Adverse Pregnancy History Research Articles

A novel mutation within intron 17 of the CUL7 gene results in appearance of premature termination codon

A couple with five adverse pregnancy history required prenatal diagnosis. The fetus of this study was their fifth pregnancy. The fetus was found NT thickening at 12 weeks and 4 days gestation and the average long bone of limbs retardation 4SD at 27 weeks and 4 days gestation. Karyotype was normal. The next-generation sequencing (NGS) and Sanger sequencing were conducted of this fetus. The compound heterozygous mutations c.3722_3749dup[p.V1252fs*23] and c.3355 + 5 G > A at CUL7 gene were detected. The mutation c.3355 + 5 G > A was a novel mutation within intron 17 of the CUL7 gene. Minigene array was used to verify whether the novel mutation c.3355 + 5 G > A really affected the splicing of CUL7gene. The results showed that the mutation could result in the appearance of premature termination codon. The fetus could be diagnosed as 3 M syndrome. We suggested that close attention needed to be paid to fetuses with intrauterine growth restriction only by ultrasonic and avoid misdiagnosis and missed diagnosis of 3 M syndrome. In addition, our study enriched gene mutations of 3 M syndrome.

Prenatal diagnosis of maternal partial trisomy 9p23p24.3 and 14q11.2q21.3 in a fetus: a case report

ObjectiveThis study aimed to report a fetus with maternal partial trisomy 9p and 14q and the phenotype detected in ultrasound.MethodsThe chromosome rearrangements in the fetus were characterized by G-banding and chromosome microarray analysis based on single nucleotide polymorphism (SNP) array of cultured amniocytes and compared with the parents’ karyotypes.ResultsThe fetal abnormal karyotype was 47,XY,+der(14)(9;14)(p23;q22). The SNP array revealed a duplicate 11.8-Mb 9p23-p24.3 fragment and a duplicate 29.6-Mb 14q11.2-q21.3 fragment. The peripheral blood karyotype of the mother was 46,XX,t(9;14)(p23;q22), while the father’s was normal at the level of 300~400 bands. A high-resolution karyotype analysis conformed the same abnormality of the mother at the level of 550~650 bands. These results indicated that the fetal chromosomal abnormality probably derived from the mother. The fetal nuchal translucency thickness was 3.5 mm, and the fetal heart was detected with around 1.0-mm ventricular defect by the ultrasound examination at 12-week gestation. The couple decided to terminate the pregnancy. They opted for in vitro fertilization and embryo transfer for the fourth pregnancy, which was successful.ConclusionsThe SNP array combined with cytogenetic analysis was particularly effective in identifying abnormal chromosomal rearrangements. These methods combined with the existing database information and fetal ultrasonography might provide a comprehensive and efficient way for the prenatal assessment of fetal situations. Preimplantation genetic diagnosis might effectively assist those women with an adverse pregnancy history in their next pregnancy.

Effect of flexible patterns of health education on enhancing the compliance of pregnant women from Tibet, China.

Prenatal examination is a pivotal measure to prevent high-risk pregnancy and to ensure the safety of both mother and infant. However, pregnant women in Linzhi Prefecture in the Tibet Autonomous Region (TAR) often cannot obtain regular prenatal examinations due to limited accessibility of healthcare facilities, shortage of medical staff, and lack of medical equipment. Health education is an important approach to solve this ever-growing issue of pregnant women in rural Tibet.To evaluate the efficacy of flexible methods of health education programs on improving compliance among pregnant women from Tibet, China.In May to November of 2018, a total of 168 pregnant women receiving prenatal examination in a tertiary referral hospital in Linzhi Prefecture were recruited and randomly assigned to a control (n = 85) and intervention group (n = 83). All pregnant women were followed up until delivery. The pregnant women in the control group received regular prenatal examination and health education programs. Other than receiving routine prenatal care, participants of the interventional group also voluntarily joined the WeChat Social Messaging platform. Online resources posted by the maternity schools provided convenience and flexibility for the pregnant woman. The number of prenatal examinations was statistically significant between the 2 groups. The effect of flexible patterns of health education programs on improving the compliance of pregnant women in Tibet was assessed.The number of prenatal examinations in the intervention group was 2.646 times, which was higher than that in the control group (P < .01). Multivariate analysis demonstrated that interventional measures and ethnicity were the influencing factors of the number of prenatal examinations for pregnant women in Linzhi after the adjustment of age, history of adverse pregnancy, education level, ethnicity, multiparity, gestational complications, and medical history. The number of prenatal examinations for the pregnant Tibetan women was 0.535 times lower compared with that of the pregnant Han women (95% CI: –0.089, 1.157, P = .091).Flexible forms of health education during the antenatal period can effectively increase the compliance of pregnant women in Tibet.

Indications of percutaneous umbilical cord blood sampling in prenatal diagnosis

Objective To investigate the tendency and safety of percutaneous umbilical cord blood sampling (PUBS) in prenatal screening and diagnosis, and the possibilities of avoiding unnecessary PUBS. Methods This was a retrospective study of pregnant women who underwent PUBS for prenatal diagnosis in Peking University First Hospital from January 2015 to December 2017. Clinical indications, timing of PUBS, further investigations (chromosome karyotype, molecular genetics and pathogen testing), results, and pregnancy outcomes were collected and analyzed. One-way analysis of variance (ANOVA), Chi-square test for linear trend, Fisher's exact probability test/Cochran-Armitage analysis and Cruskal-Wallis rank-sum test were used for statistical analysis. Results (1) A total of 412 singleton pregnancies underwent PUBS at 20-38 gestational weeks during the study period, and 379 (92.2%) of them received PUBS before 34 gestational weeks. The positive test results accounted for 10.4% (43/412). There were six (1.5%) miscarriages after PUBS. In vitro cell culture failure occurred in two cases, one in 2015 and the other in 2016. (2) Among the 412 cases, 304 (73.8%) had only one indication. Fourteen cases could be identified as high risk in the first trimester, such as advanced maternal age (AMA, >35 years), pregnant history with chromosomal abnormal fetus and one of the couples carrying abnormal genes. There were four, zero and one case receiving PUBS only for AMA in 2015, 2016 and 2017, respectively. Indications, including high risk suggested by serum screening and fetal abnormality found by ultrasound were identified in 290 cases (70.4%) in the second or third trimester. Other than AMA, there were no statistically significant differences in single indicators. The proportion PUBS with double indicators increased from 2015 to 2017 but without significant difference. AMA and positive serum screening as indicators of aneuploidy screening accounted for 7.6% (8/105) in double-indicator group and 1.9% (8/412) in all. (3) There were 363 PUBS (88.1%) performed for ultrasound abnormalities. Among them, 76.9% (280/363) only had abnormal ultrasound findings, and the percentage was decreased year by year. The other 83 cases (80 with double indicators and three with triple indicators) also presented with other indicators, including AMA, adverse pregnancy history and positive serum screening. The proportion of PUBS performed with the presence of multiple indicators tended to increase recently, but no statistically significant difference was found. All the 18 cases with abnormality diagnosed by molecular genetic testing had abnormal ultrasound findings. Conclusions Although PUBS's complications are rare, it carries some risks. The constitution of single indication has been declined every year. With the improvement of prenatal screening system and application of molecular karyotyping, the necessity of invasive prenatal diagnosis with PUBS is greatly reduced. An improvement in reasonable and standardized application of PUBS needs to be achieved. Key words: Prenatal diagnosis; Phlebotomy; Blood specimen collection; Umbilical veins

Status of demand and influencing factors in women with advanced maternal age during their second pregnancy

Objective To explore status of demand and influencing factors in women with high maternal age during their second pregnancy. Methods By convenience sampling, a total of 362 pregnant women who underwent antenatal examination at the outpatient department of a ClassⅢ Grade A hospital from March to September of 2017. General Information Questionnaire, Demands Scale of Women of Advanced Maternal Age during Second Pregnancy were used in the study. A total of 362 questionnaires were distributed and 350 valid ones were retrieved, yielding an effective recovery rate of 96.7%. Results The total score of Demands Scale of Women of Advanced Maternal Age during Second Pregnancy was (68.89±3.85) , and the average dimensional score was (2.70±0.60) . The highest score was (2.84±0.56) in the dimension of safety needs. The lowest score was (2.40±0.71) in the dimension of aesthetic needs. There were significant differences in scores of Demands Scale of Women of Advanced Maternal Age during Second Pregnancy among the participants with different ages, educational levels, histories of pregnancy and childbirth, and the first child's age were statistically significant (P<0.05) . Multivariate regression analysis showed that age, educational level, adverse pregnancy and childbirth history, and age of older child were the main factors influencing the demand of women of advanced maternal age during their second pregnancy (P<0.05) . Conclusions The level of demand is quite high among the women of advanced maternal age during their second pregnancy. In order to improve the their life quality during pregnancy, medical staff should give guidance and provide demand services from multiple perspectives according to their individual needs. Key words: Pregnant women; Pregnancy; Advanced maternal age; Demands during pregnancy; Influencing factors; Second child

The association of ToRCH infection and congenital malformations: A prospective study in China

ObjectiveToRCH infections (toxoplasmosis, rubella, cytomegalovirus and Herpes simplex virus) have long been known to be associated with bad obstetric outcomes. Little information is available about the impact of ToRCH infection on reproduction in china nearly for ten years. We designed a prospective study among 1863 pregnant women to investigate the association of ToRCH infection and congenital malformations. Study designAll participants had set up a maternal health Handbook and were managed through the maternal and child health care system. They underwent regular pregnancy check-up, including physical measurements (weight, abdominal circumference and blood pressure), laboratory examinations (blood, urine) and ultrasound scan. ToRCH IgM antibodies were tested by chemiluminescence immunoassay. Results102 participants were infected with ToRCH and the total infection rate was 6.06% (102/1683). CMV infection rate (3.15%, 53/1683) was the highest. The positive rate of ToRCH IgM antibodies increased significantly in participant with upper respiratory tract infection (14.6%, 32/219) or with adverse pregnancy history (4.8%, 70/1464). Among 85 ToRCH infected participants, adverse pregnancy outcome were observed in 57 cases which included abortions (31.8%, 27/85), premature births (8.2%, 7/85), congenital malformations (12.9%, 11/85), and stillbirths (9.4%, 8/85). Furthermore, congenital malformations was much higher than that in those without ToRCH infection (1.1%, 17/1598) (P＜0.001). ConclusionToRCH infection was a significant risk factor of severe damage to the fetus, especially congenital malformations. ToRCH screening for pregnant women can reduce the incidence of adverse pregnancy and prevent birth defects in china.

Female reproductive system dysplasia: a clinical study of 924 cases

Objective: To explore the relationship between different types of female reproductive system dysplasia and age of visit, clinical manifestations, common types of combined malformations and endometriosis. Methods: The patient's medical records in the Second Hospital of Hebei Medical University from December 2002 to June 2016 were collected and retrospectively analyzed. Results: Among 924 cases of genital tract dysplasia, uterine dysplasia (65.3%, 824/1 261) was the most common, followed by vaginal dysplasia (28.3%, 357/1 261), hymen atresia and urogenital fistula (3.7%, 47/1 261), and cervical dysplasia (2.6%, 33/1 261). (1) The youngest age was in patients with hymen atresia and urogenital fistula, with a median of 14.5 years old, while the older age were in patients with uterine, vaginal and cervical dysplasia, with median age of 25.0, 24.0 and 23.0 years old, respectively. (2) The clinical manifestations were lack of specificity, mainly abnormal findings of physical examination or accessory examination, primary amenorrhea, lower abdominal pain, infertility, adverse pregnancy history. (3) About other systemic malformations, urological malformations were the most common (4.8%, 44/924), followed by spinal malformations (0.5%, 5/924), inguinal hernia (0.4%, 4/924), heart malformations (0.2%, 2/924), cleft lip and palate (0.2%, 2/924). Oblique vaginal septal syndrome and MRKH syndrome were the most likely to be associated with other system malformations. (4) About combination with endometriosis, there was no significant difference between obstructive genital tract malformations (2.3%, 9/385) and non obstructive genital tract malformations (1.7%, 9/539; P=0.469). Conclusions: Female reproductive system dysplasia is the most common in uterine dysplasia, followed by vaginal dysplasia, hymen atresia and urogenital fistula, and cervical dysplasia. The age of visit is generally older, often found by abnormal findings of physical examination or accessory examination, primary amenorrhea, lower abdominal pain, infertility, adverse pregnancy history;and could be combined with a variety of other system malformations, most seen by urinary system malformations,there is also the risk of endometriosis.

Heterozygosity of maternal factor V G1691A (Leiden) and relationship with times of pregnancy loss among unexplained recurrent pregnancy loss women

Background: Recurrent pregnancy loss is defined by the consecutive loss of two or more pregnancies with the same partner. Recurrent pregnancy loss (RPL) or recurrent miscarriage (RM) affects from 1-5% of the reproductive age couples. This diagnosis is both emotionally challenging and confusing for most couples, as the definitive diagnosis using conventional evaluations is found in fewer than half of the couples experiencing repeated loss. The aim of this study was to evaluate the inherited heterozygosity of factor five Leiden (FVL) G1691A and Its relation to the time of recurrent spontaneous pregnancy loss. Materials and methods: Retrospective case- control study, in which women with RPL were compared to healthy women without any evidence of spontaneous abortion. This study was undertaken at Omdurman maternity hospital in Khartoum state, Sudan. The case group consisted of one hundred women who experienced at least three or more consecutive recurrent spontaneous pregnancy loss that occurred before 20 weeks of gestation and the control group consisted of ninety five healthy women without any history of adverse pregnancy outcome.Questionnaire and direct interview were used to collect information. Genotyping was based on polymerase chain reaction. Data were entered and analyzed by SPSS program version 17.0. Result: Heterozygosity for FVL alleles G/A was 8.0% in all cases and 6.4% was found in control group. Related to association with time of recurrent pregnancy loss our result shows three times (37.5%), four times (50.0%) and five times (12.5%). Conclusion: Heterozygosity of FV Leiden G1691A could be one reason for recurrent pregnancy loss and pregnancy complications among women with unexplained pregnancy loss. Our study showed that there is an association between heterozygosity for FVL G1691A and time of recurrent pregnancy loss.

The risk factors of gestational diabetes mellitus and its influence on pregnancy outcome

Objective To explore the risk factors of gestational diabetes mellitus and its influence on pregnancy outcome, and to provide guidance for early intervention of gestational diabetes to improve pregnancy outcome in clinic. Methods Totally 159 patients with gestational diabetes mellitus in our hospital from January 2014 to January 2016 as observation group were collected, and at the same time, 634 healthy pregnancy women as control group were collected. The risk factors of gestational diabetes mellitus were analyzed by the Logistic regression analysis and comparison of pregnancy outcome between two groups was conducted. Results The patients in the observation group with age ≥35 years, overweight or obesity before pregnancy, adverse pregnancy history, family history of diabetes, hypertension and vaginal candida and thyroid peroxidase antibody (TPOAb) compared with the control group, the difference was statistically significant (P 0.05). Conclusions Age ≥35 years, overweight or obesity before pregnancy, adverse pregnancy history, family history of diabetes, and thyroid dysfunction were the independent risk factors of gestational diabetes mellitus, and it has serious effect on pregnancy outcome, so that it should take measures to prevent the independent risk factors. Key words: Diabetes, gestational; Risk factors; Pregnancy outcome

Serological survey on Toxoplasma gondii infection in pregnant women with history of adverse pregnancy in Bazhou area, Hebei Province

To investigate the Toxoplasma gondii infection status in pregnant women with history of adverse pregnancy and risk factors in Bazhou area, Hebei Province. A total of 302 pregnant women with the history of adverse pregnancy were chosen as respondents (an experimental group) in the hospital from March 2012 to December 2015, and 197 pregnant women without the history of adverse pregnancy as a control group. TOX-IgG and TOX-IgM were detected by using ELISA in two groups. The risk factors of Toxoplasma infection were surveyed by questionnaires. The total positive rate of Toxoplasma antibodies was 28.15% (85/302) in the experimental group, which was significantly higher than that [9.64%(19/197)] in the control group, and the difference was statistically significant (χ2 = 24.76, P＜0.05). The positive rates of TOX-IgM, TOX-IgG and TOX-IgM + TOX-IgG were 6.95% (21/302), 18.54% (56/302), and 2.65% (8/302) respectively in the experimental group, which were higher than 2.03% (4/197), 7.61% (15/197), and 0% (0/197) respectively in the control group (χ2 = 6.07, 11.67, 3.76, all P＜0.05). The questionnaire survey showed that the proportions of keeping pets, cutting board regardless, liking to eat hot pot or barbecue, eating raw meat, often eating in the restaurant in the pregnant women with Toxoplasma infection were higher than those in the pregnant women without Toxoplasma infection, and the differences were statistically significant (χ2 = 22.57, 3.96, 5.87, 7.40, 4.86, all P＜0.05), and therefore, the above unhealthy habits may be important risk factors. Toxoplasma infection could lead to adverse pregnancy outcomes. Therefore, the above-mentioned unhealthy habits should be avoided, especially during pregnancy period.

Study on Environmental Causes and SNPs of MTHFR, MS and CBS Genes Related to Congenital Heart Disease.

PurposeCongenital heart diseases (CHD) are among the most common birth defects in China. Environmental causes and folate metabolism changes may alter susceptibility to CHD. The aim of this study is to evaluate the relevant risk-factors of children with CHD and their mothers.Methods138 children with CHD and 207 normal children for controls were recruited. Their mothers were also enlisted in this study and interviewed following a questionnaire about their pregnant history and early pregnancy situation. Five single nucleotide polymorphisms (SNPs) in methylenetetrahydrofolate reductase (MTHFR), methionine synthase (MS) and cystathionine β-synthase (CBS) of mothers and children were genotyped.ResultsThere were significant differences in the gender of children, occupation of mothers, family history with CHD, history of abortion, history of adverse pregnancy, early pregnancy health, fetus during pregnancy, pesticide exposure and drug exposure in CHD group and control group ( P < 0.05). Logistic regression analyses showed that after adjustment for above factors, MTHFR rs1801131 were significantly associated with their offspring CHD risk in mothers. Compared with the mothers whose MTHFR were rs1801131 AA and AC genotypes, the mothers who got a mutation of MTHFR rs1801131 CC genotypes had a 267% increase in risk of given birth of a CHD children (OR=3.67,95%CI=1.12-12.05). Meanwhile, MTHFR rs1801131 were significantly associated with CHD susceptibility in children (OR = 1.42, 95% CI = 1.00-2.44 in additive model).ConclusionsBesides mothers’ social and fertility characteristics, our results suggested that the genetic variants in folate metabolism pathway might be one of the most related risk-factors of CHD. MTHFR rs1801131 were identified as loci in Chinese population that were involved in CHD.

P3.356 Syphilis Screening Among 27150 Pregnant Women in Rural Southern China Using Point-Of-Care Tests

Background Guangdong province in southern China is at the centre of a national syphilis epidemic, with a tenfold increase of reported syphilis cases in the past ten years. However, the epidemic remains poorly described in rural areas of Guangdong, where hygiene stations (community-level clinics) lack the capacity to undertake routine prenatal syphilis screening. The purpose of this research was to determine the prevalence of syphilis and its risk factors among pregnant women, and to assess the acceptability of point-of-care tests in resource-limited areas of Guangdong province. Methods From June 2010 to April 2012, we invited 55 hygiene stations, 12 general hospitals, and four women and children’s hospitals in resource-limited areas of Guangdong province to participate in the study. Free point-of-care syphilis testing were provided to each of the study sites, and positive samples were confirmed at local referral centres by toluidine red unheated serum test (TRUST)) and Treponema pallidum particle agglutination (TPPA) test. Confirmed cases received free treatment with benzathine penicillin. Results A total of 27,150 pregnant women were screened for syphilis by point-of-care syphilis tests, 106 (0.39%) syphilis cases were diagnosed, of which 78 cases (73.6%) received treatment for syphilis. Syphilis infection among pregnant women was associated with older age and a previous history of adverse pregnancy. Conclusions Syphilis infection is a significant problem among pregnant women living in rural areas of southern China. Point-of-care syphilis testing was well accepted in resource-limited settings, and can increase case detection in rural areas with limited testing capacity.

Factors relevant to newborn birth weight in pregnancy complicated with abnormal glucose metabolism

Factors relevant to newborn birth weight in pregnancy complicated with abnormal glucose metabolism

Predictors of adverse events among pregnant smokers exposed in a nicotine replacement therapy trial

The purpose of this study was to determine the contribution of randomization to nicotine replacement therapy (NRT), sociodemographic and psychosocial factors, and pregnancy and medical history to serious perinatal adverse events among pregnant smokers. We performed a retrospective review of all medical records for participants in the Baby Steps Trial. Data that were abstracted from 157 records were combined with baseline characteristics for logistic regression modeling of serious adverse events and adjusted for covariates. Serious adverse events occurred in 17% (9/52 pregnancies) and 31% (33/105 pregnancies) of participants in the control and NRT arms, respectively. Black race, adverse pregnancy history, and use of analgesic medication during pregnancy were significant predictors (P = .02, .04, and .01, respectively). Remaining covariates, which included randomization to NRT, were not statistically significant. Although race, poor pregnancy history, and use of analgesics were associated with serious adverse events, randomization to NRT during pregnancy was not a significant factor. Further research is needed to examine the safety of analgesic medications during pregnancy.

Reduction of circulating annexin A5 levels and resistance to annexin A5 anticoagulant activity in women with recurrent spontaneous pregnancy losses

We investigated whether levels of annexin A5, evidence for resistance to annexin A5 activity, and levels anti-annexin A5 antibodies might be altered in women with a history of recurrent spontaneous pregnancy losses. These annexin A5 parameters were assayed in 70 nonpregnant women with a history of > or = 3 recurrent spontaneous pregnancy losses (cases) and 50 women without adverse pregnancy history (control subjects). Cases had significantly lower plasma annexin A5 levels than control subjects (median, 4.7 ng/mL [range, 0.3-40.4 ng/mL] vs 6.7 ng/mL [range, 0.7-56.0]; P = .01), significantly reduced anticoagulant ratios (188% [range, 119%-279%] vs 238% [range, 159%-286%]; P < .0001), and reduced binding of annexin A5 to phospholipid (6.3 ng/aliquot phospholipid [range, 1.5-16.4 ng/aliquot phospholipid] vs 9.7 ng/aliquot phospholipid (range, 3.5-17.0 ng/aliquot phospholipid]; P = .0002). There were no significant differences in anti-annexin A5 antibody levels. Reduction of annexin A5 and interference with its anticoagulant and binding activities are associated significantly with a history of recurrent spontaneous pregnancy losses. These data support the concept of a significant role for annexin A5 in the maintenance of pregnancy.

HUGHES (ANTIPHOSPHOLIPID) SYNDROME: Clinical Features

Hughes (antiphospholipid) syndrome is a noninflammatory autoimmune disease. The most critical pathologic process is thrombosis, which results in most of the clinical features suffered by these patients. Recurrent thrombosis together with an adverse pregnancy history and the presence of antiphospholipid antibodies defines the syndrome.

Ongoing randomized clinical trials for the treatment of thrombosis in the antiphospholipid syndrome

SummaryThrombotic events are a major clinical problem for patients with antiphospholipid antibodies (APA). However, current recommendations for their prevention and treatment are still based on retrospective studies. Data from large scale, prospective clinical trials are required to ultimately identify the optimal management of these patients. To date, at least four randomized studies are underway. The WAPS and PAPRE clinical trials are aimed to establish the correct duration and intensity of oral anticoagulation in APA patients with major arterial or venous thrombosis. The WARSS-APASS is a collaborative study to evaluate the efficacy and safety of aspirin or low-dose oral anticoagulants in preventing the recurrence of ischemic stroke. The recently announced UK Trial compares low-dose aspirin with or without low-intensity anticoagulation for the primary prevention of vascular events in APA-positive patients with SLE or adverse pregnancy history, but still thrombosis-free. It is hoped that the results of these trials will be available soon since clinicians urgently need more powerful data to treat their patients with the APA syndrome.

Mother-to-child transmission of HIV-1 in Congo, central Africa

To assess the risk of mother-to-child transmission of HIV-1 in a central African population and to study maternal factors associated with perinatal transmission. Prospective cohort study of infants born to HIV-1-positive women and controls born to HIV-1-negative women enrolled sequentially in two prenatal clinics and one maternity hospital in Brazzaville, Congo. A total of 118 exposed and 208 control infants were followed from birth for at least 2 years. Assessment of infection in children and computation of transmission rate were made according to the European Economic Community/World Health Organization Ghent guidelines (1992). The transmission rate was 40.4% [95% confidence interval (CI), 30.7-50.1]. Maternal age, parity, history of adverse pregnancy outcome or history of decreased children were not associated with transmission. However, independently, women whose relationship with their infant's father was less than 1 year, or women who had symptoms of HIV-1 during pregnancy had an increased risk of transmission [adjusted odds ratios, 11.1 (95% CI, 2.4-50.2) and 10.3 (95% CI, 2.9-37.1), respectively]. The transmission rate observed in Congo is in the upper range of the rates reported in Africa. The uneven distribution of cofactors for perinatal transmission, such as the presence of symptoms of HIV disease during pregnancy, may explain some of the variation observed across studies.

Assessment of Risk in Newborns

Data were collected on 776 newborns using a high risk register. The group consisted of 16 newborns with birthweight under 1500 grams, 121 with a family history of handicap, 82 who were the product of an adverse pregnancy history, 39 with congenital anomalies, and 61 with a gestational age of less then 37 weeks. Analysis of high risk characteristics revealed 261 primary risk incidents in the sample and 292 secondary risk factors. These accounted for 10.57 and 14.4 percent of the subjects, respectively. Possible drawbacks in the use of high-risk registers are discussed in light of procedures for follow-up of infants and other critical factors.