 2 diabetes) and the initial glycosylated hemoglobin before insulin therapy were examined for a relationship to anomalies., Results: The initial fasting serum glucose and glycosylated hemoglobin levels were significantly higher in pregnancies with major (n = 143) and minor (n = 112) anomalies and genetic syndromes (n = 9) compared with pregnancies with no anomalies (n = 3895). Of those pregnancies with major anomalies, the most commonly affected organ systems were the cardiac (37.6%), musculoskeletal (14.7%), and central nervous systems (9.8%) and anomalies involving multiple organ systems (16%). There was no increased predominance of any specific organ system involvement seen with increasing fasting serum glucose levels in pregnancies with major congenital anomalies. Pregnancies with major anomalies affecting multiple organ systems had significantly higher initial fasting serum glucose levels (166 +/- 64 mg/dL) compared with pregnancies in which one organ system was affected (141 +/- 55 mg/dL, P <.04) or no organ systems were affected (115 +/- 38 mg/dL, P <.0001)., Conclusion: Congenital anomalies in offspring of women with gestational and type 2 diabetes affect the same organ systems that have been previously described in pregnancies complicated by type 1 diabetes. Increasing hyperglycemia at diagnosis or presentation for care was associated with an increasing risk of anomalies in general and with anomalies involving multiple organ systems without a preferential increase in involvement of specific organ system.

Congenital malformations are the leading cause of the increased perinatal mortality in the infants of insulin-dependent diabetic mothers. The mechanisms(s) of diabetic teratologic development has yet to be defined. Hyperglycemia is known to depress aerobic metabolism in many organisms and cell lines. Reid hypothesized that exposure to hyperglycemia could result in decreased mitochondrial biogenesis in embryonic cells. Should these cells suddenly be changed to an environment of lower glucose concentration, decreased energy capabilities would exist until sufficient numbers of mitochondria could be regenerated. Such cells may not be capable of meeting temporal-spatial requirements, thereby resulting in structural abnormalities. In our study the explanted rat embryo model demonstrated that in the head-fold region hyperglycemia produced morphologic alterations of mitochondria but no difference in the number of mitochondria per cell. Specifically, embryos cultured in euglycemia demonstrated orthodox mitochondrial configuration, whereas those cultured in hyperglycemia had mitochondria in a condensed configuration. These findings were reversible. A modification of Reid's original hypothesis may provide an explanation for the mechanism of diabetic teratologic development.

Fetal compromise has been associated with an umbilical artery waveform pattern of low or absent diastolic velocity relative to systolic velocity. Fetuses with single umbilical arteries have an increased risk of major malformations, mortality, retarded fetal growth, and prematurity. In this study Doppler flow velocities were obtained in 13 fetuses (four twin fetuses and nine singletons) with a single umbilical artery. Five (38%) fetuses, consisting of four singletons and one twin, had anomalies. Six (46%) fetuses were small for gestational age, including two twin fetuses and three singleton fetuses with anomalies. Three (23%) of the 13 systolic-to-diastolic velocity ratios were abnormally high. Whereas this is a higher rate of abnormal ratios than the reported 2% to 3% in control populations, it is interesting to note that 77% of fetuses with single umbilical arteries had normal systolic-to-diastolic ratios.

The sacral agenesis syndrome is a severe congenital abnormality consisting of agenesis of the lumbar spine, sacrum, and coccyx, as well as hypoplasia of the lower extremities. It is considered the most characteristic of all congenital anomalies associated with maternal diabetes mellitus. We describe the sonographic and radiologic findings of agenesis of the lumbosacrococcygeal spine with lower limb and genital hypoplasia in the offspring of a woman with both diabetic retinopathy and nephropathy. The diagnosis was established at 25 weeks' gestation and was confirmed by radiologic evaluation of the neonate.

Decisions in regard to the management of patients with premature rupture of the membranes depend on the relative risks of prematurity, infection, and hypoxia for the fetus or neonate and infection and cesarean section for the mother. These risks vary primarily with gestational age. Because of the many variables and new technologies involved, the management of these patients is extremely controversial. In this article, the controversies are reviewed and management plans are presented for several different gestational age groups.

Evidence supports the idea that it is the degree of metabolic imbalance present in diabetic gravid women during the period of organogenesis that accounts for organogenetic congenital defects. In light of the proved and inferred metabolic instability occurring during early pregnancy, we propose that metabolic imbalances may occur that result in organogenetic congenital defects in offspring of apparently normal gravid women.

In an unselected and consecutive series of 1858 newborn infants of diabetic mothers, born in the Rigshospital, Copenhagen, in the period 1967 to 1986, congenital malformations were studied. The malformation rate in White Classes B to F was remarkably constant from 1967 to 1981, but a significant decrease in major congenital malformations was found in the period 1982 to 1986 versus 1977 to 1981 (2.7% vs. 7.4%, p less than 0.05). This decrease was mainly due to a fourfold decline in major congenital malformations in White Classes D and F (p less than 0.01), and consequently a correlation between the severity of maternal diabetes and the frequency of congenital malformations was no longer present. In the offspring of a control group of 1715 nondiabetic women, major congenital malformations were found in 1.7% (p greater than 0.05). Seventy-five percent of the diabetic pregnancies were planned, and in these pregnancies only 1% of the infants had major congenital malformations. The frequency of fatal malformations in White Classes B to F was still significantly higher than in the control group (p less than 0.001).

Previous studies have documented an increased incidence of structural defects in association with velamentous and marginal insertion of the umbilical cord. Evaluation of 4,677 consecutive placentas at the University of California (San Diego) Medical Center revealed 454 marginal insertions and 72 velamentous insertions. An increased incidence of structural defects was found only in association with a velamentous cord insertion. Delineation of the structural defects according to their developmental pathogenesis revealed that the majority were due to deformation of a normally formed part. These data and the finding of a disproportionate number of twins with a velamentous insertion suggest that competition for space at the implantation site leads to both the velamentous insertion of the cord and the associated structural defects.