Rate Of Congenital Malformations Research Articles

Obstetric, Neonatal, and Clinical Outcomes of Day 6 vs. Day 5 Vitrified-Warmed Blastocyst Transfers: Retrospective Cohort Study With Propensity Score Matching

Despite the large number of studies on blastocyst transfers, it is unclear whether day 6 blastocysts have similar pregnancy rates and safety with day 5 blastocysts. Thus, this study aimed to compare the obstetric, neonatal, and clinical outcomes of day 5 and day 6 vitrified blastocyst transfers (VBT). In this retrospective cohort study with propensity score matching, we evaluated 1,313 cycles of VBT performed between January 2014 and December 2015 at the Fertility Center of CHA Gangnam Medical Center. All cycles underwent natural endometrial preparation. We used propensity score matching to compare day 5 and day 6 VBTs in a matched comparison. After propensity score matching, there were 465 cycles of day 5 VBT and 155 cycles of day 6 VBT. Implantation rate (IR), clinical pregnancy rate (CPR), and live birth rate (LBR) were significantly lower in day 6 VBTs (44.2 vs. 53.1%, p = 0.023; 48.4 vs. 60.4%, p = 0.009; 33.5 vs. 51.8%, p < 0.001). Miscarriage rate was significantly higher in day 6 VBTs (29.3 vs. 10.7%, p < 0.001). Rate of multiple gestations was similar between the two groups (29.3 vs. 30.2%, p = 0.816). Assessing 241 and 52 babies from day 5 and day 6 VBTs, no differences were found in neonatal outcomes including rates of low birth weight, preterm birth, and congenital malformations. In propensity score-matched analysis, obstetric, and neonatal outcomes between day 5 and day 6 VBTs were similar so that day 6 VBTs are as safe as day 5 VBTs. IR, CPR, and LBR were are all significantly lower in day 6 VBTs. Therefore, if there are no differences in the morphological grade between day 5 and day 6 blastocysts, transfer of day 5 vitrified blastocysts should be considered first.

Pregnancy and Zika virus

Zika virus (ZIKV) is an arthropod-borne virus (arbovirus) in the genus Flavivirus and the Flaviviridae family. In 1947 and 1948 ZIKV was first isolated from a nonhuman primate as well as from mosquitoes in Africa, respectively. For half a century, ZIKV infections in human were sporadic prior to 2015–2016 pandemic spreading. Transmission of ZIKV from mother to fetus can occur in any trimester of pregnancy, even if mother was an asymptomatic carrier. The clinical signs of ZIKV infection are nonspecific and can be misdiagnosed as some other infectious diseases, especially those caused by arboviruses such as Dengue and Chikungunya. ZIKV infection was solely associated with mild illness prior to the large French Polynesian and Brazil outbreaks, when severe neurological complications, Guillain–Barre syndrome and dramatically increased rate of severe congenital malformations (including microcephaly) were reported. The adaptation of ZIKV to an urban cycle in endemic areas suggests that the incidence of ZIKV infections may be underestimated. The pandemic of novel coronavirus infection (COVID-19) demonstrates that lessons from ZIKV pandemic propagation has not been learned properly.

Carcinogenic and teratogenic status of human population and polychlorinated biphenyls contaminations of soils and biota (European pied flycatcher) in a Perm (Western Ural, Russia).

Polychlorinated biphenyls (PCBs) are included in the persistent organic pollutants designated by the Stockholm Convention and are hazardous compounds both for the environment and public health. The aim of this study was to determine the level of environmental pollution of PCBs in the Perm, in soil and biota (European pied flycatcher), and to analyze whether its presence was the cause of cancer and congenital malformations in the population. Soils in the study area had PCB concentrations of 101.87µg/kg in the Industrialniy District and 27.81µg/kg in the Leninskiy District of the Perm in 2005. The chemical composition of the individual PCBs and PCB groups were the same in the soils of both regions. The blood of nestlings of the European pied flycatcher raised in the Industrialniy District contained 9.61ng PCB/ml, while those in the Leninskiy District had 5.64ng PCB/ml in 2005. A linear correlation was established between the PCB contamination of soils and PCB contamination of pied flycatcher nestling's blood, and inverse linear correlation was established between the content of PCB in the blood of nestlings and the success of breeding of the pied flycatcher in Perm. An epidemiological analysis revealed a high incidence of cancer among the human population of the Industrialniy and Leninskiy districts (371.7 and 376.85 cases per 100,000 population, mean for the 2003-2018, respectively), which exceeded the figure for the whole of Perm (350.77 cases per 100,000 population, mean for the 2003-2018). The incidence rate of congenital malformations in Perm for the study period was 48.51 per 1000 human births. However, a decrease in the concentration of PCBs in soil and biota over a 15-year period (2005-2019) to the less than the detection limit did not lead to a decrease in the incidence of these diseases. Probably, PCB contamination was not the main cause of oncological diseases and congenital malformations in the population of the study area.

An outbreak of abortions, stillbirths and malformations in a Spanish sheep flock associated with a bovine viral diarrhoea virus 2-contaminated orf vaccine.

Bovine viral diarrhoea virus (BVDV) is a pestivirus that affects both cattle and sheep, causing an array of clinical signs, which include abortions and malformations in the offspring. Manufacturing of modified live virus (MLV) vaccines often includes the use of bovine-derived products, which implies a risk of contamination with viable BVDV. Recently, the circulation of a specific strain of BVDV2b among Spanish sheep flocks, associated with outbreaks of abortions and malformations, and whose origin was not determined, has been observed. On February 2018, a MLV orf vaccine was applied to a 1,600 highly prolific sheep flock in the Northeast of Spain that included 550 pregnant ewes. In May 2018, during the lambing season, an unusual high rate (72.7%) of abortions, stillbirths, congenital malformations and neurological signs in the offspring was observed. It was estimated that about 1,000 lambs were lost. Three 1- to 3-day-old affected lambs and a sealed vial of the applied vaccine were studied. Lambs showed variable degrees of central nervous system malformations and presence of pestiviral antigen in the brain. Molecular studies demonstrated the presence of exactly the same BVDV2b in the tissues of the three lambs and in the orf vaccine, thus pointing to a pestivirus contamination in the applied vaccine as the cause of the outbreak. Interestingly, sequencing at the 5'-untranslated region-(UTR) of the contaminating virus showed a complete match with the virus described in the previously reported outbreaks in Spain, thus indicating that the same contaminated vaccine could have also played a role in those cases. This communication provides a clear example of the effects of the application of this contaminated product in a sheep flock. The information presented here can be of interest in putative future cases of suspected circulation of this or other BVDV strains in ruminants.

Case series: Fetomaternal outcome with polytherapy in pregnant women with epilepsy at a rural tertiary care hospital

Epilepsy is most common major neurological complication encounterd in pregnancy. The etiology of seizures covers a wide range of diseases, vascular insults,infectious sequelae, malignant processes and primary central nervous dysfunction. A wide range of obstetric complications have been reported including spontaneous abortion , preterm labour, stillbirth, neonatal death, hemorrhagic disease of the newborn; low apgar and low birth weight. The incidence of malformations increase from 2.9% in the non drug user group to 3.7% in patient on monotherapy and 6.6% in patients on polytherapy. To study the maternal and perinatal outcome in pregnant women with epilepsy on polytherapy. This retrospective observational study was conducted in R.L. Jalappa Hospital Kolar India over a period of 6 months (December 2017-june2018). Five pregnant women with epilepsy attending the antenatal clinic or admitted in labour ward in a tertiary care hospital taking two or more antiepileptic drugs were evaluated. Cases included in this study concludes that, despite the increased risks of pregnancy in woman with epilepsy, with appropriate clinical management with newer drugs, more than 90 percent woman with epilepsy can have successful pregnancies and better neonatal outcome. Moreover because of prepregnancy planning, counselling and optimisation of antiepileptic drug regimens and use of preconception folic acid, pregnancy outcome have become better.A higher teratogenic potential was confirmed for traditional antiepileptic drugs, particularly Valproate. Lower rates of congenital malformations were found for levetiracetam(1.7%) than in association with VPA (6.9%)

Profile of Prenatally Diagnosed Major Congenital Malformations in a Teaching Hospital in Nigeria

Background: Prenatal diagnosis of major congenital abnormality is one of the main goals of antenatal care, because of its contribution to perinatal morbidity and mortality. Awareness of the profile in terms of rates and spectrum could aid management and prevention strategies. This study aims to determine the profile of congenital malformations, and the relationship between the rates and some maternal socio-demographic and obstetric variables.&#x0D; Methods: A retrospective cross-sectional study of prenatally diagnosed congenital malformations in singleton pregnancies over a four-year period. The ultrasound scan findings and the findings of fetal ultrasonography, together with maternal socio-demographic and obstetric variables, were collected from the ultrasound scan reports or medical records of each pregnancy. Data were analyzed using Microsoft Excel 2010.&#x0D; Results: Among the 968 singleton pregnancies, 78 had major congenital malformation, giving an antenatal rate of 8.04/1000 (0.8%). The first trimester prevalence was comparable with other trimesters. Malformation mostly involved single systems (93.6%), which are mainly central nervous (48.7%) and gastrointestinal/abdominal systems (21.8%). The rate was statistically significant (&lt; 0.0018) in women aged &gt; 35 years. The mean maternal age and parity were 31.4 + 4.7 and 2.8 + 0.4, respectively. The rates of congenital malformation in spontaneously or assisted conceptions were not statistically significant (p = 0.073 and p = 0.085).&#x0D; Conclusion: Maternal age &gt; 35 years and multiparity are important risk factors for congenital malformation. The commonly involved systems are the central nervous and gastrointestinal systems.&#x0D; Keywords: congenital malformations, prevalence, spectrum, antenatal ultrasound scan, Nigeria

Neonatal outcome of children born after ICSI with epididymal or testicular sperm: A 10-year study in China

Some studies show that children born after ICSI with non-ejaculated sperm are at increased risk of birth defects, other studies hold the opposite view. Does neonatal outcome including congenital malformations in children born after ICSI with percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA) differ from neonatal outcome in children born after ICSI with ejaculated sperm? In this study, we examined the data from our IVF center from 2006 to 2016, to compare neonatal outcomes and rates of congenital malformations in children born after ICSI with different sperm origin. The results showed the clinical pregnancy rate and implantation rate of non-ejaculated sperm group were significantly higher (P < 0.001) than ejaculated sperm group. There were 775 clinical pregnancies from non-ejaculated sperm group and 2,486 clinical pregnancies from ejaculated sperm group. Most of the clinical pregnancy outcomes were comparable between non-ejaculated sperm group and ejaculated sperm group (p > 0.05): the miscarriage rate per transfer, ectopic pregnancy rate per clinical pregnancy, induced abortion rate per clinical pregnancy and fetal deaths per clinical pregnancy. However, the live delivery rate per transfer of non-ejaculated sperm group was significantly higher than that of ejaculated sperm group (45.4% vs 36.7%, P < 0.001). Moreover, the comparison between the epididymal sperm, testicular sperm and ejaculated sperm groups showed there were no difference in the incidence of congenital malformations of babies live birth. Among singleton gestation live births, there were more girls than boys in both non-ejaculated sperm and ejaculated sperm group. In conclusion, the present study clearly showed no statistical increased risk in neonatal outcomes of newborns were found in the ICSI treatment with epididymal or testicular sperm. It may provide information for consultation for ICSI treatment in PESA or TESA patients.

P599 Trimester exposure and pregnancy outcomes in women exposed to golimumab: Results from the company pharmacovigilance database

Abstract Background Rheumatologic disorders and inflammatory bowel disease can affect women of childbearing potential. Golimumab (GLM) is approved for several rheumatological indications and ulcerative colitis (UC). To characterise pregnancy outcomes in patients treated with GLM, data obtained from maternal exposure to GLM are presented. Methods These dataset includes individual patient cases reported to the manufacturer through 06 April 2019. Cases included in the analysis were medically confirmed cases of maternal exposures to GLM during pregnancy or within 3 months prior to conception, and a reported pregnancy outcome. Both prospectively reported (ie, pregnancy outcome not known when first reported) and retrospectively reported cases (ie, pregnancy outcome known when first reported) were included. Cases originated from various sources, including spontaneous reporting, clinical studies, and registries. Results Two hundred eight pregnancy cases (131 rheumatological; 43 UC; and 34 other) with 211 reported birth outcomes were identified. Three cases reported twin pregnancies. Of the 208 pregnancy cases, 119 were prospective and 89 were retrospective (Table 1). Average maternal age was 31.9 years. Of the 119 prospectively reported pregnancy cases, 89 (74.8%) resulted in live births, 19 (16.0%) resulted in spontaneous abortion (of these, 42.1% (8/19) received GLM in combination with methotrexate [MTX]), 10 (8.4%) resulted in induced/elective abortion, and 1 (0.8%) resulted in ectopic pregnancy. Overall, 9 congenital anomalies were reported (2 prospective/7 retrospective cases). For 183 of the 208 pregnancy cases with-reported outcomes, the trimester of exposure to GLM was known (Table 2). Among the 110 prospectively reported cases, 82 (74.5%) were exposed during trimester 0 or 1. Of these, 19 had concomitant exposure to MTX, with the following birth outcomes: 8 live births, 8 spontaneous abortions, 3 elective/induced abortions. Eighteen of the prospectively reported cases (16.4%) were exposed to GLM throughout pregnancy (first, second and third trimester) and all resulted in live births. Conclusion The rates of congenital malformations and spontaneous abortions were consistent with published background rates for the general population. Persistent exposure throughout pregnancy was rare, but not associated with apparent clinical sequelae. Limitations of this analysis include the lack of a direct comparison group, the variable amount of data available in the reports, and the possible bias towards reporting more negative outcomes in retrospective cases.

A Five Years Study of Occurrence and Associated Risk Factors for Birth Defects in a Tertiary Care Hospital in Central Nepal

Introduction: Congenital anomalies account for 7.0% of neonatal deaths in Nepal. The present study was carried out to determine the overall rate of congenital malformations, incidence and prevalence in live births, still birth and incidence affecting various organ systems, at Bharatpur Hospital, Nepal.&#x0D; Methods: All the intramural deliveries between Jan 2015 to Dec 2019 were included in the study. All the newborns were looked for congenital malformations after birth within seven days. Antenatal ultrasonography findings were noted. 2D echocardiography was also used for all congenital heart diseases, along with routine X-ray chest. A total of 131 babies with congenital problem were studied and the information was recorded in WHO NBBD Proforma. Data were recorded in MS Excel and SPSS 16 version was used for analysis. &#x0D; Results: Out of the total 60160 deliveries, 131 (0.21% of total birth) were with congenital malformations, sex wise distribution was 65 (49.5%) females and 63 (48.7%) males and three (1.8%) were ambiguous. Oro-facial malformation (49, 37.4%) was the commonest form of malformation followed by the musculoskeletal system (31, 23.6 %), centre nervous system (31, 23.6%) and congenital malformations of genital organs (8, 6.0%). &#x0D; Conclusions: The incidence of congenital malformation in this study was 0.21%. Females were more common than males and oro-facial malformation was the commonest type of malformation. Lack of antenatal visit, lack of folic acid during pre-conception period and low socioeconomic status were the commonest risk factors.

958: Congenital malformation rates in a contemporary cohort with type 1 and type 2 diabetes mellitus

To evaluate fetal anomalies in women with type 1 and type 2 diabetes mellitus (DM). All women with pregestational diabetes who delivered at our institution from May 1, 2009 through December 31, 2018 were ascertained. Women who delivered a singleton live- or stillborn infant with a major malformation as defined by EUROCAT criteria were identified, excluding infants with confirmed chromosomal abnormalities. Hgb A1c values were obtained at the first prenatal visit. In infants with multiple system anomalies, each malformation was considered separately. Statistical analysis was conducted using Student’s t and chi-squared test. A total of 1676 pregnancies in 1403 women with pregestational diabetes delivered at our institution. Diabetes type was available 1594 pregnancies. One hundred and forty-nine were complicated by type 1 DM, and 1445 with type 2 DM. There were 129 pregnancies in 128 women who delivered an infant with at least one major malformation, an overall anomaly rate of approximately 8%. Of these, 18 (14%) were type 1 diabetics. In those that delivered an anomalous infant, mean hgb A1c and duration of disease were significantly higher in type 1 diabetics (Table 1). However, anomaly rates between the two groups were not statistically different, 12% versus 7%, p=.06. There was no difference in the number of women who delivered an infant with multiple anomalies, nor was there a difference in the rate of cardiac anomalies (Table 1). Additionally, there was no difference in the rate of lesions requiring specialized cardiac care in the immediate neonatal period (Table 2). In women who delivered an anomalous infant, hemoglobin A1c values were higher in type 1 diabetics than those with type 2 diabetes mellitus. However, anomaly rates between the two groups did not significantly differ, though this finding may be limited by the small number of type 1 diabetics.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Gestational Exposure to Benzodiazepines, 3: Clobazam and Major Congenital Malformations.

Clobazam is a 1,5-benzodiazepine that has been approved for use, in various parts of the world, as an add-on treatment for seizure disorders and as a treatment for anxiety. Pharmacoepidemiological data from different countries show that a small percentage of women with epilepsy (WWE) receive clobazam during pregnancy. Surprisingly, there has been little to no discussion in literature on the teratogenicity of clobazam. A network meta-analysis published in 2017 found a markedly elevated rate of overall and specific major congenital malformations (MCMs) with clobazam; whereas statistical significance was not established in any analysis, the 95% compatibility intervals did suggest increased risk. In the same meta-analysis, however, the risk with clobazam was not elevated in polytherapy. Indications of increased MCM risk also emerged in data from India and Sri Lanka. In all studies, the exposure numbers were small and information on trimester of exposure was unavailable. Given the nature of the data, adjustment for confounding would not have been possible. It is concluded that there appears to be a signal for an increased risk of MCMs in the infants of WWE who use clobazam during pregnancy. This signal merits examination in data that exist in national registers and pregnancy registries.

Spectrum of Neonatal Surgical Problems in the Newborn: Incidence, Clinical Course, Immediate Outcome, Follow up Study in a Tertiary Care NICU

Background: A congenital anomaly may be defined in terms of physical structure as a malformation, an abnormality of physical structure or form usually found at birth or during the first few weeks of life. Congenital anomalies affect approximately 1 in 33 infants and result in approximately 3.2 million birth defect-related disabilities every year. Congenital anomalies or birth defects are relatively common, affecting 3% to 5% of live births in the United States (US) and 2.1% in Europe. Congenital anomalies account for 8% to 15% of perinatal deaths and 13% to 16% of neonatal deaths in India.&#x0D; Objectives: To provide an insight on the burden and types of surgical problems encountered in our NICU of Bapuji Child Health Institute &amp; Research Center, JJM Medical College, Davangere, Karnataka, India and to study the incidence, clinical profile and outcome of surgical condition. Methodology: A total of 3820 babies were examined over a period of 2 years. The relevant information was documented on a semi-structured proforma and analysed.&#x0D; Results: Overall incidence of congenital malformations at birth was 24.8 per 1000 births. The GIT system (51.58%) was most commonly involved followed by respiratory system (26.32%). The incidence of congenital malformation was more in male babies than female babies. Increased frequency was seen in babies born to mothers between 26–30 years &amp; primigravida. The factors which significantly increased the rate of congenital malformations were consanguinity in parents &amp; bad obstetric history. Out of 95 cases, 72% got discharged normally, 18% died in NICU and 10% got discharged against medical advise.&#x0D; Conclusion: With emphasis on “small family” norms and population control it is necessary to identify malformations so that interventional programmes can be planned. Systematic clinical examination of newborns for early detection of anomalies that may warrant medical or surgical intervention. Accurate antenatal anomaly scan need to be done to identify major malformations and terminate the pregnancy.

Effect of Maternal Advanced Endometriosis on Risk of Congenital Malformations for Infants Born After in vitro Fertilization and Frozen-Thawed Embryo Transfer: Analysis of 28,600 Newborns.

Background: Endometriosis is one of the most challenging diseases for doctors helping infertile women conceive, which has become a common method to help maternal endometriosis-associated infertility. Women with advanced endometriosis possess a higher risk of several adverse outcomes both during pregnancy and at the time of delivery. Whether endometriosis gives rise to a higher occurrence of congenital abnormalities in infants via in vitro fertilization and frozen–thawed embryo transfer (IVF-ET) remains unknown.Methods: Data collected on 22,865 women undergoing IVF using a freeze-all strategy from 2007 to 2017 were analyzed to estimate the rate of congenital malformations. We used an adjusted OR to compare the fertility outcomes of women with advanced endometriosis to the control group.Results: We studied 1,495 infants born from women with advanced endometriosis and 27,105 infants born from endometriosis-free women. There was a 1.557-fold risk that the infants with advanced maternal endometriosis would develop a congenital malformation (adjusted OR: 1.557, 95% CI: 1.03–2.35). Compared with singletons, twins were 1.957 times more likely to experience an adverse outcome (OR: 1.957, 95% CI: 1.561–2.455). When analyzing specific categories of birth defects, the proportion of circulatory system defects was higher than the other categories of birth defects in total (0.56%), followed by musculoskeletal system defects (0.15%).Conclusions: Maternal advanced endometriosis might increase the risk of congenital malformations for infants born after IVF-ET. The organ system most frequently affected by congenital malformations was the cardiovascular system, followed by the musculoskeletal system.

HEALTH STATUS OF CHILD POPULATION LIVING IN THE VICINITY OF THE FAR-EASTERN CENTER FOR RADIOACTIVE WASTE MANAGEMENT (FEC DALRAO)

Introduction. The subject of the study was the health of the child population of Dunai village located in the vicinity of radiation hazardous facilities - the Far-Eastern Center for Radioactive waste management (FEC DalRAO) and Shipyard-30 . Мaterial and Methods. The material of the study was age indices of the morbidity, disability, and mortality rate of children of Dunai village over the period between 2009 and 2013. The study uses indices averaged over a five-year period and the dynamics of their changes. results. The birth rate of the healthy child amounted of 54.6% versus 72.0% in the control group. In the morbidity structure, the rate of congenital malformations was higher 68.0 ± 0.4 and 42.8 ± 5.9 per 1000. Child disability was higher and accounted for 15.3 ± 3.3 per 1000 versus 10.4 ± 0.4 per 1000 in the control group. The child mortality rate was higher than in the comparison group and accounted for 1.8 per 1000 and 0.75 per 1000 respectively. Public doses induced by manmade radiation sources were lower than those established for the population in the Russian standards, however, the increased level of natural radioactivity was induced by radon, which generates in a dose of 3.23 mSv/y. conclusion. To protect the child population there are advised additional measures such as an organization of the permanently operating system of recreational and rehabilitation activities in respect to children.

Association Between Pregnancy Outcomes and Radioactive Iodine Treatment After Thyroidectomy Among Women With Thyroid Cancer

Current guidelines recommend that women delay pregnancy for 6 to 12 months after the receipt of radioactive iodine treatment (RAIT) following thyroidectomy for differentiated thyroid carcinoma. Although concerns exist regarding the risks associated with pregnancy after RAIT, no large-scale study, to date, has investigated the association between RAIT and pregnancy outcomes. To investigate whether RAIT was associated with increases in adverse pregnancy outcomes among South Korean women who received RAIT after thyroidectomy for thyroid cancer and to evaluate the appropriate interval between RAIT and conception. This population-based cohort study used the Health Insurance Review and Assessment database of South Korea to identify a total of 111 459 women of childbearing age (20-49 years) who underwent thyroidectomy for the treatment of differentiated thyroid carcinoma between January 1, 2008, and December 31, 2015. Participants were allocated to 2 cohorts: those who underwent surgery alone (n = 59 483 [53.4%]) and those who underwent surgery followed by RAIT (n = 51 976 [46.6%]). The pregnancy outcomes data were collected from January 1, 2008, to December 31, 2017. The rates of abortion (both spontaneous and induced), preterm delivery, and congenital malformation were assessed. Multivariate logistic regression models were used to control for confounding variables. Among the 111 459 women of childbearing age who underwent thyroidectomy with or without RAIT for the treatment of thyroid cancer, the mean (SD) age at surgery or RAIT was 39.8 (6.7) years. Of those, 10 842 women (9.7%) became pregnant, and the mean (SD) age at conception was 33.3 (4.4) years. The rates of abortion, preterm delivery, and congenital malformation among patients who underwent surgery alone compared with patients who underwent surgery followed by RAIT were 30.7% vs 32.1% for abortion, 12.8% vs 12.9% for preterm delivery, and 8.9% vs 9.0% for congenital malformation, respectively (P > .05). A subgroup analysis based on the interval between RAIT and conception indicated congenital malformation rates of 13.3% for the interval of 0 to 5 months, 7.9% for 6 to 11 months, 8.3% for 12 to 23 months, and 9.6% for 24 months or more. The adjusted odds ratio of congenital malformation was 1.74 (95% CI, 1.01-2.97; P = .04) in conceptions that occurred 0 to 5 months after RAIT compared with conceptions that occurred 12 to 23 months after RAIT. The abortion rates based on the interval between RAIT and conception were 60.6% for the interval of 0 to 5 months, 30.1% for 6 to 11 months, 27.4% for 12 to 23 months, and 31.9% for 24 months or more. These large-scale real-world data indicate that receipt of RAIT before pregnancy does not appear to be associated with increases in adverse pregnancy outcomes when conception occurs 6 months or more after treatment.

Impact evaluation of Zika epidemic on congenital anomalies registration in Brazil: An interrupted time series analysis

This study aimed to assess the impact of the Zika epidemic on the registration of birth defects in Brazil. We used an interrupted time series analysis design to identify changes in the trends in the registration of congenital anomalies. We obtained monthly data from Brazilian Live Birth Information System and used two outcome definitions: 1) rate of congenital malformation of the brain and eye (likely to be affected by Zika and its complications) 2) rate of congenital malformation not related to the brain or eye unlikely to be causally affected by Zika. The period between maternal infection with Zika and diagnosis of congenital abnormality attributable to the infection is around six months. We therefore used September 2015 as the interruption point in the time series, six months following March 2015 when cases of Zika started to increase. For the purposes of this analysis, we considered the period from January 2010 to September 2015 to be “pre-Zika event,” and the period from just after September 2015 to December 2017 to be “post-Zika event.” We found that immediately after the interruption point, there was a great increase in the notification rate of congenital anomalies of 14.9/10,000 live births in the brain and eye group and of 5.2/10,000 live births in the group not related with brain or eye malformations. This increase in reporting was in all regions of the country (except in the South) and especially in the Northeast. In the period “post-Zika event”, unlike the brain and eye group which showed a monthly decrease, the group without brain or eye malformations showed a slow but significant increase (relative to the pre-Zika trend) of 0.2/10,000 live births. These findings suggest an overall improvement in the registration of birth malformations, including malformations that were not attributed to Zika, during and after the Zika epidemic.

Associations between embryo grading and congenital malformations in IVF/ICSI pregnancies.

Does the quality of transferred embryos have an impact on the rate of congenital malformations in IVF/intracytoplasmic sperm injection (ICSI)-conceived babies? Retrospective cohort study involving 6637 pregnancies of ≥20 weeks' gestation from women undergoing embryo transfer with a single Day 5 embryo at a private multisite IVF clinic between 2005 and 2015. Embryos were classified as good quality (n=5537) or poor quality (n=1100) based on an internal grading system of morphological parameters; malformation rates were compared. In pregnancies proceeding to delivery (≥20 weeks' gestation), poor quality embryos were associated with increased odds of at least one anomaly (adjusted odds ratio [OR] 1.33, 95% confidence interval [CI] 1.03-1.71), major anomalies (adjusted OR 1.42, 95% CI 1.05-1.91), musculoskeletal anomalies (adjusted OR 2.09, 95% CI 1.35-3.22), particularly talipes (adjusted OR 2.88, 95% CI 1.33-6.25), and the International Classification of Diseases (ICD) classification 'Other congenital malformations' (adjusted OR 2.34, 95% CI 1.13-4.34). Furthermore, for pregnancies ≥9 weeks' gestation, poor embryos had more than double the odds of chromosomal anomalies than good embryos (adjusted OR 2.33, 95% CI 1.30-4.18, P=0.005). This is the first study to compare the rates of individual congenital malformations for good and poor quality embryos. It provides insight into potential risks of transferring poor quality embryos. In pregnancies ≥20 weeks' gestation, poor quality Day 5 embryos are associated with major malformations, at least one anomaly, musculoskeletal anomalies, talipes and the ICD classification 'Other congenital malformations'. In pregnancies ≥9 weeks' gestation, poor quality Day 5 embryos are associated with chromosomal anomalies.

Survey of diabetic pregnancies in Baghdad

A survey of some of the problems involved in pregnancy complicated by diabetes based on 34 years of experience from the Copenhagen center is presented. The importance of centralization of the management is emphasized. The perinatal mortality among 1885 infants of diabetic mothers born in the period 1946 to 78 is analyzed; during the years a significant decrease from 22.1 to 4.4% is demonstrated. Congenital malformations are now counting for 50% of the perinatal death in diabetic pregnancies. Among infants whose mothers outside pregnancy attended two hospitals specialized in the treatment and ambulatory control of diabetes, the rate of major congenital malformations was significantly reduced compared to infants of mothers whose diabetes outside pregnancy were controlled elsewhere (5.6% and 12.2% respectively). The findings suggest that poor diabetic control outside pregnancy might be teratogenic.

Effects of Bariatric Surgery on Maternal and Infant Outcomes of Pregnancy—An Evidence Analysis Center Systematic Review

BackgroundWhile obesity presents specific acute and long-term risks to the pregnant woman and her offspring, the effects of bariatric surgery on pregnancy outcomes are undetermined. ObjectiveA systematic review was performed according to the Academy of Nutrition and Dietetics Evidence Analysis Library process to determine the effects of bariatric surgery on both maternal and infant health outcomes of pregnancy. DesignA comprehensive literature search of PubMed was conducted to identify studies published from years 2000 to 2015 that examined the health effects of pregnancy after bariatric surgery. Experimental studies and observational studies with a control group were included. Main outcome measuresOutcomes of interest were gestational weight gain, maternal complications (ie, gestational diabetes, pre-eclampsia, eclampsia, hypertension, and postpartum hemorrhage), miscarriage and/or stillbirth, cesarean section, birth weight in grams, birth weight in categories (ie, macrosomia, low birth weight, small for gestational age, and large for gestational age), gestational age and preterm birth, infant illness and complications (ie, perinatal death, admission to neonatal intensive care unit, neonatal illness, and congenital malformation rates), and Apgar scores. ResultsThirteen of 246 studies were included. Compared to body mass index–matched controls without surgery, bariatric surgery before pregnancy reduced infant birth weight in grams, with no effect on total maternal gestational weight gain or Apgar scores. Surgery did not increase risk of adverse outcomes, such as miscarriage and/or stillbirth, preterm birth, or infant complications. Effects of surgery on maternal complications, infant birth weight categories, and surgical delivery rates were inconsistent. ConclusionsBariatric surgery is a successful treatment of maternal obesity, but certain surgery-specific risks may exist. More data are needed to determine clinical guidelines. The long-term effects of surgery on pregnancy outcomes are unknown.

Identificación de malformaciones congénitas asociadas a plaguicidas disruptores endocrinos en estados brasileños productores de granos

El objetivo de esta investigación es analizar la asociación entre el uso de plaguicidas y malformaciones congénitas en municipios brasileños con exposición por mayor producción de commodities agrícolas entre 1994 y 2014, así como evaluar la correlación entre la tendencia observada y el volumen de plaguicidas dados como disruptores endocrinos. Es un estudio transversal, de carácter exploratorio, descriptivo y cuantitativo. Se analizaron las informaciones de los nacidos vivos (SINASC/Ministerio de Salud), elaborándose tasas de malformaciones ocurridas de 1994-2003 y 2004-2014. La asociación entre los tipos de malformaciones y las variables fue probada por odds ratio. Se constató que las tasas referentes a las malformaciones congénitas fueron mayores para los años de mayor exposición (2004-2014) y tuvieron asociación estadísticamente significativa. Los resultados indicaron que las malformaciones congénitas identificadas en el sitio de estudio están fuertemente correlacionadas a exposición de plaguicidas.