Single Births Research Articles

Modeling SHANK3-associated autism spectrum disorder in Beagle dogs via CRISPR/Cas9 gene editing.

Despite intensive studies in modeling neuropsychiatric disorders especially autism spectrum disorder (ASD) in animals, many challenges remain. Genetic mutant mice have contributed substantially to the current understanding of the molecular and neural circuit mechanisms underlying ASD. However, the translational value of ASD mouse models in preclinical studies is limited to certain aspects of the disease due to the apparent differences in brain and behavior between rodents and humans. Non-human primates have been used to model ASD in recent years. However, a low reproduction rate due to a long reproductive cycle and a single birth per pregnancy, and an extremely high cost prohibit a wide use of them in preclinical studies. Canine model is an appealing alternative because of its complex and effective dog-human social interactions. In contrast to non-human primates, dog has comparable drug metabolism as humans and a high reproduction rate. In this study, we aimed to model ASD in experimental dogs by manipulating the Shank3 gene as SHANK3 mutations are one of most replicated genetic defects identified from ASD patients. Using CRISPR/Cas9 gene editing, we successfully generated and characterized multiple lines of Beagle Shank3 (bShank3) mutants that have been propagated for a few generations. We developed and validated a battery of behavioral assays that can be used in controlled experimental setting for mutant dogs. bShank3 mutants exhibited distinct and robust social behavior deficits including social withdrawal and reduced social interactions with humans, and heightened anxiety in different experimental settings (n = 27 for wild-type controls and n = 44 for mutants). We demonstrate the feasibility of producing a large number of mutant animals in a reasonable time frame. The robust and unique behavioral findings support the validity and value of a canine model to investigate the pathophysiology and develop treatments for ASD and potentially other psychiatric disorders.

Effect of preimplantation genetic testing for aneuploidies on pregnancy outcome in patients with unexplained recurrent spontaneous abortion

Objective: To investigate the effect of preimplantation genetic testing for aneuploidies (PGT-A) on pregnancy outcome and perinatal outcome of single live birth in patients with unexplained recurrent spontaneous abortion (URSA). Methods: The clinical data of 351 cycles of the first transfer of a blastocyst through whole embryo freezing in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from 2019 to 2021 were retrospectively analyzed. According to whether PGT-A was performed before the transfer, the patients were divided into two groups: the PGT-A group (160 cycles) and the control group (191 cycles) were treated with in vitro fertilization/intracytoplasmic sperm microinjection (IVF/ICSI). To adjust for confounding factors, propensity score matching (PSM) was carried out in a 1∶1 ratio between the two groups of patients. After matching, 98 patients in the PGT-A group and 98 patients in the control group were compared for pregnancy outcome and perinatal outcome of singleton live births. Results: Before PSM, the female age in the PGT-A group was (33.6±4.0) years, lower than that in the control group (34.5±4.5) years (P=0.049). Male age in the PGT-A group was (33.6±4.1) years, lower than that in the control group (35.3±5.1) years (P<0.001). There were statistically significant differences between the two groups in infertility factors, female body mass index (BMI), years of infertility, number of spontaneous abortions, basal follicle stimulating hormone (FSH), endometrial thickness on the day of transfer and the percentage of high-quality blastocysts (all P values<0.05); After PSM, there was a statistically significant difference in fertilization methods and infertility factors between the two groups (P<0.05), while other differences were not statistically significant (all P values>0.05); There were statistically significant differences between the two groups in implant rate [63.3% (62 cycles) vs. 49.0% (48 cycles), P=0.044], clinical pregnancy rate [63.3% (62 cycles) vs. 49.0% (48 cycles), P=0.044], and live birth rate [42.9% (42 cycles) vs. 28.6% (28 cycles), P=0.037]. There was no statistically significant difference in perinatal outcomes between the PGT-A group and the control group in obtaining single birth live births (P>0.05). Conclusion: Compared with conventional IVF/ICSI assisted pregnancy, PGT-A assisted pregnancy significantly improves implantation rate, clinical pregnancy rate, and live birth rate in URSA patients. PGT-A improves the pregnancy outcomes in URSA patients but not perinatal outcomes in patients with singleton live births.

A Novel Macro Perspective on Family Dynamics: The Contribution of Partnership Contexts of Births to Cohort Fertility Rates

AbstractPartnering behavior is central to understanding fertility. Influential concepts, including singlehood, serial monogamy, and multiple‐partner fertility, are frequently used to analyze partnering and childbearing dynamics. These concepts are evoked to understand individual and population‐level patterns but are mainly analyzed at the individual level. We propose a measure for gauging the interplay between partnerships and childbearing at the population level, namely cohort fertility rates (CFR) as the sum of births under various partnership contexts. Surprisingly, demographers rarely measure and do not have a clear picture of the extent to which childbearing in different partnership contexts contributes to completed fertility. We analyze Finnish register data to decompose CFR into births across union status, union order, and reproductive partner order. Contrary to the discourse of partnering in the Nordics, births within first unions to first reproductive partners account for about two‐thirds of CFR. Births in higher‐order unions to first reproductive partners account for one‐fifth. Single births and births with higher‐order reproductive partners have a modest impact. This ranking holds across sex and educational level. We argue that the proposed measures offer a novel appraisal of population‐level implications of partnerships and childbearing dynamics and provide an opportunity to understand cross‐country variation in fertility patterns.

Mortality rate among Iraqi neonates in neonatal intensive care units: Retrospective study

BackgroundNeonatal mortality (NM) is defined as the death of babies within the first 28 days of their lives, and it's considered a key outcome indicator used to assess and evaluate the development of maternal and neonatal health services in the community. ObjectiveTo identify the neonatal mortality rate (NMR) and to find out the essential causes and related factors of mortality among neonates admitted to the neonatal intensive care units (NICU) at all hospitals of Babylon governorate/Iraq. MethodsA retrospective study was used to review the medical records of all the admitted neonates (No = 27379) to the NICU at hospitals of Babylon governorate, throughout 2020 and 2021 years, the study was done from mid-November 2022 to the end of March 2023. Data were obtained from the statistical department in the health directorate of Babylon governorate electronically from the program called (Microsoft Visual FoxPro). ResultsThe neonatal deaths rate was 42.9 for each 1000 live birth in 2020 and September 38, 1000 live birth in 2021 among all admitted neonates in Babylon hospitals, NMR was very high among neonates with respiratory distress syndrome (RDS) (48% in 2020 and 55.2% in 2021), and low-birth-weight preterm neonates (25.8% in 2020 and 10.3% in 2021). The obstetric history such as gestational age, mode and place of delivery, and type of pregnancy, as well as birth weight, age at the time of death, and residency, were significantly associated with high rates of neonates’ mortality. ConclusionThe neonatal mortality rate was high in Babylon governmental hospitals, especially the hospitals in rural areas. RDS and prematurity were the main cause of neonatal deaths. Furthermore, the maternal history and neonatal characteristics data were associated with increased NMR in prematurity, low birth weight, normal delivery, and delivery at home than a hospital, and in single birth than twins in both 2020 and 2021.

Estimation of genetic parameters and genetic change of first parity reproductive traits in Alpine × Beetal goats.

The study of reproductive traits is crucial for improving genetic potential of goats because of their significant utility in meat production. Hence, genetic analysis was conducted for reproductive traits on Alpine × Beetal goats using animal model for first parity data. Information on 1462 reproductive records were collected over five decades from ICAR-National Dairy Research Institute, Karnal, Haryana (1971-2021). Single-trait and multi-trait animal models were used for genetic analysis. Estimates of (co)variance components and genetic parameters were obtained using Gibbs Sampler for Animal Model due to non-normal distribution of data. Six single-trait animal models (including or excluding maternal and environmental effects) were fitted and best models were determined based on Deviance Convergence Criterion values. The prolificacy for the A × B goats for first parity data was 32%, having 68% single births, 31% twins and 1% triplets/quadruplets. The least squares mean for age at first service (AFS), age at first kidding (AFK), service period (SP), dry period (DP), gestation length (GL), kidding interval (KI), litter weight (LW), number of kids born (NKB) and number of females kids born (NFKB) in first parity were 546.15 ± 4.10 days, 679.05 ± 4.07 days, 226.51 ± 4.02 days, 67.96 ± 2.76 days, 150.74 ± 0.13 days, 362.53 ± 3.35 days, 3.99 ± 0.04 kg, 1.32 ± 0.02 and 0.64 ± 0.02, respectively. The heritability estimates obtained from best model for AFS, AFK, GL, KI, SP, and DP were 0.12 ± 0.00, 0.10 ± 0.00, 0.09 ± 0.01, 0.03 ± 0.00, 0.04 ± 0.00, and 0.05 ± 0.00, respectively. For NKB, NFKB and LW, heritability estimates were 0.16 ± 0.01, 0.03 ± 0.03, and 0.04 ± 0.00, respectively. These results imply lower heritability estimates for reproductive traits, and hence meagre scope for selection for further improvement. Maternal effects contributed significantly for traits such as GL, NKB and NFKB. Genetic correlation for number of female kids born was negative with SP and DP which is favourable. Furthermore, genetic correlation was negative for dry period and litter weight which is favourable as number of kids born and litter weight are traits of direct economic importance. Results reveal high genetic potential of this breed for meat industry owing to high prolificacy, provided consistent efforts are made for the genetic improvement of this germplasm.

The effects of high risk of ovarian hyperstimulation syndrome and duration of embryo cryopreservation on perinatal outcomes of single live births in the first frozen embryo transfer cycle after whole embryo cryopreservation

Objective: To investigate the effects of high risk of ovarian hyperstimulation syndrome (OHSS) and duration of embryo cryopreservation on perinatal outcomes of the first frozen-thawed cycle after whole embryo cryopreservation. Methods: The clinical data of 1 804 patients who underwent the first frozen-thawed cycle after whole embryo cryopreservation and achieved singleton live births in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2016 to June 2021 were retrospectively analyzed. According to whether there was high risk of OHSS in the oocyte retrieval cycle, the patients were divided into high-risk group (n=790) and non-high-risk group (n=1 014). The baseline data and perinatal outcomes were compared between the two groups. Multivariate linear regression was applied to analyze the relative factors affecting neonatal weight. And the high-risk group was divided into three subgroups according to different cryopreservation time: the embryos of 96 cycles with a cryopreservation time less than 60 days were defined as group A; the embryos of 587 cycles with a cryopreservation time around 60 to 120 days were defined as group B; the embryos of 107 cycles with a cryopreservation time more than 120 days were defined as group C. The perinatal outcomes were compared among the three groups. The measurement data in this study were represented by［M（Q1，Q3）］. Results: The female age in the high-risk group was 30.0 (27.0, 32.0) years old, which was lower than that in the non-high-risk group 31.0 (29.0, 34.0) (P<0.001). The male age in high-risk group was 30.0 (28.0, 33.0), lower than that in non-high-risk group 32.0 (29.0, 35.0) (P<0.001). The birth weight of high-risk group [3 500.0 (3 200.0,3 800.0) g] was higher than that of control group [3 400.0 (3 150.0,3 800.0) g](P=0.045). Multivariate linear regression analysis showed that female BMI was correlated with neonatal weight, β (95%CI) was 15.37(8.33, 22.41) (P<0.001), and the high risk of OHSS was not correlated with neonatal weight, β (95%CI) was 19.40 (-38.07, 76.87) (P=0.508). There was significant difference in the incidence of low birth weight and very low birth weight among groups A, B and C (all P values<0.05), and the incidence of low birth weight and very low birth weight in group C was higher than that in group B (all P values<0.017). Conclusions: The risk of adverse perinatal outcomes in high-risk OHSS patients who underwent the first frozen-thawed cycle after whole embryo cryopreservation was not increased. However, prolonged cryopreservation of embryos may lead to increased risk of low birth weight and very low birth weight.

O-161 Performance of IDAScore prediction models on clinical, obstetric and neonatal outcomes of single vitrified-thawed blastocyst transfer

Abstract Study question Does a free-annotation embryo scoring system (IDAScore) prediction model effective in clinical assisted embryo selection? Summary answer iDAScore could be used to predict the clinical pregnancy and live birth. What is known already iDAScore model, as a free-annotation and deep learning-based embryo scoring system, was created according to deep learning model by training 115,832 embryos and 14,644 known implantation embryos from 18 reproductive medical center. Then, every blastocyst was scored without any manipulation and intervention by embryologists. Although iDAScore's performance was validated by a few reproductive centers, it has not yet been verified in a sizable cohort study. As a result, the effectiveness of iDAScore should be assessed in more reproductive clinics. Study design, size, duration A total of 6,291 vitrified-thawed single blastocyst transfer (SBT) cycles from 2018 to 2021 at the Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, were analyzed a free-annotation and deep learning-based embryo scoring system (IDAScore) (EmbryoScope Plus, Vitrolife, Sweden). Participants/materials, setting, methods All blastocysts undergoing SBT were scored from 1 to 9.9 with ida system. Blastocyst scores were grouped according to quartile.The effectiveness of ida system was evaluated according to clinical outcomes, perinatal and neonatal outcomes of different groups (1.0-8.0, 8.1-8.9, 9.0-9.3, 9.4-9.9). Main results and the role of chance The iDA scores decreased with increasing maternal age. Clinical pregnancy rate and live birth rate increased with iDAScores, and there was a significant correlation (p &amp;lt; 0.001). The abortion rate decreased slightly with the increase of iDAScores, but there was no significant difference (p &amp;gt; 0.05). Ectopic pregnancy rate did not change significantly with iDAScores. No statistically significant difference were observed between single and twin live birth among different iDAScore groups (p &amp;gt; 0.05). For perinatal and neonatal outcomes, no significant difference was shown in four iDAScore group (p &amp;gt; 0.05). Among them, gestational age and premature birth rate were similar (p &amp;gt; 0.05). Besides, no significant difference was shown in types and rate of pregnancy complication (p &amp;gt; 0.05). For newborn babies, the birth weight and sex were statistically similar across all groups (p &amp;gt; 0.05). The birth defect outcome was also evaluated. No significant difference were shown on different types of birth defect in all groups (p &amp;gt; 0.05). The uni-variate and multi-variate logistic regression for live birth was also analyzed. iDAScore were significantly correlated with a positive live birth probability (OR: 1.200, 95% CI: 1.148-1.253, p &amp;lt; 0.05). Limitations, reasons for caution The experimental samples in this study are all blastocyst transfer cycles. There is no guiding significance for other centers using the cleavage embryo transfer cycle. Wider implications of the findings iDAScore could be used to predict the clinical pregnancy and live birth. For the blastocyst that has obtained live birth, different iDAScore did not cause significant differences in obstetric and neonatal outcomes. Therefore, iDAScore determined blastocyst implantation more than fetal development. Trial registration number not applicable

Outcomes of Different In Vitro Maturation Procedures for Oocyte Cryopreservation for Fertility Preservation and yet Another Live Birth in a Cancer Patient.

To ensure patient care in an oncological fertility preservation (FP) programme, specialists must provide technology that best suits the patients' clinical conditions. In vitro oocyte maturation (IVM) and ovarian tissue cryopreservation (OTC) are possible fertility preservation treatments for women in need of urgent oncological treatment. IVM consists of the retrieval of immature oocytes from small antral follicles, with no or minimal ovarian stimulation by gonadotropins. Therefore, IVM has become a pertinent option for fertility preservation, especially for cases whereby ovarian stimulation is unfeasible or contra-indicated. Existing data on immature oocytes, retrieved transvaginally (OPU-IVM) or extracted from ovarian tissue 'ex vivo' (OTO-IVM), are still limited on technical consistency, efficacy, and safety. The present retrospective cohort study includes 89 women undergoing fertility preservation using IVM methodologies and 26 women undergoing ovarian stimulation (OS) in concomitant period. In total, 533 immature oocytes were collected from IVM patients, achieving a maturation rate of 57% and 70% in OTO-IVM and 73% and 82% in OPU-IVM at 24 h and 48 h in culture, respectively. The observed high maturation rates might be due to the use of patients' serum in its innate status, i.e., without heat-inactivation. This permitted 7.6 ± 5.7 and 4.6 ± 4.9 oocytes to be vitrified in OTO-IVM and OPU-IVM, respectively, compared to 6.8 ± 4.6 from OS patients. Regarding OS patients, two of them underwent embryo transfer following the insemination of warmed oocytes after complete remission, resulting in a single live birth from one patient. Upon follow-up of two OTO-IVM patients after the termination of their oncological treatment, a total of 11 warmed oocytes lead to a transfer of a single embryo, but pregnancy was not achieved. From OPU-IVM, six embryos were transferred in three patients 4.25 years after oocyte vitrification, leading to the live birth of a healthy boy. The present case of live birth is among the first cases reported so far and supports the notion that IVM might be a relevant and safe FP option for cancer patients when oocyte preservation is required but ovarian stimulation is contra-indicated.

The thicker the endometrium, the better the neonatal outcomes?

Is endometrial thickness (EMT) on the hCG trigger day related to the neonatal outcome of a single birth after fresh embryo transfer (ET)? An EMT ≤7.8 mm was an independent predictor for greater odds of preterm delivery (PTD) of singletons born after fresh ET. There may be a positive association between live birth rates and EMT after fresh ET. It is still unknown whether a similar association is seen for the neonatal outcomes of singletons in fresh cycles. This retrospective study involved singleton live births in women undergoing autologous IVF cycles during the period from 1 October 2016 to 31 July 2021. A total of 2010 women who fulfilled the inclusion criteria were included. A multivariable regression analysis was performed to detect the relationship between EMT and neonatal outcomes after controlling for potential confounders. Smooth curve fitting and threshold effect analysis were used to evaluate the accurate cutoff value of EMT. The results of the multivariate regression analyses showed that the odds of PTD were reduced by 45% with an EMT of 9.00-9.90 mm (adjusted odds ratio (OR): 0.55, 95% CI: 0.13 to 0.98; P = 0.0451), reduced by 58% with an EMT of 10.00-10.90 mm (adjusted OR: 0.42, 95% CI: 0.06 to 0.87; P = 0.0211) and reduced by 75% with an EMT >11 mm (adjusted OR: 0.25, 95% CI: 0.04 to 0.66; P = 0.0034), compared to the group with an EMT of 6.00-8.90 mm. It could also be seen from the adjusted smooth curves that the odds of PTD decreased and gestational age (GA) increased with increasing EMT. Combined with the analysis of threshold effects, the results indicated that when the EMT was ≤7.6 mm, the incidence of PTD decreased as the EMT gradually increased (adjusted OR: 0.47, 95% CI: 0.03 to 0.99; P = 0.0107), and when the EMT was ≤7.8 mm, the GA increased (adjusted β: 1.94, 95% CI: 1.26 to 2.63; P < 0.0001) as the EMT gradually increased. The main limitation of our study is its retrospective design. Although we found a significant decrease in PTD as the EMT increased, in terms of GA, the magnitude of the differences was modest, which may limit the clinical relevance of the findings. Our data provide new insight into the relationship between EMT and neonatal outcomes by indicating that a thin endometrium of ≤7.8 mm is associated with an increased odds of PTD of singletons after fresh ET. This study was supported by the National Natural Science Foundation of China (grant no. 82071717). There are no conflicts of interest.

Body performance of the mother and the kid of sapera goats based on birth type at Kuncen Farm

Sapera goats have many excellencies but their population is still low. Efforts that can be made are to provide female goats that have the potential to give twin birth type and have high productivity. This is obtained through an assessment of body performance. The mother and her offspring of Sapera goats with twin and single birth types have different body performance. These differences can be a reference to describe the productivity of Sapera Goats on these farms. This research was conducted in January 2023 at Kuncen Farm, Mijen District, Semarang City with the criteria for a mother Sapera goat aged between 1.5 - 2 years and her offspring aged between 3 - 5 months. Based on the results of the study, the body performance of Body Length (BL), Body Height (BH), and Chest Circumferences (ChC) were superior to the mothers and offspring of the twin birth type, while Canon Circumferences (CC) and Head Length (HL) performance of the mother and her offspring in each type of birth do not have much difference. Therefore, it can be concluded that Body Length (BL) Body Height (BH), and Chest Circumferences (ChC) are related to the type of birth while Canon Circumferences (CC) and Head Length (HL) performance are not related. Goat’s body performance is influenced by environmental conditions and animal feed.

Housing and health outcomes: evidence on child morbidities from six Sub-Saharan African countries

BackgroundThe connection between healthy housing status and health is well established. The quality of housing plays a significant role in infectious and non-communicable as well as vector-borne diseases. The global burden of disease attributable to housing is considerable with millions of deaths arising from diarrheal and respiratory diseases annually. In sub-Saharan Africa (SSA), the quality of housing remains poor although improvements have been documented. There is a general dearth of comparative analysis across several countries in the sub-region. We assess in this study, the association between healthy housing and child morbidity across six countries in SSA.MethodsWe use the Demographic and Health Survey (DHS) data for six countries where the most recent survey collected health outcome data on child diarrhoea, acute respiratory illness, and fever. The total sample size of 91,096 is used in the analysis (representing 15, 044 for Burkina Faso, 11, 732 for Cameroon, 5, 884 for Ghana, 20, 964 for Kenya, 33, 924 for Nigeria, and 3,548 for South Africa). The key exposure variable is healthy housing status. We control for various factors associated with the three childhood health outcomes. These include quality housing status, residency (rural/urban), age of the head of the household, mother’s education, mother’s BMI status, marital status, mother’s age, and religious status. Others include the child’s gender, age, whether the child is from multiple or single births, and breastfeeding status. Inferential analysis using survey-weighted logistic regression is employed.ResultsOur findings indicate that housing is an important determinant of the three outcomes investigated. Compared to unhealthier housing, healthy housing status was found to be associated with reduced odds of diarrhoea in Cameroon [Healthiest: aOR = 0.48, 95% CI, (0.32,0.71), healthier: aOR = 0.50, 95% CI,(0.35,0.70), Healthy: aOR = 0.60, 95% CI, (0.44,0.83), Unhealthy: aOR = 0.60, 95% CI, (0.44,0.81)], Kenya [Healthiest: aOR = 0.68, 95% CI, (0.52,0.87), Healtheir: aOR = 0.79, 95% CI, (0.63,0.98), Healthy: aOR = 0.76, 95% CI, (0.62,0.91)], South Africa[Healthy: aOR = 0.41, 95% CI, (0.18, 0.97)], and Nigeria [Healthiest: aOR = 0.48, 95% CI,(0.37,0.62), Healthier: aOR = 0.61, 95% CI,(0.50,0.74), Healthy: aOR = 0.71, 95%CI, (0.59,0.86), Unhealthy: aOR = 0.78, 95% CI, (0.67,0.91)], and reduced odds of Acute Respiratory Infection in Cameroon [Healthy: aOR = 0.72, 95% CI,(0.54,0.96)], Kenya [Healthiest: aOR = 0.66, 95% CI, (0.54,0.81), Healthier: aOR = 0.81, 95% CI, (0.69,0.95)], and Nigeria [Healthiest: aOR = 0.69, 95% CI, (0.56,0.85), Healthier: aOR = 0.72, 95% CI, (0.60,0.87), Healthy: aOR = 0.78, 95% CI, (0.66,0.92), Unhealthy: aOR = 0.80, 95% CI, (0.69,0.93)] while it was associated with increased odds in Burkina Faso [Healthiest: aOR = 2.45, 95% CI, (1.39,4.34), Healthy: aOR = 1.55, 95% CI, (1.09,2.20)] and South Africa [Healthy: aOR = 2.36 95% CI, (1.31, 4.25)]. In addition, healthy housing was significantly associated with reduced odds of fever among children in all countries except South Africa [Healthiest: aOR = 2.09, 95% CI, (1.02, 4.29)] where children living in the healthiest homes had more than double the odds of having fever. In addition, household-level factors such as the age of the household head, and place of residence were associated with the outcomes. Child-level factors such as breastfeeding status, age, and sex, and maternal-level factors such as education, age, marital status, body mass index (BMI), and religion were also associated with the outcomes.ConclusionsThe dissimilarity of findings across similar covariates and the multiple relations between healthy housing and under 5 morbidity patterns show unequivocally the heterogeneity that exists across African countries and the need to account for different contexts in efforts to seek an understanding of the role of healthy housing in child morbidity and general health outcomes.

Understanding correlates of infant mortality in Ethiopia using 2019 Ethiopian mini demographic and health survey data.

The data, used in this study, were drawn from 2019 Ethiopian Demographic and Health Survey data. The multivariable Cox proportional hazard analysis was done to identify the correlates of infant mortality. Infant mortality rate was high in the earlier age of months. Males, higher birth order and rural residences were at higher risk of dying before first birthday compared with respective reference groups whereas health facility deliveries, single births, rich wealth indices and older maternal age were at lower risk of dying before first birthday compared with respective reference groups. The study found that age of mother, place of residence, wealth index, birth order, type of birth, child sex and place of delivery were statistically significant in affecting the survival of the infants. Thus, health facility deliveries should be encouraged and multiple birth infants should be given special care. Furthermore, younger mothers should better care of their babies to improve the survival of infants in Ethiopia.

Public health impact and cost-effectiveness of 15-valent pneumococcal conjugate vaccine use among the pediatric population of the United States.

Although use of the 13-valent pneumococcal conjugate vaccine (PCV13) among children has reduced incidence of pneumococcal disease, a considerable burden of disease remains. PCV15 is a new vaccine that contains pneumococcal serotypes 22F and 33F in addition to serotypes contained in PCV13. To inform deliberations by the Advisory Committee on Immunization Practices on recommendations for PCV15 use among U.S. children, we estimated the health impact and cost-effectiveness of replacing PCV13 with PCV15 within the routine infant immunization program in the United States. We also assessed the impact and cost-effectiveness of a supplementary PCV15 dose among children aged 2-5years who have already received a full PCV13 series. We estimated the incremental number of pneumococcal disease events and deaths averted, costs per quality adjusted life-year (QALY) gained, and costs per life-year gained under different vaccination strategies using a probabilistic model following a single birth cohort of 3.9 million individuals (based on 2020 U.S. birth cohort). We assumed that vaccine effectiveness (VE) of PCV15 against the two additional serotypes was the same as the VE of PCV13. The cost of PCV15 use among children was informed from costs of PCV15 use among adults and from discussions with the manufacturer. Our base case results found that replacing PCV13 with PCV15 prevented 92,290 additional pneumococcal disease events and 22 associated deaths, while also saving $147 million in costs. A supplementary PCV15 dose among children aged 2-5years who were fully vaccinated with PCV13 prevented further pneumococcal disease events and associated deaths but at a cost of more than $2.5 million per QALY gained. A further decrease in pneumococcal disease in conjunction with considerable societal cost savings could be expected from replacing PCV13 with PCV15 within the routine infant immunization program in the United States.

Nuchal Cord Encirclement &amp; Birth Weight

Nuchal cord encirclement is defined as the condition in which the umbilical cord is wound at least once around the neck of the fetus. The ultrasound is one of the very helpful tools for evaluation of fetus with possible Nuchal cord entanglement, especially color flow Doppler ultrasonography which is a reliable tool to detect Nuchal coiling of the umbilical cord, and therefore color Doppler waveforms assessment in nuchal cord entanglements might be helpful for clinicians to decide a closer surveillance in labor by using intra-partum cardio-toco-graphy. The aim of the study was to determine if the presence of a single or multiple nuchal cord encirclement has a negative effect on fetal growth. This study was conducted at Tikrit Teaching Hospital. All live borns, single and multiple births during the study period (August 2008 to July 2009) were examined they were 3972 including term and preterm labor. Of them 271 have nuchal cord encirclement, of those 34 have multiple encirclement and 23 7 have single encirclement. The collected data were divided into those with encirclement and those without. The effect of nuchal cord on the birth weight according to the gestational age; sex of the neonate and the parity of the mother hc1s been evaluated. There was no significant association between the diagnosis of growth restriction and the presence of cord encirclement. The mean birth weight was not significantly different in the presence of a single or multiple nuchal cord encirclement than without encirclement. The conclusion was that whether the nuchal cord encirclement is single or multiple, it has no significant effect on birth weight.

Vertical Transmission Rate of Human Immunodeficiency Virus Exposed Twin Pregnancies and Associated Factors in West Bengal, India: a Retrospective Cohort Study.

Twin pregnancies are often associated with adverse obstetric outcomes. The mother-to-child transmission of the human immunodeficiency virus (HIV) in twin pregnancies has been less explored. Therefore, the present study aimed to determine the risk of vertical transmission of HIV in HIV-exposed twin pregnancies compared with that of singleton pregnancies and to explore the associated factors. We conducted a retrospective cohort study involving 348 HIV-exposed babies (58 twins and 290 singletons) through a systematic sampling from the program database of West Bengal, India, from April 2016 to March 2021. HIV vertical transmission rates were compared between single and twin live births. The effects of factors such as maternal age, timing of maternal HIV diagnosis, duration of antiretroviral treatment, mode of delivery, birth weight, and the sex of the baby were determined. The HIV transmission rate for twin pregnancies (15.5%) was significantly higher than that for single live births (5.5%) (adjusted odds ratio [OR] = 3.38 [1.17-9.69]). Among twin deliveries, maternal HIV diagnosis during the intrapartum and postpartum period was associated with HIV transmission (crude OR = 11.0, [2.2-54.9]). Perinatal HIV transmission is more common in twin pregnancies and is associated with the time of detection of maternal HIV. Therefore, early HIV detection and additional antiretroviral regimens should be considered for twin pregnancies.

Geographical Distribution of Developmental Dysplasia of the Hip: A Brief Epidemiological Study of Iran.

Local epidemiological data are necessary to identify the disease hot spots and running screening programs. In this study, we evaluated the demographic characteristics of developmental dysplasia of the hip (DDH) in a tertiary referral hospital in Iran. In a retrospective study, the medical profiles of 137 DDH children, who were referred to our university hospital between 2014 and 2020, were reviewed for characteristics such as gender, place of birth, age at the diagnosis, gestational age (term or preterm), twin or single birth, mother's age, pregnancy number, breech presentation, associated deformity, family history of DDH, et cetera. The study population included 24 (17.5%) boys and 113 (82.5%) girls with a mean age of 2.3 ± 2 years. In the majority of cases (54.2%), it was the firstborn. Twin delivery was seen in only 5 (4.1%) cases. The associated deformity was noticed in 17 (12.4%) patients. Clubfoot was the most commonly associated deformity that was seen in 6 of 17 (35.3%) patients. A family history of DDH was recorded in 12 (8.8%) patients. The breech presentation was recorded in 19 (13.9%) patients. The mean age of the mother at the delivery was 27.2 ± 6.1 years. Tehran, Lorestan, Kurdistan, and Khuzestan provinces had the most referrals. DDH is associated with the female sex, positive family history, breech presentation at delivery, clubfoot deformity, and geographic district. These associations could be used for identifying the disease hot spots and running screening programs for earlier detection and better management of DDH.

Obstetric and neonatal outcomes after programmed frozen embryo transfer with or without GnRH agonist for polycystic ovary syndrome: secondary analysis results from a randomized controlled trial

Recent studies have reported higher risks of adverse maternal and neonatal outcomes, such as hypertensive disorders of pregnancy, after programmed frozen embryo transfer, especially in cycles with gonadotropin-releasing hormone agonist pretreatment. It remains unclear if GnRH agonist pretreatment before programmed frozen embryo transfer further increases the risk for obstetrical complications among women with polycystic ovary syndrome. This study aimed to compare the obstetrical and neonatal complications of singleton and twin pregnancies after programmed frozen embryo transfer with or without gonadotropin-releasing hormone-a pretreatment among women with polycystic ovary syndrome. This was a secondary analysis of a single-center, randomized controlled trial comparing the live birth rate and cost-effectiveness of programmed cycle-prepared frozen embryo transfers with or without gonadotropin-releasing hormone agonist pretreatment among women with polycystic ovary syndrome. The analysis was restricted to women with polycystic ovary syndrome, aged 24 to 40 years, who delivered live neonates after frozen-thawed blastocyst transfer. The obstetrical and neonatal outcomes were compared between programmed cycles with and those without gonadotropin-releasing hormone agonist pretreatment. The adjusted odds ratios with 95% confidence intervals were calculated and adjustments were made for relevant confounders. The maternal and neonatal complications associated with 177 live single births and 38 twin births (253 newborns in total) were analyzed. There were no significant differences in the frequencies of obstetrical complications, including hypertensive disorders of pregnancy, between the gonadotropin-releasing hormone agonist pretreatment and no pretreatment group for both singleton and twin pregnancies. However, there was a significantly greater incidence of having a low birthweight neonate among singleton infants born after gonadotropin-releasing hormone agonist pretreatment when compared with no pretreatment (10.2% vs 1.3%; P=0.042), and a low birthweight among singleton infants was still more likely after adjusting for confounders (relative ratio, 3.85; 95% confidence interval, 1.13-7.11; P=.024). Other neonatal complications were all comparable between the pretreatment and no pretreatment groups for both singleton and twin pregnancies. For women with polycystic ovary syndrome, programmed frozen embryo transfer cycles with gonadotropin-releasing hormone agonist pretreatment could lead to a greater risk of having a low birthweight singleton neonate.

Economic evaluation of population-based, expanded reproductive carrier screening for genetic diseases in Australia

PurposeThis study aimed to evaluate the cost effectiveness of population-based, expanded reproductive carrier screening (RCS) for a 300 recessive gene panel from health service and societal perspectives. MethodsA microsimulation model (PreConMod) was developed using 2016 Australian Census data as the base population. Epidemiologic, health, and indirect cost data were based on literature review. The study assessed the incremental cost effectiveness ratio of expanded RCS compared with (1) no population screening and (2) 3-condition screening for cystic fibrosis, spinal muscular atrophy, and fragile X syndrome in a single birth cohort. Averted affected births and health service savings with expanded RCS were projected to year 2061. Both one-way and probability sensitivity analyses were conducted to assess the uncertainty of the parameter inputs. ResultsExpanded RCS was cost saving compared with no population screening and cost effective compared with the 3-condition screening (incremental cost effectiveness ratio of Australian dollar [AUD] 6287 per quality-adjusted life year gained) at an uptake rate of 50% for RCS, 59% for in vitro fertilization and preimplantation genetic testing, 90% for prenatal diagnosis testing, and 50% for elective termination of affected pregnancies and a cost of AUD595 per couple screened. Our model predicts that expanded RCS would avert one-third of affected births in a single birth cohort and reduce lifetime health service spending by AUD632.0 million. Expanded RCS was estimated to be cost saving from the societal perspective. ConclusionExpanded RCS is cost effective from health service and societal perspectives. Expanded RCS is projected to avert significantly more affected births and result in health service saving beyond those expected from 3-condition screening or no population screening.

Brain-derived neurotrophic factor (BDNF) and the capute scales in offspring of mothers with normal and deficient vitamin D levels

Background: Vitamin D deficiency during pregnancy is associated with a child's neurocognitive development. During the COVID-19 pandemic, the Capute Scales have become ineffective because requiring face-to-face interaction to examine children's neurocognitive development. Brain-Derived Neurotrophic Factor (BDNF) is an alternative method to determine children's neurocognitive development through blood sampling. This study aims to evaluate the relationships between BDNF and the Capute Scales in the offspring of mothers with vitamin D levels. Methods: A diagnostic study from 14 community health centers in Semarang City, Central Java, Indonesia, was conducted. The study was performed from August 2017 until August 2018 and included vitamin D level records at 20–24 weeks of normal gestation in 2017 from all single births at these community health centers. The cases were divided into two groups: 30 children born to mothers with normal vitamin D levels (25(OH)D &gt; 20 ng/mL) and 30 children born to mothers with vitamin D deficiency (25(OH)D &lt; 20 ng/ml). This study aimed to assess the relationship between BDNF levels and the Capute Scales of children aged 2 years and to determine the cut-off value based on each group's examination of BDNF levels. Results: The mean age of pregnant women whose vitamin D levels were checked was 29.32 years. The cut-off value of BDNF among the two groups was 7968 pg/mL. Of the 55 samples that met the Capute Scales criteria, 44 had a BDNF value less than the cut-off value, and 11 samples had a BDNF value more than the cut-off value. Meanwhile, of the five samples that met the Capute Scales criteria and were suspected of mental retardation, three had a BDNF value less than the cut-off value, and two had a BDNF value more than the cut-off value. The sensitivity, specificity, positive, and negative predictive values were 80%, 60%, 0.93, and 0.15, respectively. Conclusions: BDNF levels can be an alternative neurocognitive examination in children born to mothers with normal and deficient vitamin D levels. BDNF is a growth factor that plays an important role in neurons' differentiation, growth, and survival in the postnatal phase.

Risk Factors Associated With de Quervain Tenosynovitis in Postpartum Women.

De Quervain (DQ) disease is caused by stenosis of the first dorsal compartment containing the abductor pollicis longus and extensor pollicis brevis. This condition affects women 6 times more than men and is also commonly reported in pregnant and lactating women. The natural course of the disease and associated risk factors are not well understood. In this study, we described the gestational risk factors associated with postpartum DQ. Sixty-three postpartum women with DQ were included in final study population. Medical records were reviewed for patient characteristics, including age, comorbidities, and body mass index (BMI), and gestational information, including length of pregnancy, gestation number, single or twin birth, and weight at birth. Odds ratio (OR) for developing DQ tenosynovitis were calculated with the control group of 630 postpartum women without DQ who gave birth between 2012 and 2020 in the same district. Length of pregnancy (>40 weeks, OR = 5.81 [3.29-10.28]), first childbirth (OR = 2.23 [1.32-3.77]), and weight (BMI > 25, OR = 2.08 [1.14-3.81]) were all statistically significant risk factors associated with developing DQ. Number of fetuses > 1 (OR = 0.98 [0.29-3.33]) and birth weight more than 3.5 kg (OR = 0.60 [0.30-1.21]) were not associated with higher risk of DQ. Gestational risk factors associated with developing postpartum DQ include first pregnancy and long pregnancy of more than 40 weeks. Interestingly, child's birthweight and number of fetuses, both factors that might increase load on the first dorsal compartment while holding the child, were not shown to increase the risk of postpartum DQ.