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The CDC issues a report on the fetal and infant mortality rates. And, could a blood marker indicate that some women have a greater risk of developing postpartum depression? Plus: Does premature birth have a psychological impact on the infant?
For the first time, fetal deaths in the United States have outnumbered infant deaths, according to a new report from the Centers for Disease Control and Prevention. The new statistics signal progress in reducing infant mortality but a need for steps to reduce fetal mortality, particularly in women with multiple pregnancies, teenagers, women of late reproductive age, and those who are unmarried.
The data were drawn from 2 different National Center for Health Statistics vital statistics files: the 2013 fetal death data set and the 2013 period linked birth/infant death set. Fetal deaths included in the report were later than 20 weeks’ gestation because most states only report fetal deaths after that benchmark. Fetal death statistics did not include induced pregnancy termination.
In 2013, 23,595 fetal deaths at 20 weeks’ gestation or later were reported in the United States. Overall that year, the fetal mortality rate was 5.96 fetal deaths at 20 weeks’ gestation or later per 1000 live births, versus 6.05 in 2014. That lack of decline in fetal mortality means that more fetal deaths occurred than infant deaths between 2011 and 2013, even though the rates were essentially the same.
Non-Hispanic black women had a fetal mortality rate of 10.53, more than double that for non-Hispanic white women. Asian and Pacific Islanders had the lowest fetal mortality rate at 4.68. American Indian or Alaska Native women had a fetal mortality rate of 6.22 versus 5.22 for Hispanic women.
Rates of fetal mortality were slightly higher in male than in female fetuses: 6.12 compared with 5.80. Multiplicity was associated with significantly higher rates than for singletons: 30.53 for triplets and 14.07 for twins versus 5.65 for singletons. Looking at age, rates of fetal mortality were lowest in women aged 25 to 29 (5.34) versus teenagers younger than 15 (15.88) and women aged 45 and older (13.76). Half (51%) of fetal deaths were to unmarried women.
Public concern about reproductive loss, the authors said, primarily focuses on infant mortality, but interest in fetal mortality is increasing, with several organizations monitoring those losses and providing research opportunities.
Marker may signal risk of postpartum depression
A receptor gene for oxytocin-a hormone stimulated during birth and breastfeeding-may have potential as a marker for postpartum depression, according to results of a study led by researchers from the University of Virginia. Published in Frontiers in Genetics, the findings suggest that women who carry the gene may have lower sensitivity to oxytocin, potentially impacting their emotional wellbeing.
In a nested case-control study, the authors test the hypothesis that individual epigenetic variability in OXTR, the oxytocin receptor gene, might impact development of postpartum depression. The research was part of the Avon Longitudinal Study of Parents and Children, a survey of 14,541 pregnancies in women who resided in UK and had an expected delivery date between April 1991 and December 1992 which was designed to collect data on symptoms of depression during pregnancy and postnatally.
Included in the new analysis were 269 cases with postpartum depression and 276 controls matched for age, parity, and presence or absence of depressive symptoms in pregnancy. Blood samples were taken from the women between 7 and 41 weeks’ gestation and from their offspring. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association of elevated symptoms of postpartum depression with genotype (rs53576 and rs2254298), methylation, and their interaction adjusted for psychosocial factors.
Evidence was found for an interaction between rs53576 and methylation in the OXTR gene in women who did not have depression during pregnancy but did have it in the 8 weeks after birth (P interaction = 0.026, adjusted for covariates, n = 257). Women with GG genotype were 2.63 times more likely to have postpartum depression for every 10% increase in methylation (95% CI: 1.37-5.03), whereas methylation was unrelated to postpartum depression in women who were “A” carriers (OR = 1.00, 95% CI: 0.58-1.73). There was no interaction among women who had both prenatal and postpartum depression.
Their findings, the authors said, “argue for the integrative use of genetic and epigenetic markers in the oxytocin pathway to better understand and predict risk of psychological disorders in the postnatal period.” If susceptibility to postpartum depression could be detected early, they theorized, it might allow targeting of preventative interventions.
Striking a note of caution, the researchers noted limitations of their study, including the number of cases and controls, particularly the limited number of women with postpartum depression, and the use of controls matched for prenatal depression rather than inclusion of women as controls who did not have the condition.
Does prematurity affect personality?
A new cohort study seems to indicate that in addition to the physical ramifications, preterm birth and very low birthweight may also predispose an infant to having a socially withdrawn personality.
Researchers from the University of Warwick analyzed data from the Bavarian Longitudinal Study, which enrolled neonatal at-risk children born in 1985 and 1986 in Germany. The prospective study enrolled 200 very preterm (gestational age at birth <32â weeks; VP) or very low birthweight (birth weight <1500â g; VLBW) adults and 197 controls. The main outcome measures were personality traits, broad spectrum phenotype, and risk-taking at age 26.
Tools used to assess the participants’ personalities, autistic features, and risk-taking, respectively, were a 10-item version of the Big Five Inventory (BFI-10), the Broad Autism Phenotype Questionnaire, and the Arnett Inventory of Sensation Seeking. Pregnancy complications, maternal age, child sex, socioeconomic status, and IQ were considered as confounders.
In comparison with controls, the VP/VLBW adults had significantly higher scores for introversion, neuroticism, and autistic features. Scores for conscientiousness and closeness scales did not differ significantly between the two groups. A profile analysis showed that higher levels of introversion, autistic features, neuroticism, and lower risk-taking were unique features in the VP/VLBW adults (Fwithin-group=0.81, ns; Fbetween-group=49.56, P<0.001).
The researchers concluded that VP/VLBW birth poses a risk for having a global withdrawn personality, most likely related to alterations in brain structure and functioning associated with brain development and neonatal insult. Being aware of the risks can help explain social difficulties that VP/VLBW people experience as adults.