Teenage primigravidae: a comparative study

A review of history sheets of obstetric cases recorded in a district hospital in 1992 was done to compare the obstetric outcome in 200 teenage first pregnancies (Study group) with that in Control group i.e. 20 years to 29 years. It revealed that incidence of complications of pregnancy like anaemia, pregnancy induced hypertension (PIH) and preterm labour were significantly higher among teenage mothers. The normal mode of delivery was commoner in teenagers (82.5%) in comparison to control group (76.5%), probably because of higher number of low birth weight babies. The fetal outcome was significantly worse in teenage mothers with high incidence of perinatal mortality (8%) and low birth weight babies (35%). There was not a single newborn with birthweight above 3500 gms, in teenage group, whereas, control group had 5 babies (2.5%) in the category.     

Low fetal morbidity in pregnancy associated with acute and chronic idiopathic thrombocytopenic purpura

Forty-six mothers with immune thrombocytopenic purpura (ITP) gave birth to 72 babies. Sixty-two babies were delivered vaginally and 10 babies by cesarean section. There was no mortality among mothers or babies. Eighteen infants were born thrombocytopenic (PLT < 100 x 10(9)/l). Eleven infants had a platelet count of less than 50 x 10(9)/l. All the severely thrombocytopenic babies (except 1) were born to post splenectomy thrombocytopenic mothers, regardless of steroid treatment during pregnancy. Five babies had clinical manifestations of bleeding; 3 had mild purpura, 1 severe gastrointestinal bleeding, and 1 intracranial bleeding. The latter 2 babies were born prematurely to the same mother who was severely thrombocytopenic despite splenectomy in childhood. In view of very low morbidity in babies of ITP mothers, we suggest that they be delivered vaginally. Cesarean delivery should be performed in selected cases where the mother is severely thrombocytopenic despite splenectomy or where prematurity or obstetrical complications are encountered.     

Births following oral contraceptive failures

Neonatal outcome was studied in 108 infants conceived while their mothers were taking oral contraceptives. The infants tended to be born to younger, less educated mothers and were more likely to have been exposed to hormonal pregnancy tests. Ten newborns were malformed; 8 of these were males. One was anencephalic, and 1 infant had Down's syndrome. There was also a significantly large number of twins and an excess of perinatal mortality. These results are similar to those of previous studies, showing a small but increased risk of adverse outcome in infants born after oral contraceptive failure.     

Diabetes in pregnancy

Diabetes, while at one time a rarity in pregnancy, is now one of the more common medical problems encountered by the obstetrician. Immaculate control is essential and can only be accomplished by close co-operation between the patient and all her medical attendants. The patient can then anticipate an almost trouble free pregnancy and should deliver a baby of normal weight with none of the usual stigmata associated with babies of diabetic mothers.     

The Diabetes in Early Pregnancy Study: beta-hydroxybutyrate levels in type 1 diabetic pregnancy compared with normal pregnancy. NICHD-Diabetes in Early Pregnancy Study Group (DIEP). National Institute of Child Health and Development

OBJECTIVE: The objective was to assess relationships between beta-hydroxybutyrate (beta-OHB) level and pregnancy outcome in human pregnancy in light of the fact that high levels of beta-OHB cause malformations and growth retardation in in vitro studies. RESEARCH DESIGN AND METHODS: We analyzed beta-OHB in prospectively collected specimens from the National Institute of Child Health and Human Development-Diabetes in Early Pregnancy Study, in gestational weeks 6-12 in diabetic (n = 204-239) and nondiabetic (n = 316-332) pregnant women. RESULTS: Levels of beta-OHB in diabetic women were 2.5-fold higher than in nondiabetic pregnant women at 6 weeks' gestation and declined to 1.6-fold above nondiabetic women by 12 weeks' gestation (P < 0.0001 at all times). beta-OHB was positively correlated with glucose levels (P < 0.0001) in diabetic mothers, probably reflecting degree of diabetic control. beta-OHB correlated inversely with glucose (P < 0.0003) (gestational week 6 only) in nondiabetic mothers, possibly reflecting caloric intake. beta-OHB tended to be lower (not higher) in diabetic and nondiabetic mothers with malformed infants or pregnancy losses, but the difference was not statistically significant. beta-OHB in diabetic mothers at 8, 10, and 12 weeks correlated inversely with birth weight (P = 0.004-0.02), even after adjusting for maternal glucose levels. beta-OHB levels were also generally lower in diabetic mothers of macrosomic infants, and week 12 ultrasound crown-rump measurements were inversely related to beta-OHB levels. CONCLUSIONS: The lst trimester beta-OHB is significantly higher in diabetic than nondiabetic pregnant women. In both groups, beta-OHB tended to be lower, not higher, in mothers who had a malformed infant or pregnancy loss. beta-OHB was inversely related to crown-rump length and birth weight. The modest beta-OHB elevation in the 1st trimester of reasonably well-controlled diabetic pregnancy is not associated with malformations, probably because beta-OHB levels causing malformations in embryo culture models are 20- to 40-fold higher. The mechanism of the beta-OHB association with impaired fetal growth is unknown.     

A prospective study of drugs and pregnancy. 4. Miscellaneous drugs

The results are presented of a prospective study on drug use during pregnancy involving antibiotics, analgesic drugs and iron and vitamin preparations. The study was conducted in Malm? between 1963 and 1965. No unfavourable effect of the use of antibiotics, mainly penicillin and sulphonamides, could be demonstrated. Among 15 women who had an infant with hypospadias, three had used penicillin during the first trimester, but this may well be coincidental. Analgesic drug use shows a variability which resembles that previously described for psychopharmaca. No effect on the malformation rate or infant survival could be found. A possible lengthening of the mean duration of pregnancy occurred after the use of analgesic drugs during the 2nd or 3rd trimesters. Women who are going to have a dead or malformed infant use iron and/or vitamin preparations less often during late pregnancy than women who prove to have a normal infant. When such drugs were used, the percentage of pregnancies ending in birth before the 38th week is reduced, and the birth weight among term babies is higher. The associations between pregnancy outcome and the use of iron and vitamin preparations is probably indirect, due to social factors associated with drug use.     

Syme amputation: results in patients with severe forefoot ischemia

Teenage pregnancy has become a serious public health problem, particularly in developing countries with limited obstetric facilities. The condition has often been associated with obstetric and gynaecological risks. The present study which attempts to identify such risks has revealed teenage pregnancy an an important public health problem in Nigeria. Out of 4,649 pregnant mothers followed up in an antenatal clinic of a general hospital, 704 (15.1%) were teenagers. The highest frequency of low birth weight babies was recorded amongst these teenage mothers; so also was anaemia. In addition, the number of stillbirths and the incidence of low birth-weight babies were found to increased with decreasing maternal haemoglobin level. As a result of the identified risk factors associated with teenage pregnancy, it is suggested that teenage pregnant mothers be given more specialised supervision during antenatal period and at delivery; while efforts should be made to reduce the incidence of teenage pregnancy through scholarship programs for the education of girls.     

Somatostatin analogue inhibits intestinal regeneration

This work analyzes the mother-son segregation of MN blood group in malformed and normal newborns. MN blood group was measured in 90 malformed, 70 paired normal newborns and their respective mothers, at the Maternity of the University of Chile Clinical Hospital. The expected values for the different mother-child pairs were calculated according to the ITO matrix method, using maximally probable appraisers. Among malformed newborns, there was an excess of heterozygous sons when the mother was homozygous for the MN system. Among malformed males, there was an excess of MM-MN and MN-MM mother-son pairs. Among control newborns, no distortions were found. These results suggest that there is a strong association between MN heterozygosis, sex and congenital malformations.     

Relationship of passive cigarette-smoking to sudden infant death syndrome

The smoking habits of 56 families who lost babies to the sudden infant death syndrome (SIDS) were compared to those of 86 control families. A higher proportion of SIDS mothers smoked both during pregnancy (61% vs. 42%) and after their babies were born (59% vs. 37%). SIDS mother also smoked a significantly greater number of cigarettes than controls. Exposure to cigarette smoke ("passive smoking") appears to enhance the risk of SIDS for reasons not known.     

A cytogenetic study in women who had used oral contraceptives and in their progeny

A study has been made of the chromosome numbers and characteristics of leucocytes cultured from mothers (a total of 77) who had taken one or more types of oral contraceptive, and their babies (108), and compared with similar numbers of control subjects. When the total cytogenetic results from test and control mothers were compared, no significant differences in frequency or type of chromosome abnormalities was observed. However, with certain types of oral contraceptive, minor differences in the numbers of chromosome abnormalities were found between test and control groups and the significance of these findings are discussed. The only significant abnormalities observed in the babies from mothers taking oral contraceptives were slight increases in the numbers who had cells with less than 46 chromosomes and who exhibited chromosomal gaps. The number of abnormal cells was significantly higher in babies born to mothers who had been taking norethynodrel (Conovid) (4.6% abnormal cells in test babies; 2.0% in controls).     

Contraception in diabetic women

There is a very strong need for an effective and reliable method of contraception in the diabetic woman. An unplanned pregnancy that occurs when her diabetes is not under good control can have disastrous consequences, ranging from abortion to a congenitally malformed fetus. The most important factor in the contraceptive decision for the diabetic patient, especially the IDDM patient, is that the choice be made not by the clinician alone or the patient alone, but through a carefully through-out process that involves both patient and physician.     

Infantile colic as maternal reason of consulting a pediatrician: characteristics of mother and child

About 10-20% of infants under four months of age suffer from infantile colic (IC), an excessive screaming behaviour caused by multiple factors. WESSELS et al. (1954) definition is that babies in usually good health and nutritional condition are screaming/whining more than three hours daily, more than three days weekly for no apparent reasons. The question is whether/in what way daily routines of infants concerned differ from normal infants. Mothers of colicky infants (n = 25) and mothers in a control group (n = 25) record characteristics of the mother/child relationship, their assumptions why the child is screaming, care and attention they provide and babies' reactions. For seven days the mothers kept a diary about the babies' behaviour and worked on questionnaires concerning social support received, depressant effects and exhaustion. Interviews about the extent of care provided as well as personal thoughts and emotions were conducted. The "colic group" formed two subgroups: one fulfilling Wessels criteria (Wessel-Koliker; WK), the other more conforming with the "control group" babies though mothers complained about screaming (Non-Wessel-Koliker; NWK). "Colic group"-babies received more attention and care (compared to the "control group" babies), attempts to calm them down frequently failed and mothers in this group reacted less promptly to their babies' screaming. "NWK-group"-mothers strongly tend to attribute the babies' screaming to "meteorism" or "discontent". No differences existed between groups concerning social support, depressant effects and exhaustion. There is a risk that the colic may negatively influence the mother/child interaction beyond three months.     

The smoking addiction of pregnant women and the consequences on their offspring's intellectual development

Many scientists have studied the effects of smoking by pregnant women on intrauterine development. Because nicotine and other toxic substances in cigarette smoke are not stopped by the placental barrier, there is a risk that the development of the child could be hindered. It has been shown, for instance, that babies whose mothers smoked during pregnancy have lower size and weight at birth. Few authors have studied the consequences a mother's pre-natal smoking may have on the intellectual development of her child. We compared two samples of children, aged 4 to 5, and aged 6 to 7 (40 children in total), whose mothers had smoked during pregnancy, with two samples of 40 children of the same ages whose mothers had not smoked. We tested them on the Wechsler scale. The social and cultural levels were equivalent. We found a difference of more than 15 IQ points in favor of the children of nonsmoking mothers. These results permit us to suppose that smoking during pregnancy hinders the intellectual development of the child.     

Low birth weight as an additional indication for chromosomal analysis

INTRODUCTION: Even though there are few epidemiological studies evaluating the birth weights of different groups of malformed babies with chromosomal abnormalities, it is widely known that infants with trisomy 18, and to a lesser degree those with trisomy 13 and other chromosomal alterations, have low birth weights. PATIENTS AND METHODS: In this study we present the analysis of the birth weights and gestational ages of a large sample of babies (23,155 malformed and a similar number of nonmalformed babies), separating the different groups of chromosomal anomalies and comparing the weight in the clinical groups of malformed infants. RESULTS: Most of the groups with chromosomal abnormalities present lower birth weights in comparison to the other groups. CONCLUSIONS: The results of our study support the conclusion that the relationship between chromosomal alterations and low birth weight is sufficiently important that such a low birth weight in children with minor or major anomalies should be considered as one more indication to perform chromosomal analysis.     

Effects of efferent neurotransmitter acetylcholine and cochlear active substance ATP on cochlear outer hair cells

Toxoplasma antibody serological tests were carried out using the Dye test on sera of pregnant and postpartum Nigerian women to investigate whether there was any association between the levels of antibody titres and the occurrence of stillbirths and congenital malformations. There was a high prevalence of toxoplasma antibodies in the sera of both pregnant and postpartum women. The prevalence rates for the pregnant women ranged from 72.5% to 88.8% with an overall rate of 75.4%; whilst for the postpartum women, the prevalence rates ranged from 75.0% to 94.4% with an overall rate of 80.5%. The toxoplasma antibody titres of the sera from the live-born babies as well as stillbirths and congenitally malformed babies ranged from 1:16 to 1:1024. The exact role played by toxoplasma in the occurrence of stillbirths and congenital malformation in our area of study is, however, not clear. For future research, it is suggested that larger samples be studied in order to enhance the validity of the findings of the present study.     

A comparison of one-sided methods to identify significant individual outcomes in a multiple outcome setting: stepwise tests or global tests with closed testing

We compare two approaches to the identification of individual significant outcomes when a comparison of two groups involves multiple outcome variables. The approaches are all designed to control the familywise error rate (FWE) with any subset of the null hypothesis being true (in the strong sense). The first approach is initially to use a global test of the overall hypothesis that the groups are equivalent for all variables, followed by an application of the closed testing algorithm of Marcus, Peritz and Gabriel. The global tests considered here are ordinary least squares (OLS), generalized least squares (GLS), an approximation to a likelihood ratio test (ALR), and a new test based on an approximation to the most powerful similar test for simple alternatives. The second approach is that of stepwise testing, which tests the univariate hypotheses in a specific order with appropriate adjustment to the univariate p-values for multiplicity. The stepwise tests considered include both step-down and step-up tests of a general type, and likewise permutation tests that incorporate the dependence structure of the data. We illustrate the tests with two examples of birth outcomes: a comparison of cocaine-exposed new-borns to control new-borns on neurobehavioural and physical growth variables, and, in a separate study, a comparison of babies born to diabetic mothers and babies born to non-diabetic mothers on minor malformations. After describing the methods and analysing the birth outcome data, we use simulations on Gaussian data to provide guidelines for the use of these procedures in terms of power and computation.     

Differential effects of maternal heroin and methadone use on birthweight

An analysis of birthweights of 337 neonates in relation to history of maternal narcotic usage was undertaken. Mean birthweight of infants born to mothers abusing heroin during the pregnancy was 2,490 gm, an effect primarily of intrauterine growth retardation. Low mean birthweight (2,615 gm) was also seen in infants born to mothers who had abused heroin only prior to this pregnancy, and mothers who had used both heroin and methadone during the pregnancy (2,535 gm). Infants born to mothers on methadone maintenance during the pregnancy had significantly higher mean birthweights (2.961 gm), but lower than the control group (3,176 gm). A highly significant relationship was observed between maternal methadone dosage in the first trimester and birthweight, i.e., the higher the dosage, the larger the infant. Heroin causes fetal growth retardation, an effect which may persist beyond the period of addiction. Methadone may promote fetal growth in a dose-related fashion after maternal use of heroin.     

Effects of maternal physical training on the fetus

The latest results of influences of physical training during pregnancy on the foetus are presented. In humane, no pathological effects on the embryogenesis have been demonstrated. During exercise, a modest increase (5-25 bpm) in foetal heart rate is a common finding. This might be caused by reduced oxygen supply to the foetus, but could more likely be due to stimuli from vasoactive hormones or training-induced uterine contractions. Foetal growth seems to be influenced by maternal training, as moderate training has resulted in significantly bigger babies compared to both inactivity and hard training. In one study it was shown that low body weight in babies from hard-training mothers was due to reduced neonatal fat mass. Pathological sequelae due to increased maternal temperature during training have not been found in humans. The results strongly suggest that moderate training during pregnancy can be recommended if simple precautions are taken.     

Cesarean delivery in the United States, 1990

Information now available on method of delivery from birth certificates confirms past findings on the groups at highest risk of cesarean delivery and greatly expands our knowledge of the demographic and health characteristics associated with cesarean delivery. Mothers who live in the South, who are in the oldest years of childbearing, having their first birth, married, or who have high educational attainment are all at increased risk of a cesarean delivery. Very short gestations, low or high birthweights, multiple delivery, the presence of certain complications of pregnancy, labor and/or delivery, abnormal conditions of the newborn, and the use of some obstetric procedures are also associated with elevated cesarean rates. Several recent studies (28,29) have concluded that advanced maternal age in and of itself may be an independent risk factor for cesarean delivery, due to physician and patient concern over pregnancy outcome for older women. Many of the characteristics examined in this study are highly related to maternal age (for example, marital status and educational attainment). Therefore, for these variables, mother's age is also taken into account to determine if age itself is the underlying reason for differences in rates of cesarean delivery. The importance of the role of maternal age in the risk of cesarean delivery is clearly demonstrated throughout this report: Older mothers are more likely to deliver by cesarean regardless of race, Hispanic origin, parity, marital status, or educational attainment. The overall rate of cesarean delivery is only slightly lower for black than for white mothers (22.1 percent compared with 23.0 percent), despite the generally lower educational attainment of black mothers and the higher percentage who are unmarried or in their teen years, all factors that tend to substantially lower the risk of cesarean delivery. However, there are many offsetting factors that tend to raise the cesarean rate for black mothers. A relatively high proportion of black births occur in the South, which has the highest cesarean rate of all regions; the incidence of low and very low birthweight is far higher for black births; and premature delivery is twice as frequent for black babies. Also, although rates of cesarean delivery for most medical risk factors, complications of labor and or delivery, and abnormal conditions of the infant are about the same for both races, the incidence of a number of these conditions is substantially higher for black mothers and babies, and that has the effect of increasing the overall cesarean rate for black mothers.(ABSTRACT TRUNCATED AT 400 WORDS)