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Birth defects research. Part A, Clinical and molecular teratology最新文献

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Evidence for a teratogenic risk in the offspring of health personnel exposed to ionizing radiation?! 暴露于电离辐射的医务人员的后代有致畸风险的证据?!
Q Medicine Pub Date : 2016-06-14 DOI: 10.1002/bdra.23532
Awi Wiesel, Gabriela Stolz, Annette Queisser-Wahrendorf

Background

The evidence concerning safety of occupational exposure to ionizing radiation on teratogenic effects mainly relies on animal models, disaster epidemiology and experience in cancer etiology. Following an explorative result on maternal exposure in medical occupations we conducted a feasibility study, addressing congenital anomalies (CA) in the offspring of health workers potentially exposed to radiation.

Methods

In a prospective follow-up study, we enrolled women, identified by mandatory registration at the office of radiation protection as wearing a dosimeter. The participating women answered a questionnaire and if pregnant agreed to an examination of their infant. CA were diagnosed and categorized, and demographic and anamnestic findings (including dosimeter values) were ascertained. Mainz Birth Registry data were used for comparison, and a nonresponder analysis was performed.

Results

Answers were received from 286 of 604 (51%) women exposed and 183 (30.3%) of them participated in the study including 88 nonparticipants who provided exposure data only. Further sources of ionizing radiation and other factors relevant for CA did not differ between the groups. Thirty pregnancies occurred among the participants. Eight of the resulting 27 infants were diagnosed with CA (30%) compared with 6.2% of the comparison group.

Conclusion

Previous explorative findings were corroborated by this feasibility study. The increased prevalence for CA could not be explained by any other factor. A preferable prospective active design is achievable, and the participation rate is essential to calculate valid results and answer this important issue. Birth Defects Research (Part A) 106:475–479, 2016. © 2016 Wiley Periodicals, Inc.

职业电离辐射暴露对致畸效应的安全性研究主要依靠动物模型、灾害流行病学和癌症病因学方面的经验。在对医疗职业中母亲暴露的探索性结果之后,我们进行了一项可行性研究,解决可能暴露于辐射的卫生工作者后代的先天性异常(CA)问题。方法在一项前瞻性随访研究中,我们招募了在辐射防护办公室强制登记的佩戴剂量计的妇女。参与研究的妇女回答了一份调查问卷,如果怀孕了,她们同意对婴儿进行检查。对CA进行诊断和分类,并确定人口统计学和遗忘的结果(包括剂量计值)。使用美因茨出生登记处的数据进行比较,并进行无应答分析。结果604名暴露妇女中有286名(51%)回答了问题,其中183名(30.3%)参与了研究,包括88名仅提供暴露数据的非参与者。进一步的电离辐射源和其他与CA相关的因素在两组之间没有差异。参与者中有30人怀孕。结果27名婴儿中有8名被诊断为CA(30%),而对照组为6.2%。结论本研究证实了前人的探索性发现。CA患病率的增加不能用任何其他因素来解释。一个较好的前瞻性主动设计是可以实现的,参与率是计算有效结果和回答这一重要问题的关键。出生缺陷研究(A部分),2016.(06):475 - 479。©2016 Wiley期刊公司
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引用次数: 3
Use of azathioprine and corticosteroids during pregnancy and birth outcome in women diagnosed with inflammatory bowel disease 诊断为炎症性肠病的妇女妊娠期间硫唑嘌呤和皮质类固醇的使用和分娩结果
Q Medicine Pub Date : 2016-06-14 DOI: 10.1002/bdra.23509
Anne Veie Plauborg, Anne Vinkel Hansen, Ester Garne

Background

The aim of this study was to describe prescription patterns for azathioprine and corticosteroids for pregnant women with inflammatory bowel diseases (IBD) before, during, and after pregnancy and to describe pregnancy outcomes.

Methods

A cohort composed of all singleton pregnancies in Danish registries from 1996 to 2009 was divided by maternal IBD status: Crohn's disease (CD, n = 827), ulcerative colitis (UC, N = 1361), or no IBD diagnosis (background population, n = 814,231). The number of women with a prescription for azathioprine, local and systemic steroids within a 3-month period was computed for each of the pregnancy trimesters and the year before and after pregnancy. Outcomes of interest were stillbirth, perinatal mortality, low birth weight (LBW), preterm birth, and small for gestational age (SGA).

Results

Number of prescriptions for azathioprine decreased just before and during pregnancy and increased after birth. Number of prescriptions for local and systemic corticosteroids decreased approximately 30% compared with before pregnancy and increased in the second trimester. There was an increased risk among mothers with IBD of LBW (adjusted odds ratio [adjOR]: CD: 2.25 [95% confidence interval {CI}, 1.74–2.91], UC: 1.81 [95% CI, 1.42–2.30]), preterm birth (adjOR: CD: 2.54 [95% CI, 2.04–3.15], UC: 1.86 [95% CI, 1.52–2.27]), and SGA (adjOR: CD: 1.99 [95% CI, 1.26–3.15], UC: 1.80 [95% CI, 1.18–2.75]).

Conclusion

Use of azathioprine and corticosteroids was often reduced or discontinued before or during early pregnancy followed by an increased use of corticosteroids later in pregnancy. Women diagnosed with IBD and with prescriptions for azathioprine and/or corticosteroids, have an increased risk of LBW, pre-term birth, and SGA. Birth Defects Research (Part A) 106:494–499, 2016. © 2016 Wiley Periodicals, Inc.

本研究的目的是描述妊娠前、妊娠期间和妊娠后患有炎症性肠病(IBD)的孕妇硫唑嘌呤和皮质类固醇的处方模式,并描述妊娠结局。方法对1996年至2009年丹麦登记的所有单胎妊娠患者进行队列研究,根据产妇IBD状况分为:克罗恩病(CD, n = 827)、溃疡性结肠炎(UC, n = 1361)或无IBD诊断(背景人群,n = 814,231)。计算妊娠三个月期间以及妊娠前后一年服用硫唑嘌呤、局部类固醇和全身性类固醇的妇女人数。研究结果包括死产、围产期死亡率、低出生体重(LBW)、早产和小于胎龄(SGA)。结果氮唑嘌呤的用药数量在孕前和孕中均有所减少,分娩后有所增加。与怀孕前相比,局部和全身皮质类固醇的处方数量减少了约30%,在妊娠中期增加。患有IBD的母亲发生LBW(校正优势比[adjOR]: CD: 2.25[95%可信区间{CI}, 1.74-2.91], UC: 1.81 [95% CI, 1.42-2.30])、早产(adjOR: CD: 2.54 [95% CI, 2.04-3.15], UC: 1.86 [95% CI, 1.52-2.27])和SGA (adjOR: CD: 1.99 [95% CI, 1.26-3.15], UC: 1.80 [95% CI, 1.18-2.75])的风险增加。结论在妊娠前或妊娠早期,硫唑嘌呤和糖皮质激素的使用经常减少或停止,随后在妊娠后期增加糖皮质激素的使用。被诊断为IBD并服用硫唑嘌呤和/或皮质类固醇的妇女,发生LBW、早产和SGA的风险增加。出生缺陷研究(A辑)106:494-499,2016。©2016 Wiley期刊公司
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引用次数: 18
Acardiac twin pregnancies part II: Fetal risk of chorangioma and sacrococcygeal teratoma predicted by pump/acardiac umbilical vein diameters 心脏双胎妊娠第二部分:通过泵/心脏脐静脉直径预测胎儿脉络瘤和骶尾畸胎瘤的风险
Q Medicine Pub Date : 2016-06-07 DOI: 10.1002/bdra.23531
Martin J.C. van Gemert, Peter G.J. Nikkels, K. Marieke Paarlberg, Jeroen P.H.M. van den Wijngaard, Helena M. Gardiner

Background

We recently published pump/acardiac umbilical venous diameter (UVD) ratios, representing the pump twin's excess cardiac output fraction, of 27 acardiac twin pregnancies. There was a clear separation between the 17 pump twins that had life-threatening complications and the 10 that did not. The hypothesis of this study is that placental chorangioma and sacrococcygeal teratoma (SCT), tumors whose perfusion also causes high-output complications, have the same fetal outcome as pump twins when perfusion of the tumor requires the same excess cardiac output fraction.

Methods

We compared the three fetoplacental circulations. Fetuses with a placental chorangioma and acardiac twin pregnancies both have their feeding artery and draining vein located at the placental cord insertion. In contrast, SCT lacks a prescribed feeding artery and draining vein. We, therefore, had to modify our model to assume that the diameter of the hypothetical draining vein is related to the flow difference between inferior vena cava and superior vena cava. The latter flow has been estimated sonographically and is the same as the inferior vena cava flow in the absence of an SCT. Furthermore, a simple modification accounts for the different location of the tumor with respect to the placental cord insertion.

Results

We propose to apply the clinical pump/acardiac UVD ratios to pregnancies complicated by placental chorangiomas and the modified pump/acardiac UVD ratios for SCT.

Conclusion

Risk prediction of these rare fetal tumors may be possible based on application of data on excess cardiac output fractions from pump/acardiac UVD ratios and will require future clinical validation. Birth Defects Research (Part A) 106:733–738, 2016. © 2016 Wiley Periodicals, Inc.

我们最近发表了27例双心胎妊娠的泵/心脏脐静脉直径(UVD)比率,代表泵双胞胎的过量心输出量分数。有17个有危及生命的并发症的双胞胎和10个没有的双胞胎有明显的区别。本研究的假设是,胎盘脉管瘤和骶尾翼畸胎瘤(SCT)这两种肿瘤的灌注也会导致高输出量并发症,当肿瘤的灌注需要相同的过量心输出分数时,其胎儿结局与泵双胞胎相同。方法对三种胎胎盘循环进行比较。胎盘绒毛膜瘤胎儿和双胎妊娠的喂食动脉和引流静脉都位于胎盘脐带插入处。相比之下,SCT缺乏规定的供血动脉和引流静脉。因此,我们必须修改我们的模型,假设假设的引流静脉的直径与下腔静脉和上腔静脉之间的流量差有关。后者的流量已被超声估计,在没有SCT的情况下与下腔静脉流量相同。此外,一个简单的修改说明肿瘤的不同位置相对于胎盘脐带插入。结果我们建议将临床泵/心脏UVD比值应用于合并胎盘脉络膜瘤的妊娠,并将改良后的泵/心脏UVD比值应用于SCT。结论基于泵/心脏UVD比值的过量心输出量数据预测这些罕见胎儿肿瘤的风险是可能的,但需要进一步的临床验证。出生缺陷研究(A辑)(06):733 - 738,2016。©2016 Wiley期刊公司
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引用次数: 4
Temporal trend in the reported birth prevalence of cleft lip and/or cleft palate in Brazil, 2000 to 2013 2000年至2013年巴西唇裂和/或腭裂出生患病率的时间趋势
Q Medicine Pub Date : 2016-06-03 DOI: 10.1002/bdra.23528
Mauro Henrique Nogueira Guimarães Abreu, Kyu Ha Lee, Daniela Varela Luquetti, Jacqueline Rose Starr

Background

The birth prevalence of cleft lip with or without cleft palate (CL/P) in Brazil increased between the years from 1975 to 1994 but has not been evaluated for temporal trend since then.

Methods

We used data from the Brazilian National Health Information System for the years 2000 through 2013. We calculated the reported CL/P birth prevalence each year per 10,000 live births and estimated the average increase in reported prevalence per year (and 95% confidence interval [CI]) by fitting a negative binomial regression model. We also estimated the temporal trend in each of the five Brazilian regions for this time period.

Results

The overall reported birth prevalence was 4.85 (95% CI, 4.78–4.91) per 10,000 live births. The reported birth prevalence of CL/P increased over this time period, from 3.94 (95% CI, 3.73–4.17) per 10,000 in 2000 to 5.46 (95% CI, 5.20–5.74) per 10,000 in 2013. The temporal trend differed for different Brazilian geographic regions, being confined primarily to the Northeast (4.7% per year; 95% CI, 4.0%–5.5%), North (3.3% per year; 95% CI, 1.8%–4.7%), and Central (2.9% per year; 95% CI, 0.9%–4.9%) regions.

Conclusion

In recent years, there appears to be an upward trend in the reported prevalence of CL/P in Brazil, confined to the less developed regions of the country. The increase likely reflects improved surveillance; whether it also reflects etiologic differences is unknown. Birth Defects Research (Part A) 106:789–792, 2016. © 2016 Wiley Periodicals, Inc.

背景1975年至1994年间,巴西出生时唇裂伴或不伴腭裂的患病率呈上升趋势,但此后尚未对其时间趋势进行评估。方法:我们使用巴西国家卫生信息系统2000年至2013年的数据。我们通过拟合负二项回归模型计算了每年每10,000例活产报告的CL/P出生患病率,并估计了每年报告患病率的平均增长(和95%置信区间[CI])。我们还估计了这段时间内巴西五个地区的时间趋势。结果报告的总体出生患病率为4.85 (95% CI, 4.78-4.91) / 10,000活产。报告的出生CL/P患病率在此期间有所增加,从2000年的3.94 / 10000 (95% CI, 3.73-4.17)增加到2013年的5.46 / 10000 (95% CI, 5.20-5.74)。巴西不同地理区域的时间趋势有所不同,主要局限于东北部(4.7% /年;95% CI, 4.0%-5.5%),北方(3.3% /年;95% CI, 1.8%-4.7%)和中部(2.9% /年;95% CI, 0.9%-4.9%)区域。近年来,巴西报告的CL/P患病率似乎呈上升趋势,但仅限于该国欠发达地区。这一增长可能反映了监测的改善;它是否也反映了病因差异尚不清楚。出生缺陷研究(A辑)(06):789 - 792,2016。©2016 Wiley期刊公司
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引用次数: 20
Obituary: Dr. Ed Lammer 讣告:Ed Lammer博士
Q Medicine Pub Date : 2016-06-01 DOI: 10.1002/bdra.23524
Richard H. Finnell Ph.D., Gary M. Shaw Dr.Ph.

The son of an Iowa schoolteacher and milkman, Ed was a gifted athlete who received his undergraduate education at Washington University in Saint Louis and his medical training at the University of Iowa. Following his pediatric residency in Iowa City, Dr. Lammer was an Epidemic Intelligence Service Officer at the Centers for Disease Control in Atlanta, GA prior to pursuing a medical genetics fellowship with Dr. Lewis B. Holmes at the Mass-General in Boston, MA. Ed received additional postdoctoral training at Stanford Medical School prior to establishing a brilliant career at the California Birth Defects Monitoring Program and the Children's Hospital Oakland Research Institute (now known as Benioff Children's Hospital Research Institute of the University of California, San Francisco) from which he retired in January, 2016.

As a pediatric geneticist and teratologist, Ed was an expert at diagnosing children with complex malformations. His keen understanding of genetics, epidemiology and teratology enabled him to make seminal contributions to the scientific literature, most notably about the risks involved to women of reproductive age being treated for cystic acne with the drug Accutane (Hoffmann-La Roche). His 1985 landmark paper in the New England Journal of Medicine describe his evaluation of 150 Accutane compromised pregnancies and described the most serious human teratogen since Thalidomide in the 1960s. He continued to publish on risks associated with in utero exposure to Accutane to fully articulate the clinical manifestations of the Accutane Embryopathy, and provided a unique insight into the underlying mechanisms of how this compound interfered with normal neural crest cell migration resulting in abnormal development. Ed also provided similar clinical and scientific insights into the teratogenicity of the anti-epileptic drug Depakene (Valproic Acid; Abbott Laboratories). Leaving behind a publication record of over 165 papers and many more to follow posthumously, Ed Lammer truly embodied the spirit of the Teratology Society's F. Clarke Fraser award for gifted young investigators, as the first recipient of the award and the individual most like the namesake of this honor.

In recent years, as the Principal Investigator of multiple National Institutes of Health grants, Ed directed a research program focused on gene-environment interactions that compromised heart and craniofacial development. He collaborated widely with colleagues at Stanford University School of Medicine, UC-Berkeley, UCSF, and the University of Texas, who valued his impeccable intellectual honesty and his rigorous high standards, as much as his unusual generosity. Ed was someone who lived well into the 21st century without a cell phone. Using only his trusted ‘soul pilot’ (index card in chest pocket) to monitor his time and whereabouts, Ed could always make time to chat, discuss a case, hear out an idea for a grant or provide valued input

埃德是爱荷华州一名教师和送奶工的儿子,他是一名有天赋的运动员,在圣路易斯的华盛顿大学接受本科教育,在爱荷华大学接受医学训练。在爱荷华市担任儿科住院医师之后,Lammer博士在乔治亚州亚特兰大的疾病控制中心担任流行病情报服务官员,之后在马萨诸塞州波士顿的麻省总医院与Lewis B. Holmes博士一起攻读医学遗传学奖学金。在加州出生缺陷监测计划和儿童医院奥克兰研究所(现称为加州大学旧金山分校贝尼奥夫儿童医院研究所)建立辉煌的职业生涯之前,Ed在斯坦福医学院接受了额外的博士后培训,他于2016年1月退休。作为一名儿科遗传学家和畸形学家,Ed是诊断儿童复杂畸形的专家。他对遗传学、流行病学和致畸学的敏锐理解使他对科学文献做出了开创性的贡献,其中最引人注目的是对育龄妇女使用药物Accutane治疗囊性痤疮的风险。1985年,他在《新英格兰医学杂志》上发表了一篇具有里程碑意义的论文,描述了他对150例阿曲坦孕妇的评估,并描述了自20世纪60年代沙利度胺以来最严重的人类致畸物。他继续发表与子宫内暴露于Accutane相关的风险,以充分阐明Accutane胚胎病的临床表现,并提供了该化合物如何干扰正常神经嵴细胞迁移导致异常发育的潜在机制的独特见解。Ed也提供了类似的临床和科学见解的致畸性的抗癫痫药物Depakene(丙戊酸;雅培公司)。留下了超过165篇论文的出版记录,并留下了更多的论文,埃德·拉默真正体现了畸形学会为有天赋的年轻研究者设立的f·克拉克·弗雷泽奖的精神,作为该奖项的第一个获得者,也是最喜欢这一荣誉的同名个人。近年来,作为多个国家卫生研究院拨款的首席研究员,Ed指导了一个研究项目,专注于影响心脏和颅面发育的基因-环境相互作用。他与斯坦福大学医学院(Stanford University School of Medicine)、加州大学伯克利分校(UC-Berkeley)、加州大学旧金山分校(UCSF)和德克萨斯大学(University of Texas)的同事广泛合作,这些人都很欣赏他无可挑剔的学术诚实和严格的高标准,以及他不同寻常的慷慨。埃德在21世纪没有手机的情况下也活得很好。只使用他信任的“灵魂飞行员”(胸前口袋里的索引卡)来监控他的时间和行踪,Ed总能抽出时间来聊天,讨论一个案子,听取一个资助的想法,或者为一篇初稿提供有价值的意见。Ed在教学和指导学生方面非常有耐心。他对这么多年轻人的指导将永远证明他的耐心和才华。开会时,他会聚精会神地听。他总是会问一些看似简单的问题,这些问题直接切入了所展示作品的意义。这些问题会迅速揭示出任何逻辑上的捷径或缺陷,并揭示出在15分钟的聆听时间里,Ed已经比演讲者对这个主题有了更深入的思考,但他的提问方式从来没有威胁、冒犯或轻视。艾德太好了。这就是为什么科学家和临床医生在会议上总是被埃德吸引,希望有机会得到他对他们正在研究的任何东西的看法,而不用担心任何科学上的羞辱。埃德为他的同事和朋友设定了很高的标准。我们都珍惜这次挑战,希望他还在这里继续挑战我们。让Ed Lammer与他的大多数科学和临床同事不同的是,他能够在生活中实现平衡。埃德是一个充满激情的人,他培养并热情地接受了多种兴趣和爱好,这些兴趣和爱好塑造了他的非职业生活。首先是他的家庭。埃德深爱着他的妻子迪布西和他们的两个孩子,亚伦和埃莉,他为他们的成就感到高兴。埃德对音乐充满热情,虽然他的品味很广泛,但他特别喜欢杰里·加西亚和感恩而死乐队。他喜欢户外活动。无论是徒步旅行、登山、观鸟还是飞钓,他都很喜欢和他的朋友和同事们分享这个爱好。埃德也喜欢和朋友们分享好酒,随着时间的推移,他在伯克利的酒窖里积累了令人羡慕的藏品。 他对自己的领域有着渊博的知识、诚实的知识、批判性的思维、无限的慷慨、对孩子和他们的家庭充满同情心的承诺、美酒和音乐。一个杰出的儿科遗传学家/畸形学家,一个完美的家庭男人,一个非凡的导师,一个温柔的巨人,他真正改变了孩子们的生活。当我们想起我们深爱的朋友埃德·拉默时,我们会这样想。
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引用次数: 0
Indoor air pollution and the risk of orofacial clefts in a rural population in Shanxi province, China 中国山西省农村人口的室内空气污染与唇腭裂风险
Q Medicine Pub Date : 2016-05-26 DOI: 10.1002/bdra.23522
Yingying Liu, Bin Wang, Zhiwen Li, Le Zhang, Jufen Liu, Aiguo Ren

Background

Shanxi Province is a region in China with a high incidence of orofacial clefts (OFCs). Our objective is to investigate the effect of maternal exposure to indoor air pollution (IAP) from coal combustion and tobacco smoke on the risk of an infant being born with orofacial clefts.

Methods

Data were derived from an ongoing population-based case–control study of major external structural birth defects in Shanxi Province. Subjects included 213 cases with OFCs and 1319 healthy babies born between November 2002 and December 2014 in four rural counties. Exposure information was collected by face-to-face interview with mothers within 1 week of delivery or pregnancy termination. The authors derived an exposure index by integrating a series of IAP-related characteristics concerning dwelling and lifestyle.

Results

Increased odds of OFC were associated with IAP exposure from heating (adjusted odds ratio [aOR] = 2.4; 95% confidence interval [CI], 1.2–4.5) and from smoking (aOR = 1.8; 95% CI: 1.3, 2.5), but not with exposure from cooking (aOR = 0.9; 95% CI, 0.6–1.4). Compared with women without IAP exposure, the aORs of OFC for children of women with exposure indices of 1, 2, 3 and ≥ 4 were 1.1 (95% CI, 0.6–1.8), 1.4 (95% CI, 0.8–2.4), 1.8 (95% CI, 1.0–3.2), and 3.4 (95% CI, 1.6–7.4), respectively, demonstrating a clear dose–response trend (p < 0.001).

Conclusion

Periconceptional exposure to IAP from coal combustion and tobacco smoking may increase the risk of OFCs in offsprings of women in Shanxi Province. Birth Defects Research (Part A) 106:708–715, 2016. © 2016 Wiley Periodicals, Inc.

山西省是中国口腔颌面部唇裂的高发地区。我们的目的是调查母亲暴露于煤炭燃烧和烟草烟雾引起的室内空气污染(IAP)对婴儿出生时患唇腭裂风险的影响。方法数据来源于一项正在进行的基于人群的病例对照研究,研究对象为山西省主要外部结构性出生缺陷。研究对象包括2002年11月至2014年12月在4个农村县出生的213例OFCs和1319例健康婴儿。在分娩或终止妊娠1周内,通过与母亲面对面访谈收集暴露信息。作者通过综合一系列与居住和生活方式有关的内酰胺相关特征,得出了一个暴露指数。结果:OFC的几率增加与加热引起的IAP暴露相关(调整后的优势比[aOR] = 2.4;95%可信区间[CI], 1.2-4.5)和吸烟(aOR = 1.8;95% CI: 1.3, 2.5),但与烹饪暴露无关(aOR = 0.9;95% ci, 0.6-1.4)。与没有IAP暴露的妇女相比,暴露指数为1、2、3和≥4的妇女的子女OFC的aORs分别为1.1 (95% CI, 0.6-1.8)、1.4 (95% CI, 0.8-2.4)、1.8 (95% CI, 1.0-3.2)和3.4 (95% CI, 1.6-7.4),显示出明显的剂量-反应趋势(p <0.001)。结论燃煤和吸烟围孕期暴露于IAP可增加山西省妇女子代OFCs的发病风险。出生缺陷研究(A辑)(06):708 - 715,2016。©2016 Wiley期刊公司
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引用次数: 12
Birth defects in infants born to employees of a microelectronics and business machine manufacturing facility 微电子和商用机器制造工厂雇员所生婴儿的出生缺陷
Q Medicine Pub Date : 2016-05-25 DOI: 10.1002/bdra.23520
Sharon R. Silver, Lynne E. Pinkerton, Carissa M. Rocheleau, James A. Deddens, Adrian M. Michalski, Alissa R. Van Zutphen

Background

Concerns about solvent releases from a microelectronics/business machine manufacturing facility in upstate New York led to interest in the health of former workers, including this investigation of birth defects in children of male and female employees.

Methods

Children born 1983 to 2001 to facility employees were enumerated and matched to New York State's Congenital Malformations Registry. Reported structural birth defects were compared with numbers expected from state rates (excluding New York City), generating standardized prevalence ratios (SPRs). Exposure assessors classified employees as ever/never potentially exposed at the facility to metals, chlorinated hydrocarbons, and other hydrocarbons during windows critical to organogenesis (female workers) or spermatogenesis (male workers). Among workers, adjusted prevalence ratios were generated to evaluate associations between potential exposures and specific birth defects.

Results

External comparisons for structural defects were at expectation for infants of male workers (SPR = 1.01; 95% confidence interval [CI], 0.77–1.29; n = 60) and lower for births to female workers (SPR = 0.84; 95% CI, 0.50–1.33; n = 18). Among full-term infants of male workers, ventricular septal defects (VSDs) were somewhat elevated compared with the general population (SPR = 1.58; 95% CI, 0.99–2.39; n = 22). Within the cohort, potential paternal metal exposure was associated with increased VSD risk (adjusted prevalence ratio = 2.70; 95% CI, = 1.09–6.67; n = 7).

Conclusion

While overall SPRs were near expectation, paternal exposure to metals (primarily lead) appeared to be associated with increased VSD risk in infants. Take-home of occupational exposures, nonoccupational exposures, and chance could not be ruled out as causes. Case numbers for many defects were small, limiting assessment of the role of occupational exposures. Birth Defects Research (Part A) 106:696–707, 2016. © 2016 Wiley Periodicals, Inc.

背景:对纽约州北部一家微电子/商业机器制造工厂溶剂释放的关注引起了人们对前工人健康的兴趣,包括对男女雇员子女出生缺陷的调查。方法对1983 ~ 2001年出生的儿童进行枚举,并与纽约州先天性畸形登记处进行匹配。将报告的结构性出生缺陷与州比率(不包括纽约市)的预期数字进行比较,得出标准化的患病率比率(SPRs)。暴露评估人员将员工分类为在对器官发生(女工)或精子发生(男工)至关重要的窗口期间,从未/从未潜在地接触过金属、氯化碳氢化合物和其他碳氢化合物。在工人中,产生了调整的患病率比率,以评估潜在暴露与特定出生缺陷之间的关系。结果男婴结构缺陷的外部比较符合预期(SPR = 1.01;95%置信区间[CI], 0.77-1.29;n = 60),女性工人的出生率更低(SPR = 0.84;95% ci, 0.50-1.33;N = 18)。在男性工人的足月婴儿中,室间隔缺损(VSDs)与一般人群相比有所升高(SPR = 1.58;95% ci, 0.99-2.39;N = 22)。在队列中,潜在的父亲金属暴露与VSD风险增加相关(调整患病率= 2.70;95% ci, = 1.09-6.67;结论:虽然总体SPRs接近预期,但父亲接触金属(主要是铅)似乎与婴儿VSD风险增加有关。不能排除职业暴露、非职业暴露和偶然因素的影响。许多缺陷的病例数很小,限制了对职业暴露作用的评估。出生缺陷研究(A部分)106:696-707,2016。©2016 Wiley期刊公司
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引用次数: 4
PLAGL1 epimutation and bladder exstrophy: Coincidence or concurrent etiology? PLAGL1脱位和膀胱外翻:是巧合还是同时的病因?
Q Medicine Pub Date : 2016-05-25 DOI: 10.1002/bdra.23521
Julia Kolarova, Susanne Bens, Ole Ammerpohl, Alina C. Hilger, Rong Zhang, Heiko Reutter, Reiner Siebert

Background

The bladder exstrophy-epispadias complex (BEEC) is characterized by a spectrum of genitourinary malformations. Both classical bladder exstrophy and the most severe phenotype, exstrophy of the cloaca, display omphaloceles, a cardinal anomaly of some disorders caused by altered imprinting. Therefore, we hypothesized that BEEC in some patients could occur on the basis of an undiagnosed imprinting disorder. Such altered imprinting is associated with changes in the parent-of-origin-specific DNA methylation.

Methods

We analyzed the DNA methylation of 54 imprinted loci in 23 selected patients with different BEEC subtypes (epispadias n = 1, classical bladder exstrophy n = 10, exstrophy of the cloaca n = 12) using the Infinium HumanMethylation450 BeadChip. A total of 471,722 not imprinted autosomal CpG loci and 891 imprinted CpG loci were investigated. Findings were corroborated by methylation-specific-multiplex ligation-dependent probe amplification (MS-MLPA) and microsatellite analysis.

Results

No significant differences in the DNA methylation of the not imprinted and imprinted CpG were observed depending on subtype of BEEC. Nevertheless, in 1 of the 23 patients who displayed a classical bladder exstrophy, we detected hypomethylation of the imprinted PLAGL1 locus in chromosome 6q24. We verified this hypomethylation by MS-MLPA and showed further the methylation loss to be caused most likely by a mosaic epimutation.

Conclusion

Considering that it is highly unlikely to detect a PLAGL1 epimutation among 23 individuals given the low incidence of this alteration in the population, our observations further support a link between BEEC and imprinting disorders. Birth Defects Research (Part A) 106:724–728, 2016. © 2016 Wiley Periodicals, Inc.

背景:膀胱外翻-上尿道复合体(BEEC)以一系列泌尿生殖系统畸形为特征。典型的膀胱外翻和最严重的表现型,泄殖腔外翻,都表现出脐膨出,这是一些由印记改变引起的疾病的主要异常。因此,我们假设一些患者的BEEC可能发生在未确诊的印迹障碍的基础上。这种改变的印记与父母起源特异性DNA甲基化的变化有关。方法采用Infinium HumanMethylation450芯片,对23例不同BEEC亚型患者(1例尿道外翻、10例膀胱外翻、12例泄殖腔外翻)的54个印迹位点进行DNA甲基化分析。共研究了471,722个非印迹常染色体CpG位点和891个印迹CpG位点。研究结果通过甲基化特异性多重连接依赖探针扩增(MS-MLPA)和微卫星分析得到证实。结果在不同的BEEC亚型中,未印迹和印迹CpG的DNA甲基化没有显著差异。然而,在23例典型膀胱外翻患者中的1例中,我们检测到6q24染色体上印迹PLAGL1位点的低甲基化。我们通过MS-MLPA验证了这种低甲基化,并进一步表明甲基化损失很可能是由马赛克增殖引起的。考虑到在23个个体中检测到PLAGL1突变的可能性非常低,我们的观察结果进一步支持了BEEC与印迹疾病之间的联系。出生缺陷研究(A辑)106:724-728,2016。©2016 Wiley期刊公司
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引用次数: 2
Prospective study of pregnancy and newborn outcomes in mothers with West nile illness during pregnancy 怀孕期间患有西尼罗河疾病的母亲妊娠和新生儿结局的前瞻性研究
Q Medicine Pub Date : 2016-05-25 DOI: 10.1002/bdra.23523
Gabriella Pridjian, Patricia A. Sirois, Scott McRae, Alison F. Hinckley, Sonja A. Rasmussen, Patricia Kissinger, Pierre Buekens, Edward B. Hayes, Dan O'Leary, Stephanie Kuhn, Kenneth F. Swan, Xu Xiong, Dawn M. Wesson

Background

A previous case report of West Nile virus (WNV) illness during pregnancy suggested that WNV could be a cause of congenital defects. We performed a prospective, longitudinal cohort study of pregnant women with WNV illness to increase our knowledge of the effects of WNV illness during pregnancy.

Methods

Participants were enrolled in 2005 to 2008 from pregnant women with serologically confirmed WNV illness reported to the Centers for Disease Control and Prevention. Comparison was made to WNV-uninfected women, matched on maternal age and enrollment month. Pregnancy and newborn data were collected; cord blood WNV serology was obtained. Pediatric exams and the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) were performed.

Results

Twenty-eight WNV-infected mothers and 25 WNV-uninfected mothers participated. Maternal demographics were similar except for a higher rate of planned pregnancies, education, and household income in the WNV-uninfected mothers. There were no differences in pregnancy and delivery characteristics except that infected mothers had a higher incidence of febrile illnesses and used more medications. Birth weight, length, head circumference, and rate of congenital malformations were similar in babies born to WNV-infected and -uninfected mothers. Follow-up physical exams were generally normal. The Bayley-III assessments, available for 17 children born to mothers with WNV illness, showed performance at or above age level across domains.

Conclusion

The risk for adverse pregnancy and newborn outcomes in women experiencing WNV illness in pregnancy appears to be low, but future studies with larger numbers are needed to rule out a small risk. Birth Defects Research (Part A) 106:716–723, 2016. © 2016 Wiley Periodicals, Inc.

背景以前的病例报告西尼罗病毒(WNV)疾病在怀孕期间表明,西尼罗病毒可能是一个先天性缺陷的原因。我们对患有西尼罗河病毒疾病的孕妇进行了一项前瞻性、纵向队列研究,以增加我们对怀孕期间西尼罗河病毒疾病影响的认识。方法2005年至2008年,从向疾病控制与预防中心报告的经血清学证实患有西尼罗河病毒疾病的孕妇中招募参与者。与未感染西尼罗河病毒的妇女进行比较,根据产妇年龄和入组月份进行匹配。收集妊娠和新生儿数据;进行脐带血WNV血清学检测。进行了儿科检查和Bayley婴幼儿发育量表-第三版(Bayley- iii)。结果28名感染西尼罗河病毒的母亲和25名未感染西尼罗河病毒的母亲参与了调查。除了未感染西尼罗河病毒的母亲的计划怀孕率、受教育程度和家庭收入较高外,产妇人口统计数据相似。在怀孕和分娩特征上没有区别,除了感染的母亲有更高的发热性疾病发病率和使用更多的药物。感染西尼罗河病毒和未感染西尼罗河病毒的母亲所生婴儿的出生体重、身长、头围和先天性畸形发生率相似。后续体检基本正常。对患有西尼罗河病毒疾病的母亲所生的17名儿童进行的Bayley-III评估显示,各领域的表现达到或超过年龄水平。结论妊娠期感染西尼罗河病毒的妇女发生不良妊娠和新生儿结局的风险似乎很低,但需要更多的研究来排除小风险。出生缺陷研究(A辑)(06):716 - 723,2016。©2016 Wiley期刊公司
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引用次数: 15
Folic acid fortification and prevalences of neural tube defects, orofacial clefts, and gastroschisis in California, 1989 to 2010 1989 - 2010年加州叶酸强化与神经管缺陷、口面裂和胃裂的患病率
Q Medicine Pub Date : 2016-05-18 DOI: 10.1002/bdra.23514
Wei Yang, Suzan L. Carmichael, Gary M. Shaw

Background

We examined whether prevalences of neural tube defects (NTDs), orofacial clefts, and gastroschisis changed more rapidly after than before folic acid fortification in California.

Methods

This population-based study used vital statistics and birth defects registry data. The study population included all live births and stillbirths delivered in central California counties from 1989 to 2010. Cases included deliveries with NTDs, orofacial clefts, and gastroschisis. Weighted least squares regression was used to estimate slopes during prefortification (before 1997) and postfortification (after 1998), respectively. The difference of the two slopes with the 95% confidence interval (CI) was calculated.

Results

For all NTDs combined, slopes indicated that NTD prevalence was decreasing by 8.7 (slope: -8.7; 95% CI, -13.5–−3.9) cases per 100,000 deliveries per year before fortification and by 1.7 (slope: -1.7; 95% CI, -3.7–0.3) after fortification; thus the decline had slowed by 7.0 (95% CI, 2.7–11.3) cases per 100,000 deliveries per year. For orofacial clefts, slopes for cleft lip with/without palate as well as for cleft palate alone indicated that the postfortification slope was lower than the prefortification slope suggesting a more accelerated decrease in the postfortification time period. For gastroschisis, the slope after fortification was lower compared with prefortification, indicating a less accelerated prevalence increase in the postfortification time period. Stratification by race/ethnicity did not substantially alter results.

Conclusion

We observed a slower decline in prevalence of NTDs, an emergence of a decline in orofacial clefts, and a slower increase in gastroschisis, during the postfortification period in central California, relative to the prefortification period. Birth Defects Research (Part A), 2016. © 2016 Wiley Periodicals, Inc. Birth Defects Research (Part A) 106:1032–1041, 2016. © 2016 Wiley Periodicals, Inc.

研究背景:我们研究了加利福尼亚州的神经管缺陷(NTDs)、口面裂和胃裂的患病率在叶酸强化后是否比叶酸强化前变化更快。方法本研究采用人口统计学和出生缺陷登记资料。研究人群包括1989年至2010年在加州中部县分娩的所有活产和死产。病例包括分娩时伴有NTDs、口面裂和胃裂。加权最小二乘回归分别用于估算加固前(1997年之前)和加固后(1998年之后)的坡度。用95%置信区间(CI)计算两个斜率的差值。结果所有NTD合并后,斜率表明NTD患病率下降了8.7(斜率:-8.7;95% CI, -13.5 - - 3.9),防御工事前每年每10万次交付的病例数增加1.7例(斜率:-1.7;95% CI, -3.7-0.3);因此,每年每10万例分娩中有7.0例(95% CI, 2.7-11.3)病例下降。对于口面裂,有/无腭裂的唇裂和单独腭裂的斜率表明,强化后的斜率低于强化前的斜率,表明在强化后的时间内下降速度更快。对于胃裂病,与防御前相比,防御后的坡度较低,表明在防御后的时间内患病率的增加速度较慢。种族/民族分层并没有实质性地改变结果。结论:我们观察到,与强化前相比,强化后加利福尼亚中部地区ntd患病率下降较慢,口面裂发生率下降,胃裂发生率增加较慢。出生缺陷研究(上),2016。©2016 Wiley期刊公司出生缺陷研究(A辑)106:1032-1041,2016。©2016 Wiley期刊公司
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引用次数: 28
期刊
Birth defects research. Part A, Clinical and molecular teratology
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