Presence Of Congenital Malformations Research Articles

Performance of Neonatal Unit, Arifin Achmad Hospital, Pekanbaru

Background Arifin Achmad Hospital is the largest hospital inRiau Province, Indonesia, which serves as referral hospital andoffers tertiary care for sick neonates.Objective To review the performance of the Neonatal Unit ofArifin Ahmad Hospital as a mean to further improve the overallcare Mth specific interest to improve neonatal outcomes.Methods We collected the clinical data of all patients admitted tothe Neonatal Unit from 2008 to 2010. Diagnoses were classifiedaccording to the International Statistical Classification of Diseasesand Related Health Problems 10th Revision (Revised leD 10). Weevaluated the overall performance of the unit, including numberof beds, number of patients, and bed occupancy rates (BOR). Thespectrum of diagnoses was also described. Associations betweenclinical characteristics and patient outcomes were analyzed usingunivariate Chi square test.Results The number of available beds increased from 10 beds in2008 to 24 beds in 2010, thereby decreasing the BORfrom 112%in 2008 to 82% in 2010, despite the yearly increase in numberof patients (702 in 2008, 772 in 2009, and 821 in 2010). MostNeonatal Unit patients were male, aged 0􀁒3 days at the time ofadmission, had birth weights of 2500􀁒4000 grams, born in RSUDArifin Achmad and were born vaginally. Respiratory problems,prematurity and infections were the three main reasons foradmission. Birth weight, the presence of congenital malformations,referral status, and < 7 day length of stay were associated withmortality.Conclusions The performance of the unit increased during the3􀁒year period of study. Most patients admitted had respiratoryproblems, fetal growth problems, or infections. We found that birthweight, congenital malformations, referral status, and decreasedlength of stay were prognostic factors for patient outcomes.[Paediatr rndones. 2012;52:356-61].

Performance of Neonatal Unit, Arifin Achmad Hospital, Pekanbaru

Background Arifin Achmad Hospital is the largest hospital inRiau Province, Indonesia, which serves as referral hospital andoffers tertiary care for sick neonates.Objective To review the performance of the Neonatal Unit ofArifin Ahmad Hospital as a mean to further improve the overallcare Mth specific interest to improve neonatal outcomes.Methods We collected the clinical data of all patients admitted tothe Neonatal Unit from 2008 to 2010. Diagnoses were classifiedaccording to the International Statistical Classification of Diseasesand Related Health Problems 10th Revision (Revised leD 10). Weevaluated the overall performance of the unit, including numberof beds, number of patients, and bed occupancy rates (BOR). Thespectrum of diagnoses was also described. Associations betweenclinical characteristics and patient outcomes were analyzed usingunivariate Chi square test.Results The number of available beds increased from 10 beds in2008 to 24 beds in 2010, thereby decreasing the BORfrom 112%in 2008 to 82% in 2010, despite the yearly increase in numberof patients (702 in 2008, 772 in 2009, and 821 in 2010). MostNeonatal Unit patients were male, aged 0ô€’3 days at the time ofadmission, had birth weights of 2500ô€’4000 grams, born in RSUDArifin Achmad and were born vaginally. Respiratory problems,prematurity and infections were the three main reasons foradmission. Birth weight, the presence of congenital malformations,referral status, and < 7 day length of stay were associated withmortality.Conclusions The performance of the unit increased during the3ô€’year period of study. Most patients admitted had respiratoryproblems, fetal growth problems, or infections. We found that birthweight, congenital malformations, referral status, and decreasedlength of stay were prognostic factors for patient outcomes.[Paediatr rndones. 2012;52:356-61].

Are Hypnotic Benzodiazepine Receptor Agonists Teratogenic in Humans?

Hypnotic benzodiazepine receptor agonists (HBRAs; zolpidem, zopiclone, and zaleplon) are used in the treatment of insomnia. Little is known about the safety of HBRAs during pregnancy. Data from the Swedish Medical Birth Registry from July 1, 1995, up to 2007 were used to identify 1318 women who reported the use of HBRAs in early pregnancy. They gave birth to 1341 infants. Maternal characteristics and the presence of congenital malformations were compared with all other women who gave birth (n = 1,106,001) and all other infants (n = 1,125,734) born during the study period. Use and/or reporting of HBRAs increased with maternal age and were higher at first than higher parity. Maternal smoking was strongly associated with reported use of HBRAs. The probability of using HBRAs increased in women who had had 3 or more earlier miscarriages or 5 or more years of involuntary childlessness. An excess use of other drugs and above all psychoactive drugs were seen in women reporting use of HBRAs.Hypnotic benzodiazepine receptor agonists were not associated with an increased risk for congenital malformations. A statistically significant high risk for other intestinal malformations than atresias/stenosis was based on only 4 infants. Maternal use of HBRAs does not seem to increase malformation risk. The tentative association with some intestinal malformations may be due to chance because of multiple testing and needs confirmation.

Risk factors of childhood epilepsy in Kerala

Background:We aimed to identify the risk factors for epilepsy in children.Materials and Methods:This case–control retrospective study was carried out in the pediatric neurology outpatient service of the Trivandrum Medical College. All children (1–12 years) with epilepsy satisfying the selection criteria were included, after obtaining consent from parents. Those with single seizures or febrile seizures were excluded. Controls were children without epilepsy attending the same hospital. Parents were interviewed and clinical data were obtained from medical records. Statistical analysis included chi-square test, odds ratio (OR), and logistic regression.Results:There were 82 cases and 160 controls whose mean age was 6.9 + 3.6 and 5.2 + 3.1, years respectively. On univariate analysis, family history of epilepsy, prolonged labor, cyanosis at birth, delayed cry after birth, admission to newborn intensive care unit, presence of congenital malformations, neurocutaneous markers, incessant cry in the first week, delayed developmental milestones, meningitis, encephalitis, and head trauma were found to be significant. On logistic regression, family history of epilepsy (OR 4.7), newborn distress (OR 8.6), delayed developmental milestones (OR 12.6), and head trauma (OR 5.8) were found to be significant predictors. Infants who had history of newborn distress are likely to manifest epilepsy before 1 year if they are eventually going to have epilepsy (OR 3.4).Conclusion:Modifiable factors such as newborn distress and significant head trauma are significant risk factors for childhood epilepsy. Newborn distress is a risk factor for early-onset (<1 year age) epilepsy.

Congenital malformations in infants born after in vitro fertilization in Sweden

The risk for congenital malformations is increased in infants born after in vitro fertilization (IVF). Some specific malformations appear to be more affected than others. The presence of congenital malformations in 15,570 infants born after IVF with an embryo transfer between April 1, 2001, and the end of 2006 were compared with all infants born in Sweden during 2001 to 2007 (n = 689,157). Risk estimates were made after adjusting for year of birth, maternal age, parity, smoking, and body mass index. The risks of specific malformations were compared with data from a previous study (1982 to March 31, 2001) of 16,280 infants born after IVF. Different IVF methods were compared to respect to malformation risk. Increased risks of a similar magnitude were found for most cardiovascular malformations and limb reduction defects for both study periods. For neural tube defects, cardiac septal defects, and esophageal atresia, there was still an increased risk, but it was lower during the second than during the first period. For small bowel atresia, anal atresia, and hypospadias, the risk increase observed during the first study period had disappeared during the second period. An increased risk was seen for some syndromes that have been associated with imprinting errors. No difference in malformation risk according to IVF method was apparent. A slightly increased risk for congenital malformations after IVF persists. A decreasing risk is seen for some specific malformations, either true or the result of multiple testing.

Delivery outcome after maternal use of antidepressant drugs in pregnancy: an update using Swedish data

Concerns have been expressed about possible adverse effects of the use of antidepressant medication during pregnancy, including risk for neonatal pathology and the presence of congenital malformations. Data from the Swedish Medical Birth Register (MBR) from 1 July 1995 up to 2007 were used to identify women who reported the use of antidepressants in early pregnancy or were prescribed antidepressants during pregnancy by antenatal care: a total of 14 821 women with 15 017 infants. Maternal characteristics, maternal delivery diagnoses, infant neonatal diagnoses and the presence of congenital malformations were compared with all other women who gave birth, using the Mantel-Haenszel technique and with adjustments for certain characteristics. There was an association between antidepressant treatment and pre-existing diabetes and chronic hypertension but also with many pregnancy complications. Rates of induced delivery and caesarean section were increased. The preterm birth rate was increased but not that of intrauterine growth retardation. Neonatal complications were common, notably after tricyclic antidepressant (TCA) use. An increased risk of persistent pulmonary hypertension of the newborn (PPHN) was verified. The congenital malformation rate was increased after TCAs. An association between use of paroxetine and congenital heart defects was verified and a similar effect on hypospadias was seen. Women using antidepressants during pregnancy and their newborns have increased pathology. It is not clear how much of this is due to drug use or underlying pathology. Use of TCAs was found to carry a higher risk than other antidepressants and paroxetine seems to be associated with a specific teratogenic property.

The Impact of the Chromosome Alterations in the Reproductive Efficiency of the Domestic Animal Carriers: the Role of the Reciprocal Translocations in the Porcine Reproduction

The chromosome alterations with higher negative impact on reproduction of domestic species, particularly on swine (Sus scrofa domestica), are the reciprocal translocations (rcp). It is clear that its economic consequences are very important if the animals are selected to produce a large number of litters such as those used in insemination centres. Until 2008 a number of 148 reciprocal translocations between two non-homologous chromosomes, as well as three different types of reciprocal translocations in those three non-homologous chromosomes are involved and three different Robertsonian translocations have been described in pigs. The chromosomes involved in the first group were all of the chromosome complement including the sexual ones, appearing involved in the reciprocal translocations among three non-homologous chromosomes the pairs 2, 4, 9, 14 and 15 and the pairs 13, 14, 15, 16 and 17 in the Robertsonian translocations. The effects on the prolificacy in some of the types of these chromosome alterations have been analyzed. In these cases a clear reduction was observed when the females were inseminated with semen from carriers of translocations males. In some of them the percentage of fertility reduction has been calculated, observing in some cases even the sterility of the carrier animals. Other negative effects in some translocations, as the presence of congenital malformations in the newborn piglets, have been observed. Following the literature in sixteen countries from Europe (mainly France and Sweden) plus EEUU, Canada and India these alterations have been detected, without doubt result of their political of systematic studies of breeders.

Excesses of Congenital Malformations in Areas of Tuscany Region (Italy) at High Risk of Environmental Crisis

MAB1-PD-08 Introduction: Congenital malformations (CMs) constitute one of the main causes of infant mortality, disease, and permanent disabilities, with a birth prevalence of 2% to 3%. CMs can represent one of the earliest biologic indicators of environmental exposure to toxic and teratogenic substances, allowing early warnings 6 to 8 months after exposure. Areas at risk of environmental crisis, listed in regional and national official documents, are zones in which one or more environmental risk factors (presence of industries, reclaiming areas, hazardous wastes, water and air pollution) require various interventions (environmental, economic, community, and public health). Objective: The main objective of this descriptive study is to provide general information on geographic distribution of CMs risk and to point out excesses of CMs in areas at environmental risk. Material and Methods: This study used data concerning major CMs subgroups observed in births and induced abortions over 1992 to 2002 in approximately 295,000 births collected at the municipality level by the Tuscany Birth Defects Registry. Spatial analyses at the municipality level were performed by standardized CMs ratios (SMR) and adjusted bayesian ratios (BMR), using the socioeconomic index of deprivation. Results: Spatial distribution of CMs risk showed, for the majority of CM subgroups, a strong spatial pattern with several significant excesses of CMs in groups of municipalities, including areas at environmental risk. The majority of statistically significant excesses of all CMs concerned municipalities included in areas at risk of environmental crisis (8 municipalities with statistically significant excesses out of 11) with SMR between 120 and 210 and BMR between 120 and 190. These municipalities showed both SMR and BMR statistically significant excesses also for one or more specific subgroups of CMs. Conclusions: Several excesses were observed in areas at high risk of environmental crisis in which industries (steel plants, cokeries, petrochemical plants) and hazardous waste incinerators are located. Results for these areas suggest that further insights are required from studies that, unlike descriptive studies of geographic distribution, investigate analytically causal associations between residence in areas at environmental risk and presence of CMs. Spatial and temporal surveillance of CMs represents an important activity in the framework of environmental health in order to plan public health measures for preventing and protecting health of vulnerable populations.

P12.19: Growth discordance in twin pregnancies at birth: determining factors?

To study factors determining severe intertwin growth discordance Obstetric and perinatal data of 494 consecutive twin pregnancies registered from 22 weeks of gestation were retrospectively retrieved from a computerized database. Pathological examination of the placenta was available in each case. Discordant fetal growth was defined as absent (ADG), moderate (MDG) or severe (SDG) when the intertwin weight difference at birth was respectively < 5%, 5–25% or > 25%. The impact of maternal age, fetal death, the presence of congenital malformations, total placental weight and placental and umbilical cord abnormalities was analyzed. SDG was present in 48/494 twin pregnancies (9.4%), but occurred significantly less frequently in dichorionic (36/429 or 8.4%) compared with monochorionic pregnancies (12/65 or 18.5%) (p: 0.02; RR: 0.45). SDG in dichorionic twin pregnancies was not significantly associated with maternal age, fetal death, an excess of congenital malformations, nor with placental or umbilical cord abnormalities. Total placental weight in the SDG twins (850 g ± 187) was not significantly lower than in MDG (893 ± 240) or ADG (906 g ± 216) (P = 0.428). Monochorionic pregnancies with SGD showed less frequently no congenital malformations in both fetuses (9/12) and had a significantly lower placenta weight (712 g ± 140) than normal or MGD ones (34/36; p: 0.07 and 880 g ± 214; p: 0.048). There were no other significant determining factors. Severe discordant birth weight in dichorionic pregnancies might reflect individual fetal growth potential or be induced by growth restriction related pathology. This will further be examined. In monochorionic pregnancies, the higher incidence of congenital malformations may contribute to SGD.

Malformaciones congénitas y patología crónica de la madre.: Estudio ECLAMC 1971-1999

Several maternal diseases, such as diabetes mellitus or high blood pressure, are associated with a higher risk for fetal or neonatal problems. To study the association between chronic diseases of the mother and congenital malformations. Review of the records of the Latin American Collaborative Study of Congenital Malformations (ECLAMC) at the University of Chile Clinical Hospital. A sample of 383 mothers with a chronic disease was compared with 297 healthy mothers. The presence of congenital malformations in the newborns was studied. The odds ratio (OR) of a mother to have a child with a congenital malformation was calculated. Mothers with bronchial asthma, diabetes mellitus, hypertension and hypothyroidism had an OR over 1 of having a child with a congenital malformation. No association between maternal obesity and offspring malformations was observed. Offspring of diabetic mothers had 8.95 times more probabilities of having a major malformation and 4.95 times more probabilities of having a minor defect. Offspring of mothers with diabetes mellitus, bronchial asthma, hypertension or hypothyroidism have a higher risk of presenting a congenital malformation, when compared with offspring of healthy mothers.

Flow on the symmetry plane of a total cavo-pulmonary connection

The flow inside a total cavo-pulmonary connection, a bypass operation of the right heart adopted in the presence of congenital malformation, is here studied for a specific geometry which has been recently introduced in clinics. The analysis has been performed by preliminary experimental observation and a novel Navier–Stokes formulation on the symmetry plane. This method, once some basic hypotheses are verified, allows to reproduce the flow on the symmetry plane of a three-dimensional field by using an extension of the two-dimensional approach. The analysis has confirmed the existence of a central vortex showing that it is not a real vortex (i.e. a place with accumulation of vorticity) but, rather, a weakly dissipative recirculating zone. It is surrounded by a shear layer that becomes spontaneously unsteady at moderately high Reynolds number. The topological changes and energy dissipation have been analysed in both cases of unbalanced and of balanced pulmonary artery and caval flows.

Use of omeprazole during pregnancy — no hazard demonstrated in 955 infants exposed during pregnancy

Objectives: To evaluate the magnitude of possible fetal risks involved in maternal use of omeprazole during pregnancy. Study design: Infants whose mothers used omeprazole during pregnancy were identified from the Swedish Medical Birth Registry. A total of 955 exposed infants born in 1995–1999 were identified: 863 of which were exposed in early pregnancy and 131 later in pregnancy and 39 who had been exposed both in early and late pregnancy. Delivery outcome was studied: presence of congenital malformations, perinatal survival, low birth weight, low Apgar score and hospitalization up to the end of 1997. Results: No clear-cut indication of ill effects were seen. Five infants were stillborn and the rate of congenital heart defects was slightly increased, but both effects may be random. Conclusions: The present dataset and previously published data give no reason for concern after exposure for omeprazole during pregnancy.

Congenital malformations in infants born after IVF: a population-based study.

The presence of congenital malformations in infants born after IVF was studied from a register consisting of practically all infants born in Sweden after IVF, 1982--1997 (n = 9111). A further 64 infants were studied using only medical records. It is a nation-wide study and has a population-based control group (n = 1,690,577) and relevant potential confounders have been taken into account. There was an excess of congenital malformations registered in the Medical Birth Registry (n = 516, odds ratio = 1.47) but this excess disappeared when confounders were taken into consideration: year of birth, maternal age, parity, and period of unwanted childlessness (odds ratio = 0.89). For some specific conditions, an approximately 3-fold excess risk was seen: neural tube defects, alimentary atresia, omphalocele, and hypospadias (after intracytoplasmatic sperm injection). No excess risk for hypospadias was seen after standard IVF. Various explanations for these findings are discussed. It is postulated that the excess risk for alimentary atresia, like the excess risk for monozygotic twinning after IVF, is a direct consequence of the IVF procedure. The excess risk for hypospadias after ICSI may be related to paternal subfertility with a genetic background. The absolute risk for a congenital malformation in association with IVF is small.

The CRIB (Clinical Risk Index for Babies) score and neurodevelopmental impairment at one year corrected age in very low birth weight infants.

To assess the ability of the Clinical Risk Index for Babies (CRIB) to predict long-term neurodevelopmental impairment in very low birth weight (VLBW) infants. Single-center cohort study. Tertiary neonatal care hospital and follow-up clinic. Four hundred fifty-five VLBW infants consecutively admitted from 1992 to 1997 inclusive. Calculations of CRIB scores from birth weight, gestational age, the presence of congenital malformations, worst base excess, maximum and minimum appropriate fraction of inspired oxygen (FIO2) during the first 12 h of life was possible in 430 infants. Three hundred eighty-six infants survived until discharge (89%) and 352 (91%) were examined at 1 year corrected age using the Griffiths scales of mental development. Major neurodevelopmental impairment (general quotient < 2 standard deviations below average) was observed in 76 infants (22%). CRIB scores and the individual CRIB components differed significantly between infants with and those without neurodevelopmental impairment. By logistic regression analysis, CRIB scores and minimum FIO2 were independent predictors of death, while CRIB and maximum FIO2 were independently associated with neurodevelopmental impairment. For combined poor outcome (death or impairment), CRIB, minimum and maximum FIO2 were independent predictors. In predicting major neurodevelopmental impairment, the area under the receiver operating characteristic curve for CRIB (0.703 +/- 0.035) did not differ significantly from that of birth weight (0.697 +/- 0.035) or any other CRIB component. While high CRIB scores are associated with major neurodevelopmental impairment, the CRIB score is of limited value for stratification in randomized trials or for adjustments in comparing performance between hospitals with neurodevelopmental impairment as the main outcome measure.

Congenital malformations after the use of inhaled budesonide in early pregnancy

Objective: To study possible teratogenic risks with the use of an inhaled glucocorticoid, budesonide, in early pregnancy. Methods: Using the Swedish Medical Birth Registry, congenital malformations were studied in 2014 infants whose mothers had used inhaled budesonide for asthma in early pregnancy. The presence of congenital malformations was checked further with auxilliary registries. Results: No increase in the general rate of congenital malformations was observed: 3.8% (95% confidence interval [CI] 2.9, 4.6) of the infants had a congenital malformation diagnosed, which is similar to the population rate (3.5%). After exposure to budesonide, four infants were born with orofacial clefts; this also is similar to the expected number (3.3). Conclusion: Even though a specific teratogenic effect of use of budesonide in early pregnancy cannot be ruled out, it is unlikely that a clinically significant teratogenic risk exists.

Predictive value of the "Clinical Risk Index for Babies" for the risk of neonatal death

Several indicators, mainly birthweight and gestational age, have been used to predict the mortality risk in neonatal intensive care units. In order to assess the potential value of CRIB in predicting neonatal mortality, the score was used over the first 12 hours of life of the newborns admitted to this unit, during the year of 1996. The inclusion criteria consisted of all infants without inevitably lethal congenital malformations, birthweight below 1,500 g and/or gestational age less than 31 weeks. Newborn children who died within 12 hours after delivery were excluded. The CRIB score covers birth weight, gestational age, the presence of congenital malformations (not inevitably lethal) and three indexes of physiological status during first 12 hours after birth-maximum and minimum appropriate fraction of inspired oxygen and maximum (most acidotic) base excess. In a prospective cohort, seventy one newborn children were studied. The birthweight (average) was 1,119 +/- 275.6 g, gestational age 30 weeks 4/7 +/- 2 weeks 3/7; male (57%); Apgar 1(0) min. score < or = 3 (36.2%) and Apgar 5 degrees min. score < 5 (5.8%). The mortality rate was 29.6% (gold standard). But mortality rate by birthweight less than 1,000 gr. or gestational age lower than 29 weeks was 60.0% and for the CRIB score above 10 was 100%. The specificity and predictive positive values for CRIB score above 10 were greater than any other two parameters. The area under the receiver operating characteristic (ROC) curve for predicting death was significantly greater for CRIB than for birthweight alone. It was concluded that the CRIB score is a better predictive indicator for mortality than are birthweight and gestational age.

Delivery outcome after the use of acid‐suppressing drugs in early pregnancy with special reference to omeprazole

To study delivery outcome after maternal use of acid-suppressing drugs during early pregnancy. Cohort study of women identified by interview in early pregnancy. Sweden women giving birth from 1995 to early 1997. Comparison of infants exposed to acid-suppressing drugs with all births in 1995-1996. Presence of congenital malformations. Proton pump blockers were used by 275 women, H2 receptor antagonists by 255 women, and both categories of drugs by 20 women. No effect of the use of omeprazole or H2-receptor antagonists on the rate of congenital malformations could be demonstrated. Though a teratogenic effect of these drugs cannot be completely ruled out, the individual risk after exposures during the first trimester seems to be negligible.

The CRIB (clinical risk index for babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units

Assessment of different hospitals' performance in neonatal intensive care has tended to rely on risk of mortality adjusted only for birthweight. We have developed a neonatal scoring system, CRIB (clinical risk index for babies), to take account of other factors. Scores are given for birthweight, gestational age, maximum and minimum fraction of inspired oxygen and maximum base excess during the first 12 h, and presence of congenital malformations. CRIB was developed retrospectively in a cohort of 812 infants of birthweight 1500 g or less or gestational age less than 31 weeks treated in four UK tertiary hospitals between 1988 and 1990. The scoring system was then validated by comparing its value as a predictor of hospital death with that of birthweight in a separate cohort of 488 similar infants. The area under the receiver operating characteristic (ROC) curve for predicting death in this validation cohort (a measure of the predictor's accuracy) was significantly greater for CRIB than for birthweight alone (0·90 [SE 0·05] vs 0·78 [0·03], p=0·03). Both indices of initial risk were used to assess the performance of nine tertiary and four non-tertiary hospitals in the UK. We looked at hospital mortality among the 1300 infants in the development and validation cohorts plus 248 other infants of birthweight 1500 g or less or gestational age less than 31 weeks. Without adjustment for initial risk, there was no clear difference in group mortality between the tertiary and non-tertiary hospitals. However, calculation of risk- adjusted mortality by means of CRIB showed that babies were twice as likely to die in the non-tertiary hospitals as in the tertiary hospitals (odds ratio 2·12 [95% Cl 1·39-3·24]). Adjustment for birthweight alone also showed higher odds of death in non-tertiary hospitals (1·45 [1·01-2·11]). CRIB is a robust index of initial neonatal risk that is more accurate than birthweight and simple enough for routine use. International comparisons of staffing policy and organisation of neonatal intensive care units are needed to investigate the reasons for variations in performance.

Psoralen Photochemotherapy (PUVA) and Pregnancy

Psoralen photochemotherapy (PUVA) may carry a risk of mutagenesis and teratogenesis. Using a medical birth registry and other health registries, infants born to women who had been treated with PUVA were identified. Exposure information was obtained from treating hospitals and from the license-granting agency. A total of 504 infants were born of pregnancies occurring after PUVA treatment, and 689 infants were born of pregnancies occurring before such treatment. In another 14 cases, treatment occurred during pregnancy. No increase in infant or child mortality or in the presence of congenital malformations could be seen after PUVA treatment. There was a marked increase in low-birth-weight infants when pregnancy occurred after treatment, and this is probably not explained by maternal smoking, but could be an effect of the underlying disease. The theoretical mutagenic and teratogenic effect of PUVA treatment apparently does not carry any significant risk for abnormal delivery outcome.

Cord serum bromide concentration: Variation and lack of association with pregnancy outcome

Excessive maternal bromide exposure during pregnancy from drugs and occupation have been reported to have adverse effects on the fetus and newborn, including central nervous system depression at birth and possible teratogenicity. To define further fetal bromide exposure during pregnancy, we determined the cord serum bromide concentration in 1267 newborn babies born in Rochester, New York, during the 6-month period from January 1, 1984 to June 30, 1984. There was a normal distribution of the cord serum bromide concentration values (mean +/- SD = 8.6 +/- 2.6 mg/L; range 3.1 to 28.5 mg/L). The highest concentration was still significantly below the minimal bromide concentration associated with toxic effects (720 mg/L). There was no association between the cord serum bromide concentration and indices of fetal health including Apgar scores, presence of congenital malformations, and neonatal disposition. No mothers were taking significant amounts of bromide-containing drugs during pregnancy. The second highest cord serum bromide concentration (21.4 mg/L) was in a woman who was an amateur photographer and developed her own film, which required her to use chemicals containing bromide. Our results indicate that excessive fetal bromide exposure is rare and probably occurs only in the setting of maternal use of bromide-containing drugs or occupational exposure during pregnancy.