Search

Background Data on the relationship between bariatric surgery and risk of birth defects are conflicting. Objectives We studied the association of bariatric surgery with birth defects in future pregnancies in a large cohort of women. Methods We carried out a retrospective cohort study of 2,194,348 pregnancies that occurred between 1989 and 2016 in Quebec, Canada. We identified women who had bariatric surgery before pregnancy, and included nonobese women with no surgery as a comparison group. We estimated risk ratios (RRs) and 95% CIs for the associations between bariatric surgery and the risk of birth defects, using log-binomial regression models adjusted for maternal age, comorbidities, parity, whether there was a multiple birth, socioeconomic deprivation, and the presence of folic acid food fortification. Results In this study, 1845 deliveries were among women who had bariatric surgery before pregnancy (0.08%). Having bariatric surgery was associated with 1.20 times the risk of birth defects in later pregnancies (95% CI: 1.01, 1.43), compared with having no surgery or obesity. Obesity without having bariatric surgery was, in contrast, more weakly associated with birth defects (RR: 1.09; 95% CI: 1.07, 1.12). The association with bariatric surgery was greater for heart (RR: 1.47; 95% CI: 1.02, 2.12) and musculoskeletal defects (RR: 1.32; 95% CI: 1.02, 1.71). Associations were primarily present before folic acid food fortification was implemented (RR: 2.03; 95% CI: 1.41, 2.92), but not after (RR: 1.05; 95% CI: 0.86, 1.28). Conclusions Having bariatric surgery was a risk factor for birth defects, and particularly heart and musculoskeletal defects. After fortification, however, an association was no longer present. Future studies are needed to determine whether micronutrient supplementation underpins the difference in the changing results pre- and postfortification. [ABSTRACT FROM AUTHOR]

Infertility, may be a harbinger for future health risk in women, including early mortality. Fertility status itself could serve as an early biomarker, (present in a woman's reproductive years) for risk stratification later in life. The relationship between infertility and early mortality involves the impact of nulliparity on future adverse health events, potential sequelae from the underlying cause(s) of infertility, the risks of fertility treatments, as well as the potential for risk reduction from a healthy pregnancy. This complex interplay coupled with difficulties ascertaining infertility on a population level has presented unique challenges to assessing infertility and early mortality risk. With further study, a better understanding the role of fertility status in health at various stages of life may provide unique opportunities for surveillance and risk reduction. [ABSTRACT FROM AUTHOR]

Background Exposure to perfluoroalkyl substances (PFASs) may impact children's neurodevelopment. Objective To examine the association of prenatal and early childhood serum PFAS concentrations with children's reading skills at ages 5 and 8 years. Methods We used data from 167 mother-child pairs recruited during pregnancy (2003–2006) in Cincinnati, OH, quantified prenatal serum PFAS concentrations at 16 ± 3 weeks of gestation and childhood sera at ages 3 and 8 years. We assessed children's reading skills using Woodcock-Johnson Tests of Achievement III at age 5 years and Wide Range Achievement Test-4 at age 8 years. We used general linear regression to quantify the covariate-adjusted associations between natural log-transformed PFAS concentrations and reading skills, and used multiple informant model to identify the potential windows of susceptibility. Results Median serum PFASs concentrations were PFOS > PFOA > PFHxS > PFNA in prenatal, 3-year, and 8-year children. The covariate-adjusted general linear regression identified positive associations between serum PFOA, PFOS and PFNA concentrations and children's reading scores at ages 5 and 8 years, but no association between any PFHxS concentration and reading skills. The multiple informant model showed: a) Prenatal PFOA was positively associated with higher children's scores in Reading Composite (β: 4.0, 95% CI: 0.6, 7.4 per a natural log unit increase in exposure) and Sentence Comprehension (β: 4.2, 95% CI: 0.5, 8.0) at age 8 years; b) 3-year PFOA was positively associated with higher children's scores in Brief Reading (β: 7.3, 95% CI: 0.9, 13.8), Letter Word Identification (β: 6.6, 95% CI: 1.1, 12.0), and Passage Comprehension (β: 5.9, 95% CI: 1.5, 10.2) at age 5 years; c) 8-year PFOA was positively associated with higher children's Word Reading scores (β: 5.8, 95% CI: 0.8, 10.7) at age 8 years. Prenatal PFOS and PFNA were positively associated with children's reading abilities at age 5 years, but not at age 8 years; 3-year PFOS and PFNA were positively associated with reading scores at age 5 years. But PFHxS concentrations, at any exposure windows, were not associated with reading skills. Conclusion Prenatal and childhood serum PFOA, PFOS and PFNA concentrations were positively associated with better children's reading skills at ages 5 and 8 years, but no association was found between serum PFHxS and reading skills. [ABSTRACT FROM AUTHOR]

Objective: To estimate the association of pregnancy loss with common air pollutant exposure. Ambient air pollution exposure has been linked to adverse pregnancy outcomes, but few studies have investigated its relationship with pregnancy loss.Design: Prospective cohort study.Setting: Not applicable.Patient(s): A total of 343 singleton pregnancies in a multisite prospective cohort study with detailed protocols for ovulation and pregnancy testing.Intervention(s): None.Main Outcome Measure(s): Timing of incident pregnancy loss (from ovulation).Result(s): The incidence of pregnancy loss was 28% (n = 98). Pollutant levels at women's residences were estimated using modified Community Multiscale Air Quality models and averaged during the past 2 weeks (acute) and the whole pregnancy (chronic). Adjusted Cox proportional hazards models showed that an interquartile range increase in average whole pregnancy ozone (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.07-1.17) and particulate matter <2.5 μm (HR 1.13, 95% CI 1.03-1.24) concentrations were associated with faster time to pregnancy loss. Sulfate compounds also appeared to increase risk (HR 1.58, 95% CI 1.07-2.34). Last 2 weeks of exposures were not associated with loss.Conclusion(s): In a prospective cohort of couples trying to conceive, we found evidence that exposure to air pollution throughout pregnancy was associated with loss, but delineating specific periods of heightened vulnerability await larger preconception cohort studies with daily measured air quality. [ABSTRACT FROM AUTHOR]

Pregnant women are particularly vulnerable to iron deficiency and related adverse pregnancy outcomes and, as such, are routinely recommended for iron supplementation. Emerging evidence from both animal and population-based studies, however, has raised potential concerns because significant associations have been observed between greater iron stores and disturbances in glucose metabolism, including increased risk of type 2 diabetes among nonpregnant individuals. Yet, the evidence is uncertain regarding the role of iron in the development of gestational diabetes mellitus (GDM), a common pregnancy complication which has short-term and long-term adverse health ramifications for both women and their children. In this review, we critically and systematically evaluate available data examining the risk of GDM associated with dietary iron, iron supplementation, and iron status as measured by blood concentrations of several indicators. We also discuss major methodologic concerns regarding the available epidemiologic studies on iron and GDM. [ABSTRACT FROM AUTHOR]

This opinion addresses the ethics of providing fertility treatment to women at elevated risk from fertility treatment or pregnancy. Providers ethically may treat women at elevated risk provided that they are carefully assessed; that specialists in their medical condition are consulted as appropriate; and that patients are fully informed about risks, benefits, and alternatives, including oocyte and embryo donation, use of a gestational surrogate, not undergoing fertility care, and adoption. Providers also may conclude that the risks are too high for them to treat particular patients ethically; such determinations must be made in a medically objective and unbiased manner and patients must be fully informed of the decision. Counseling of women who wish to initiate fertility treatment with underlying medical conditions that confer increased risk during treatment or pregnancy should incorporate the most current knowledge available, being cognizant of the woman's personal determinants in relation to her reproductive desires. In such a way, both physician and patient will optimize decision making in an ethically sound, patient-supportive context. [ABSTRACT FROM AUTHOR]

Background Exposure to road traffic noise has been associated with adiposity and diabetes in adults. The suggested pathways have been through sleep disturbance and stress. Children may be particularly susceptible to noise induced sleep disturbance and stress and the effects hereof. Objectives To examine the association between traffic noise exposure during pregnancy and early childhood and adiposity in children. Methods We identified 40,974 singletons from the Danish National Birth Cohort with parentally given questionnaire information on weight and height at 7-years of age. Road and railway traffic noise were modeled at all historical addresses and expressed as time-weighted means for two exposure periods (pregnancy and childhood). Adiposity was assessed using BMI z-scores and a dichotomous measure of childhood overweight based on age and sex specific cut-offs. Associations were analyzed using linear regression for BMI z-scores and logistic regression for risk of childhood overweight, adjusting for socioeconomic position, maternal BMI, maternal smoking, maternal age, parity and degree of urbanization. Results We found both pregnancy and childhood exposure to road traffic noise to be associated with a higher risk for childhood overweight (odds ratio (OR) = 1.06 per 10 dB, 95% confidence interval (CI): 1.00–1.12 for exposure during pregnancy and OR = 1.06 per 10 dB, 95% CI: 0.99–1.12 for childhood exposure). There were no associations between road traffic noise and BMI z-scores. We found no associations between railway noise and adiposity. Conclusions We found suggestions of a positive association between road traffic noise and risk of overweight in 7-years old children. [ABSTRACT FROM AUTHOR]

Concerns over adverse effects of air pollution on children's health have been rapidly rising. However, the effects of air pollution on childhood growth remain to be poorly studied. We investigated the association between prenatal and postnatal exposure to PM10 and children's weight from birth to 60 months of age. This birth cohort study evaluated 1129 mother-child pairs in South Korea. Children's weight was measured at birth and at six, 12, 24, 36, and 60 months. The average levels of children's exposure to particulate matter up to 10 μm in diameter (PM10) were estimated during pregnancy and during the period between each visit until 60 months of age. Exposure to PM10 during pregnancy lowered children's weight at 12 months. PM10 exposure from seven to 12 months negatively affected weight at 12, 36, and 60 months. Repeated measures of PM10 and weight from 12 to 60 months revealed a negative association between postnatal exposure to PM10 and children's weight. Children continuously exposed to a high level of PM10 (> 50 μg/m 3 ) from pregnancy to 24 months of age had weight z -scores of 60 that were 0.44 times lower than in children constantly exposed to a lower level of PM10 (≤ 50 μg/m 3 ) for the same period. Furthermore, growth was more vulnerable to PM10 exposure in children with birth weight < 3.3 kg than in children with birth weight > 3.3 kg. Air pollution may delay growth in early childhood and exposure to air pollution may be more harmful to children when their birth weight is low. [ABSTRACT FROM AUTHOR]

Studies of the effects on pregnancy outcomes of in utero exposure to phthalates, contaminants that are widely present in the environment, have yielded conflicting results. In addition, the mode of assessment of exposure varies between studies. The aim of this review was therefore to establish a current state of knowledge of the phthalates and metabolites involved in unfavorable pregnancy outcomes. Extant data were analyzed to determine which biomarker is the best suited to assess the relation between in utero exposure to phthalates and pregnancy outcomes. This review of the literature was conducted using the database of PubMed. A search was made of studies investigating exposure to phthalates and the following birth outcomes: preterm birth (gestational age < 37 weeks), change in gestational age, change in body size at birth (birth weight, length, head circumference), anti-androgenic function, decreased anogenital distance, cryptorchidism, hypospadias and congenital malformation. The methodological approach adopted in each study was examined, in particular the methods used for exposure assessment (biomarkers and/or questionnaire). Thirty-five studies were included. Premature birth and decreased anogenital distance were the most commonly reported outcomes resulting from a moderate level of exposure to phthalates. The principal metabolites detected and involved were primary metabolites of di-2(ethylhexyl)-phthalate (DEHP) and di- n -butyl-phthalate (DnBP). No clear conclusion could be drawn with regard to gestational age at birth, body size at birth and congenital malformations. In epidemiological studies, maternal urine is the most suitable matrix to assess the association between in utero exposure to phthalates and pregnancy outcomes: in contrast to other matrices (cord blood, amniotic fluid, meconium and milk), sampling is easy, non-invasive and, can be repeated to assess exposure throughout pregnancy. Oxidative metabolites are the most relevant biomarkers since they are not prone to external contamination. Further epidemiological studies are required during pregnancy to i) determine the role of phthalates other than DEHP [currently replaced by various substitution products, in particular diisononyl-phthalate (DiNP)]; ii) establish the effect of phthalates on other outcomes (body size adjusted for gestational age, and congenital malformations); iii) determine the pathophysiological pathways; and iv) identify the most suitable time for biomarker determination of in utero exposure to phthalates. [ABSTRACT FROM AUTHOR]

Background Studies from several countries report increases in rates of gestational diabetes mellitus (GDM) over recent decades. Exposure to environmental chemicals could contribute to this trend. Objectives To determine the associations between plasticisers and metals measured in early pregnancy with impaired glucose tolerance (IGT) and GDM in a Canadian pregnancy cohort. Methods Women enrolled in the Maternal–Infant Research on Environmental Chemicals (MIREC) Study were included if they had a singleton delivery and did not have pre-existing diabetes. Eleven phthalate metabolites and total bisphenol A (BPA) were measured in first-trimester urine samples, and four metals (lead, cadmium, mercury and arsenic) were measured in first-trimester blood samples. IGT and GDM were assessed in accordance with standard guidelines by chart review. Chemical concentrations were grouped by quartiles, and associations with outcomes were examined using logistic regression with adjustment for maternal age, race, pre-pregnancy BMI, and education. Restricted cubic spline analysis was performed to help assess linearity and nature of any dose–response relationships. Results Of 2001 women recruited into the MIREC cohort, 1274 met the inclusion criteria and had outcome data and biomonitoring data measured for at least one of the chemicals we examined. Elevated odds of GDM were observed in the highest quartile of arsenic exposure (OR = 3.7, 95% CI = 1.4–9.6) in the adjusted analyses. A significant dose–response relationship was observed in a cubic spline model between arsenic and odds of GDM (p < 0.01). No statistically significant associations were observed between phthalates or BPA or other metals with IGT or GDM. Conclusions Our findings add to the growing body of evidence supporting the role of maternal arsenic exposure as a risk factor for gestational diabetes. [ABSTRACT FROM AUTHOR]

Background: Hypertensive disorders of pregnancy (HDPs), including gestational hypertension and pre-eclampsia, are common obstetric complications associated with adverse health outcomes for the mother and child. It remains unclear how dietary intake can influence HDP risk. Objective: We investigated associations between prepregnancy dietary patterns and risk of HDPs. Design: We selected 3582 women participating in the Australian Longitudinal Study on Women's Health, which is an observational population-based study. Women were not pregnant at baseline in 2003 and reported at least one live birth between 2003 and 2012. Diet was assessed by using a validated 101-item food-frequency questionnaire in 2003, and factor analysis was used to identify dietary patterns. HDPs were assessed by using the question, "Were you diagnosed or treated for hypertension during pregnancy?" Generalized estimating equation models were used to estimate RRs (95% CIs) adjusted for dietary, reproductive, sociodemographic, and lifestyle factors. Results: During 9 y of follow-up of 3582 women, 305 women (8.5%) reported a first diagnosis of HDPs in 6149 pregnancies. We identified 4 dietary patterns labeled as meat, high-fat, and sugar; Mediterranean-style; fruit and low-fat dairy; and cooked vegetables. In the adjusted model, the meat, high-fat, and sugar, fruit and low-fat dairy, and cooked vegetable dietary patterns were not associated with HDP risk. The Mediterranean-style dietary pattern (characterized by vegetables, legumes, nuts, tofu, rice, pasta, rye bread, red wine, and fish) was inversely associated with risk of developing HDPs (quartile 4 compared with quartile 1: RR, 0.58; 95% CI, 0.42, 0.81). Conclusions: In this population-based study of Australian women, we observed an independent protective dose-response association between prepregnancy consumption of a Mediterranean-style dietary pattern and HDP risk. Additional studies are recommended to confirm our findings by prospectively examining whether the implementation of the Mediterranean-style dietary pattern before pregnancy has a role in the prevention of HDPs. [ABSTRACT FROM AUTHOR]

Extensive research defines the impact of advanced maternal age on couples' fecundity and reproductive outcomes, but significantly less research has been focused on understanding the impact of advanced paternal age. Yet it is increasingly common for couples at advanced ages to conceive children. Limited research suggests that the importance of paternal age is significantly less than that of maternal age, but advanced age of the father is implicated in a variety of conditions affecting the offspring. This review examines three aspects of advanced paternal age: the potential problems with conception and pregnancy that couples with advanced paternal age may encounter, the concept of discussing a limit to paternal age in a clinical setting, and the risks of diseases associated with advanced paternal age. As paternal age increases, it presents no absolute barrier to conception, but it does present greater risks and complications. The current body of knowledge does not justify dissuading older men from trying to initiate a pregnancy, but the medical community must do a better job of communicating to couples the current understanding of the risks of conception with advanced paternal age. [ABSTRACT FROM AUTHOR]

Objective: To evaluate factors associated with monozygosity (MZ) (number of fetal heartbeats on early ultrasound greater than the number of embryos transferred) and the risk of recurrence in subsequent pregnancies using a national assisted reproduction database. Design: Historical cohort study. Setting: Clinic-based data. Patient(s): 197,327 pregnancies (including 2,824 with evidence of MZ) from cycles reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) between 2004 and 2010. Intervention(s): None. Main Outcome Measure(s): Evidence of MZ, adjusted odds ratios and their 95% confidence intervals computed from logistic regression models. Result(s): In the univariate analysis, the risk of MZ was increased with ovulation disorders, donor oocytes, gonadotropin-releasing hormone agonist (GnRH-a) suppression, assisted hatching (AZH), and day 5–6 transfer, and was decreased with higher follicle-stimulating hormone (FSH) doses (≥3,000 IU). In the multivariate analysis, the risk of MZ was increased with GnRH-a suppression, AZH, and decreased with intracytoplasmic sperm injection (ICSI) and higher FSH dose. The interaction showed that although MZ was more likely with day 5–6 embryos, AZH had a minimal nonsignificant effect, whereas in day 2–3 embryos, AZH had a substantial statistically significant effect. Only one woman had a recurrence of MZ in a subsequent assisted reproduction pregnancy, which is consistent with randomness. Conclusion(s): The risk of MZ was higher with fresh day 5–6 embryos, donor oocytes, GnRH-a suppression, lower FSH doses, and AZH (particularly with day 2–3 embryos). [ABSTRACT FROM AUTHOR]

Over the past 20 years, a substantial body of research has accumulated about ectopic pregnancy, especially about its epidemiology, risk factors, and diagnosis. Nonetheless, the care of women with these pregnancies remains a topic of debate, and no consensus or guidelines exist to clarify the optimal treatment choices. This review revisits the four primary treatments for ectopic pregnancy and defines and details the concept of “activity,” which guides the indications for each treatment. Recent findings of no difference in fertility during the 2 years after an ectopic pregnancy have answered some old questions and raised new ones for determining the optimal management of ectopic pregnancies. Most especially, they allow the consideration and weighing of a wider range of factors, including the woman's own preferences as well as efficacy and the monitoring time until recovery. [ABSTRACT FROM AUTHOR]

The purpose of this committee opinion, which replaces the 2006 ASRM Practice Committee document titled Multiple Pregnancy Associated with Infertility Therapy, is to provide physicians with pertinent information that may help to avoid multiple gestations and to aid in patient counseling regarding the associated risks. [Copyright &y& Elsevier]

Background: Fatty acids play a vital role in glucose homeostasis; however, studies on habitual dietary fat intakes and gestational diabetes mellitus (GDM) risk are limited and provide conflicting findings. Objective: We determined whether the total amount and the type and source of prepregnancy dietary fats are related to risk of GDM. Design: A prospective study was conducted in 13,475 women who reported a singleton pregnancy between 1991 and 2001 in the Nurses' Health Study II. In these women, 860 incident GDM cases were reported. The adjusted RR of GDM was estimated for quintiles of total fat, specific fat, and the source of fat intakes by pooled logistic regression. Results: Higher animal fat and cholesterol intakes were significantly associated with increased GDM risk. Across increasing quintiles of animal fat, RRs (95% CIs) for GDM were 1.00 (reference), 1.55 (1.20, 1.98), 1.43 (1.09, 1.88), 1.40 (1.04, 1.89), and 1.88 (1.36, 2.60) (P-trend = 0.05). Corresponding RRs (95% CIs) for dietary cholesterol were 1.00 (reference), 1.08 (0.84, 1.32), 1.02 (0.78, 1.29), 1.20 (0.93, 1.55), and 1.45 (1.11, 1.89) (P-trend = 0.04). The substitution of 5% of energy from animal fat for an equal percentage of energy from carbohydrates was associated with significantly increased risk of GDM [RR (95% CI): 1.13 (1.08, 1.18); P < 0.0001]. No significant associations were observed between dietary polyunsaturated fat, monounsaturated fat, or trans fat intakes and GDM risk. Conclusion: Higher prepregnancy intakes of animal fat and cholesterol were associated with elevated GDM risk. [ABSTRACT FROM AUTHOR]

Background & Aims: Women with Crohn''s disease (CD) are considered to be at increased risk for adverse outcomes of pregnancy. However, the few studies assessing this risk have had small sample sizes and limitations. We examined outcomes of pregnancy among a large cohort of primiparous women with CD. Methods: Our population-based prevalence study utilized data from medical birth registries in Sweden and Denmark between 1994 and 2006. Linking birth registry data with national patient registries, we identified 2377 women with a hospital diagnosis of CD prior to delivery and 869,202 women with no diagnosis of CD. Using logistic regression analysis, we estimated relative risks with 95% confidence intervals (CI) for pre-eclampsia, preterm birth, 5-minute Apgar scores below 7, cesarean section, small for gestational age (SGA), stillbirth, and congenital malformations. Results: Maternal CD was associated with increased risk of moderately and very preterm birth (prevalence odds ratio [POR], 1.76; 95% CI, 1.51–2.05; and POR, 1.86; 95% CI, 1.38–2.52, respectively). Maternal CD was also associated with increased risk for cesarean section (POR, 1.93; 95% CI, 1.76–2.12). The strongest associations with CD were observed for prelabor cesarean section and induced preterm delivery. Risk of small size for gestational age birth was slightly increased among women with CD, especially during the time period of 2002–2006 (POR, 1.43; 95% CI, 1.09–1.89). We found no increased risks for pre-eclampsia, low 5-minute Apgar score, stillbirth, or congenital malformations. Conclusions: Maternal CD is a risk factor for preterm birth, but not birth defects. [Copyright &y& Elsevier]

No statistical difference was found for the total aneuploidy rate in the spontaneous abortions between intracytoplasmic sperm injection and IVF groups; however, differences in the distribution of chromosomal abnormalities between the two groups were seen. [Copyright &y& Elsevier]

Presents a study which analyzed the relationship of anemia as a risk factor for pregnancy-related maternal mortality. Estimation of mortality risk; Methodology; Results and discussion.

Caffeine consumption has been equivocally associated with miscarriage, despite an absence of prospective longitudinal measurement of caffeine intake during sensitive windows of human development. In response to this critical data gap, we analyzed daily caffeine consumption while attempting pregnancy through 12 menstrual cycles at risk for pregnancy and found that caffeine consumption did not increase the risk or hazard of miscarriage, even after adjusting for relevant covariates. [Copyright &y& Elsevier]

Objectives Serological case–control studies suggest that certain chlamydia-related bacteria ( Chlamydiales ) which cause cows to abort may do the same in humans. Chlamydiales include Waddlia chondrophila , Chlamydia abortus and Chlamydia trachomatis. Data on prevalence of Chlamydiales in pregnancy are sparse. Using stored urine samples from a carefully characterised cohort of 847 newly pregnant women recruited from 37 general practices in London, UK, we aimed to investigate the prevalence and types of Chlamydiales infections. We also explored possible associations with miscarriage or spontaneous preterm birth. Methods Samples were tested using W. chondrophila and pan- Chlamydiales specific real-time PCRs targeting the 16S rRNA gene. Samples positive on either PCR were subjected to DNA sequencing and C. trachomatis PCR. Results The overall prevalence of Chlamydiales was 4.3% (36/847, 95% CI 3.0% to 5.8%). The prevalence of W. chondrophila was 0.6% ( n = 5), C. trachomatis 1.7% ( n = 14), and other Chlamydiales species 2.0% ( n = 17). Infection with C. trachomatis was more common in women aged <25, of black ethnicity or with bacterial vaginosis, but this did not apply to W. chondrophila or other Chlamydiales. Follow up was 99.9% at 16 weeks gestation and 90% at term. No infection was significantly associated with miscarriage at ≤12 weeks (prevalence 10%, 81/827) or preterm birth <37 weeks (prevalence 4%, 23/628). Of 25 samples sequenced, seven (28%) were positive for Chlamydiales bacterium sequences associated with respiratory tract infections in children. Conclusion In the first study to use the pan- Chlamydiales assay on female urine samples, 4% of pregnant women tested positive for Chlamydiales , including species known to be pathogenic in mothers and neonates. [ABSTRACT FROM AUTHOR]

Objective: To study whether women conceiving after preimplantation genetic diagnosis (PGD) and their children have greater risks of adverse pregnancy and birth outcomes compared with children conceived spontaneously or after IVF with or without intracytoplasmic sperm injection (ICSI).Design: Historical cohort study.Setting: Not applicable.Patient(s): All deliveries following PGD treatment for single gene and sex-linked disorders or structural chromosomal aberrations (n = 126 deliveries/149 children), IVF/ICSI treatment (n = 30,418 deliveries/36,115 children), and spontaneous conception (n = 896,448 deliveries/909,624 children).Intervention(s): None.Main Outcome Measure(s): Adverse obstetric and neonatal outcomes, such as pre-eclampsia, preterm primary rupture of membranes, placenta previa, abruption of placenta, preterm birth, low birth weight, malformations, and neonatal admission.Result(s): Compared with spontaneously conceived pregnancies, PGD pregnancies were at significantly increased risk of placenta previa (adjusted odds ratio [ORa] 9.1; 95% confidence interval [95% CI] 3.4, 24.9), cesarean section (ORa 2.0; 95% CI 1.3, 2.9), preterm birth (ORa 1.6; 95% CI 1.0, 2.7), shorter gestation (mean difference -3.4 days; 95% CI -5.7, -1.1 days), and longer neonatal admission (mean difference 21 days; 95% CI 15, 28 days). The risks were comparable to that of pregnancies following IVF/ICSI. In subanalyses, adverse outcomes were only present in children conceived by PGD owing to parental monogenetic disorder and comparable to those of children born to parents with monogenic disorders conceiving without PGD, except for a higher risk of placenta previa.Conclusion(s): In this cohort study, the risk of adverse obstetric and neonatal outcomes was mainly related to the underlying parental condition rather than the PGD procedure. [ABSTRACT FROM AUTHOR]

The fecundity of women decreases gradually but significantly beginning approximately at age 32 years and decreases more rapidly after age 37 years. Education and enhanced awareness of the effect of age on fertility are essential in counseling the patient who desires pregnancy. Given the anticipated age-related decline in fertility, the increased incidence of disorders that impair fertility, and the higher risk of pregnancy loss, women older than 35 years should receive an expedited evaluation and undergo treatment after 6 months of failed attempts to conceive or earlier, if clinically indicated. In women older than 40 years, more immediate evaluation and treatment are warranted. [ABSTRACT FROM AUTHOR]

Objective: To describe the first reported cases of two women with polycystic ovary syndrome (PCOS) desirous of pregnancy who conceived trichorionic pregnancies following ovulation induction with metformin alone and metformin plus clomiphene. Design: Case report. Setting: Private fertility practice. Patient(s): Two women with polycystic ovary syndrome, one lean and one overweight, both oligoovulatory and not undertaking their first cycle of treatment. Intervention(s): Ovulation induction by metformin alone or in combination with clomiphene Main Outcome Measure(s): Higher-order multiple pregnancy (triplet or greater) Result(s): Two cases of trichorionic pregnancy. Conclusion(s): This is the first report of higher-order multiple pregnancies resulting from the use of either metformin alone or in combination with clomiphene. The additive effects of adjunctive treatments such as weight reduction, ovarian drilling, and clomiphene and metformin therapy may result in an increased incidence of higher-order multiple pregnancy and women need to be counseled about this risk. Further research is required to quantify the risk of this event per treatment cycle. [Copyright &y& Elsevier]