Objectives: Most obstetric clinics have a program for the identification of small‐for‐gestational age (SGA) fetuses because of the increased risk of fetal complications that they present. We have a structured model for the identification and follow‐up of SGA pregnancies. We aimed to determine whether the recognition of SGA antepartum improves fetal outcome.Methods: All pregnancies at Malmö University Hospital from 1990 to 1998 (n = 26 968) were reviewed. SGA fetuses identified prior to delivery (n = 681) were compared with those not identified (n = 573). Also, all pregnancies with SGA fetuses were compared with those appropriate‐for‐gestational age (AGA) (n = 24 585). The risk of serious fetal complications (hypoxic encephalopathy grade 2 or 3, intracranial hemorrhage, Apgar score <4 at 5 min, neonatal convulsions, umbilical pH <7.0, cerebral palsy, mental retardation, stillbirth, intrapartum or infant death) was assessed with cross‐tabulation and logistic regression analysis, adjusted for gestational age and degree of SGA.Results: When compared with SGA fetuses identified before delivery (54%), SGA fetuses not identified before delivery were characterized by a four‐fold increased risk of adverse fetal outcome (odds ratio, 4.1; 95% CI, 2.5–6.8). Similarly, compared with AGA fetuses, SGA fetuses were associated with a four‐fold increased risk of serious fetal complications.Conclusions: A structured antenatal surveillance program for fetuses identified as SGA results in a lower risk of adverse fetal outcome, compared with cases of SGA fetuses not identified antepartum. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.

Factor V Leiden (FVL) and prothrombin gene mutation (PGM) are common inherited thrombophilias. Retrospective studies variably suggest a link between maternal FVL/PGM and placenta-mediated pregnancy complications including pregnancy loss, small for gestational age, pre-eclampsia and placental abruption. Prospective cohort studies provide a superior methodologic design but require larger sample sizes to detect important effects. We undertook a systematic review and a meta-analysis of prospective cohort studies to estimate the association of maternal FVL or PGM carrier status and placenta-mediated pregnancy complications. A comprehensive search strategy was run in Medline and Embase. Inclusion criteria were: (1) prospective cohort design; (2) clearly defined outcomes including one of the following: pregnancy loss, small for gestational age, pre-eclampsia or placental abruption; (3) maternal FVL or PGM carrier status; (4) sufficient data for calculation of odds ratios (ORs). We identified 322 titles, reviewed 30 articles for inclusion and exclusion criteria, and included ten studies in the meta-analysis. The odds of pregnancy loss in women with FVL (absolute risk 4.2%) was 52% higher (OR = 1.52, 95% confidence interval [CI] 1.06–2.19) as compared with women without FVL (absolute risk 3.2%). There was no significant association between FVL and pre-eclampsia (OR = 1.23, 95% CI 0.89–1.70) or between FVL and SGA (OR = 1.0, 95% CI 0.80–1.25). PGM was not associated with pre-eclampsia (OR = 1.25, 95% CI 0.79–1.99) or SGA (OR 1.25, 95% CI 0.92–1.70). Women with FVL appear to be at a small absolute increased risk of late pregnancy loss. Women with FVL and PGM appear not to be at increased risk of pre-eclampsia or birth of SGA infants. Please see later in the article for the Editors' Summary

To determine the incidence of pregnancy-related venous thromboembolic events and the relationship to selected risk factors such as maternal age, parity, smoking, preeclampsia, or cesarean delivery. All Swedish women reported as having pregnancy-related venous thromboembolic events during 1990-1993 (608 of 479,422 deliveries) were compared with all thrombosis-free Swedish pregnant women during 1993 (114,940). The incidence of pregnancy-related venous thromboembolic events was 13 per 10,000 deliveries. Cesarean delivery was associated with a fivefold increased risk of venous thromboembolic events. Advanced age was not a significant risk factor itself, but was associated with an age-related increase in frequency of cesareans. Women with preeclampsia were at a threefold higher risk postpartum, but at no increased risk before delivery. There was a tobacco consumption-dependent increase in the risk of thrombosis among smokers. The incidence of pregnancy-related thrombosis was 13 per 10,000 and provided new insights to important risk factors such as age, cesarean delivery, smoking, and preeclampsia.

The human skin papillomaviruses (HPVs) represent a group of ubiquitous viruses detected at a high prevalence in the normal skin of healthy adults. In the present study, we analyzed skin swab samples from babies during their first days of life and from infants at various ages up to age 4 years. Specimens from their parents and, for the newborn babies, environmental samples were also investigated. HPV DNA was already detected on the day of birth in samples from 2 of the 16 babies, and 45% of the samples from the babies were positive for HPV in the days following birth. Seventy-seven percent of the skin samples collected from the mothers were HPV DNA positive. The prevalence of HPV DNA among children from the ages of 1 month to 4 years varied between 50 and 70%. The HPV DNA sequences detected revealed a great diversity of genotypes and putative genotypes. Among 115 samples from 38 infants and 31 parents and 7 environmental samples, a total of 73 HPV types or putative types were isolated. Of these, 26 putative HPV types have not been described before. Our data suggest that asymptomatic HPV infections of normal skin are acquired very early in infancy and are caused by a great multiplicity of HPV types.

The Nordic medical birth registers have long been used for valuable clinical research. Their collection of data for more than four decades offers unusual possibilities for research across generations. At the same time, serum and blotting paper blood samples have been stored from most neonates. Two large cohorts (approximately 100 000 births) in Denmark and Norway have been described by questionnaires, interviews and collection of biological samples (blood, urine and milk teeth), as well as a systematic prospective follow‐up of the offspring. National patient registers provide information on preceding, underlying and present health problems of the parents and their offspring. Researchers may, with permission from the national authorities, obtain access to individualized or anonymized data from the registers and tissue‐banks. These data allow for multivariate analyses but their usefulness depends on knowledge of the specific registers and biological sample banks and on proper validation of the registers.