Previous History Of Miscarriage Research Articles

Coping strategies as psychological risk factor for antenatal anxiety, worries, and depression among Greek women

A range of psychosocial, medical, and demographic variables may influence pregnant women's psychological status. However the association between coping strategies, anxiety, worries, and depression during pregnancy is a relatively neglected area of research. Therefore, the aim of this study was to examine the relationship between coping strategies, antenatal anxiety, pregnancy worries, and depressive symptomatology after controlling for the effects of background variables. The study sample consisted of 163 pregnant women, with gestational age ranging from 11 to 26 weeks, attending antenatal screening at a Greek public hospital. Coping strategies were measured with Brief COPE, pregnancy worries were measured with Cambridge Worry Scale (CWS), anxiety was assessed using State-Trait Anxiety Inventory (STAI-X version), and depression was measured with Center for Epidemiologic Studies-Depression scale (CES-D). Pearson's correlation coefficients were calculated among all study variables, followed by hierarchical multiple linear regression. In the univariate analysis, low annual income, unemployment, conception after an IVF treatment, and a previous history of miscarriage were associated with anxiety, depression, and worries. Additionally, almost all coping strategies (denial, behavioral disengagement, self-blame, self-distraction, substance use, acceptance, positive reframing, active coping, and seeking emotional support) were significantly associated with antenatal anxiety, worries, and depression. Linear regression analysis showed that only previous history of miscarriage, conception after IVF, as well as denial, behavioral disengagement and acceptance coping strategies were significantly related to anxiety, worries and depressive symptomatology. The risk factors found in this study could help clinicians target anxiety and depression screening to high-risk populations of pregnant women. Provision of adequate training for obstetricians and midwives in the detection and management of anxiety and depression among pregnant women should help to decrease the psychological burden during pregnancy.

Women undergoing multiple IVF attempts have higher incidence of chromosomally normal embryos than in women suffering from repetitive miscarriages

The majority of recurrent spontaneous abortions like the recurrent failures of embryo implantation share the same cause high incidence of preimplantation embryo aneuploidy. Therefore, our objective was to compare the incidence of chromosomally normal embryos (CNE) from couples undergoing preimplantation genetic screening (PGS) with a history of previous miscarriages following natural conceptions (NC) and in couples undergoing PGS after multiple IFV treatment (MIVF).

Environmental tobacco smoke and stress as risk factors for miscarriage and preterm births

Back groundExposure of pregnant women to environmental tobacco smoke has been shown to be associated with low birth weight. Many studies have suggested that stress have a role in the etiology of preterm birth.AimsThis study carried out from June 2008 to March 2009 to find the relation between environmental tobacco smoke, stress and miscarriage and preterm births.MethodsA total of 33 subjects consisted of multiparous pregnant women that were in their early third trimester were chosen for this investigation. Subjects were divided into test group women with adverse pregnancy outcome, control group women with successful pregnancy. Four ml of unstimulated whole saliva were collected. The concentrations of cotinine and cortisol were evaluated using commercially available ELISA kit.ResultsPregnancies in which the average standardized cortisol during history of previous miscarriage(s) which occurred within 6th–27th week or/and history of preterm labor which occurred within 28th–36th weeks of gestation, demonstrated higher cortisol level (1.0201 ± 0.1855 ng/ml) compared to control group 0.9757 ± 0.2860 ng/ml (P = 0.323); statistical analysis showed no significant differences. Women of control group were more likely to be environmental tobacco smoke exposed (1.2714 ± 1.7639 ng/ml) than women with miscarriage and preterm births (0.9889 ± 0.5498 ng/ml).ConclusionThe results from this primarily study demonstrated no association between cotinine, cortisol, miscarriage and preterm births.

Salivary alpha‐amylase during pregnancy: Diurnal course and associations with obstetric history, maternal demographics, and mood

Diurnal patterns of salivary alpha amylase (sAA) in pregnant women have not previously been described. The current study employed ecological momentary assessment to examine the association between the diurnal sAA, obstetric history, maternal demographics, and mood during pregnancy. Saliva was self-collected by 83 pregnant women (89% White, age 25.3-43.0 years; mean gestational age 21.9 weeks, range 6-37 weeks; gravida 1-6) at home over three days. Results indicated that current pregnancy (gestational age and fetal sex) and maternal demographics were not related to diurnal sAA. In contrast, a history of previous miscarriage (Parameter = -.17; SE = .05; p < .05) was associated with an atypical diurnal pattern. Even after accounting for obstetric history, trait anxiety (Parameter = .16; SE = .04; p < .001) was associated with increased sAA over the day while chronic levels of fatigue (Parameter = -.06; SE = .03; p < .05) were associated with decreased sAA. In a separate model, we also tested the time varying covariation of sAA and mood. The effects of momentary mood were in contrast to those for trait mood. Both momentary depression (Parameter = .22; SE = .09; p < .01) and vigour/positive mood (Parameter = .12; SE = .04; p < .001) were associated with momentary increases in sAA while momentary anxiety and fatigue were not related to sAA. The findings suggest that basal sAA during pregnancy is sensitive to emotional arousal. Evaluating diurnal patterns of sAA holds promise for advancing understanding of how emotional arousal during pregnancy may affect fetal development.

Thrombophilic Genes Mutations in Women with Repeated &lt;i&gt;In-Vitro&lt;/i&gt; Fertilization Failure

Problem statement: Thrombophilia has been recently implicated in earl y pregnancy loss and IVF implantation failure, by impairing the init ial vascularization process occurring at implantati on, which is necessary for a successful pregnancy. Approach: The aim of this study is to assess the presence possibility of mutation in thrombophilic g enes (Factor V (FV) gene, Prothrombin (PT) gene and Methylenetetrahydrofolate Reductase (MTHFR) gene) in women with repeated IVF-embryo transfer failure with unknown causes. The study was performed on patients with two or more previously failed IVF-embryo transfer cycles with u nknown causes. Women who conceived spontaneously with no previous history of miscarria ge and women who have had successful pregnancy after their first IVF-embryo transfer cycle are inc luded as control groups. Results: There are increase in allelic frequencies of thrombophilic genes (fact or V, prothrombin and methylenetetrahydrofolate reductase) mutation, in addition to genotype freque ncies (both homozygote and heterozygote) and increase in frequency of multiple gene mutations am ong women with IVF- embryo transfer failure. Conclusion: Thrombophilia has a significant role in IVF- embry o transfer implantation failure. Women with repeated IVF- embryo transfer failure should be screened for Thrombophilia to avoid repeated IVF- embryo transfer failure.

Lupus and pregnancy: integrating clues from the bench and bedside

Adequate pregnancy care of women with systemic lupus erythematosus (SLE) rests on three pillars: a coordinated medical-obstetrical care, an agreed and well-defined management protocol and a good neonatal unit. Pregnancy should be planned following a preconceptional visit for counselling. Women with severe active disease or a high degree of irreversible damage, such as those with symptomatic pulmonary hypertension, heart failure, severe restrictive pulmonary disease or severe chronic renal failure should best avoid pregnancy. Treatment is based on hydroxychloroquine, low-dose steroids and azathioprine. Patients with antiphospholipid antibodies/syndrome should receive low-dose aspirin +/- low molecular weight heparin. The addition and the dose of heparin depend on the clinical profile of the patient, i.e. a previous history of miscarriage, foetal loss, placental insufficiency or thrombosis. A close surveillance, with monitoring of blood pressure, proteinuria and placental blood flow by Doppler studies helps the early diagnosis and treatment of complications such as preeclampsia and foetal distress. Postpartum follow-up is important.

Preeclampsia in the Second Pregnancy: Does Previous Outcome Matter?

ABSTRACT Although it has been observed that the incidence of preeclampsia is lower among women having their second pregnancy than among women having their first, it is unclear whether protection against preeclampsia results from parity or gravidity. For example, 1 previous study reported a protective effect in the second pregnancy of a late miscarriage in the first pregnancy, whereas other studies have found that only deliveries >37 completed weeks have a protective effect. Another study showed that a previous abortion, either spontaneous or therapeutic, was protective, irrespective of gestational age. This retrospective observational study was designed to determine whether the reduced risk of preeclampsia in the second pregnancy is dependent or independent of the first pregnancy's outcome, including the gestational age at delivery. Data from 24,500 women with first and second pregnancies between 1986 and 2006 were obtained from the Aberdeen Maternity and Neonatal Databank in Scotland. The treatment group included all women who developed preeclampsia in their second pregnancy, whereas the control group included all women with normotensive second pregnancies. Potential independent risk factors for the development of preeclampsia in the second pregnancy were evaluated, and crude and adjusted odds ratios (OR) were estimated using binary logistic regression. A total of 903 (3.7%) of the 24,500 women in the study population had preeclampsia in the second pregnancy. Of these, 167 had a previous history of preeclampsia, for a recurrence rate of 14.2%. The incidence of preeclampsia was increased in women with interpregnancy intervals of 6 years or more (19.3% vs. 14.7%) and in those with an increase in BMI (70.8% vs. 63.2%), whereas a change of partner appeared to have a protective effect (3.5% vs. 5.6%). Compared to women who were normotensive in the first pregnancy, women with a history of preeclampsia in the previous pregnancy had an adjusted odds ratio of 5.12 (95% confidence interval [CI] of 4.42–6.48) for developing preeclampsia in the second pregnancy. Using a model that included only live births, and after controlling for maternal age, BMI, smoking, change of partner, interpregnancy interval, and previous history of preeclampsia or gestational hypertension, the risk of preeclampsia in the second pregnancy appeared to decrease with increasing gestational age at delivery of the first pregnancy. Compared to women who had a previous term delivery, the odds ratio for developing preeclampsia in the second pregnancy was 4.22 (95% CI, 2.54–7.03) for women whose previous pregnancy ended in the second trimester, 2.32 (95% CI, 1.62–3.32) for women who had a previous preterm birth at 25 to 32 weeks', and 1.62 (95% CI, 1.46–1.72) for those with a previous preterm birth at 33 to 36 weeks'. The effect of a previous fetal death was evaluated using a second model that included all study patients whose previous pregnancy extended beyond 20 weeks. After adjusting for the same variables listed above, the risk of preeclampsia was the same for women with a previous history of stillbirth as for those with a previous live birth. Only first deliveries beyond 37 weeks were protective against preeclampsia, independent of outcome, in the second pregnancy. These findings suggest that the protective effect of a previous pregnancy against preeclampsia in the second pregnancy is dependent on the gestational age at delivery of the first pregnancy but not on that pregnancy's outcome.

Where have all the neutrophils gone?

An 8-week-old boy presented with a history of fever associated with an ulcerating rash over both hips that had worsened over the preceding 5 days (fig 1). He was the...

Rates of Spontaneous and Therapeutic Abortions Following Use of Antidepressants in Pregnancy: Results From a Large Prospective Database

ObjectiveThe use of antidepressants during pregnancy remains a controversial issue, and there is little information on the risk of spontaneous abortions following antidepressant exposure in early pregnancy. We sought to examine whether use of antidepressants increases the rates of spontaneous abortion (SA) and therapeutic abortion (TA) in women exposed in early pregnancy. MethodsIn a cohort of women who contacted the Motherisk program during pregnancy, we compared two groups of women, one exposed and the other not exposed to antidepressants during pregnancy, and calculated the associated rates of SA and TA. ResultsAmong 937 women exposed to antidepressants prior to and during early pregnancy, there were 122 SAs (13.0%) including three ectopic pregnancies, and in the comparison group there were 75 SAs (8.0%) and no ectopic pregnancies. The relative risk was 1.63 (95% CI 1.24–2.14). Three-fold more women reported a TA in the exposed group, 26 (2.4%) compared to 8 (0.7%) in the non-exposed group (RR 3.25; 95% CI 1.48–7.14). A sub-analysis revealed that in both groups, of 338 women with a prior SA, 58 (17.2%) reported having a SA in the current pregnancy, compared with 61/652 (9.4%) with no prior SA (χ2 = 12.09, P < 0.001). In the antidepressant group, the incidence was 20.7%, and in the non-exposed group, it was 13.3%. Logistic regression confirmed that only antidepressant exposure and prior SA were significantly associated with current SA. ConclusionExposure to antidepressants in the first trimester of pregnancy appears to be associated with a small but statistically significant increased risk of SA and decision to terminate a pregnancy. The risk for SA is further elevated with a history of previous SA. However, any underlying depression must be taken into consideration when evaluating these results.

Factors associated with a positive intake of folic acid in the periconceptional period among Korean women

We aimed to investigate the factors associated with a positive intake of folic acid (FA) during the periconceptional period among Korean women. In a cross-sectional study of demographic, obstetric and socio-economic data, history of periconceptional intake of FA and awareness of the benefits of FA supplementation in pregnancy were obtained and analysed using the chi2 test, followed by multiple logistic regression analysis. The Maternity School, Cheil General Hospital and Women's Healthcare Center, Seoul, South Korea, between October 2005 and March 2006. In total 1313 pregnant women participating in a two-day training course available every month. After excluding subjects with incomplete or inconsistent data, there were 1277 women included in the analysis. Participants were aged 29.4 (sd 2.9) years and had a mean gestational age of 27.9 (sd 7.1) weeks. Only 131 (10.3 %) women took FA during the periconceptional period. According to multiple logistic regression analyses, the adjusted OR for FA supplementation was 1.79 (95 % CI 1.10, 2.91) in women who had previous spontaneous abortions, 4.10 (95 % CI 2.43, 6.78) in women who planned their pregnancy and 6.63 (95 % CI 2.08, 21.12) in those who were aware of the protective effects of FA. Periconceptional intake of FA was more likely among Korean women with a history of previous spontaneous abortion, who planned their pregnancy or who were aware of the protective effects of FA during pregnancy. However, the proportion of women who took FA in the periconceptional period was low.

Repeated in vitro Fertilization Failure and Its Relation with Thrombophilia

Background: The objective of this study was to determine the prevalence of some thrombophilic factors and its relation to in vitro fertilization (IVF)-embryo transfer failure in women who had had three or more previously failed IVF-embryo transfer cycles. Methods: The study group included 51 consecutive women with three or more previously failed IVF-embryo transfer cycles (group 1). The control group included 50 women who conceived spontaneously with at least one uneventful pregnancy and no previous history of miscarriage. All women were tested for the presence of factor V Leiden, prothrombin (G20210A), and methylenetetrahydrofolate reductase (C677T) mutations. Results: A similar prevalence of factor V Leiden, prothrombin, and methylenetetrahydrofolate reductase mutations was found in both groups. At least one inherited thrombophilic factor was detected in 62.7% of women with repeated IVF failure and in 53.9% of women in group 2. No association between repeated IVF failure and these thrombophilic factors was found statistically. Conclusion: These data suggest that factor V Leiden, methylenetetrahydrofolate reductase and prothrombin gene mutation do not have a significant role in IVF-embryo transfer implantation failure.

Platelet-derived microparticle levels in women with recurrent spontaneous abortion

Objective To investigate the significance of platelet-derived microparticles (PMPs) in women with recurrent spontaneous abortion. Methods We measured platelet P-selectin (CD62P) as a platelet activation marker and CD42b + microparticles as PMPs by flow cytometry in whole blood of 20 women with recurrent spontaneous abortion and 20 age-matched healthy controls with no previous history of spontaneous abortion. Results PMP levels in women with recurrent spontaneous abortion were higher than in women in the control group (4.79 ± 1.18% vs 3.06 ± 0.92%; P < 0.000). CD62P levels were not significantly higher in the study group compared with the control group (13.78 ± 8.62% vs 10.78 ± 7.35%; P > 0.05). Conclusion Our findings suggest that PMPs may have a role in the pathogenesis of recurrent spontaneous abortion.

History of spontaneous abortion increases the risk of oocyte donation pregnancy loss

A history of live birth may be an advantage to women who later need to undergo fertility treatments, although supporting data is lacking. We sought to see if pregnancy history, including live birth and frequency of spontaneous abortion (SAB) would relate to the incidence of pregnancy and miscarriage in women undergoing oocyte donation. Retrospective chart review of 606 donor oocyte transfers from January 2001– December 2004. All recipients were screened and treated for correctable anatomic causes of infertility prior to enrolling in donor egg (DE). Pre-embryo transfer data collected included the number of full term deliveries, pre-term deliveries, SAB, elective terminations and ectopic pregnancies. Post DE transfer data included delivery, no successful implantation, SAB, elective termination and ectopic pregnancy. Each cycle was assigned to three main groups; GxPx (x ≥ 1), GxP0 and G0P0. GxP0 was subdivided into those with history of (1) elective abortion only and (2) SAB and elective abortion or SAB only. Data was analyzed using chi square. 606 recipient cycles resulted in 369 pregnancies, 322 live births and 40 SAB. There was a significant difference between SAB rates in those with a history of successful pregnancy vs. those with history of SAB only (2.78% vs. 8.14% P<0.05). There was also a significant difference in the DE live birth rate of patients with previous history of live birth compared to those with history of spontaneous abortion only (61.81% vs. 44.19% P<0.01). There was no significant difference in the pregnancy or live birth rate in the GxPx group compared to the G0P0 group. Patients with history of elective abortion only had a pregnancy rate of 65.51% and a DE live birth rate of 54.10%, comparable to G0P0 group. Table 1Pregnancy outcomes after donor oocyte transferGestational HistoryGxPx N = 144GxP0 N = 172G0P0 N = 229Pregnancy rate (%)61.81 (89/144)44.19 (76/172)54.15 (124/229)Live birth rate (%)64.58 (93/144)54.10 (93/172)62.45 (143/229)Spontaneous abortion rate (%)2.78 (4/144)8.14 (14/172)6.55 (15/229) Open table in a new tab Women with a previous history of SAB have an increased risk of miscarriage and decreased live birth rate when compared to women who have had a live birth and who have never been pregnant. This model confirms that some women with anatomically normal uteri have intrinsic factors, uterine or systemic, that increase their risk for miscarriage. Oocyte donation provides an excellent model to study the etiology of pregnancy loss.

Risk factors associated with preterm birth in the Gaza Strip: hospital-based case-control study

This study aimed to assess the main maternal risk factors associated with preterm birth in the Gaza Strip. A hospital-based case-control study was carried out at El-Shifa and Khan-Younis hospitals with 200 women with preterm births and 200 control women. Significant risk factors for preterm birth were: maternal age > or = 35 years, being a refugee, inadequate antenatal care, failure to gain adequate weight during pregnancy and previous history of preterm birth. Other significant risk factors included: short stature, short interval between the last 2 pregnancies, presence of congenital gynaecological abnormalities, previous history of caesarean delivery and previous history of stillbirth.

Human exposure to endocrine-disrupting chemicals and prenatal risk factors for cryptorchidism and hypospadias: a nested case-control study.

BackgroundExposure to xenoestrogens during pregnancy may disturb the development and function of male sexual organs.ObjectiveIn this study we aimed to determine whether the combined effect of environmental estrogens measured as total effective xenoestrogen burden (TEXB) is a risk factor for male urogenital malformations.MethodsIn a case–control study, nested in a mother–child cohort (n = 702) established at Granada University Hospital, we compared 50 newborns with diagnosis of cryptorchidism and/or hypospadias with 114 boys without malformations matched by gestational age, date of birth, and parity. Controls did not differ from the total cohort in confounding variables. TEXB and levels of 16 organochlorine pesticides were measured in placenta tissues. Characteristics of parents, pregnancy, and birth were gathered by questionnaire. We used conditional and unconditional regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs).ResultsTEXB from organohalogenated compounds was detectable in 72% and 54% of case and control placentas, respectively. Compared with controls, cases had an OR for detectable versus non-detectable TEXB of 2.82 (95% CI, 1.10–7.24). More pesticides were detected in cases than in controls (9.34 ± 3.19 vs. 6.97 ± 3.93). ORs for cases with detectable levels of pesticides, after adjusting for potential confounders in the conditional regression analysis, were o,p′-DDT (OR = 2.25; 95% CI, 1.03–4.89), p,p′-DDT (OR = 2.63; 95% CI, 1.21–5.72), lindane (OR = 3.38; 95% CI, 1.36–8.38), mirex (OR = 2.85; 95% CI, 1.22–6.66), and endosulfan alpha (OR = 2.19; 95% CI, 0.99–4.82). Engagement of mothers in agriculture (OR = 3.47; 95% CI, 1.33–9.03), fathers’ occupational exposure to xenoestrogens (OR = 2.98; 95% CI, 1.11–8.01), and history of previous stillbirths (OR = 4.20; 95% CI, 1.11–16.66) were also associated with risk of malformations.ConclusionsWe found an increased risk for male urogenital malformations related to the combined effect of environmental estrogens in placenta.

A study of luteal phase expression of inhibin, activin, and follistatin subunits in the endometrium of women with recurrent miscarriage

To compare the luteal phase endometrial expression of inhibin, activin, and follistatin subunits in women with recurrent miscarriage compared to a control group. Other parameters of luteal function assessed included Doppler blood flow, serum biochemical markers, and histopathology. This was a prospective case control study. The study was conducted in a tertiary care hospital of Sheffield, United Kingdom. Thirty-three women with recurrent miscarriage and 10 women with no previous history of miscarriage (control group) were recruited. Histologic assessment of the luteal phase endometrium was done using Noyes criteria followed by immunohistochemical analysis for expression of inhibin, activin, and follistatin subunits. Doppler analysis for perifollicular and endometrial blood flow was also done. Simultaneously serum concentrations of E(2), LH, FSH, P, and inhibin B at the time of LH surge and at LH +7 days were measured. Difference in endometrial expression of inhibin, activin, and follistatin subunit in the two groups. Endometrial expression of follistatin and beta A in the endometrial stromal cells of women with recurrent miscarriage was significantly lower than in control women. There were no differences in results of the Doppler studies or the hormonal profiles between cases and controls. The lower expression of follistatin and beta A subunit in women with recurrent miscarriage may imply an altered activity of activin A at the time of decidualization, which may lead to poor pregnancy outcome in the form of miscarriage.

Acquired and inherited thrombophilia: implication in recurrent IVF and embryo transfer failure

The objective of this study was to determine the incidence of undiagnosed thrombophilic factors and its relation to IVF and embryo transfer failure in women who have had three or more previous IVF-embryo transfer cycles. The study group comprised of 90 consecutive women with three or more previously failed IVF-embryo transfer cycles (group A). Two control groups were enrolled: group B (n=90) included women who have had successful pregnancy after their first IVF-embryo transfer cycle, and group C (n=100) included women who conceived spontaneously with at least one uneventful pregnancy and no previous history of miscarriage. All women were tested for the presence of inherited [factor V Leiden (FVL) mutation, prothrombin mutation, methylenetetrahydrofolate reductase (MTHFR) mutation and deficiencies in proteins S and C and antithrombin III] or acquired (lupus anticoagulant and anticardiolipin) thrombophilic factors. An increase in the incidences of FVL, MTHFR and antiphospholipid antibodies was found in the study group compared with the two control groups. At least one inherited or acquired thrombophilic factor was detected in 68.9% of women with repeated IVF failure compared with 25.6 and 25% in the groups B and C, respectively (P<0.01). Combined thrombophilia (two or more thrombophilic factors) was significantly higher in women who have had repeated IVF failure as compared with the two control groups (35.6 versus 4.4 and 3%) (P<0.0001). Thrombophilia has a significant role in IVF-embryo transfer implantation failure. Women with repeated IVF-embryo transfer failure should be screened for thrombophilia.

Absence of follicular phase defect in women with recurrent miscarriage

The study was designed to compare the follicular phase of women with recurrent pregnancy loss and a healthy control group. It is possible that a defective or aberrant follicular phase may be associated with poor oocyte quality leading to a production of an embryo with compromised quality and hence early pregnancy loss. Prospective case-control study. A tertiary care hospital of Sheffield, UK. Thirty-four women with recurrent miscarriage and 10 women with no previous history of miscarriage and regular menstrual cycles (control group) were recruited. The characteristics studied included Doppler assessment of blood flow to the follicle and the endometrium. Simultaneously, serum concentrations of biochemical markers such as anti-Müllerian hormone, inhibin B, FSH, LH, and P were compared in the two groups. Differences in the two groups. We were unable to detect significant differences in various biochemical and ultrasound measurements in the follicular phase between women with recurrent miscarriage and a control group; however, the expected correlation between ovarian and pituitary hormones, which was observed in the control group, was absent in women with recurrent miscarriage. There may be subtle derangements of the feedback mechanism responsible for regulation of follicle development in this group of women. However, there were no obvious differences in the follicular phase of women with recurrent miscarriage and a healthy control group.

Maternal miscarriage history and risk of anencephaly

Women with a history of reproductive loss may be at an increased risk of having an unfavourable outcome in subsequent pregnancies. Using data from a matched case-control study based on the record of the Epidemiological Surveillance System of Neural Tube Defects, we evaluated the association between history of maternal reproductive loss and the risk of anencephaly in three Mexican states. Mothers of 157 cases of anencephaly and 151 controls born during the period March 2000 to February 2001, were interviewed about their reproductive history and other additional factors, including socio-economic characteristics, prenatal care, use of tobacco and alcohol, presence of chronic diseases, acute illnesses and fever during the periconceptional period, and consumption of multivitamins and medicines during this period; mothers who reported no prior pregnancies were excluded from the analysis; 58 matched case-control pairs were used for the analysis. After adjusting for potential confounders, women with a history of miscarriage in previous pregnancies had 4.58 times more risk of having a child with anencephaly, than those who did not have this history; OR = 4.58, [95% CI 1.22, 17.23]. Our results suggest that a history of previous miscarriages is a risk indicator for anencephaly in future gestations. This does not necessarily mean that the miscarriage itself is the cause, but that common mechanisms could be involved in the aetiology of both events. Thus, women who have had histories of reproductive losses, especially miscarriages, should be a priority group for the primary and secondary prevention of neural tube defects.

Prevalence and correlates of depression in late pregnancy among Nigerian women

The objectives of this study were to estimate the prevalence of depressive disorder in late pregnancy in a group of Nigerian women and to examine the associated factors. One hundred and eighty women in late pregnancy completed a questionnaire on sociodemographic and obstetrical details. They also completed the Edinburgh Postnatal Depression Scale (EPDS). A proportion of them were then assessed for the DSM-IV diagnosis of depressive disorder. Fifteen (8.3%) women met the current (2 weeks) DSM-IV diagnosis of depressive disorder. The factors independently associated with depression included being single [odds ratio (OR)=16.67, 95% confidence interval (CI)=3.17-87.76], divorced/separated (OR=11.11, 95% CI=1.55-19.65), polygamous (OR=3.92, 95% CI=0.94-16.33), and having a previous history of stillbirth (OR=8.00, 95% CI=1.70-37.57) and perceived lack of social support (OR=6.08, 95% CI=1.42-26.04). Depression is common in late pregnancy among Nigerian women, with the significant correlates including mainly social and family factors. Such factors should be considered when planning health care services or formulating a predictive model. Interventions aimed at reducing the occurrence of antenatal depression need further research.