Uncomplicated Monochorionic Diamniotic Twins and the Timing of Delivery

Cleary-Goldman and d'Alton discuss the implications of a new study in PLoS Medicine examining the risk of fetal death in uncomplicated monochorionic diamnotic twin pregnancies

Using record linkage to investigate perinatal factors and neonatal thyroid-stimulating hormone

Context: Studies examining the relationship between maternal and infant thyroid parameters have shown conflicting results. Record-linkage provides an opportunity to examine the association between maternal and infant thyroid stimulating hormone (TSH) levels. Objective: To demonstrate the feasibility of record-linkage of newborn screening, laboratory, and birth databases for research by investigating the association between maternal and newborn TSH levels. Design: Record-linkage cohort study Setting and Participants: The records of 2,802 women with first trimester serum TSH concentrations were linked with population-based birth data and newborn screening data (NBS) containing infant TSH levels. Association between moderately high neonatal TSH levels (>5mlU/L) and maternal and infant characteristics were evaluated. The correlation and association between maternal and infant TSH levels were assessed using Pearson’s correlation coefficient and multivariable linear regression, respectively. Results: 99.3% of maternal and birth records linked with a NBS record. Mother’s country of birth, gestational age (>41 weeks) and lower birth weight were associated with neonatal TSH levels >5mlU/L. Neonatal and maternal first-trimester TSH levels were not correlated, although statistically significant (r=0.05, P=0.008). The association between neonatal TSH and maternal TSH, after adjusting for maternal age, gestational age and age at NBS testing, was also small ( =0.039, P=0.009). Conclusions: Record-linkage is a feasible and cost-efficient way to investigate the association between maternal factors and neonatal hormone levels. First trimester maternal thyroid levels are not correlated with neonatal TSH levels. This method of outcome assessment can be used for future research examining long term outcomes for infants with different newborn screening results.Funding: This work was supported by a National Health and Medical Research Council (NHMRC) Project Grant (#1050688). SJL is supported by a NHMRC Early Career Research Fellowship (#1054751), CLR is supported by a NHMRC Senior Research Fellowship (#1021025) and NN by a NHMRC Career Development Fellowship (#1067066)

Comparison of Milk Fat Globule Membrane (MFGM) Proteins of Chianina and Holstein Cattle Breed Milk Samples Through Proteomics Methods

Identification of proteins involved in milk production is important to understand the biology of lactation. Many studies have advanced the understanding of mammary function and milk secretion, but the critical molecular mechanisms implicated in milk fat secretion is still incomplete. Milk Fat Globules are secreted from the apical surface of the mammary cells, surrounded by a thin membrane bilayer, the Milk Fat Globule Membrane (MFGM), formed by proteins which have been suggested to be cholesterolemia-lowering factors, inhibitors of cancer cell growth, vitamin binders, bactericidal, suppressors of multiple sclerosis. Using a proteomic approach, we compared MFGM from milk samples of individuals belonging to two different cattle breeds, Chianina and Holstein, representative of selection for milk and meat traits, respectively. We were able to isolate some of the major MFGM proteins in the examined samples and to identify differences between the protein fractions of the two breeds. We detected differences in the amount of proteins linked to mammary gland development and lipid droplets formation, as well as host defence mechanisms. We have shown that proteomics is a suitable, unbiased method for the study of milk fractions proteins and a powerful tool in nutritional genomics

Prevalence of placenta praevia by world region: a systematic review and meta-analysis.

OBJECTIVES: (i) To estimate the prevalence burden of placenta praevia in each world region, and (ii) to investigate potential sources of heterogeneity. METHODS: Systematic review of the literature and random-effects meta-analysis. Potential sources of heterogeneity were investigated using meta-regression. RESULTS: The overall prevalence of placenta praevia was 5.2 per 1000 pregnancies (95% CI: 4.5-5.9). However, there was evidence of regional variation (P = 0.0001); prevalence was highest among Asian studies (12.2 per 1000 pregnancies; 95% CI: 9.5-15.2) and lower among studies from Europe (3.6 per 1000 pregnancies; 95% CI: 2.8-4.6), North America (2.9 per 1000 pregnancies; 95% CI: 2.3-3.5) and Sub-Saharan Africa (2.7 per 1000 pregnancies; 95% CI: 0.3-11.0). The prevalence of major placenta praevia was 4.3 per 1000 pregnancies (95% CI: 3.3-5.4). CONCLUSION: The prevalence of placenta praevia is low at around 5 per 1000 pregnancies. There is some evidence suggestive of regional variation in its prevalence, but it is not possible to determine from existing data whether this is due to true ethnic differences or other unknown factor(s)

Effectiveness of an online curriculum for medical students on genetics, genetic testing and counseling

Background: It is increasingly important that physicians have a thorough understanding of the basic science of human genetics and the ethical, legal and social implications (ELSI) associated with genetic testing and counseling. Methods: The authors developed a series of web-based courses for medical students on these topics. The course modules are interactive, emphasize clinical case studies, and can easily be incorporated into existing medical school curricula. Results: Results of a ‘real world’ effectiveness trial indicate that the courses have a statistically significant effect on knowledge, attitude, intended behavior and self-efficacy related to genetic testing (p<0.001; N varies between 163 and 596 for each course). Conclusions: The results indicate that this curriculum is an effective tool for educating medical students on the ELSI associated with genetic testing and for promoting positive changes in students' confidence, counseling attitudes and behaviors

Parental Reports of Infant and Child Eating Behaviors are not Affected by Their Beliefs About Their Twins’ Zygosity

Parental perception of zygosity might bias heritability estimates derived from parent rated twin data. This is the first study to examine if similarities in parental reports of their young twins’ behavior were biased by beliefs about their zygosity. Data were from Gemini, a British birth cohort of 2402 twins born in 2007. Zygosity was assessed twice, using both DNA and a validated parent report questionnaire at 8 (SD = 2.1) and 29 months (SD = 3.3). 220/731 (8 months) and 119/453 (29 months) monozygotic (MZ) pairs were misclassified as dizygotic (DZ) by parents; whereas only 6/797 (8 months) and 2/445 (29 months) DZ pairs were misclassified as MZ. Intraclass correlations for parent reported eating behaviors (four measured at 8 months; five at 16 months) were of the same magnitude for correctly classified and misclassified MZ pairs, suggesting that parental zygosity perception does not influence reporting on eating behaviors of their young twins

Influence of maternal and social factors as predictors of low birth weight in Italy

Abstract Background The purpose of this study is to provide insight into the determinants of low birth weight (LBW) in Italy. Methods The study was carried out in a non-teaching hospital in Catanzaro (Italy). All LBW and very LBW newborns (200) were included in the study and a random sample of 400 newborns weighing ≥ 2500 g was selected. Data were collected from the delivery certificates during one year. Smoking activity of mother and familiar and/or social support during pregnancy was gathered through telephone interviews. Results Overall annual LBW rate was 11.8%. Among LBW newborn there were 125 preterm and 75 term. Younger mothers, those who smoked during pregnancy, and had fewer prenatal care visits were more likely to deliver a LBW child; moreover, preterm newborns, delivered by caesarean section, and twin or multiple birth were significantly more likely to have a LBW. The comparison of very LBW ( Conclusion Several modifiable factors affect the risk of LBW, even when universal access to health care is freely available, but socio-economic status appears to correlate only to very LBW.</p

Obstetric interventions in two groups of hospitals in Catalonia: A cross-sectional study

Background: Childbirth assistance in highly technological settings and existing variability in the interventions performed are cause for concern. In recent years, numerous recommendations have been made concerning the importance of the physiological process during birth. In Spain and Catalonia, work has been carried out to implement evidence-based practices for childbirth and to reduce unnecessary interventions. To identify obstetric intervention rates among all births, determine whether there are differences in interventions among full-term single births taking place in different hospitals according to type of funding and volume of births attended to, and to ascertain whether there is an association between caesarean section or instrumental birth rates and type of funding, the volume of births attended to and women's age. Methods: Cross-sectional study, taking the hospital as the unit of analysis, obstetric interventions as dependent variables, and type of funding, volume of births attended to and maternal age as explanatory variables. The analysis was performed in three phases considering all births reported in the MBDS Catalonia 2011 (7,8570 births), full-term single births and births coded as normal. Results: The overall caesarean section rate in Catalonia is 27.55% (CI 27.23 to 27.86). There is a significant difference in caesarean section rates between public and private hospitals in all strata. Both public and private hospitals with a lower volume of births have higher obstetric intervention rates than other hospitals (49.43%, CI 48.04 to 50.81). Conclusions: In hospitals in Catalonia, both the type of funding and volume of births attended to have a significant effect on the incidence of caesarean section, and type of funding is associated with the use of instruments during delivery. © 2014 Escuriet et al.; licensee BioMed Central Ltd