No abstract

In approximately 85% of stillbirths, the fetus dies before labor begins. Whether the risk of stillbirth is determined in the first trimester-like several complications of pregnancy, including preterm birth and low birth weight-is not clear. This large-sale multicenter trial, a prospective cohort study, assessed the risk of antepartum stillbirth as related to maternal serum levels of 2 placental proteins, pregnancy-associated plasma protein A (PAPP-A) and the free beta subunit of human chorionic gonadotropin (hCG). Protein levels were determined within 10 weeks after conception in 7934 women living in Scotland in the years 1998-2000 who had singleton births at or after 24 weeks gestation. The median gestational age at the time of blood sampling was 11.9 weeks.Low PAPP-A levels could not be related to any maternal characteristics, but were more frequent with male than with female fetuses. Ten of the 25 antepartum stillbirths were ascribed to placental causes, 4 of them to abruption. The risk of stillbirth from any cause was increased 9.2-fold in women with a low PAPP-A level (the lowest fifth percentile) and 58-fold when stillbirth was a result of abruption. The risk was increased 40-fold in small-for-gestational-age unexplained stillbirths and 46% when stillbirth was the result of placental dysfunction. These associations remained just as strong after adjusting for maternal factors. No relationship was noted between the risk of stillbirth from any cause and maternal serum levels of the free beta subunit of hCG.An association between maternal PAPP-A levels and stillbirth is plausible because this protein is known to be a protease for insulin-like growth factor-binding proteins. Low levels might well result in reduced levels of free insulin-like growth factor, which appears to play an important role in trophoblast function. Identifying placental function in early pregnancy may help to anticipate serious complications of late pregnancy and guide prenatal care. ABSTRACTWomen planning pregnancy often are urged to take extra folic acid or fortified food to lower the risk of a neural tube defect and other malformations. Some studies have found evidence of an increased rate of dizygotic twinning in women taking folic acid supplements, but others have failed to confirm such an effect. This study explored the putative association between folic acid supplementation and twinning in 6953 women in the Swedish Medical Birth Registry who had a total of 7181 infants and who had taken folic acid in early pregnancy. Of 8676 women who had different-sexed dizygotic twins, 232 reported having used folic acid. In Sweden, folic acid is available in doses of 400 g over the counter and 5 mg by prescription.After adjusting for year of birth, maternal age, parity, smoking, and years of unplanned childlessness, the odds ratio (OR) for folic acid use by women with a body mass index (BMI) less than 19.8 was 0.96, and for those with a BMI greater than 26, 0.89. Those with a BMI less than 19.8 had a lowered risk of dizygotic twinning (OR, 0.75), ...

No abstract

Loss of insurance has adverse health consequences even within 2 years after becoming uninsured. Studies of insurance coverage should routinely measure the number of Americans uninsured at any time over the preceding 2 years as a more accurate measure of the population at risk from being uninsured.