Summary
Background
Maternal anti‐viral treatment prevents mother‐to‐infant transmission of hepatitis B virus (HBV), but the role of neonatal viremia on subsequent HBV infection is not clear.
Aims
To ...investigate the effect of maternal anti‐viral treatment on neonatal serum HBV DNA and hepatitis B surface antigen (HBsAg) in infants born to highly viremic mothers and the roles of neonatal markers in predicting chronic HBV infection in children.
Methods
Serum HBV DNA and HBsAg were tested in children. Of the 201 pregnant mothers, 110 received tenofovir during the third trimester. Chronic infection in children was defined by HBsAg seropositivity at 6 or 12 months lasting more than 6 months.
Results
The maternal HBV viral loads from baseline to delivery were 8.25 ± 0.48 to 4.29 ± 0.98 log10 IU/mL; and 8.29 ± 0.49 to 8.12 ± 0.68 log10 IU/mL in the tenofovir and control group respectively. Of the 208 children, those in the tenofovir group had a lower rate of neonatal HBV DNA seropositivity at birth (5.22% vs 30.11%, P < 0.0001) and HBsAg seropositivity at 6 months (1.74% vs 11.83%, P = 0.003) and 12 months (1.74% vs 10.75%, P = 0.007). In a first multivariate analysis, maternal HBV DNA level at delivery (odds ratio = 1.70, P = 0.0172) and neonatal HBsAg positivity (odds ratio = 19.37, P < 0.0001) were significantly associated with children's chronic HBV infection. In a second model, neonatal HBV DNA positivity was a strong independent influence variable (odds ratio = 61.89, P = 0.0002).
Conclusions
Maternal tenofovir therapy decreased maternal viral load and neonatal viremia. Positive neonatal HBV DNA was highly correlated with chronic HBV infection in children. Clinical Trial Identifier: NCT01312012.
The copy number variation (CNV) of 15q11.2, an emerging and common condition observed during prenatal counseling, is encompassed by four highly conserved and non-imprinted genes-
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-which are ...reportedly related to developmental delays or general behavioral problems. We retrospectively analyzed 1337 samples from genetic amniocentesis for fetal CNV using microarray-based comparative genomic hybridization analysis between January 2014 and December 2019. 15q11.2 CNV showed a prevalence of 1.5% (21/1337). Separately, 0.7% was noted for 15q11.2 BP1-BP2 microdeletion and 0.8% for 15q11.2 microduplication. Compared to the normal array group, the 15q11.2 BP1-BP2 microdeletion group had more cases of neonatal intensive care unit transfer, an Apgar score of <7 at 1 min, and neonatal death. Additionally, the group was symptomatic with developmental delays and had more infantile deaths related to congenital heart disease (CHD). Our study makes a novel contribution to the literature by exploring the differences in the adverse perinatal outcomes and early life conditions between the 15q11.2 CNV and normal array groups. Parent-origin gender-based differences may help in the prognosis of the fetal phenotype; development levels should be followed up in the long term and echocardiography should be offered prenatally and postnatally for the prevention of a delayed diagnosis of CHD.
Abstract Objective To investigate perinatal outcomes according to the 2009 Institute of Medicine (IOM) gestational weight gain (GWG) guidelines. Materials and methods A retrospective cohort study was ...conducted among all term, singleton, live births to women who delivered at the Taipei Chang Gung Memorial Hospital, Taipei, Taiwan between 2009 and 2014. Women were categorized into three groups based on prepregnancy body mass index and GWG relative to the IOM guidelines. Multivariable logistic regression analysis was used to assess the associations between GWG outside the IOM guidelines and adverse perinatal outcomes. Women with GWG within the guidelines served as the reference group. Results Of 9301 pregnancies, 2574 (27.7%), 4189 (45.0%), and 2538 (27.3%) women had GWG below, within, and above the IOM guidelines. Women with GWG above the IOM guidelines were at risk for preeclampsia adjusted odds ratio (OR) 3.0, 95% confidence interval (CI) 1.9–4.7, primary cesarean delivery (adjusted OR 1.4, 95% CI 1.2–1.6) due to dysfunctional labor and cephalopelvic disproportion, large-for-gestational age (adjusted OR 1.8, 95% CI 1.5–2.1), and macrosomic neonates (adjusted OR 2.2, 95% CI 1.6–3.1). Women with GWG below the IOM guidelines were more likely to be diagnosed with gestational diabetes mellitus (adjusted OR 1.5, 95% CI 1.3–1.8) and were at higher risk for placental abruption (adjusted OR 1.7, 95% CI 1.1–2.5), small-for-gestational age (adjusted OR 1.6, 95% CI 1.4–1.9), and low birth weight neonates (adjusted OR 1.9, 95% CI 1.4–2.4). Conclusion Women with GWG outside the 2009 IOM guidelines were at risk for adverse maternal and neonatal outcomes.
Abstract Objective To evaluate the outcomes associated with fetal ventriculomegaly. Materials and methods Reports of women who underwent ultrasound scanning between 18 and 36 weeks of gestation ...during the period from January 1, 2000, to December 31, 2010, were reviewed. According to the defined severity of ventriculomegaly of affected fetuses, the women were divided into the following groups: (1) mild ventriculomegaly (Group A); (2) moderate ventriculomegaly (Group B); and (3) severe ventriculomegaly (Group C). The women were classified into the “gray zone” group if the fetal lateral ventricle measured between 7 mm and <10 mm. All cases were followed up with additional ultrasound scans. Postnatal information was obtained from the computer database or the medical charts. Results A total of 41 cases were recruited for this analysis. Four (9.8%) cases had an abnormal karyotype. Twelve women (29.3%) opted for termination of pregnancy. Of the 29 women who delivered, 56.1% ( N = 23) were from Group A, 14.6% ( N = 6) were from Group B, and none was from Group C. All children in Group A had normal neurological development. Three children in Group B had normal neurological development, whereas the other three had neurologic deficits. A total of 432 cases were classified into the “gray zone” group. Of these cases, 2.8% ( N = 12) progressed to ventriculomegaly. Conclusion Cases of isolated and mild ventriculomegaly without additional structural anomalies or chromosomal aberrations had good prognoses. However, the parents of fetuses with moderate or severe ventriculomegaly should be counseled regarding related risks. If the ventricular size of the fetus falls within the “gray zone”, at least one additional exam in the third trimester should be performed, for early detection of ventriculomegaly and other related abnormalities. It is important to make the parents of these fetuses aware of these risks, from a medico-legal point of view.
Abstract Objective To determine risk factors and perinatal outcomes associated with small for gestational age (SGA) neonates among healthy pregnant women. Methods A retrospective cohort study was ...conducted of 49 945 women who gave birth at Chang Gung Memorial Hospital, Taipei, Taiwan, after 24 weeks of pregnancy. Idiopathic SGA newborns (n = 3398) were characterized by a birth weight below the 10th percentile for mean weight corrected for GA and fetal sex. Results Risk factors for idiopathic SGA newborns included hypercoiling of the umbilical cord (adjusted odds ratio aOR, 3.3; 95% confidence interval CI, 1.6–7.0); prior fetal death (aOR, 2.8; 95% CI, 2.0–3.9); primiparity (aOR, 1.5; 95% CI, 1.4–1.7); adolescent pregnancy (aOR, 1.5; 95% CI, 1.2–2.0), low prepregnancy weight (aOR, 1.6; 95% CI, 1.5–1.8), low prepregnancy body mass index (aOR, 1.1; 95% CI, 1.0–1.3); short stature (aOR, 1.3; 95% CI, 1.1–1.4); and entangled umbilical cord (aOR, 1.1; 95% CI, 1.0–1.3). Idiopathic SGA newborns correlated with increased risk of adverse perinatal outcomes, including fetal death, low Apgar scores, oligohydramnios, placental abruption, and admission to the neonatal intensive care unit. Conclusion Some risk factors for idiopathic SGA newborns were modifiable, suggesting potential implications for public health.
Abstract Objective To investigate (1) whether there is an increasing trend in the mean maternal age at the birth of the first child and in the group of women giving birth at age 35 or older, and (2) ...the association between advanced maternal age and adverse perinatal outcomes in an Asian population. Study design We conducted a retrospective cohort study involving 39,763 Taiwanese women who delivered after 24 weeks of gestation between July 1990 and December 2003. Multivariable logistic regression was used to adjust for potential confounding variables. Results During the study period, the mean maternal age at the birth of the first child increased from 28.0 to 29.7 years, and the proportion of women giving birth at age 35 or older increased from 11.4% to 19.1%. Compared to women aged 20–34 years, women giving birth at age 35 or older carried a nearly 1.5-fold increased risk for pregnancy complications and a 1.6–2.6-fold increased risk for adverse perinatal outcomes. After adjusting for the confounding effects of maternal characteristics and coexisting pregnancy complications, women aged 35–39 years were at increased risk for operative vaginal delivery (adjusted odds ratio OR 1.5, 95% confidence interval CI 1.2–1.7) and cesarean delivery (adjusted OR 1.6, 95% CI 1.5–1.7), while women aged 40 years and older were at increased risk for preterm delivery (before 37 weeks of gestation) (adjusted OR 1.7, 95% CI 1.3–2.2), operative vaginal delivery (adjusted OR 3.1, 95% CI 2.0–4.6), and cesarean delivery (adjusted OR 2.6, 95% CI 2.2–3.1). In those women who had a completely uncomplicated pregnancy and a normal vaginal delivery, advanced maternal age was still significantly associated with early preterm delivery (before 34 weeks of gestation), a birth weight <1500 g, low Apgar scores, fetal demise, and neonatal death. Conclusion In this population of Taiwanese women, there is an increasing trend in the mean maternal age at the birth of the first child. Furthermore, advanced maternal age is independently associated with specific adverse perinatal outcomes.
Abstract Objective To identify the risk factors for placenta previa in an Asian population. Methods This retrospective cohort study involved Taiwanese women delivered between July 1990 and December ...2003 at Chang Gung Memorial Hospital, Taipei, Taiwan. Pregnancies complicated by multiple gestation and fetal anomalies were excluded. Results There were 457 cases of placenta previa (1.2%) among the 37,702 pregnancies analyzed. Risk factors for placenta previa included a prior preterm birth (OR, 6.6; 95% confidence interval CI, 4.1–10.6); technology-assisted conception (OR, 4.8; 95% CI, 2.9–7.8); smoking (OR, 3.3; 95% CI, 1.2–9.1) or working (OR, 3.8; 95% CI, 2.8–5.3) during pregnancy; maternal age of, or greater than 35 years (OR, 2.0 to 2.2; 95% CI, 1.3–3.7); and previous induced abortions (OR, 1.3–3.0; 95% CI, 1.1–7.1). Conclusion The risk factors for placenta previa were found to be the same for Asian women as those previously recorded for American and European women, but additional factors were detected.
The objective of this study was to identify risk factors for placental abruption in an Asian population. The authors conducted a retrospective review of 37 245 Taiwanese women who delivered between ...July 1990 and December 2003. Pregnancies complicated by placenta previa, multiple gestation, and fetal anomalies were excluded. Multivariable logistic regression was used to adjust for potentially confounding variables and to identify independent risk factors for placental abruption. Three hundred thirty-two women had placental abruption (9 per 1000 singleton deliveries). Women who smoked during pregnancy (adjusted odds ratio OR = 8.4; 95% confidence interval CI = 3.0-23.9), had gestational hypertensive diseases (adjusted OR = 4.9; 95% CI = 3.3-7.3), pregnancies complicated by oligohydramnios (adjusted OR = 4.2; 95% CI = 2.7-6.7), polyhydramnios (adjusted OR = 3.3; 95% CI = 1.4-7.7), preterm premature rupture of membranes (adjusted OR = 1.9; 95% CI = 1.1-3.1), entanglement of umbilical cord (adjusted OR = 1.6; 95% CI = 1.2-2.1), were of or more than 35 years of age (adjusted OR = 1.5; 95% CI = 1.1-2.0), and had a low prepregnancy body mass index (adjusted OR = 1.3; 95% CI = 1.0-1.6) were at increased risk for placental abruption. Some risk factors for placental abruption among Taiwanese women are the same as those of other ethnic groups, whereas some of the risk factors are different.
Background. The aim of this study was to evaluate our institution's 12-year experience in managing primary abdominal pregnancy by laparotomy or laparoscopy. Methods. We identified 11 cases of primary ...abdominal pregnancy treated at our institution between January 1994 and December 2005, and separated the cases into 2 groups based on type of surgical management. The outcome measures we evaluated were operative time, blood loss and duration of hospital stay. In addition, the incidence rates for all types of ectopic pregnancy were recorded. Analysis excluded secondary abdominal pregnancy. Results. Of the 11 primary abdominal pregnancies, 6 were treated with laparotomy and 5 with laparoscopy. The laparoscopy group had significantly better results in operative time, blood loss and hospital stay (p<0.05). The difference in gestational age was not significant (p=0.141), even after excluding the patient whose abdominal pregnancy was only identified after cesarean delivery. Conclusion. Our experience shows a trend toward better management of primary abdominal pregnancy with laparoscopy. These patients had shorter operative time, reduced blood loss, and fewer days in hospital then patients treated with laparotomy. Choice of management should depend on the patient's condition, gestational age of the pregnancy, and the physician's clinical experience.
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