Vitamin D deficiency and adverse fetal outcome

Background: Vitamin D deficiency is recognized as the most untreated nutritional deficiency in the world. It is plausible that vitamin D deficiency could make the fetal heart more vulnerable to distress/birth asphyxia. Vitamin D deficiency has been hypothesized to be associated with low birth weight, low Apgar score at birth, higher rates of still births and admission to NICU. The aim of present study was to study prevalence of vitamin D deficiency in pregnancy and evaluate perinatal outcome.Methods: The study was conducted in the department of obstetrics and gynecology, Kamla Nehru Hospital, Shimla, India over a period of 12 months. Six hundred women were included in the study.Results: All the mothers who had still births suffered from vitamin D deficiency and the severe vitamin D deficiency was there in 90.91% (30) of these subjects. Severe vitamin D deficiency was seen in 78.95% (75) of the subjects having babies with birth weights <2.5 kg compared to 61.16% (288) subjects of the other group.Conclusions: Adverse fetal outcome are more common in vitamin D deficient group.

Analysis of still births in a tertiary care system and changed scenario over six year period

Background: In India, the maternal and infant mortality rates have been steadily decreasing in recent years, but there has been no corresponding decrease in the perinatal mortality. Hence, there is need to evaluate the factors leading to this unfortunate event. The objective of this study was to find out various factors (especially preventable) responsible for perinatal stillbirths.Methods: An analytical comparative study in a tertiary care hospital comparing fresh and macerated still births over a period of one year in 2011 and 2017 and responsible factors were analysed.Results: Amazingly, despite improvement in the antenatal services, more institutional deliveries, there is no change in the incidence of still birth rate. However, there was decrease in the rate of still births due to extreme prematurity and congenital malformations. There was no change in incidence of PIH/ Eclampsia, IUGR and placental causes but there was substantial increase in the incidence of GDM.Conclusions: Perinatal mortality can definitely be reduced by strengthening and improving quality of antenatal services, early identification of high risk pregnancies, timely referral and appropriate intervention.

Study of cases with perinatal mortality

Background: Perinatal loss is one of the most traumatic life events. It is indeed a great psychological and emotional shock to not only the mother and father but the entire family and society as a whole. The perinatal mortality rate (PMR) is an important indicator of the quality of obstetric care during pregnancy. Perinatal deaths result largely from obstetric complications that can be prevented with proper antenatal care and quality neonatal services. The study was aims to study the factors related with perinatal loss and its prevention in future pregnancy.Methods: It was a prospective analytical study. All patients with IUFD, stillbirths and early neonatal loss were studied. Postpartum both mother and father were counselled. Detailed history and thorough physical examination were conducted. Data was recorded and tabulated, observation made and compared with results of various studies.Results: The results showed that the incidence of IUFD was 3.7% and early neonatal death was 10.8% per total admissions. The perinatal mortality rate was 63.62 per 1000 live births. Perinatal mortality rate was inversely related to the number of antenatal visits taken by the patient. Lack of antenatal care results in perinatal deaths probably due to failure of early identification and management of maternal problems that impact negatively on perinatal outcome. Even in advanced economies with sophisticated diagnostic and monitoring equipment, lack of antenatal care categorizes a pregnant woman as a high-risk pregnancy.Conclusions: There is a need for awareness regarding importance of antenatal care and institutional delivery. Perinatal mortality is an important indicator of maternal care, health and nutrition. It also reflects the quality of Obstetric and Pediatric care available. Every effort must be made to reduce perinatal mortality.

Historical Demography of Iceland.

Knowledge of the seasonal variation in births and deaths during normal years is important for analyses of the effects of wars, famines, epidemics or similar privations on these variables. In studies of seasonality, multiple trigonometric regression models are more flexible than the simple sine curve. The seasonal variation in mortality in Iceland, 1856-1990, shows a strong secular decrease, and a connection between this and the epidemiological transition is considered. Comparisons with findings in other European countries are made. The temporal trends in Iceland of the birth components; the twinning rate, the still birth rate and the secondary sex ratio, are presented and compared with the corresponding values in neighbouring countries. No marked differences were emerged.

Genetic radiation risks: a neglected topic in the low dose debate

OBJECTIVES: To investigate the accuracy and scientific validity of the current very low risk factor for hereditary diseases in humans following exposures to ionizing radiation adopted by the United Nations Scientific Committee on the Effects of Atomic Radiation and the International Commission on Radiological Protection. The value is based on experiments on mice due to reportedly absent effects in the Japanese atomic bomb (Abomb) survivors. METHODS: To review the published evidence for heritable effects after ionising radiation exposures particularly, but not restricted to, populations exposed to contamination from the Chernobyl accident and from atmospheric nuclear test fallout. To make a compilation of findings about early deaths, congenital malformations, Down’s syndrome, cancer and other genetic effects observed in humans after the exposure of the parents. To also examine more closely the evidence from the Japanese A-bomb epidemiology and discuss its scientific validity. RESULTS: Nearly all types of hereditary defects were found at doses as low as one to 10 mSv. We discuss the clash between the current risk model and these observations on the basis of biological mechanism and assumptions about linear relationships between dose and effect in neonatal and foetal epidemiology. The evidence supports a dose response relationship which is non-linear and is either biphasic or supralinear (hogs-back) and largely either saturates or falls above 10 mSv. CONCLUSIONS: We conclude that the current risk model for heritable effects of radiation is unsafe. The dose response relationship is non-linear with the greatest effects at the lowest doses. Using Chernobyl data we derive an excess relative risk for all malformations of 1.0 per 10 mSv cumulative dose. The safety of the Japanese A-bomb epidemiology is argued to be both scientifically and philosophically questionable owing to errors in the choice of control groups, omission of internal exposure effects and assumptions about linear dose response.

Approach to the patient with pregnancy-associated fulminant type 1 diabetes mellitus / 中华内分泌代谢杂志

One case with fulminant type 1 diabetes during the third trimester of pregnancy was reported.If a patient manifests abrupt onset of hyperglycemia,nausea,vomiting,and bellyache during pregnancy or immediately after delivery,fulminant type 1 diabetes should be considered.