Maternal and Neonatal Variables in Twins: an Epidemiological Approach

Abstract From 1948 to 1954, the Atomic Bomb Casualty Commission conducted a study of pregnancy outcomes of children of atomic bomb survivors who had received radiation doses from zero to near-lethal levels. Past reports (1956, 1981, and 1990) on the cohort did not identify significant associations of radiation exposure with untoward pregnancy outcomes such as major congenital malformations, stillbirths, or neonatal deaths, individually or in aggregate. We have re-examined the risk of major congenital malformations and perinatal deaths in the children of the atomic bomb survivors (N=71,603) using fully reconstructed data to minimize the potential for bias, with refined estimates of the gonadal dose from the Dosimetry System 2002 and refined analytical methods for characterizing dose-response relationships. The analyses show that parental exposure is associated with increased risk for major congenital malformations and perinatal deaths, but the estimates are imprecise for direct radiation effects and most are not statistically significant. Nonetheless, the uniformly positive estimates for untoward pregnancy outcomes among children of both maternal and paternal survivors are useful for risk assessment purposes, although extending them to circumstances other than atomic bomb survivors comes with uncertainty as to the generalizability of the Hiroshima and Nagasaki populations.

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THE INCIDENCE OF CONGENITAL MALFORMATIONS: A STUDY OF 5,964 PREGNANCIES

PEDIATRICS ◽

10.1542/peds.14.5.505 ◽

1954 ◽

Vol 14 (5) ◽

pp. 505-522

Author(s):

RUSTIN MCINTOSH ◽

KATHARINE K. MERRITT ◽

MARY R. RICHARDS ◽

MARY H. SAMUELS ◽

MARJORIE T. BELLOWS

Keyword(s):

Birth Order ◽

Congenital Malformations ◽

Maternal Age ◽

Neonatal Period ◽

Incidence Rates ◽

Organ System ◽

Neonatal Deaths ◽

Products Of Conception ◽

A Prospective Study ◽

Relationship Of

I. The plan is described of a prospective study of the outcome of 5,964 pregnancies, with special emphasis on the relationship of factors in fetal environment to the incidence of abortions, stillbirths, neonatal mortality and congenital malformations. II. Data are presented on the overall incidence of congenital malformations according to sex, race, weight at delivery, maternal age and order of birth. A. The incidence of congenital malformations among 5,739 products of conception weighing over 500 grams was 7.5%. The rate was 7.0% among infants born alive and surviving the neonatal period, 13.6% among antepartum deaths, 23.3% among intrapartum deaths, 29.6% among neonatal deaths and 70.6% among deaths occurring between the ages of one and 12 months. B. The following relationships in incidence rates among live-born infants surviving the neonatal period were found. 1. The rate among males (8.4%) was half again as high as among females (5.5%). 2. Non-white infants had a higher rate (7.8%) than white infants (6.3%). 3. Infants weighing 2,500 grams or less had a higher proportion with defects (9.7%) than did those weighing over 2,500 grams (6.7%), although this difference occurred entirely among females. 4. Maternal age had no effect on the incidence of congenital malformations. 5. White infants of lower birth order had a lower rate (5.3%) than did those of higher birth orders (8.2%). No difference according to birth order was observed among non-white infants. III. A system of classification of malformations is described and discussed. Incidence rates by organ system groups are presented. A. Less than one-half of the malformations found among live-born infants were suspected or noted at birth. B. Malformations of musculo-skeletal system and skin were more frequent than malformations of other systems. Incidence rates by organ system groups are directly related to problems of diagnosis. C. Of the malformed live-born infants, 14.8% had more than one malformation and in 9.1% more than one system was involved. Of the malformed stillbirths and neonatal deaths, 66.0% had more than one malformation and in 51.1% more than one system was involved.

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Perinatal Mortality in Twins, Australia, 1973-1980: II. Maternal Age, Lethal Congenital Malformations and Sex

Acta geneticae medicae et gemellologiae twin research ◽

10.1017/s0001566000003913 ◽

1988 ◽

Vol 37 (3-4) ◽

pp. 321-329 ◽

Cited By ~ 3

Author(s):

John D.H. Doherty

Keyword(s):

Birth Weight ◽

Mortality Rate ◽

Sex Ratio ◽

Perinatal Mortality ◽

Congenital Malformations ◽

Maternal Age ◽

Teenage Mothers ◽

Neonatal Deaths ◽

Perinatal Mortality Rate

AbstractThe influence of maternal age and congenital malformations on perinatal mortality in twins in Australia from 1973 to 1980, is described. Stillbirths and neonatal deaths in twins fell with advancing maternal age. For teenage mothers, the twin perinatal mortality rate was 127.15/1,000. The sex ratio in twins is closer to unity than in singletons. Perinatal mortality due to malformation fell as maternal age increased up to 35 years. The role of zygosity and the distribution of birth weight with maternal age are discussed.

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Rate, determinants, and causes of stillbirth in Jordan: Findings from the Jordan Stillbirth and Neonatal Deaths Surveillance (JSANDS) system

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03267-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Khulood K. Shattnawi ◽

Yousef S. Khader ◽

Mohammad S. Alyahya ◽

Nihaya Al-Sheyab ◽

Anwar Batieha

Keyword(s):

Gestational Age ◽

Congenital Malformations ◽

Chromosomal Abnormalities ◽

Data Entry ◽

Maternal Complications ◽

Middle Income ◽

Neonatal Deaths ◽

Increased Risk ◽

Appropriate For Gestational Age ◽

Surgical Conditions

Abstract Background Annually, 2.6 million stillbirths occur around the world, with approximately 98% occurring in low- and middle-income countries. The stillbirth rates in these countries are 10 times higher than the rates in high-income countries. Methods An electronic stillbirths and neonatal deaths surveillance system (JSANDS) was established in five large hospitals located in three of the largest cities in Jordan in August 2019. JSANDS was developed as a secure on-line data entry system to collect, organize, analyze, and disseminate data on stillbirths, neonatal deaths, and their contributing conditions. Data on births, stillbirths and their contributing conditions, and other demographic and clinical characteristics in the period between August 2019 – January 2020 were extracted and analyzed. Results A total of 10,328 births were registered during the reporting period. Of the total births, 102 were born dead (88 antepartum stillbirths and 14 intrapartum stillbirths), with a rate of 9.9 per 1000 total births. The main contributing fetal conditions of antepartum stillbirths were antepartum death of unspecified cause (33.7%), acute antepartum event (hypoxia) (33.7%), congenital malformations and chromosomal abnormalities (13.3%), and disorders related to the length of gestation and fetal growth (10.8%). The main contributing maternal conditions of antepartum stillbirths included complications of the placental cord and membranes (48.7%), maternal complications of pregnancy (23.1%), and maternal medical and surgical conditions (23.1%). Contributing fetal conditions of intrapartum stillbirths included congenital malformations, deformations and chromosomal abnormalities, other specified intrapartum disorders, and intrapartum death of unspecified cause (33.3% each). Contributing maternal conditions of intrapartum stillbirths included complications of the placental cord and membranes. In the multivariate analysis, small for gestational age (SGA) pregnancies were associated with a significant 3-fold increased risk of stillbirth compared to appropriate for gestational age (AGA) pregnancies. Conclusions Although the rate of stillbirth is lower than that in other countries in the region, there is an opportunity to prevent such deaths. While the majority of stillbirths occurred during the antepartum period, care should be taken for the early identification of high-risk pregnancies, including the early detection of SGA pregnancies, and ensuring adequate antenatal obstetric interventions.

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Rate, determinants, and causes of stillbirth in Jordan: Findings from the Jordan Stillbirth and Neonatal Deaths Surveillance (JSANDS) system

10.21203/rs.3.rs-21739/v3 ◽

2020 ◽

Author(s):

Khulood Kayed Shattnawi ◽

Yousef S. Khader ◽

Mohammad S. Alyahya ◽

Nihaya Al-Sheyab ◽

Anwar Batieha

Keyword(s):

Gestational Age ◽

Congenital Malformations ◽

Chromosomal Abnormalities ◽

Data Entry ◽

Maternal Complications ◽

Middle Income ◽

Neonatal Deaths ◽

Increased Risk ◽

Appropriate For Gestational Age ◽

Surgical Conditions

Abstract Background: Annually, 2.6 million stillbirths occur around the world, with approximately 98% occurring in low- and middle-income countries. The stillbirth rates in these countries are 10 times higher than the rates in high-income countries. Methods: An electronic stillbirths and neonatal deaths surveillance system (JSANDS) was established in five large hospitals located in three of the largest cities in Jordan in August 2019. JSANDS was developed as a secure on-line data entry system to collect, organize, analyze, and disseminate data on stillbirths, neonatal deaths, and their contributing conditions. Data on births, stillbirths and their contributing conditions, and other demographic and clinical characteristics in the period between August 2019 – January 2020 were extracted and analyzed.Results: A total of 10,328 births were registered during the reporting period. Of the total births, 102 were born dead (88 antepartum stillbirths and 14 intrapartum stillbirths), with a rate of 9.9 per 1000 total births. The main contributing fetal conditions of antepartum stillbirths were antepartum death of unspecified cause (33.7%), acute antepartum event (hypoxia) (33.7%), congenital malformations and chromosomal abnormalities (13.3%), and disorders related to the length of gestation and fetal growth (10.8%). The main contributing maternal conditions of antepartum stillbirths included complications of the placental cord and membranes (48.7%), maternal complications of pregnancy (23.1%), and maternal medical and surgical conditions (23.1%). Contributing fetal conditions of intrapartum stillbirths included congenital malformations, deformations and chromosomal abnormalities, other specified intrapartum disorders, and intrapartum death of unspecified cause (33.3% each). Contributing maternal conditions of intrapartum stillbirths included complications of the placental cord and membranes. In the multivariate analysis, small for gestational age (SGA) pregnancies were associated with a significant 3-fold increased risk of stillbirth compared to appropriate for gestational age (AGA) pregnancies.Conclusions: Although the rate of stillbirth is lower than that in other countries in the region, there is an opportunity to prevent such deaths. While the majority of stillbirths occurred during the antepartum period, care should be taken for the early identification of high-risk pregnancies, including the early detection of SGA pregnancies, and ensuring adequate antenatal obstetric interventions.

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Rate, determinants, and causes of stillbirth in Jordan: Findings from the Jordan Stillbirth and Neonatal Deaths Surveillance (JSANDS) system

10.21203/rs.3.rs-21739/v4 ◽

2020 ◽

Author(s):

Khulood Kayed Shattnawi ◽

Yousef S. Khader ◽

Mohammad S. Alyahya ◽

Nihaya Al-Sheyab ◽

Anwar Batieha

Keyword(s):

Gestational Age ◽

Congenital Malformations ◽

Chromosomal Abnormalities ◽

Data Entry ◽

Maternal Complications ◽

Middle Income ◽

Neonatal Deaths ◽

Increased Risk ◽

Appropriate For Gestational Age ◽

Surgical Conditions

Abstract Background: Annually, 2.6 million stillbirths occur around the world, with approximately 98% occurring in low- and middle-income countries. The stillbirth rates in these countries are 10 times higher than the rates in high-income countries. Methods: An electronic stillbirths and neonatal deaths surveillance system (JSANDS) was established in five large hospitals located in three of the largest cities in Jordan in August 2019. JSANDS was developed as a secure on-line data entry system to collect, organize, analyze, and disseminate data on stillbirths, neonatal deaths, and their contributing conditions. Data on births, stillbirths and their contributing conditions, and other demographic and clinical characteristics in the period between August 2019 – January 2020 were extracted and analyzed.Results: A total of 10,328 births were registered during the reporting period. Of the total births, 102 were born dead (88 antepartum stillbirths and 14 intrapartum stillbirths), with a rate of 9.9 per 1000 total births. The main contributing fetal conditions of antepartum stillbirths were antepartum death of unspecified cause (33.7%), acute antepartum event (hypoxia) (33.7%), congenital malformations and chromosomal abnormalities (13.3%), and disorders related to the length of gestation and fetal growth (10.8%). The main contributing maternal conditions of antepartum stillbirths included complications of the placental cord and membranes (48.7%), maternal complications of pregnancy (23.1%), and maternal medical and surgical conditions (23.1%). Contributing fetal conditions of intrapartum stillbirths included congenital malformations, deformations and chromosomal abnormalities, other specified intrapartum disorders, and intrapartum death of unspecified cause (33.3% each). Contributing maternal conditions of intrapartum stillbirths included complications of the placental cord and membranes. In the multivariate analysis, small for gestational age (SGA) pregnancies were associated with a significant 3-fold increased risk of stillbirth compared to appropriate for gestational age (AGA) pregnancies.Conclusions: Although the rate of stillbirth is lower than that in other countries in the region, there is an opportunity to prevent such deaths. While the majority of stillbirths occurred during the antepartum period, care should be taken for the early identification of high-risk pregnancies, including the early detection of SGA pregnancies, and ensuring adequate antenatal obstetric interventions.

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Mechanisms of Congenital Malformations. Proceedings of the Second Scientific Conference of the Association for the Aid of Crippled Children (1954)

PEDIATRICS ◽

10.1542/peds.19.3.536 ◽

1957 ◽

Vol 19 (3) ◽

pp. 536-536

Author(s):

JOSEF WARKANY

Keyword(s):

Environmental Factors ◽

Congenital Malformations ◽

Scientific Conference ◽

Neonatal Deaths ◽

Present Volume ◽

Physical Chemical

For many years the Association for the Aid of Crippled Children has supported teratologic research in many ways. Among the activities of the Association scientific conferences and publication of their proceedings play an important role. In the present volume one will find brief summaries of papers presented at a conference in 1954 and abstracts of the discussions contributed by the participants. Part I dealing with physical, chemical and sociological aspects of the fetal environment contains an interesting report by J. Walker of Aberdeen, Scotland, on the effects of obstetrical, physical and environmental factors on the incidence of stillbirths, neonatal deaths and prematurity.

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