Risks of pregnancy and birth in obese primiparous women: an analysis of German perinatal statistics

Purpose: To compare risks of pregnancy and birth in obese (body mass index, BMI≥30) and normal weight women (BMI 18.5-24.99) giving birth to their first child. Methods: We analysed data of 243,571 pregnancies in primiparous women from the German perinatal statistics of 1998-2000. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for selected pregnancy and birth risks. ORs were adjusted for the confounding factors age, smoking status, single mother status, and maternal education. Results: Obesity during pregnancy is common in primiparous women (n=19,130; 7.9% of all cases) and it is significantly associated with a number of risks of pregnancy and birth, including diabetes [OR 3.71 (95% CI 2.93; 4.71); p<0.001], hypertension [OR 8.44 (7.91; 9.00); p<0.001], preecalmpsia/eclampsia [OR 6.72 (6.30; 7.17); p<0.001], intraamniotic infection [OR 2.33 (2.05; 2.64); p<0.001], birth weight ≥4,000g [OR 2.16 (2.05; 2.28); p<0.001], and an increased rate of Caesarean section [OR 2.23 (2.15; 2.30); p<0.001]. Some risks were less frequent in the obese such as cervical incompetence [OR 0.55 (0.48; 0.63); p<0.001] and preterm labour [OR 0.47 (0.43; 0.51); p<0.001]. Conclusions: Obesity during pregnancy is an important clinical problem in primiparous women because it is common and it is associated with a number of risks of pregnancy and birth. Because of these increased risks, obese women need special attention clinically during the course of their first pregnancy. Weight reduction before the first pregnancy is generally indicated in obese women to prevent the above-mentioned complications of pregnancy and birt

Vitamin D receptor genotype BB is associated with higher serum osteocalcin in first pregnancy

Aim: Serum osteocalcin was shown in a previous study on first trimester pregnant women to correlate with bone density and to distinguish between fast and slow bone losers. The objective of the present study is to examine whether serum osteocalcin is related to vitamin D receptor (VDR) BsmI polymorphism in pregnant women. Study design: We determined osteocalcin serum levels and VDR BsmI genotype in 97 healthy first trimester pregnant women consecutively recruited during six months. Results: BB (21%), Bb (38%) and bb (41%) genotypes showed similar osteocalcin serum levels. However, in primigravidas (n=38) the BB genotype was significantly associated with higher mean osteocalcin level (9.67 ng/mL) than the Bb (8.07ng/mL) and the bb genotype (8.14ng/mL), respectively (P<0.05). The VDR genotype was the only independent parameter to correlate with serum osteocalcin (P<0.05). Conclusion: Only primigravidas show in the first trimester a relation between the bone formation parameter serum osteocalcin and the VDR genotype BB which indicates a higher risk of fractures. For further clinical applications serum osteocalcin and VDR genotype should be tested on a cohort of primigravidas including measurements of bone densit

Risks of pregnancy and birth in obese primiparous women: an analysis of German perinatal statistics

PURPOSE: To compare risks of pregnancy and birth in obese (body mass index, BMI ≥ 30) and normal weight women (BMI 18.5–24.99) giving birth to their first child. METHODS: We analysed data of 243,571 pregnancies in primiparous women from the German perinatal statistics of 1998–2000. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for selected pregnancy and birth risks. ORs were adjusted for the confounding factors age, smoking status, single mother status, and maternal education. RESULTS: Obesity during pregnancy is common in primiparous women (n = 19,130; 7.9% of all cases) and it is significantly associated with a number of risks of pregnancy and birth, including diabetes [OR 3.71 (95% CI 2.93; 4.71); p &lt; 0.001], hypertension [OR 8.44 (7.91; 9.00); p &lt; 0.001], preecalmpsia/eclampsia [OR 6.72 (6.30; 7.17); p &lt; 0.001], intraamniotic infection [OR 2.33 (2.05; 2.64); p &lt; 0.001], birth weight ≥4,000 g [OR 2.16 (2.05; 2.28); p &lt; 0.001], and an increased rate of Caesarean section [OR 2.23 (2.15; 2.30); p &lt; 0.001]. Some risks were less frequent in the obese such as cervical incompetence [OR 0.55 (0.48; 0.63); p &lt; 0.001] and preterm labour [OR 0.47 (0.43; 0.51); p &lt; 0.001]. CONCLUSIONS: Obesity during pregnancy is an important clinical problem in primiparous women because it is common and it is associated with a number of risks of pregnancy and birth. Because of these increased risks, obese women need special attention clinically during the course of their first pregnancy. Weight reduction before the first pregnancy is generally indicated in obese women to prevent the above-mentioned complications of pregnancy and birth

Cowpox Virus Outbreak in Banded Mongooses (Mungos mungo) and Jaguarundis (Herpailurus yagouaroundi) with a Time-Delayed Infection to Humans

BACKGROUND:Often described as an extremely rare zoonosis, cowpox virus (CPXV) infections are on the increase in Germany. CPXV is rodent-borne with a broad host range and contains the largest and most complete genome of all poxviruses, including parts with high homology to variola virus (smallpox). So far, most CPXV cases have occurred individually in unvaccinated animals and humans and were caused by genetically distinguishable virus strains. METHODOLOGY/PRINCIPAL FINDINGS:Generalized CPXV infections in banded mongooses (Mungos mungo) and jaguarundis (Herpailurus yagouaroundi) at a Zoological Garden were observed with a prevalence of the affected animal group of 100% and a mortality of 30%. A subsequent serological investigation of other exotic animal species provided evidence of subclinical cases before the onset of the outbreak. Moreover, a time-delayed human cowpox virus infection caused by the identical virus strain occurred in a different geographical area indicating that handling/feeding food rats might be the common source of infection. CONCLUSIONS/SIGNIFICANCE:Reports on the increased zoonotic transmission of orthopoxviruses have renewed interest in understanding interactions between these viruses and their hosts. The list of animals known to be susceptible to CPXV is still growing. Thus, the likely existence of unknown CPXV hosts and their distribution may present a risk for other exotic animals but also for the general public, as was shown in this outbreak. Animal breeders and suppliers of food rats represent potential multipliers and distributors of CPXV, in the context of increasingly pan-European trading. Taking the cessation of vaccination against smallpox into account, this situation contributes to the increased incidence of CPXV infections in man, particularly in younger age groups, with more complicated courses of clinical infections

In utero and postnatal imaging findings of parasitic conjoined twins (ischiopagus parasiticus tetrapus)

Conjoined twins are a rare developmental anomaly with a reported prevalence of 1.47 per 100,000 births. We present an uncommon case of a parasitic ischiopagus tetrapus with a parasitic ischiopagus partial twin joined to the complete fetus at the level of the ischium diagnosed in utero by fetal MRI. The correct prenatal diagnosis led to birth by caesarean section. Prenatal MRI findings are presented and corroborated by postnatal imaging delineating the full extent and associated anomalies of this rare malformation. Differential diagnosis of duplicated lower extremities is discussed