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The article discusses the crucial role that mutant conserved helix-loop-helix ubiquitous kinase (CHUK) plays in the development of skin epidermis and severe fetal encasement malformation. Tow human fetuses deficient in CHUK are described to conclude that null mutation of CHUK is associated with a lethal inherited condition called the cocoon syndrome.

The studies related to the mutations in SYCP3, a gene encoding an essential component of the synaptonemal complex that is central to the interaction of homologous chromosomes, and its association with recurrent pregnancy loss in humans is reported. The results revealed that generation of an aberrant synaptonemal complex in a dominant-negative manner, during mutations might contribute to abnormal chromosomal behavior that might lead to recurrent miscarriage.

A study to establish a relationship between mild hyperglycemia and chances of adverse outcomes during pregnancy is conducted. Results indicate that some sort of relationship between mild hyperglycemia and increased birth weight and increased cord-blood serum C-peptide levels.

The role of dental diseases like gingivitis and periodontitis in causing adverse complications like preterm birth in pregnant women is discussed.

Objectives. We undertook a case-control study to evaluate whether some occupational conditions during pregnancy increase the risk of delivering a small-for-gestational-age (SGA) infant and whether taking measures to eliminate these conditions decreases that risk. Methods. The 1536 cases and 4441 controls were selected from 43898 women who had single live births between January 1997 and March 1999 in Quebec, Canada. The women were interviewed by telephone after delivery. Results. The risk of having an SGA infant increased with an irregular or shiftwork schedule alone and with a cumulative index of the following occupational conditions: night hours, irregular or shift-work schedule, standing, lifting loads, noise, and high psychological demand combined with low social support. When the conditions were not eliminated, the risk increased with the number of conditions ([P.sub.trend] = .004; odds ratios = 1.00, 1.08, 1.28, 1.43, and 2.29 for 0, 1, 2, 3, and 4-6 conditions, respectively). Elimination of the conditions before 24 weeks of pregnancy brought the risks close to those of unexposed women. Conclusions. Certain occupational conditions experienced by pregnant women can increase their risk of having an SGA infant, but preventive measures can reduce the risk.

The association between birth spacing and relative risk of adverse perinatal outcomes is examined. Interpregnancy intervals shorter than 18 months and longer than 59 months are significantly associated with increased risk of adverse perinatal outcomes suggesting that spacing pregnancies appropriately could help prevent such adverse perinatal outcomes.

Byline: Stefan Kostadinov (1), Halit Pinar (1) Keywords: chorioamnionitis; Eikenella; oral pathogens Abstract: Different microorganisms not commonly found in the female genital tract have been implicated as causative agents for amniotic fluid infections. Eikenella corrodens is part of the normal flora in the human oral cavity and upper respiratory tract. It is most commonly found in the clinical setting of polymicrobial infections involving human bite wounds, head and neck infections, and periodontitis. On rare occasions, E. corrodens has been reported as a cause of gynecologic infections. There are only 3 reports of documented E. corrodens chorioamnionitis of the placenta resulting in preterm labor, one of which is associated with early neonatal demise. We report a case of preterm delivery of twin infants at 23 weeks of gestation with documented E. corrodens infection in 1 twin who was not resuscitated. Author Affiliation: (1) Division of Perinatal Pathology, Women and Infants Hospital, Brown Medical School, 101 Dudley Street, Providence, RI, 02905, USA Article History: Registration Date: 01/01/2005 Received Date: 14/03/2005 Accepted Date: 11/04/2005 Online Date: 18/10/2005

Byline: Raymond W. Redline (1), Theonia Boyd (2), Valarie Campbell (3), Scott Hyde (4), Cynthia Kaplan (5), T. Yee Khong (6), Heather R. Prashner (7), Brenda L. Waters (8) Keywords: intrauterine growth retardation; maternal vascular underperfusion; placenta; preeclampsia; reproducibility; uteroplacental insufficiency Abstract: Placental examination can be a useful tool for specifying the etiology, prognosis, and recurrence risk of pregnancy disorders. The purpose of this study was to test the reliability of a predetermined set of placental reaction patterns seen with maternal vascular underperfusion in the hope that this might provide a useful diagnostic framework for practicing pathologists. Study cases (14 with clinical and pathologic evidence of maternal underperfusion plus 6 controls) were evaluated for the presence or absence of 11 lesions by eight perinatal pathologists. After analysis of initial results, diagnostic criteria were refined and a second, overlapping set of cases was reviewed. The collective sensitivity, specificity, and efficiency of individual assessments for the 11 lesions relative to the group consensus ranged from 74--93% (22/33 &gt 90%). Reproducibility was measured by unweighted kappa-values and interpreted as follows: &lt 0.2 poor, 0.2--0.6 fair/moderate, &gt 0.6 substantial. Kappa values for lesions affecting villi and the intervillous space were increased syncytial knots (any -0.42, severe -0.50), villous agglutination (0.42), increased intervillous fibrin (0.25), and distal villous hypoplasia (0.57). Individual estimates of percent involvement for syncytial knots, intervillous fibrin, and distal villous hypoplasia were correlated with placental and fetal weight for gestational age. Extent of increased intervillous fibrin showed the strongest correlation with both placental weight (R = -0.64) and fetal weight (R = -0.45). Kappa values for lesions affecting maternal vessels and the implantation site were acute atherosis (0.50), mural hypertrophy of membrane arterioles (0.43), muscularized basal plate arteries (0.48), increased placental site giant cells (0.54), and immature intermediate trophoblast (0.36). Correlation of maternal vessel and implantation site lesions with the clinical diagnosis of preeclampsia showed that excessive placental site giant cells and immature intermediate trophoblast were more sensitive and efficient predictors, whereas atherosis and muscularized basal plate arteries were more specific. Kappa value for a thin umbilical cord, a possible indicator of fetal volume depletion, was 0.61. Reproducibility for a global impression of maternal vascular underperfusion, taking into account all of the above lesions, was moderate (kappa 0.54) and improved after inclusion of additional pathologic and clinical data (kappa 0.68). Adoption of this clearly defined, clinically relevant, and pathologically reproducible terminology could enhance clinicopathologic correlation and provide a more objective framework for future clinical research. Author Affiliation: (1) Department of Pathology, University Hospitals of Cleveland and Case Western Reserve University, 1100 Euclid Avenue, 44106, USA (2) Department of Pathology, Baystate Medical Center, Springfield, MA, USA (3) Iowa Pathology Associates, Des Moines, IA, USA (4) Department of Pathology, St. Francis Hospital, Tulsa, OK, USA (5) University Hospital, SUNY Stony Brook, Stony Brook, NY, USA (6) Department of Histopathology, Women's and Children's Hospital, North Adelaide, South Australia, Australia (7) Department of Pathology, University of Texas Medical School, Houston, TX, USA (8) Department of Pathology, Fletcher Allen Health Care, Burlington, VT, USA Article History: Registration Date: 01/01/2003 Received Date: 11/08/2003 Accepted Date: 11/12/2003 Online Date: 17/03/2004

Byline: Raymond W. Redline (1), Ona Faye-Petersen (2), Debra Heller (3), Faisal Qureshi (4), Van Savell (5), Carole Vogler (6) Keywords: amniotic infection syndrome; chorioamnionitis; nomenclature; placenta; reproducibility Abstract: Clinically responsive placental examination seeks to provide useful information regarding the etiology, prognosis, and recurrence risk of pregnancy disorders. The purpose of this study was to assemble and validate a complete set of the placental reaction patterns seen with amniotic fluid infection in the hope that this might provide a standardized diagnostic framework useful for practicing pathologists. Study cases (14 with amniotic fluid infection, 6 controls) were reviewed blindly by six pathologists after agreement on a standard set of diagnostic criteria. After analysis of initial results, criteria were refined and a second, overlapping set of cases were reviewed. Majority vote served as the gold standard. Grading and staging of maternal and fetal inflammatory responses was found to be more reproducible using a two- versus three-tiered grading system than a three- versus five-tiered staging system (overall agreement 81% vs. 71%). Sensitivity, specificity, and efficiency for individual observations ranged from 67--100% (24/30 &gt 90%). Reproducibility was measured by unweighted kappa values and interpreted as follows: &lt 0.2, poor 0.2--0.6, fair/moderate &gt 0.6, substantial. Kappa values for the 12 lesions evaluated in 20 cases by the six pathologists were: acute chorioamnionitis/maternal inflammatory response (any, 0.93 severe 0.76 advanced stage, 0.49) chronic (subacute) chorioamnionitis (0.25) acute chorioamnionitis/fetal inflammatory response (any, 0.90 severe, 0.55 advanced stage, 0.52) chorionic vessel thrombi (0.37) peripheral funisitis (0.84) acute villitis (0.90) acute intervillositis/intervillous abscesses (0.65), and decidual plasma cells (0.30). Adoption of this clearly defined, clinically relevant, and pathologically reproducible terminology could enhance clinicopathologic correlation and provide a framework for future clinical research. Author Affiliation: (1) Department of Pathology, University Hospitals of Cleveland and Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA (2) Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA (3) Department of Pathology, University of Medicine and Dentistry of New Jersey--New Jersey Medical School, Newark, NJ, USA (4) Pathology Department, DMC University Laboratories, Hutzel Site and Wayne State University, Detroit, MI, USA (5) Department of Pathology, Driscoll Children's Hospital, Corpus Christie, TX, USA (6) Department of Pathology, St. Louis University School of Medicine, St. Louis, MO, USA Article History: Received Date: 01/07/2002 Accepted Date: 12/05/2003 Online Date: 11/09/2003

This paper provides an overview of the occurrence, etiology and temporal trends of adverse pregnancy outcomes. Disparities between developed and developing countries are highlighted for maternal mortality, infant mortality, stillbirth and low birth weight. The higher rate of low birth weight in developing countries is primarily due to intrauterine growth restriction rather than preterm birth. Much of the excess intrauterine growth restriction is caused by short maternal stature, low prepregnancy body mass index and low gestational weight gain (due to low energy intake). No important contribution has been established for micronutrient intake, nor have different fetal growth trajectories been demonstrated to reflect the timing of exposure to nutritional or other etiologic factors. Infant mortality has declined substantially over time both in developed and developing countries despite no decline (and even an increase) in low birth weight. Several developed countries have reported a temporal increase in fetal growth in infants born at term, a reduction in stillbirth rates and prevention of neural tube defects. More progress is required, however, in understanding the etiology and prevention of preterm birth. KEY WORDS: * infant mortality * stillbirth * low birth weight * preterm birth * intrauterine growth restriction

Only partially understood host defense mechanisms operate against infections affecting maternal and fetal morbidity. Subclinical ascending infections through the lower female genital tract are predominant worldwide. Important micronutrient deficiencies may prevail in low-income countries where these infections are much more common than in high-income countries. Important morbidities related to poor perinatal outcome both for the mother and for the fetus and newborn comprise preterm birth, prelabor rupture of membranes, placental abruption (predelivery detachment of the placenta), postpartum sepsis and maternal anemia. In the fetus, sepsis and intrauterine growth retardation are suspected to be consequences of ascending maternal infections. In the newborn, septicemia and respiratory disorders as well as some neurological disorders seem to be consequences of such ascending genital infections in the pregnant woman. It is concluded that much more attention should be given to efforts to elucidate the host defense mechanisms and antimicrobial barriers from the vagina through the cervix, fetal membranes and amniotic fluid including the early fetal immunocompetence in the second and the third trimester of pregnancy. KEY WORDS: * maternal morbidity * fetal disease * chorioamnionitis

Numerous studies support the concept that a major cause of pregnancy complications can be suboptimal embryonic and fetal nutrition. Although the negative effects of diets low in energy on pregnancy outcome are well documented, less clear are the effects of diets that are low in one or more essential micronutrients. However, several observational and intervention studies suggest that diets low in essential vitamins and minerals can pose a significant reproductive risk in diverse human populations. Although maternal nutritional deficiencies typically occur as a result of low dietary intakes of essential nutrients, nutritional deficiencies at the level of the conceptus can arise through multiple mechanisms. Evidence from experimental animals supports the concept that in addition to primary deficiencies, secondary embryonic and fetal nutritional deficiencies can be caused by diverse factors including genetics, maternal disease, toxicant insults and physiological stressors that can trigger a maternal acute phase response. These secondary responses may be significant contributors to the occurrence of birth defects. An implication of the above is that the frequency and severity of pregnancy complications may be reduced through an improvement in the micronutrient status of the mother. KEY WORDS: * zinc * copper * pregnancy * nutrition * malformations

Objective: The aim of this study was to investigate the importance of nutritional deficiencies and infections in the development of anaemia in pregnant Nepali women. Design: Case-control study. Setting: Patan Hospital, Kathmandu, Nepal. Subjects: A sub-sample (n = 479) of all pregnant women (n = 2856) coming for their first antenatal visit in a 12 month period, 1994-1995. Women who had already received any micronutrient supplementation (n = 82), and those whose serum samples showed macroscopic haemolysis (n = 7) were excluded. The remaining women (n=390) were included in the statistical analysis. They were divided into three groups; a non-anaemic control group, haematocrit (Hct)>33% (n = 82), and two case-groups: moderately anaemic, Hct 25-33% (n = 254), and severely anaemic, Hct Results: We found high prevalences of nutritional deficiencies and intestinal infections, both among cases and controls. The prevalence of low s-ferritin was high, especially among the severely anaemic women (55.6%). In a multiple logistic regression model, the presence of low s-vitamin A, elevated s-C-reactive protein or hookworm infection was associated with a significantly increased risk of severe anaemia. The adjusted odds ratios (95% CI) were 8.38 (1.99, 35.30), 4.91 (1.22, 19.67) and 5.43 (1.20, 24.61), respectively. Conclusions: In addition to the present routine iron and folate supplementation to pregnant Nepali women, vitamin A supplementation needs to be considered. Prevention and treatment of infections should, together with dietary advice, be emphasized more strongly in the antenatal care. Sponsorship: The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education. Descriptors: Nepal; anaemia; pregnancy; nutritional deficiencies; infection, Introduction Nepal, with its population of 22 million, is one of the poorest countries in the world. Maternal death is the predominal cause of death amongst women in the 15-44 [...]

Premature rupture of fetal membranes is the tearing of the amniotic sac before the full term of pregnancy and the beginning of labor. This complication may affect nearly 10% of pregnant women, and can increase the risk of infection in the newborn. This rupture may result from the natural stretching caused by a growing pregnancy, or more subtle structural changes. Research suggests changes in collagen production and degradation, nutritional deficiencies, reproductive tract infections, and tobacco smoking may increase the risk of rupture.

Women with moderate to severe kidney disease will probably have a higher incidence of pregnancy complications but the probability that their infants will survive is very high. This was demonstrated in 82 pregnancies in 67 women with moderate to severe kidney disease. Twenty-eight percent had high blood pressure before pregnancy but that figure rose to 48% by the third trimester. Forty-three percent experienced a rapid decline in kidney function directly related to the pregnancy and eight of these pregnancies led to end-stage kidney disease. However, 93% of the infants survived.

Heavy caffeine use during pregnancy may not translate into specific health risks for the fetus. Although lower birth weight and spontaneous abortion rates may be linked to maternal caffeine use, the relationship between caffeine and adverse pregnancy outcomes remains uncertain. Caffeine does not cause known fetal abnormalities and has no detrimental effect on premature labor and delivery. The combination of caffeine consumption and smoking in the later stages of pregnancy may be harmful to the fetus.

A common cold during the first three months of pregnancy may increase the risk of birth defects. Researchers have found that colds with or without fever were most closely related to defects in the central nervous system and facial anomalies. These defects included anencephalus, spina bifida, hydrocephalus, cleft lip and undescended testicles. Women who were exposed to a cold in the first trimester had a 40% increased risk of birth defects. No impact on the results occurred from adjustment for maternal age, parity, severe vomiting in early pregnancy, threatened abortion and paternal smoking. Cautious interpretation of these findings is advised. It is possible that medications taken for colds, rather than the colds themselves, are the cause of malformations., ABSTRACT. Objective. To examine the association between the common cold with or without fever in the first 3 months of pregnancy and birth defects in offspring. Design. A case-control study. Setting. Data are from the Shanghai Birth Defects Monitoring Program, conducted in 29 hospitals in Shanghai, China from October 1, 1986 to September 30, 1987. Subjects. A total of 986 birth defects cases, 990 frequency-matched live birth controls, and 159 stillbirth controls. Results. Modestly elevated risk of birth defects was identified among women who reported having a cold with or without fever in the first trimester of pregnancy. Notably increased relative risks were observed for anencephalus (odds ratio [OR] = 3.9, 95% confidence interval [CI] = 2.0 to 7.7), spina bifida (OR = 4.1, 95% CI = 1.7 to 9.7), hydrocephalus (OR = 2.3, 95 (CI = 1.1 to 5.1), cleft lip (OR = 2.2, 95 % CI = 1.4 to 3.4), and undescended testicle (OR = 1.8, 95 (CI = 1.0 to 3.0). Our study further found that the overall relative risks were consistent by using two different control groups, suggesting that this association was unlikely to be due to recall or report bias. Conclusion. Common cold in the first trimester of pregnancy may be associated with an increased risk of birth defects in offspring. However, these findings should be interpreted cautiously. Pediatrics 1993; 92:559-563; birth defect, cold, fever, pregnancy

In this survey, 998 children and adolescents between 7 months and 17 years of age who attended a hospital diagnostic center in the city of Halifax, Nova Scotia, for routine evaluation were tested for Toxoplasma gondii antibody. The 5.2% prevalence rate of antibody for children living in the outlying rural areas was significantly higher than the 1.1% rate among the urban children (P = .0006). Seroprevalence increased with age for both rural and urban children. Cat ownership was associated with antibodies to Toxoplasma among rural children but not urban children. Rural children who lived in a house with more than one cat were two times more likely to be infected than children who had one cat and three times more likely to be infected than children with no cats. The geometric mean titer was also significantly higher among the rural children with more than one cat, 1:152, than rural children with one or no cats, 1:63 (P = .02). In light of these findings for children and adolescents, the association of Toxoplasma infection with cat ownership needs to be thoroughly evaluated among pregnant women in rural areas.

Medical residency is a difficult, strenuous period of training that often demands night work, long shifts and prolonged periods of standing. All of these factors have been associated with an increased risk of preterm delivery (before the 37th week of gestation). Female physicians generally pass through residency training during a period of life when many women wish to have children, and some studies have indicated that pregnant residents suffer an increased rate of adverse outcomes. The present study examines the risks of preterm delivery and other complications of pregnancy in a group of 4,412 medical residents, and a group of 4,235 wives of male residents (a control group). Despite the arduous work of the residents, there were no significant differences in the numbers of miscarriages, ectopic pregnancies (outside of the uterus), and stillbirths between the two groups of pregnant women. A similar number of babies with birth weights less than the 10th percentile for their gestational age were born to mothers in both groups. Although the female residents reported a greater incidence of preterm labor (11 percent) than the control group (6.5 percent), they did not deliver more preterm babies (6.5 percent versus 6.0 percent). Preeclampsia (toxicity of pregnancy) was more frequent among residents (8.8 percent) than controls (3.5 percent). The authors conclude that the effects of long working hours in a very stressful role generally had little effect on the outcome of pregnancy in female medical residents. (Consumer Summary produced by Reliance Medical Information, Inc.)

A condition called fetal alcohol syndrome (FAS) is the result of alcohol abuse by the mother during pregnancy. Infants with FAS suffer mental retardation, which may be mild or severe, behavioral abnormalities, and facial deformities. Estimates of rates of FAS are limited by the lack of recognition of this syndrome by physicians. Also, because the drinking patterns of mothers are not always known, the diagnosis of FAS may be missed. The medical records of women who were known to have abused alcohol during pregnancy were extracted from a database containing reports of over 28,000 births which occurred between September 1977 and December 1980 in Dallas County, Texas. Out of the 5,602 records that had information on alcohol usage, 38 contained documentation of alcohol abuse by the mother during pregnancy. Out of this subgroup, 40 babies were born (there were two sets of twins), and 38 infants survived long enough to be evaluated. A group of 80 women who also gave birth, but were not reported to have abused alcohol during pregnancy, were used for comparison (controls); 81 infants were born to this group. Most demographic factors in the two groups were comparable, except that the alcohol-abusing group contained more white women than the control group. Higher infant mortality and rates of pregnancy complications occurred in the alcohol-abusing group. Half of the infants exposed to alcohol during pregnancy had very poor postnatal growth and development. Six of these infants had physical features which were consistent with FAS. Although these observations were made and the mother's medical records indicated alcohol abuse during pregnancy, none of the infants had any mention of FAS as a possible diagnosis in their medical records. These results suggest that FAS is dramatically underdiagnosed, and that affected infants are not given adequate follow-up medical care for FAS. (Consumer Summary produced by Reliance Medical Information, Inc.)