Richard L. Berkowitz

Bio: Richard L. Berkowitz is an academic researcher from Yale University. The author has contributed to research in topics: Pregnancy & Gestational age. The author has an hindex of 53, co-authored 126 publications receiving 11257 citations. Previous affiliations of Richard L. Berkowitz include Mount Sinai Hospital & Wright State University.

Outcomes among 562 Recipients of Placental-Blood Transplants from Unrelated Donors

Abstract: Background A program for banking, characterizing, and distributing placental blood, also called umbilical-cord blood, for transplantation provided grafts for 562 patients between August 24, 1992, and January 30, 1998. We evaluated this experience. Methods Placental blood was stored under liquid nitrogen and selected for specific patients on the basis of HLA type and leukocyte content. Patients were prepared for the transplantation of allogeneic hematopoietic cells in the placental blood and received prophylaxis against graft-versus-host disease (GVHD) according to routine procedures at each center. Results Outcomes at 100 days after transplantation were known for all 562 patients, and outcomes at 1 year for 94 percent of eligible recipients. The cumulative rates of engraftment among the recipients, according to actuarial analysis, were 81 percent by day 42 for neutrophils (median time to engraftment, 28 days) and 85 percent by day 180 for platelets (median, day 90). The speed of myeloid engraftment was as...

First-trimester or second-trimester screening, or both, for down's syndrome

Abstract: background It is uncertain how best to screen pregnant women for the presence of fetal Down’s syndrome: to perform first-trimester screening, to perform second-trimester screening, or to use strategies incorporating measurements in both trimesters. methods Women with singleton pregnancies underwent first-trimester combined screening (measurement of nuchal translucency, pregnancy-associated plasma protein A [PAPP-A], and the free beta subunit of human chorionic gonadotropin at 10 weeks 3 days through 13 weeks 6 days of gestation) and second-trimester quadruple screening (measurement of alpha-fetoprotein, total human chorionic gonadotropin, unconjugated estriol, and inhibin A at 15 through 18 weeks of gestation). We compared the results of stepwise sequential screening (risk results provided after each test), fully integrated screening (single risk result provided), and serum integrated screening (identical to fully integrated screening, but without nuchal translucency). results First-trimester screening was performed in 38,167 patients; 117 had a fetus with Down’s syndrome. At a 5 percent false positive rate, the rates of detection of Down’s syndrome were as follows: with first-trimester combined screening, 87 percent, 85 percent, and 82 percent for measurements performed at 11, 12, and 13 weeks, respectively; with second-trimester quadruple screening, 81 percent; with stepwise sequential screening, 95 percent; with serum integrated screening, 88 percent; and with fully integrated screening with first-trimester measurements performed at 11 weeks, 96 percent. Paired comparisons found significant differences between the tests, except for the comparison between serum integrated screening and combined screening. conclusions First-trimester combined screening at 11 weeks of gestation is better than secondtrimester quadruple screening but at 13 weeks has results similar to second-trimester quadruple screening. Both stepwise sequential screening and fully integrated screening have high rates of detection of Down’s syndrome, with low false positive rates.

First-Trimester or Second-Trimester Screening, or Both, for Down???s Syndrome

Abstract: Debate continues over whether to screen pregnant women for fetal Down syndrome in the first or the second trimester of pregnancy or in both trimesters. The First- and Second-Trimester Evaluation of Risk Factors (FASTER) Trial obtained direct comparative data on current screening methods from 38,167 women with singleton pregnancies who were cared for at 15 U.S. centers over approximately 3 years in 1999-2002. Down syndrome was found in 117 instances. Inclusion criteria included a maternal age of 16 or older and a fetal crown-rump length of 36 to 79 mm-consistent with a gestational age of 10 weeks 3 days through 13 weeks 6 days. First-trimester screening combined measurement of the nuchal translucency with maternal serum pregnancy-associated plasma protein A (PAPP-A) and free beta human chorionic gonadotropin (fβhCG) levels. Quadruple screening in the second trimester, from 15 to 18 weeks gestation, included alpha-fetoprotein, total hCG, unconjugated estriol, and inhibin. Stepwise sequential screening, in which the Down syndrome risk estimate was provided after each test, was compared with "fully integrated" screening, which yielded only a single risk result after both the first- and second-trimester screening tests had been done. Although first-trimester serum screening and measurement of nuchal translucency gave similar results, the combination proved to be superior for detecting Down syndrome at 11 to 13 weeks gestation. When the false-positive rate was 5%, first-trimester combined screening at 11,12, and 13 weeks identified 87%, 85%, and 82% of Down syndrome cases, respectively. The detection rate for second-trimester quadruple screening was 81%. Quadruple screening outperformed triple screening, resulting in a higher detection rate at a lower false-positive rate. With fully integrated screening, in which the first-trimester studies were performed at 11 weeks gestation, 96% of cases were detected. For women younger than 35 years of age, first-trimester combined screening detected 75% of cases at a 5% false-positive rate, compared with 77% and 2.3%, respectively, for second-trimester quadruple screening and 77% and 0.4% for fully integrated screening. In women aged 35 and older, first-trimester combined screening detected 95% of cases with a false-positive rate of 22%. The respective figures for second-trimester quadruple screening were 92% and 13%, and for integrated screening with first-trimester markers measured at 11 weeks, 91% and 2%. In stepwise sequential screening, women have combined screening in the first trimester and results are provided immediately. Women with positive results are offered chorionic villus sampling. Women with negative results return at 15 weeks for quadruple testing, and a combined risk estimate is provided at that time. Using this approach and setting the false-positive rate for each component at 2.5%, 95% of cases were detected with a false-positive rate of 4.9%. For fully integrated screening, in which both first- and second-trimester tests are done but the woman gets only one risk estimate after the second-trimester tests are completed, setting the Down syndrome detection rate at 95% resulted in a false-positive rate of 4%. First-trimester combined screening is an effective means of detecting Down syndrome, assuming that there is adequate quality control for measuring nuchal translucency. Both stepwise sequential screening and fully integrated screening have high detection rates at acceptably low false-positive results. The lower false-positive rate must be weighed against the advantages of earlier diagnosis using sequential screening.

Delayed childbearing and the outcome of pregnancy.

Abstract: Whether women who delay childbearing are at increased risk for adverse outcomes of pregnancy is of concern because of the growing proportion of first births to older women. We assessed the effect of advancing maternal age on the outcome of pregnancy in first births in a hospital-based cohort study of 3917 private patients who were 20 years of age or older with a singleton gestation. There was a slight elevation in the risk of having a low-birth-weight infant among women who were 35 years of age or older (adjusted odds ratio, 1.3; 95 percent confidence interval, 0.9 to 1.9) as compared with the risk among women 20 to 29 years of age. However, there was no evidence that women between 30 and 34 or those 35 and older had an increased risk of having a preterm delivery or of having an infant who was small for gestational age, had a low Apgar score, or died in the perinatal period. In contrast, even after controlling for sociodemographic and medical risk factors, we found that women who were 35 or older were significantly more likely to have specific antepartum and intrapartum complications and those who were 30 or older were significantly more likely to have both cesarean sections and infants who were admitted to the newborn intensive care unit. This study suggests that although older primiparous women have higher rates of complications of pregnancy and delivery, their risk of a poor neonatal outcome is not appreciably increased.

Determinants of low birth weight: Methodological assessment and meta-analysis

Abstract: PIP: 43 determinants of low birth weight were analyzed from 895 published papers in the English and French literature from 1970-1984 The assessment was limited to singleton births of women living at sea level with no chronic illness; rare factors and complications of pregnancy were excluded The 43 factors were categorized as genetic and constitutional, demographic and psychosocial, obstetric, nutritional, maternal morbidity during pregnancy, toxic exposure and antenatal care The existence and magnitude of a causal effect on birth weight, gestational age, prematurity and intrauterine growth retardation were determined by a set of methodological standards In developed countries, the most important factor was cigarette smoking, followed by nutrition and pre-pregnancy weight In developing countries the major determinants were racial origin, nutrition, low pre-pregnancy weight, short maternal stature, and malaria Pre-pregnancy weight, prior premature birth or miscarriage, diethylstilbestrol exposure and smoking were major determinants of gestational duration, but the majority of prematurity was unexplained in both developed and developing countries There is a need for future research on the effect of maternal work, prenatal care, and certain vitamin and mineral deficiencies on intrauterine growth, and the effect of genital tract infection, prenatal care, maternal employment, stress and anxiety on prematurity

Maternal age and fetal loss: population based register linkage study

Abstract: Objective: To estimate the association between maternal age and fetal death (spontaneous abortion, ectopic pregnancy, stillbirth), taking into account a woman9s reproductive history. Design: Prospective register linkage study. Subjects: All women with a reproductive outcome (live birth, stillbirth, spontaneous abortion leading to admission to hospital, induced abortion, ectopic pregnancy, or hydatidiform mole) in Denmark from 1978 to 1992; a total of 634 272 women and 1 221 546 pregnancy outcomes. Main outcome measures: Age related risk of fetal loss, ectopic pregnancy, and stillbirth, and age related risk of spontaneous abortion stratified according to parity and previous spontaneous abortions. Results: Overall, 13.5% of the pregnancies intended to be carried to term ended with fetal loss. At age 42 years, more than half of such pregnancies resulted in fetal loss. The risk of a spontaneous abortion was 8.9% in women aged 20–24 years and 74.7% in those aged 45 years or more. High maternal age was a significant risk factor for spontaneous abortion irrespective of the number of previous miscarriages, parity, or calendar period. The risk of an ectopic pregnancy and stillbirth also increased with increasing maternal age. Conclusions: Fetal loss is high in women in their late 30s or older, irrespective of reproductive history. This should be taken into consideration in pregnancy planning and counselling.