Rate Of Major Congenital Malformations Research Articles

A follow-up study of children born after diode laser assisted hatching

This follow-up study of children born after laser assisted hatching (LAH) with a non-contact laser aims to compile data on karyotypes, deliveries, congenital malformations and growth parameters to evaluate the safety of this new technique. The study design consisted of karyotyping and completion of a standardized questionnaire. Data were analyzed for the first 134 children born after LAH. Indication for LAH were the age (over 35 years) (group I), previously minimum three unsuccessful IVF-ET treatment cycles (group II) and age >35 years with at least three unsuccessful IVF cycles (group III). In our study group of 134 babies we found no increase in the major congenital malformation rate (2.2%) which is comparable with the major congenital malformation rate (3%) among all deliveries at our hospital. No increase in chromosomal aberrations could be observed. Neither could we observe a difference in minor congenital malformations between the LAH treated group and all deliveries at our hospital (10.4% versus 11.1%). On this limited number of children born after LAH there was neither evidence of an increased incidence of chromosomal aberrations nor of congenital malformations.

Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors: a prospective controlled multicenter study.

Although a large number of women of reproductive age use new selective serotonin reuptake inhibitors (SSRIs) and half of all pregnancies are unplanned, no data exist on the safety of these agents for the human fetus. To assess fetal safety and risk of fluvoxamine, paroxetine, and sertraline. A prospective, multicenter, controlled cohort study. Nine Teratology Information Service centers in the United States and Canada. All women who were counseled during pregnancy following exposure to a new SSRI and followed up by the participating centers. Controls were randomly selected from women counseled after exposure to nonteratogenic agents. Rates of major congenital malformations. A total of 267 women exposed to an SSRI and 267 controls were studied. Exposure to SSRIs was not associated with either increased risk for major malformations (9/222 live births [4.1%] vs 9/235 live births [3.8%] in the controls, relative risk, 1.06, 95% confidence interval, 0.43-2.62) or higher rates of miscarriage, stillbirth, or prematurity. Mean (SD) birth weights among SSRI users (3439 [505] g) were similar to the controls (3445 [610] g) as were the gestational ages (39.4 [1.7] weeks vs 39.4 [1.9] weeks). The new SSRIs, fluvoxamine, paroxetine, and sertraline, do not appear to increase the teratogenic risk when used in their recommended doses.

Diabetes in pregnancy

Diabetes is probably the most frequent pathological condition that influences the outcome of pregnancy. 0.2–0.3% of women of reproductive age are known to have diabetes prior to conception and a further significant proportion of pregnancies in otherwise normal women may be complicated by gestational diabetes. Diabetic pregnancy is a high risk state for both the woman and fetus. The usual complications of pregnancy such as infection, hydramnios, pre-eclampsia and placental insufficiency may occur more frequently and the diabetic state predisposes additional complications. These include: the development of progression of specific diabetic complications; particularly retinopathy; miscarriage; stillbirth; intrauterine death; congenital malformation and macrosomia in the fetus; increased perinatal mortality rate and neonatal morbidity. Without appropriate care of established diabetes during pregnancy, perinatal mortality may exceed 10% and the rate of major congenital malformations is at least 2–3 times higher than in non-diabetic pregnancies. Increased fetal growth in the last trimester of pregnancy is the main risk in gestational diabetes and early recognition through screening is important. Most of these complications can be reduced to the level of the non-diabetic pregnant population by expert medical care and the achievement of nearly normal glucose levels in the pregnant woman.

Psychotropic Medications During Pregnancy: Risk to the Fetus

To the Editor. —I was excited to read the article by Pastuszak et al1reporting on a prospective study of 128 women who took therapeutic doses of fluoxetine during their first trimester of pregnancy compared with the pregnancy outcome of two matched groups of women exposed to either nonteratogens or tricyclic antidepressants. Rates of major congenital malformations were similar for the three groups. This prospective study follows close on the heels of two studies reported inLancetin 1992. Jacobson et al2reported in a prospective study the pregnancy outcome after lithium exposure during the first trimester of pregnancy, and Bergman et al3published the results of a study of exposure to benzodiazepines during fetal life using a retrospective approach. In the first study,2women taking an average of 927 mg of lithium were compared with a control group of pregnant women who were taking drugs

Perinatal mortality and prevalence of major congenital malformations of twins in Taipei city.

In order to examine perinatal mortality and prevalence of major congenital malformations in twins, deliveries in four teaching hospitals in Taipei City were studied. Among a total of 73,264 deliveries from October 1985 to June 1989, there were 844 pairs of twins. The zygosity of the twin pairs was determined by sex, placentation and 12 red blood cell antigens. There were 482 MZ and 252 DZ twin pairs identified, but the zygosity of a further 110 twin pairs was indeterminable due to lack of information on plancentation and/or blood types. A total of 4,573 singletons delivered in one study hospital from July 1986 to June 1987 were also studied as controls. The perinatal mortality rate was 7.5% for MZ twins, 1.4% for DZ twins, and 0.7% for singletons. The concordance rate of perinatal death was significantly higher in MZ (60%) than in DZ (0%) twins. The prevalence of major congenital malformations was 2.7% for MZ twins, 1.0% for DZ twins, and 0.6% for singletons. The concordance rate of major congenital malformations was 18% for MZ twins, but no DZ pair was concordant in any major congenital malformation. The concordance rate of facial clefts was 29% for MZ twins. There were 2 sets of conjoined twins giving a prevalence rate of 2.7 per 100,000 deliveries. These findings showing the prevalence of perinatal mortality and major congenital malformation to be highest in MZ twins, intermediate in DZ twins and lowest in singletons, suggest the importance of intrauterine environments in the determination of perinatal mortality and congenital malformations.

Prospective multicentre study of pregnancy outcome after lithium exposure during first trimester

Lithium carbonate is an effective drug for prophylaxis and treatment of major affective disorders. In-utero exposure to lithium during the first trimester of pregnancy might be associated with an increased risk of cardiac malformations, especially the rare Ebstein's anomaly. We prospectively recruited and followed 148 women (mean age 30 years, SD 5 range 15-40) using lithium during the first trimester of pregnancy, who consulted four teratogen information centres in the USA and Canada. Pregnancy outcome was compared with that of controls matched for maternal age. We had complete follow-up of pregnancy outcome in 138 of 148 patients recruited. In the other 10, fetal echocardiograms were available but postnatal follow-up was not done. Mean daily dose of lithium was 927 mg (SD 340). Rates of major congenital malformations did not differ between the lithium (2·8%) and control (2·4%) groups. 1 patient in the lithium group chose to terminate pregnancy after Ebstein's anomaly was detected by a prenatal echocardiogram. There was 1 ventricular septal defect in the controls. Birthweight was significantly higher in the lithium-exposed infants than in the controls despite identical gestational ages (3475 [660] g vs 3383 [566] g, p=0·02). The true difference in birthweight might have been even larger, since significantly more women using lithium than controls were cigarette smokers (31·8% vs 15·5%, p=0·002). These results indicate that lithium is not an important human teratogen. Women with major affective disorders who wish to have children may continue lithium therapy, provided that adequate screening tests, including level II ultrasound and fetal echocardiography, are done.