July 15, 2005 • www.obgynnews.com 11 Planned Home Births Safe, Study Results Suggest

Researchers compare outcomes among term, There were no maternal deaths in the haustion, according to the investigators. home-birth group. Three infants died from After delivery, 1.3% of mothers and singleton vertex births at home versus the . fatal birth defects. There were five intra- 0.7% of newborns were transferred. The partum fetal deaths and six neonatal most common reasons mentioned were BY MICHELE G. SULLIVAN satisfaction were reported, and more than deaths. maternal hemorrhage (0.6% of total Mid-Atlantic Bureau 87% of mothers and neonates did not re- There were no deaths among the 80 births), retained (0.5% of total quire transfer to hospital,” the study au- planned home-delivered breeches, nor births), or respiratory problems in the in- ot only are planned home births in thors said. among the 13 sets of twins. fant (0.5% of total births). North America safe for mother The cohort includ- When the re- The reportedly considered Nand baby, they are associated with ed information from ‘Our study of certified searchers excluded transfers urgent in 3.4% of cases. Transfers a lower rate of medical intervention than 5,418 women whose planned breech de- were four times more common among are low-risk hospital births in the United births during the professional midwives liveries and twins primiparous women (25%) than multi- States, results of the largest prospective year 2000 were at- suggests they achieve good (not considered low- parous women (6%). analysis of such births suggest. tended by 409 of the risk), the rate of in- Compared with low-risk hospital births, “Our study of certified professional 534 registered pro- outcomes among low-risk trapartum and planned home births had a significantly midwives suggests they achieve good out- fessional midwives in women without routine use’ neonatal death was lower rate of induction of labor (9.6% vs. comes among low-risk women without the United States and 1.7/1,000 planned 21%), stimulation of labor (9.2% vs. routine use of expensive hospital inter- Canada (BMJ 2005; of hospital intervention. low-risk home births. 18.9%), episiotomy (2.1% vs. 33%), forceps vention,” said study authors Kenneth C. 330:1416-9). About 12% of the (1% vs. 2.2%), and vacuum extractions Johnson, M.D., senior epidemiologist for The researchers compared outcomes in mothers were transferred to a hospital ei- (0.6% vs. 5.2%). the Agency of Canada, and that group with outcomes among more ther intrapartum or post partum. The rate of cesarean section for women Betty-Anne Daviss, a certified profession- than 3.3 million term, singleton vertex Five of every six who went to a hospi- transferred to a hospital also was lower al from Canada. hospital births the same year in the Unit- tal did so before delivery: 51% went for than the rate among low-risk hospital “A high degree of safety and maternal ed States. failure to progress, pain relief, and/or ex- births (3.7% vs. 18%). ■ ‘Vanishing Twin’ in IVF Tied Gene Mutation Associated To Low in Remaining Twin With Miscarriage, Found I NDIAN W ELLS, CALIF. — Women the main purpose of the study was to in- who conceive through in vitro fertilization vestigate if selective fetal reduction really and have a “vanishing twin” are still at risk improved birth weight and risk of preterm More Common in PCOS of having the remaining twin born at a low delivery, said Dr. Mitwally of the division birth weight for , Mohamed of reproductive endocrinology and infer- BY HEIDI SPLETE women, Dr. Glueck said at the meeting, Mitwally, M.D., said at the annual meeting tility at Wayne State University, Detroit. Senior Writer sponsored by the American Federation of the Pacific Coast Reproductive Society. The study showed that selective fetal re- for Medical Research. In a review of 945 live-birth deliveries of duction did result in better birth weight and WASHINGTON — The hypofibri- The overall frequency of the 4G allele infants conceived through in vitro fertil- less risk of preterm birth, without increased nolytic plasminogen activator inhibitor was 53% among PCOS women, com- ization (IVF), 40 patients experienced spon- loss, except perhaps when twins was an independent predictor of mis- pared with 46% of the controls. taneous reduction of fetuses in a multiple were reduced to singletons. The reason the carriage in a cohort of 441 women with Dr. Glueck and his associates also eval- gestation and then gave birth to one infant. study observed no benefit from selectively polycystic ovary syndrome who had pre- uated 30 women who took metformin Those infants weighed a mean 2,842 g reducing twins may have been that there vious pregnancies, Charles J. Glueck, during pregnancy and had live births and at a mean 271 days’ gestation. That com- were only a few cases in which twins were M.D., reported at the Clinical Research 23 women who took it and had first- pared with a mean birth weight of 3,206 reduced, Dr. Mitwally said. 2005 meeting. trimester miscarriages. The PAI-Fx level g in 514 women who gave birth to single- The rest of the literature on fetal re- PAI-Fx is highly correlated with fasting fell by approximately 44% among the tons and had not experienced fetal reduc- duction, including a recent metaanalysis, serum insulin re- women who had tion, either spontaneous or selective, and “supports the findings of this study,” said sistance, and Glu- PCOS-associated live births, but it a mean birth weight of 3,166 g in 15 pa- Sae Sohn, M.D., a fertility specialist who cophage (met- obesity and rose approximate- tients who delivered singleton infants af- practices in Greenbrae, Calif., and who formin) (2.25-2.5 hyperinsulinemia ly 19% among the ter selective fetal reductions. commented on the study at the meeting. g/day) sharply can contribute to women who had The finding was somewhat unexpected; —Timothy F. Kirn lowers both in- high PAI-Fx levels early miscar- sulin and PAI-Fx that promote riages. Among D A T A W A T C H levels, significant- miscarriage. the women who ly improving the had live births, odds of live births DR. GLUECK PAI-Fx fell consis- Infant Deaths Caused by Respiratory Distress Syndrome for women with tently from pre- PCOS, said Dr. Glueck, director of the pregnancy treatment through the first 40 Jewish Hospital Cholesterol Center in trimester, from 16.8 to 6.7 units/mL. Cincinnati. Left untreated, approximately 50% of 35 The 441 women were part of a larger pregnant women with PCOS experi- 30 cohort of 968 women with PCOS. Of ence first-trimester miscarriages; treat- these 441 women, 206 had only live ment with metformin, combined with 25 births, 118 had at least one live birth and dietary changes, reduces this figure to 20 one miscarriage, and 75 had only mis- approximately 15% (the national aver- 15 carriages. age in the United States). In addition, of 926 women with PCOS-associated obesity, hyperinsu- 10 PCOS for whom genetic data were linemia, and hypertriglyceridemia can available, 727 (79%) had the 4G5G or contribute to the high PAI-Fx levels that Rate per 100,000 Live Births 5 4G4G genotype vs. 87 of 126 (69%) promote miscarriage in women with 0 1996 1997 1998 1999 2000 2001 healthy female controls. PCOS, Dr. Glueck noted.

ESEARCH This PAI-1 genetic mutation was sig- Physicians can optimize pregnancy

Note: Adapted from period-linked birth and death data from the National Center for ,R nificantly associated with miscarriage, outcomes by prescribing metformin and

Health Statistics. OLEY in part through its gene product, PAI-Fx, diet, which has been shown to reduce F Source: March of Dimes and appears to be more common in obesity, hyperinsulinemia, hypertriglyc- EVIN

K women with PCOS than in healthy eridemia, and PAI-Fx levels. ■