Recurrence of prolonged and post-term gestational age across generations: maternal and paternal contribution.

OBJECTIVE: To estimate intergenerational recurrence risk of prolonged and post-term gestational age. DESIGN: Population-based cohort study. SETTING: Norway, 1967-2006. POPULATION: Intergenerational data from the Medical Birth Registry of Norway of singleton mothers and fathers giving birth to singleton children: 478 627 mother-child units and 353 164 father-child units. A combined mother-father-child file including 295 455 trios was also used. METHODS: Relative risks were obtained from contingency tables and relative risk modelling. MAIN OUTCOME MEASURES: Gestational age ≥41 weeks (≥287 days), ≥42 weeks (≥294 days) and ≥43 weeks (≥301 days) of gestation in the second generation. RESULTS: A post-term mother (≥42 weeks) had a 49% increased risk of giving birth to a child at ≥42 weeks (relative risk [RR] 1.49, 95% CI 1.47-1.51) and a post-term father had a 23% increased risk of fathering a child at ≥42 weeks (RR 1.23, 95%CI 1.20-1.25). The RRs for delivery at ≥41 weeks were 1.29 (1.28-1.30) and 1.14 (1.13-1.16) for mother and father, respectively, and for ≥43 weeks 1.55 (1.50-1.59) and 1.22 (1.17-1.27). The RR of a pregnancy at ≥42 weeks in the second generation was 1.76 (1.68-1.84) if both mother and father were born post-term. Adjustment for maternal age in both generations, fetal sex in the second generation, parity, and maternal and paternal birthweight did not influence the risk estimates. CONCLUSIONS: There is a familial factor related to recurrence of prolonged pregnancy across generations and both mother and father seem to contribute.

Maternal birth characteristics and perinatal mortality in twin offspring. An intergenerational population-based study in Norway, 1967-2008.

OBJECTIVE: To investigate the relationship between maternal preterm birth and fetal growth in one generation and perinatal mortality of twin offspring in the next generation. DESIGN: Population-based cohort study. SETTING: The Medical Birth Registry of Norway from 1967 to 2008. POPULATION: Linked generational data with 9426 mother-twin pair units. METHODS: Twin offspring were linked to their mothers by means of the unique national identification numbers. MAIN OUTCOME MEASURES: Perinatal mortality in twin offspring. RESULTS: The twin prevalence was not dependent on the mother's gestational age at birth, but increased with increasing birthweight in term mothers. Maternal gestational age was strongly and inversely associated with a risk of perinatal death in one or both of her twin offspring. Compared with term mothers, preterm mothers born at 27-31 and 32-34 weeks had relative risks (RRs) for perinatal loss of 3.83 [95% confidence interval (CI), 1.56-9.36] and 2.41 (95% CI, 1.29-4.50), respectively. This effect was even stronger after the use of assisted reproductive technologies (ART), with a significant interaction between maternal gestational age and ART (P = 0.03). Further, term mothers with birthweight-by-gestational age Z-scores of -2 or less had more than twice the risk of a perinatal loss in their twin offspring relative to mothers with the most favourable birthweight Z-scores (1-1.99) [RR, 2.42 (95% CI, 1.37-4.29)]. CONCLUSIONS: Women born preterm had an increased risk of perinatal mortality in their twin offspring, particularly after ART treatment. The same was true for women who were growth restricted at term. A twin pregnancy is a high-risk pregnancy in general, but even more so if the mother herself was born preterm or was growth restricted at birth.

Parenthood probability and pregnancy outcome in patients with a cancer diagnosis during adolescence and young adulthood.

BACKGROUND: To compare first-time parenthood probability and pregnancy outcome between cancer patients and the general population. METHODS: Data from a hospital registry on cancer patients aged 15-35 years at diagnosis, including date/type of diagnosis, treatment and date of death, were merged with data from the Cancer Registry and the Medical Birth Registry, providing date of childbirth, IVF, pregnancy outcomes and demographics. RESULTS: The first-time parenthood probability at the age of 35 years was 63% in male patients (n = 463) and 64% in the male general population (n = 367 068). Figures in female patients were 66% (n = 284) compared with 79% in the female general population (n = 349 576) (P = 0.007). A total of 487 male and 251 female cancer patients were childless pre-diagnosis, and 130 male and 104 female cancer patients had one child before diagnosis and at least one birth post-diagnosis. Congenital anomalies were more frequent in first-borns to previously childless male patients [adjusted odds ratio (OR(adj)): 1.5; 95% confidence interval (CI): 1.1-2.3]. The risk of low birth weight and preterm delivery after cancer was increased in infants born to female patients, as was perinatal mortality (OR(adj) 2.3; 95% CI: 1.1-5.0) among post-diagnosis first births. CONCLUSIONS: The first-time parenthood probability in 35-year old cancer patients is approximately 60%, which in female patients is significantly reduced compared with the general population. Post-diagnosis pregnancies to female patients are high-risk pregnancies.

Twenty years experience with semen cryopreservation in testicular cancer patients: who needs it?

PURPOSE: To evaluate the role of semen cryopreservation (SCP) in the fertility saving management of testicular cancer (TC) patients, treated at the Norwegian Radium Hospital between 1983 and 2002. PATIENTS AND METHODS: 422 of 1388 newly diagnosed TC patients had SCP All patients were followed up for post-treatment paternity. RESULTS: During the 20 years study period, by 2002 an increasing percentage of patients had pre-treatment SCP, reaching 43% after 1994. Twenty-nine (7%) of the 422 patients with SCP had used their frozen semen for assisted reproductive techniques (ART) at least once to achieve fatherhood. Pregnancies were achieved in 16 of these patients' partners, but two of these pregnancies ended in abortions. 67(17%) of 393 men with SCP fathered at least one child without use of frozen semen. The comparable figures for those without SCP were 205 out of 966(21%). Twenty years after orchiectomy the cumulative incidence of first post-treatment fatherhood was 47% for the 393 patients who had SCP but did not use it for ART, and 34% for the 966 patients without SCP (p=0.12). CONCLUSION: If offered, about 50% of the young and middle-aged patients newly diagnosed with TC are interested in pre-treatment SCP. Though our study reveals that a considerable number of TC patients referred to SCP, achieve fatherhood without the use of frozen semen, the psychological impact of pre-treatment cryopreservation is undeniable. Furthermore, for some TC survivors ART with cryopreserved sperm offers the only chance of post-treatment paternity.

Infants' length at birth: an independent effect on perinatal mortality.

AIM: To investigate whether variations in birth length (crown-heel-length) were associated with perinatal mortality rate independent of birth weight. MATERIAL: The study population was singleton live- and stillbirths from 16 weeks of gestation compiled in the Medical Birth Registry of Norway from 1967 to 1997, totaling 1,705,652 births. METHOD: The total population was analyzed using z-scores for length at birth, birth weight and gestational age. Variation in perinatal mortality by length at birth was studied within birth weight strata (250 g) by logistic regression. RESULTS: Perinatal mortality varied more by birth length than by birth weight or gestational age, especially for values above the population means. Within birth weight strata, the association between perinatal mortality and length was similar in all 250 g birth weight categories above 1,500 grams: mortality was lowest at birth lengths 0-2 cm below average, with mortality rates increasing exponentially in either direction. CONCLUSION: Within all birth weight strata, and adjusted for gestational age, long infants had the higher risk of perinatal death, suggesting that length at birth may be a valuable predictor when assessing the risk of perinatal mortality.

Recurrence of gestational age in sibships: implications for perinatal mortality.

The authors studied the extent to which preterm birth and perinatal mortality are dependent on the gestational ages of previous births within sibships. The study was based on data collected by the Medical Birth Registry of Norway from 1967 to 1995. Newborns were linked to their mothers through Norway's unique personal identification number, yielding 429,554 pairs of mothers and first and second singleton newborns with gestational ages of 22-46 weeks, based on menstrual dates. Siblings' gestational ages were significantly correlated (r = 0.26). The risk of having a preterm second birth was nearly 10 times higher among mothers whose firstborn child had been delivered before 32 weeks' gestation than among mothers whose first child had been born at 40 weeks. However, perinatal mortality in preterm second births was significantly higher among mothers whose first infant had been born at term, compared with mothers whose firstborn child was delivered at 32-37 weeks. Since perinatal mortality among preterm infants is dependent on the gestational age in the mother's previous birth, a common threshold of 37 weeks' gestation for defining preterm birth as a risk factor for perinatal death may not be appropriate for all births to all mothers.

Signs of subclinical eating disorders in teenage girls.

OBJECTIVE: To study possible indicators for subclinical eating disorders among teenage girls. DESIGN: A descriptive cross-sectional study based on two anonymous self-report questionnaires. SETTING: Girls aged 15 to 19 years in secondary high school in Bergen, Norway. SUBJECTS: 100 girls, mean age 16.6 years, were included. One girl fulfilled DSM-III-R criteria for bulimia nervosa, and was therefore excluded from analysis. Ten girls fulfilled criteria for subclinical eating disorders. MAIN OUTCOME MEASURES: The Eating Disorder Examination Questionnaire and a 48-item questionnaire designed for the study were used. Attitudes towards own body size/weight, food habits, and somatic symptoms were studied. RESULTS: Girls with subclinical eating disorders experienced their own body as fatter and were more unhappy with their weight than girls without eating problems. They more often skipped breakfast or lunch, reported more dyspeptic problems and regurgitation, and had a larger weight fluctuation than girls without eating problems. CONCLUSION: Questions about main meals may serve as neutral opening questions for the general practitioner when case finding in eating disorders. Obviously unrealistic feelings about body size/weight indicate the need to enquire more closely about symptoms of eating disorders.