Mortality in mothers after perinatal loss: a population-based follow-up study.

OBJECTIVE: To assess whether mothers who lost a child from stillbirth or in the first week of life have an increased overall mortality and cause-specific mortality. DESIGN: A population based follow-up study. SETTING: Data from Danish national registers. POPULATION: All mothers in Denmark were included in the cohort at time of their first delivery from 1 January 1980 to 31 December 2008 and followed until 31 December 2009 or death, whichever came first. METHODS: The association between perinatal loss and total and cause-specific mortality in mothers was estimated with hazard ratios (HR) and 95% confidence intervals (95% CI) calculated using Cox proportional hazards regression analyses. MAIN OUTCOME MEASURES: Overall mortality and cause-specific mortality. RESULTS: During the follow-up period, 838,331 mothers in the cohort gave birth to one or more children and 7690 mothers (0.92%) experienced a perinatal loss. During follow-up, 8883 mothers (1.06%) died. There was an increased overall mortality for mothers who experienced a perinatal loss adjusted for maternal age and educational level, hazard ratio (HR) 1.83 [95% confidence interval (CI) 1.55-2.17]. The strongest association was seen in mortality from cardiovascular diseases (CVD) with an HR of 2.29 (95% CI 1.48-3.52) adjusted for CVD at time of delivery. We found no association between a perinatal loss and mortality from traumatic causes. CONCLUSIONS: Mothers who experience a perinatal loss have an increased mortality, especially from CVD.

Maternal milk consumption, birth size and adult height of offspring: a prospective cohort study with 20 years of follow-up.

BACKGROUND/OBJECTIVES: Previous studies have suggested that milk consumption during pregnancy may have growth-promoting effects on the offspring in utero. Whether this effect tracks beyond the prenatal period remains unclear. We examined whether milk consumption during pregnancy is associated with infant size at birth and offspring's height- and growth-related biomarkers at ∼20 years of age. SUBJECT/METHODS: A prospective cohort of 809 Danish pregnant women was recruited in 1988-1989, with offspring follow-up at ∼20 years of age (n=685). Milk consumption was assessed at gestational week 30 using a food frequency questionnaire. Birth weight and birth length were measured according to standard procedures at delivery and converted to specific z-scores, adjusted for gestational age and gender. RESULTS: In adjusted models, maternal milk consumption of ≥150 ml/day vs <150 ml/day was associated with 0.32 higher z-scores for birth weight (95% confidence interval (CI) 0.06; 0.58) and 0.34 higher z-scores for birth length (95% CI 0.04; 0.64). At follow up, ∼20 years later, those offspring whose mothers had consumed < 150 ml milk/day tended to have 0.19 higher z-scores for height (P=0.16), ∼8% higher levels of insulin-like growth factor I (P=0.12) and ∼14% higher insulin levels (P=0.11) compared with offspring whose mothers consumed <150 ml milk/day. CONCLUSIONS: Our findings add to recent observations that maternal milk consumption may have a growth-promoting effect with respect to weight and length at birth. Furthermore, the results provide some suggestion that this effect may even track into early adult age, although further studies with more statistical power are needed for that purpose.

Prevalence of Coxiella burnetii in women exposed to livestock animals, Denmark, 1996 to 2002.

Q fever is a zoonotic infection which can pose a danger to pregnant women. To our knowledge, Denmark has never experienced a clinically verified Q fever outbreak. We aimed to quantify risk of infection in pregnant women occupationally and environmentally exposed to Coxiella burnetii. The Danish National Birth Cohort collected blood samples from 100,418 pregnant women in the period 1996 to 2002. We sampled 195 women with occupational exposure to livestock (veterinarians and female farmers), 202 women with domestic exposure (dairy cattle and/or sheep) and a random sample of 459 unexposed women. Samples were screened for antibodies against C. burnetii by commercial enzyme-linked immunosorbent assay. Positive samples were confirmed by immunofluorescence (cut-off titre ≥1:128). The proportion of seropositive women was higher in the occupationally exposed (47.2% seropositive; relative risk (RR): 9.8; 95% confidence interval (CI): 6.4­15.2) and the domestically exposed population (32.2% seropositive; RR: 6.7; 95% CI: 4.3­10.6) than in unexposed women (4.8% seropositive). We found a high prevalence of antibodies to C. burnetii among pregnant women with occupational or domestic exposure to cattle and/or sheep compared with unexposed pregnant women. Our findings suggest that contact to livestock is a risk factor for C. burnetii infection in Denmark.

Prediction of light-for-gestational age at delivery in twin pregnancies: an evaluation of fetal weight deviation and growth discordance measured by ultrasound.

The purpose of this retrospective study was to evaluate and discuss different ultrasound methods widely used, among other things, as predictors for light-for-gestational age (LGA) in twin pregnancies. The methods evaluated and compared as predictors for LGA at birth were: (1) Difference between twins in biparietal diameter; (2) difference in abdominal diameter; (3) the percentage difference in estimated fetal weight between twins; and (4) estimation of the weight deviation from the expected weight during pregnancy. The study comprised 66 twin pregnancies, examined by ultrasound scanning less than 15 days before delivery. Using Relative Operating Characteristic curves (ROC curves) estimated fetal weight deviation was the most sensitive and specific of the methods. It is stressed that fetal discordance is not the appropriate predictor of LGA at birth in twin pregnancies.

Continuous direct tissue oxygen tension measurement. A new application for an intravascular oxygen sensor.

An oxygen tension measurement equipment, developed for continuous intravascular monitoring was tested as a direct tissue oxygen tension meter. The sterile disposable oxygen probe consists of a Clark type polaro-graphic bipolar electrode placed in a 5 cm long flexible polyethylene catheter (OD 0.55 mm). The probe is easily placed, e.g. in subcutaneous tissue or muscle, with the aid of an introduction needle. In vitro measurements as well as subcutaneous and intramuscular readings were performed. The animals were subjected to various experimental conditions such as different inspiratory oxygen fractions, hypovolemia, and circulatory impairment. Results were comparable to those obtained with previously used and well characterized tissue oxygen tension measurement equipment. The clinical applicability of the oxygen sensor for tissue oxygen measurement was assessed in one patient by 40 hours' surveillance in a free myocutaneous flap. The procedure was simple and implied minimal discomfort for the patient.