Efficacy of maternal tenofovir disoproxil fumarate in interrupting mother-to-infant transmission of hepatitis B virus.

UNLABELLED: The efficacy and safety of maternal tenofovir disoproxil fumarate (TDF) in reducing mother-to-infant hepatitis B virus (HBV) transmissions is not clearly understood. We conducted a prospective, multicenter trial and enrolled 118 hepatitis B surface antigen (HBsAg)- and hepatitis B e antigen-positive pregnant women with HBV DNA ≥7.5 log10 IU/mL. The mothers received no medication (control group, n = 56, HBV DNA 8.22 ± 0.39 log10 IU/mL) or TDF 300 mg daily (TDF group, n = 62, HBV DNA 8.18 ± 0.47 log10 IU/mL) from 30-32 weeks of gestation until 1 month postpartum. Primary outcome was infant HBsAg at 6 months old. At delivery, the TDF group had lower maternal HBV DNA levels (4.29 ± 0.93 versus 8.10 ± 0.56 log10 IU/mL, P < 0.0001). Of the 121/123 newborns, the TDF group had lower rates of HBV DNA positivity at birth (6.15% versus 31.48%, P = 0.0003) and HBsAg positivity at 6 months old (1.54% versus 10.71%, P = 0.0481). Multivariate analysis revealed that the TDF group had lower risk (odds ratio = 0.10, P = 0.0434) and amniocentesis was associated with higher risk (odds ratio 6.82, P = 0.0220) of infant HBsAg positivity. The TDF group had less incidence of maternal alanine aminotransferase (ALT) levels above two times the upper limit of normal for ≥3 months (3.23% versus 14.29%, P = 0.0455), a lesser extent of postpartum elevations of ALT (P = 0.007), and a lower rate of ALT over five times the upper limit of normal (1.64% versus 14.29%, P = 0.0135) at 2 months postpartum. Maternal creatinine and creatinine kinase levels, rates of congenital anomaly, premature birth, and growth parameters in infants were comparable in both groups. At 12 months, one TDF-group child newly developed HBsAg positivity, presumably due to postnatal infection and inefficient humoral responses to vaccines. CONCLUSIONS: Treatment with TDF for highly viremic mothers decreased infant HBV DNA at birth and infant HBsAg positivity at 6 months and ameliorated maternal ALT elevations. (Hepatology 2015;62:375-386.

Extended first-trimester screening using multiple sonographic markers and maternal serum biochemistry: a five-year prospective study.

OBJECTIVE: To examine the performance of first-trimester screening test combining several fetal sonographic and maternal biochemical markers for major aneuploidy in a Chinese population. METHODS: This was a prospective study performed over 5 years between January 2005 and December 2010 in Taiwan, with 20,586 cases that had a combination of a variety of sonographic markers and maternal serological ß-human chorionic gonadotropin and pregnancy-associated plasma protein-A levels assessed at first trimester screening between 11(+0) and 13(+6) weeks of gestation. The risk of aneuploidy was calculated using algorithm software developed by Fetal Medicine Foundation, London. Fetal karyotyping was performed when the prenatal screening showed a risk of 1/300 or higher. All cases were followed for fetal outcome. RESULTS: The study population was divided into four groups according to the screening strategy performed. The combination of maternal serological biochemistry and nuchal translucency measurement had a 66.7% detection rate of trisomy 21. Addition of nasal bone status increased the detection rate of trisomy 21 to 88.2%. Inclusion of tricuspid regurgitation flow showed an 87.5% detection rate of trisomy 21. Further inclusion of ductus venosus flow increased the detection rate of trisomy 21 to 100%. Incorporating more markers greatly increased the detection rate and decreased the false-positive rate (FPR). CONCLUSION: Extension of first-trimester screening to include more sonographic markers greatly increased the sensitivity and decreased FPR for detection of chromosomal abnormalities. Such screening strategy is effective in clinical practice for the Chinese ethnic population.

Adverse Perinatal and Early Life Outcomes following 15q11.2 CNV Diagnosis.

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-TUBGCP5, CYFIP1, NIPA1, and NIPA2-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.

Decreased neonatal hepatitis B virus (HBV) viremia by maternal tenofovir treatment predicts reduced chronic HBV infection in children born to highly viremic mothers.

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.

Risk factors for recurrence of group B streptococcus colonization in a subsequent pregnancy.

OBJECTIVE: To document rates of recurrent group B streptococci (GBS) colonization in women with previous GBS colonization in an initial pregnancy and to assess maternal risk factors associated with recurrence. METHODS: A retrospective, longitudinal study was performed in a teaching hospital on women with GBS colonization who were pregnant between 2002 and 2006 and had at least one subsequent pregnancy during the same time period. When only the index and first subsequent pregnancy were analyzed, the cohort included 251 women. The rate of recurrence was estimated for GBS colonization in the pregnancy after the index pregnancy for GBS colonization. Multivariable regression models were constructed to model recurrence of GBS colonization in a subsequent pregnancy as functions of potential predictors to estimate relative risks and confidence intervals. RESULTS: The rate of recurrence of GBS colonization in the pregnancy subsequent to the index pregnancy was 38.2% (95% confidence interval 33.5-42.9%). Multivariable regression models showed that the time interval between the two pregnancies and the intensity of GBS colonization from the index pregnancy were predictive of recurrent GBS colonization. CONCLUSION: More than one third of women had recurrent GBS colonization in a subsequent pregnancy. These findings should assist clinicians in counseling women with GBS colonization about their risk for recurrence, the importance of appropriate prenatal GBS screening in a subsequent pregnancy, and intrapartum antibiotic prophylaxis for unknown GBS status.

X pentasomy in an intracytoplasmic sperm injection pregnancy detected by nuchal translucency testing.

Althoughmaternally derived X pentasomy following intracytoplasmic sperm injection (ICSI) is rare, prenatal detection of a case offers insight into etiology and diagnosis. A 29-year-old gravida 1 whose pregnancy resulted from ICSI was referred for ultrasound screening at 11 weeks' gestation. Nuchal translucency thickness was 3.2 mm, and the fetal nasal bone was absent. Subsequent evaluation revealed karyotype 49,XXXXX. DNA microsatellite analysis showed the extra X chromosomes were maternal in origin. Termination of pregnancy was performed at 15 weeks. Because of the increased risk of sex chromosomal abnormalities in ICSI pregnancies, patients should be counseled prior to fertilization and standard prenatal care should include nuchal translucency measurement and any other elements necessary for indicated pregnancies to obtain a diagnosis.

Maternal anxiety about first trimester nuchal translucency screening and impact of positive screening results.

BACKGROUND: To assess pre- and post-procedural maternal anxiety about nuchal translucency thickness screening for Down syndrome in the first trimester of pregnancy, and the psychological impact of positive screening results. METHODS: A total of 172 women whose screens were positive for excess fetal nuchal translucency thickness, and 180 women whose screens were within normal limits (controls) were recruited. Anxiety levels were measured with the Spielberger State-Trait Anxiety Inventory just before screening, 1 week after screening, at 22 weeks' gestation, and 6 weeks after delivery. After delivery, all women were asked to respond using a Likert-type scale regarding their attitudes toward fetal nuchal translucency screening. RESULTS: Women with positive screening results reported significantly greater psychological distress on state-anxiety scores after the full report was received. The trait- and state-anxiety scores before screening, at 22 weeks' gestation, and after delivery did not differ between groups. Both groups of women were strongly positive about nuchal translucency screening, both in the current pregnancy and in future pregnancies. CONCLUSION: Women with positive screening results did not have a sustained increase in anxiety and remained supportive about the value of screening. Clinician concerns about causing maternal anxiety should not be an impediment to screening.

Risk factors for placenta previa in an Asian population.

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 impact of interpregnancy interval and previous preterm birth on the subsequent risk of preterm birth.

OBJECTIVE: To examine the impact of the interpregnancy interval and a previous preterm birth on the subsequent risk of a preterm birth. METHODS: A retrospective analysis was conducted on a group of 4072 women who had at least two consecutive births, excluding multiple gestation, fetal anomalies, cervical incompetence, and stillbirth. Multivariate logistic regression was used to investigate the association between interpregnancy interval, preterm birth of the first child in the pair (index pregnancy), and the risk of a preterm birth of the second child in the pair (outcome pregnancy). RESULTS: Women with interpregnancy intervals of less than 12 months (odds ratio [OR] 1.3; 95% confidence interval [CI] 1.0-1.7) were at increased risks of preterm birth with the outcome pregnancy. Furthermore, there was an increased risk for a subsequent preterm birth in women who had a preterm birth in the index pregnancy (OR 4.2; 95% CI 3.0-6.0). The risk decreased as the interpregnancy interval increased, with a relatively low risk at 18 to 48 months; subsequently, it increased sharply. In contrast, women who had delivered their previous infants at term carried an increased risk of preterm birth with the outcome pregnancy only if the interval was less than 6 months. CONCLUSION: A difference was found in the impact of the interpregnancy interval on the subsequent risk of preterm birth between women with a prior preterm birth and those who previously delivered an infant at term.

Gestational weight gain and risks for adverse perinatal outcomes: A retrospective cohort study based on the 2009 Institute of Medicine guidelines.

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.

A retrospective study on the course and outcome of fetal ventriculomegaly.

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.

Risk factors and perinatal outcomes associated with idiopathic small for gestational age Taiwanese newborns.

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 24weeks 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.

Advanced maternal age and adverse perinatal outcomes in an Asian population.

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.

Measurement of nuchal volume in the first trimester Down screening using three-dimensional ultrasound.

OBJECTIVES: Screening of fetuses at 11 to 14 weeks of gestation for Down syndrome using stored volumes acquired by a three-dimensional (3D) scanner. METHOD: Thirty-four healthy singleton fetuses were recruited consecutively and prospectively during routine first trimester scans in our unit. Two-dimensional (2D) images of nuchal translucency (NT), crown-rump length (CRL), and biparietal diameter (BPD) were obtained by following a standard protocol. The volume of the nuchal area (NV) was obtained by a 3D scanning machine. RESULTS: The mean time to perform a 2D first trimester scan was 15.3 min, while the mean time to obtain and examine the stored volumes was 11.1 min (p<0.001) in a 3D scan. There were no significant differences in NT, CRL, and BPD between the two groups. Two cases with an NT thickness>2.5 mm also revealed increased volume data in the nuchal area. The Pearson's correlations between NT and CRL, BPD and CRL, NT and NV, and NV and CRL were moderate-to-high positive. CONCLUSION: The nuchal volume data and the standard curve in the first trimester may be possible markers for Down syndrome screening. 3D scans can also minimize the scanning time, providing views not easily following strict NT guidelines.

The changes in Doppler indices of fetal ductus venosus and umbilical artery after amnioinfusion for women with preterm premature rupture of membranes before 26 weeks' gestation.

OBJECTIVE: To investigate the changes in Doppler indices of the fetal ductus venosus (DV) and umbilical artery (UMA) after amnioinfusion in pregnant women with preterm premature rupture of membranes (pPROM). Pregnancies with pPROM and severe oligohydramnios cause sequelae in newborns and mothers. MATERIALS AND METHODS: This cross-sectional study included a group of 25 patients with pPROM before 26 weeks' gestation. Color Doppler imaging was used to measure the impedance index and quantitative blood flow in the DV and systolic/diastolic ratio (S/D) of the UMA before and 30 minutes after the end of amnioinfusion. The following velocity parameters were measured: (1) DV peak systolic velocity; (2) DV time-averaged velocity; (3) DV maximum forward velocity during atrial contraction; (4) DV S/D; (5) DV pulsatility index (PI); (6) DV Pourcelots resistance index (RI); (7) fetal heart rate; and (8) UMA S/D. RESULTS: Twenty-one of the 25 patients underwent a total of 27 amnioinfusions. The mean PI and RI of the DV, and S/D of the DV and UMA decreased significantly after amnioinfusion (PI, 0.75 +/- 0.24 vs. 0.60 +/- 0.18, p = 0.009; RI, 0.60 +/- 0.15 vs. 0.50 +/- 0.13; DV S/D, 3.07 +/- 1.81 vs. 2.13 +/- 0.66, p = 0.008; UMA S/D, 3.58 +/- 0.87 vs. 2.88 +/- 0.62, p = 0.001). CONCLUSION: Amnioinfusion increases the space for the fetuses and reduces the impedance of the fetoplacental circulation. Improvements in DV and UMA flow may benefit fetuses suffering severe oligohydramnios in mid-pregnancy.

Tumor necrosis factor-alpha converting enzyme in the human placenta throughout gestation.

Ectodomain shedding of epidermal growth factor receptor ligands such as transforming growth factor- alpha (TGF-alpha), heparin-binding epidermal growth factor-like growth factor (HBEGF), and amphiregulin (AREG) is considered to be important during implantation. Tumor necrosis factor-alpha converting enzyme (TACE) has been suggested as the major sheddase for these molecules. The objectives of this study are (1) to characterize the expression of TACE in the human placenta throughout gestation; (2) to determine the association between the expression of TACE with TGF-alpha, HBEGF, and AREG; (3) to ascertain whether TACE mediates TGF-alpha, HBEGF, and AREG shedding; and (4) to examine the effect of hypoxia on the expression of TACE. By analyzing a total of 55 villous samples representing different gestational ages, the authors found that TACE was continuously expressed in the placentas throughout gestation and that the levels of TACE were positively correlated with the levels of TGF-alpha, HBEGF, and AREG. Preadministration of a TACE inhibitor in villous explant cultures or transfection of cytotrophoblastic cells with TACE-specific small interference RNA decreased the shedding of HBEGF and AREG. Moreover, hypoxia (2% O(2)) caused an increase in the levels of TACE mRNA and protein in villous explants and primary cytotrophoblastic cells in vitro. These results indicate that oxygen regulates the expression of TACE and that TACE may be important for placental development during human pregnancy.

First- and second-trimester Down syndrome screening: current strategies and clinical guidelines.

Down syndrome (DS) is the most common human disease caused by a structural chromosome defect. The original screening test for DS was maternal age or a history of a previously affected infant. Maternal serum screening has been incorporated into routine prenatal checkup in Taiwan since 1994. We used free beta-human chorionic gonadotropin and alpha-fetoprotein (double test) as the serum markers, and this was carried out between the 15th to 20th week of gestation. The overall detection rate was 56% and was compatible with studies of Caucasian populations. The impact of double tests in Taiwan has shown itself by a dramatic lowering of the rate of DS live birth from 0.63 before screening to 0.16 per 1,000 live births at present. However, because of its relatively low detection rate and poor cost-effectiveness, the double test is not justified as a routine screening tool currently. First-trimester combined test is now becoming more widely available and provides increased sensitivity when detecting DS; it has a detection rate of approximately 85% with a false-positive rate of 5%. Nuchal translucency measurement requires ongoing quality control and sufficient certified obstetricians; therefore, first-trimester ultrasound is limited only in designated centers. The quadruple test, having comparable detection rate, should be considered for incorporation into second-trimester screening in Taiwan in the near future. Other screening approaches and combinations have also been utilized in the Western countries. In this review, we outline the various options with respect to DS screening and hope that this will provide practical information for physicians offering such screenings.

Anxiety levels in women undergoing prenatal maternal serum screening for Down syndrome: the effect of a fast reporting system by mobile phone short-message service.

OBJECTIVE: To study the effect of fast reporting by mobile phone short-message service (SMS) on anxiety levels in women undergoing prenatal biochemical screening for Down syndrome. METHOD: From January 2005 to December 2006, 2782 women undergoing prenatal biochemical serum screening were randomized into fast reporting by SMS (group A) or without mobile phone reporting (group B). Anxiety levels were measured with the Spielberger State-Trait Anxiety Inventory (STAI) before prenatal screen testing, before the appointed clinic (when the SMS report had already been given to group A), and 3 days after the appointed clinic (when the full screening report had been given to groups A and B). RESULTS: For screen-negative women, anxiety scores did not differ between groups before prenatal screen testing and 3 days after the appointed clinic. The state-anxiety scores measured on the second occasion had declined significantly in group A. The state-anxiety scores in both groups increased over the 3-week period after being informed of positive screen results. The trait- and state-anxiety scores at all points did not differ between the two groups of screen-positive women. CONCLUSIONS: The provision of a routine reporting system plus additional SMS report revealed some overall benefits in reducing anxiety among women with screen-negative result.

Risk factors for spontaneous preterm delivery before 34 weeks of gestation among Taiwanese women.

OBJECTIVE: To identify the risk factors for spontaneous preterm delivery before 34 weeks of gestation among Taiwanese women. MATERIALS AND METHODS: This retrospective cohort study involved 36,453 Taiwanese women who delivered between July 1990 and December 2003. Pregnancies complicated by multiple gestation, fetal anomalies, and iatrogenic preterm births due to maternal or fetal indications were excluded. RESULTS: Five hundred and five spontaneous preterm deliveries (1.4%) were identified. Risk factors for early preterm delivery included a prior preterm delivery (odds ratio [OR], 16.5; 95% confidence interval [CI], 11.1-24.6), placental abruption (OR, 13.4; 95% CI, 9.4-19.2), history of fetal demise (OR, 11.8; 95% CI, 7.7-18.0), chorioamnionitis (OR, 10.5; 95% CI, 7.4-14.9), oligohydramnios (OR, 10.1; 95% CI, 6.7-15.3), history of abruption (OR, 7.9; 95% CI, 2.4-26.0), unmarried (OR, 6.2; 95% CI, 2.9-13.2), conception by reproductive technology (OR, 2.7; 95% CI, 1.4-5.5), maternal age less than 20 years (OR, 3.5; 95% CI, 1.8-6.7), maternal age greater than 34 years (OR, 1.6; 95% CI, 1.2-2.1), three or more abortions (OR, 1.6; 95% CI, 1.9-2.3), and premature rupture of membranes (OR, 1.6; 95% CI, 1.3-2.0). CONCLUSION: Some of the risk factors for early preterm delivery among Taiwanese women were the same as those of other ethnic groups, whereas some of the other risk factors were different.

Total hCG versus free beta-hCG combined with alpha-fetoprotein for Down syndrome screening in Taiwan.

OBJECTIVE: The purpose of this study was to compare the effectiveness between total human chorionic gonadotropin (hCG) and free beta-hCG in two-marker Down syndrome screening programs during the second trimester in a Taiwanese population. MATERIALS AND METHODS: From a multicenter collaborative study, we investigated the second-trimester maternal serum levels of total hCG from 67 data, free beta-hCG from 72 and alpha-fetoprotein (AFP) from 96 obtained from Taiwanese pregnant women carrying fetuses with Down syndrome. RESULTS: High total hCG and free beta-hCG, as well as low AFP levels, were found with median values of 2.06, 2.49 and 0.77 multiples of the median (MoM), respectively. At a 5% false-positive rate, total hCG and free beta-hCG could detect 31% and 43% of Down syndrome pregnancies, respectively, whilst AFP alone could detect only 15% of affected cases. When combined with maternal age-specific risk, total hCG could achieve a 52% detection rate, free beta-hCG a 54% and AFP a 39%. Combined total hCG and AFP achieved a detection rate of 55%, and combined free beta-hCG and AFP achieved a rate of 60%. CONCLUSION: The measurement of free beta-hCG is more beneficial than total hCG in serum screening for Down syndrome during the second trimester of pregnancy.