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Preconception Care
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
In recent years, there has been a trend to delay childbearing. This trend is especially prevalent in developed countries, for example, in the United States where the birth rate in 40- to 44 years old patients has increased from 5.2 births per 1,000 in 1990 to 10.4 births per 1,000 patients in 2013 [57]. It is well established that patients of advanced maternal age (AMA) are at increasing risk of poor obstetric outcomes, stillbirth, and fetal death [58–60]. Patients of extreme AMA (>45 years old) have been found to have an increased prevalence of preexisting chronic disease [61]. Although no Level I evidence exists for preconception testing in this population, it is reasonable to screen patients of extreme AMA who also have chronic hypertension, diabetes, hyperlipidemia, or heart disease with a cardiac echocardiogram.
Simple Linear Regression
Published in Marcello Pagano, Kimberlee Gauvreau, Heather Mattie, Principles of Biostatistics, 2022
Marcello Pagano, Kimberlee Gauvreau, Heather Mattie
Consider Figure 17.12. This graph is a two-way scatter plot of crude birth rate per 1000 population versus gross domestic product per capita for 241 countries around the world [280]. The gross domestic product (GDP) is expressed in United States dollars. Note that birth rate decreases as gross domestic product increases. The relationship, however, is not a linear one. Instead, birth rate drops off rapidly at first; when the GDP per capita reaches approximately $15,000, it begins to level off. Consequently, if we wish to describe the relationship between birth rate and gross domestic product, we cannot use simple linear regression without applying some type of transformation first.
Neonatal diseases II
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Brian P. Hackett, Jeffrey Dawson, Akshaya Vachharajani, Barbara Warner, F. Sessions Cole
An expert panel convened by the National Institute of Child Health and Human Development in July, 2005, recommended that infants born between 34 0/7 weeks (day 239) and 36 6/7 weeks (day 259) of gestation be referred to as late preterm (39,40). Late preterm infants account for 360,000 of more than 4 million births in the United States (40). Davidoff and Dias et al. found that two-thirds of the last decade’s increase in the rate of all preterm births was associated with an increase in the rate of late preterm births. Also noteworthy was that 74.1% of all singleton preterm births in 2002 occurred at 34, 35, and 36 weeks of gestation (41). Late preterm births also accounted for 61% of preterm multiple births (41). Since late preterm infants constitute such a large proportion of preterm infants, even a modest increase in their birth rate can have a significant impact on infant outcomes and health-care costs. Maternal and fetal indications commonly associated with late preterm delivery include pre-eclampsia, multiple gestation, and abnormal presentations (42). A portion of late preterm delivery may be preventable, especially those births that result from “maternal preference” (43,44).
Effect of intrauterine infusion of platelet-rich plasma for women with recurrent implantation failure: a systematic review and meta-analysis
Published in Journal of Obstetrics and Gynaecology, 2023
Haiyu Deng, Suqing Wang, Zhijie Li, Lingfei Xiao, Ling Ma
Live birth rate was defined as the number of live birth events (>24weeks of gestation) divided by the number of ET cycles. Live birth rate was reported in four studies (n=871; 428 cases and 443 controls) (Coksuer et al. 2019, Safdarian et al. 2020, Nazari et al. 2022, Xu et al. 2022). The meta-analysis demonstrated a significantly higher live birth rate in women treated with PRP compared to controls (RR=2.83, CI [1.45, 5.52], p=0.0007). There was evidence of high heterogeneity between studies (I2=83%) (Figure 3(a)). Sensitivity analysis showed the robustness of the pooled RR, ranging from RR 1.93, CI [1.43, 2.59] to 3.49. When one study that used stringent inclusion criteria (Nazari et al. 2022; patient age ≤ 38years versus < 40years, serum FSH level ≤10 mIU/mL on day 2 or 3 of the menstrual cycle, exclusion of patients with PCOS and OHSS, which may result in a higher rate of euploid embryos) was excluded, effect size was similar but there was no evidence of heterogeneity between studies (RR=1.93, CI [1.43, 2.59], p<0.0001, I2=0%) (Figure 3(b)).
Burden and severity of disease of aromatic L-amino acid decarboxylase deficiency: a systematic literature review
Published in Current Medical Research and Opinion, 2022
Katharina Buesch, Rongrong Zhang, Katarzyna Szczepańska, Vladica Veličković, Lucy Turner, Milena Despotović, Branka Đorđević, Alexis Russell
Aromatic L-amino acid decarboxylase deficiency (AADCd) is an extremely rare and severe autosomal recessive disorder. Prevalence is uncertain and current predictions suggest birth rates of 1:90,000 in the US, 1:118,000 in Europe, and 1:182,000 in Japan1. The prevalence in the US population at risk is approximately 0.112% or 1:900, and the estimated new-born incidence in an at-risk population is approximately 1:41,000 to 1:68,000 births2. AADCd is caused by mutations in the dopa decarboxylase (DDC) gene that encodes the enzyme aromatic L-amino acid decarboxylase (AADC). AADC is a critical enzyme for the synthesis of the neurotransmitters dopamine and serotonin, which are essential mediators in the synthesis of melatonin, epinephrine, and norepinephrine3. An insufficient or complete lack of synthesis of these neurotransmitters leads to a phenotypic spectrum. In the majority of cases, signs and symptoms present during the first months of life resulting in severe motor and cognitive impairments that do not improve over time4. AADCd is a life-threatening condition for individuals without direct and dedicated caregiver support. For individuals with access to dedicated caregiver support, the management of AADCd requires consistent and lifelong care5. In routine clinical management, only symptomatic treatment is available, and response to treatment varies substantially among patients5. Novel gene therapies, using viral vectors containing the human DDC gene to substitute the defected gene, are emerging6,7.
Thalassemia in Pakistan
Published in Hemoglobin, 2022
The estimated population of Pakistan is approximately 225,663,392 (225 million). The birth rate is 21.9 births/1000 population. There are four provinces and people belong to various ethnicities. The largest ethnic group are the Punjabi, who account for 44.7% of the total population, followed by the Pashtun (Pathan) at 15.4%, Sindhi 14.1%, Sariaki 8.4%, Muhajirs 7.6%, Balochi 3.6%, and others account for the remaining 6.3%. The religion of Pakistan is Islam (94.0% of the population). The GDP is US$305 billion, with the health budget being 2.6% of GDP. The sex ratio at birth is 1.05 males:females. The literary rate among males is 72.5%, while in females it is approximately 51.8%. Sixty-four percent of the total population lives in rural areas, while 36.0% were found to reside in urban areas [1].