Dose-dependent induction of IL-12 but not IL-10 from human keratinocytes after exposure to ultraviolet light A

OBJECTIVE: Our purpose was to assess the risk of ectopic pregnancy among women who smoke cigarettes. STUDY DESIGN: We used data from a case-control study of ectopic pregnancy conducted from October 1988 to August 1990 at an inner-city hospital in Georgia. Cases were 196 non-Hispanic black women with a surgically confirmed ectopic pregnancy. Controls were non-Hispanic black women who had delivered either a live or a stillborn infant weighing at least 500 gm (n = 882) or who were pregnant and seeking an induced abortion (n = 237). RESULTS: After we adjusted for parity, douching history, history of infertility, and age, the odds ratio for ectopic pregnancy was 1.9 (95% confidence interval 1.4 to 2.7) for women who smoked during the periconception period compared with women who did not smoke at that time. After stratification by the amount of daily smoking during the periconception period, the odds ratio rose from 1.6 (95% confidence interval 0.9 to 2.9) for women who smoked 1 to 5 cigarettes to 1.7 (95% confidence interval 1.1 to 2.8) for women who smoked 6 to 10 cigarettes to 2.3 (95% confidence interval 1.3 to 4.0) for women who smoked 11 to 20 cigarettes, and to 3.5 (95% confidence interval 1.4 to 8.6) for women who smoked >20 cigarettes per day. CONCLUSION: In this inner-city population, cigarette smoking was an independent, dose-related risk factor for ectopic pregnancy among black women. The public health and medical care communities should inform the public of this additional risk associated with cigarette smoking and intensify intervention strategies to reduce cigarette smoking among women of reproductive age.     

Risk factors for ectopic pregnancy. Case-control study

BACKGROUND: To analyze risk factors for ectopic pregnancy in an Italian population. METHODS: A retrospective case-control study has been carried out on 213 cases of ectopic pregnancy and 213 controls. The control subjects were women who delivered spontaneously at the same time and in the same hospital of the cases considered. RESULTS: Smoking more than 10 cigarettes/die doubles the risk of ectopic pregnancy. IUD causes an increased risk in women using this contraceptive method for less than two years. A history of abdominal surgery was associated with about a double risk of ectopic pregnancy. The risk was higher in cases of cesarean section and pelvic surgery. CONCLUSIONS: Abdominal surgery (particularly pelvic surgery and cesarean sections), use of IUD for less than two years and cigarette smoking are the risk factors found to be a cause for ectopic pregnancy in the population studied. It was not possible to evaluate the history of pelvic inflammatory disease because there were not enough data. For this reason it is suggested it will be possible in the future to compile a register data, collecting all the cases of ectopic pregnancy as a part of a prevention campaign.     

Association of bacterial vaginosis with a history of second trimester miscarriage

The aim of this study was to determine whether bacterial vaginosis (BV) is associated with a history of recurrent pregnancy loss. A total of 500 consecutive patients attending the Recurrent Miscarriage Clinic were screened for the presence of BV. In women who had had at least one late miscarriage BV was found twice as commonly (27/130; 21%) as in women who had had only early losses (31/370; 8%) (P < 0.001). The difference was even larger (26 versus 8%) if women who had had term pregnancies were excluded. Moreover, BV was found three times more commonly in Afro-Caribbean women [17 (29%) of 58] than in Caucasian women [36 (9%) of 379] and, in both groups of women, BV was diagnosed at least twice as frequently in those with a history of at least one late miscarriage than in those who had experienced first trimester pregnancy losses only (P < 0. 001). The condition occurred twice as often among smokers than non-smokers and, in both groups, it was at least twice as common in women with a history of at least one late miscarriage as in those who had had early pregnancy losses only (P < 0.001). However, the relationship between BV and smoking was independent of ethnic origin. Women who douched with chloroxylenol were mostly Afro-Caribbean and had BV more than twice as often as women who did not douche.     

The risk of ectopic pregnancy after tubal sterilization. U.S. Collaborative Review of Sterilization Working Group

BACKGROUND: Tubal sterilization is an increasingly common method of contraception in the United States. Although pregnancy after sterilization is uncommon, it can occur and may be ectopic. We used data from the U.S. Collaborative Review of Sterilization to estimate the risk of ectopic pregnancy in women who had undergone the common types of tubal sterilization. METHODS: A total of 10,685 women undergoing tubal sterilization were followed in a multicenter, prospective cohort study. We intended to follow all the women for 5 years by means of annual telephone interviews; for women enrolled early in the study, we attempted an additional follow-up telephone interview 8 to 14 years after sterilization. To assess the risk of ectopic pregnancy in these women, we used cumulative life-table probabilities and proportional-hazards analysis. RESULTS: There were 47 ectopic pregnancies in the 10,685 women; the 10-year cumulative probability of ectopic pregnancy for all methods of tubal sterilization combined was 7.3 per 1000 procedures. The cumulative probability varied substantially according to the method of sterilization and the woman's age at the time of sterilization. Women sterilized by bipolar tubal coagulation before the age of 30 years had a probability of ectopic pregnancy that was 27 times as high as that among women of similar age who underwent postpartum partial salpingectomy (31.9 vs. 1.2 ectopic pregnancies per 1000 procedures). The annual rate of ectopic pregnancy for all methods combined in the 4th through 10th years after sterilization was no lower than that in the first 3 years. CONCLUSIONS: A history of tubal sterilization does not rule out the possibility of ectopic pregnancy, even many years after the procedure.     

The association between Chlamydia trachomatis serology and pelvic damage in women with tubal ectopic gestations

OBJECTIVE: To determine whether pelvic damage is associated with positive Chlamydia trachomatis serology in women with tubal ectopic pregnancy. DESIGN: Cross-sectional retrospective study. SETTING: A prepaid health maintenance organization. PATIENTS: Two-hundred eighty-one women admitted with confirmed tubal ectopic pregnancy were interviewed for history of sexually transmitted diseases. Chlamydia serology was obtained for 135 subjects, and operative findings were available for 121 of these. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Pelvic damage, as determined by review of operative findings of the pelvis at the time of ectopic surgery. RESULTS: Pelvic damage was associated with positive chlamydia serology with an adjusted odds ratio of 4.2 (95% confidence interval: 1.8 to 9.7). Moderate and severe pelvic damage were more strongly associated with positive serology than mild damage. CONCLUSIONS: Women with ectopic pregnancies and antibodies to C. trachomatis are more likely to have damaged pelves than women with ectopic pregnancies without such antibodies. Prevention or early treatment of C. trachomatis infection may reduce pelvic damage and, therefore, reduce incidence of ectopic pregnancy.     

Ectopic pregnancy loss during fertility management

Using qualitative techniques, data were obtained from seven women who experienced an ectopic pregnancy loss while undergoing fertility management. Ectopic pregnancy is a risk factor associated with fertility management, but unlike early miscarriage in fertility management, an ectopic pregnancy has additional potential negative sequelae for the women, including risk for severe hemorrhage and death and threat to future fertility. The purpose of this study was to describe women's experiences of loss following diagnosis and treatment of an ectopic pregnancy while undergoing fertility management. A thematic analysis of the data derived from semistructured interviews was conducted. Themes emerging from the women's discussion of their pregnancy loss and fertility plans included physical pain and shutdown, emotional protection, grief, and pressure, endpoints, and decision making. For women continuing fertility management, both the life-threatening risks of future ectopics and time allowances for grieving were minimized.     

Suicides after pregnancy in Finland, 1987-94: register linkage study

OBJECTIVE: To determine rates of suicide associated with pregnancy by the type of pregnancy. DESIGN: Register linkage study. Information on suicides in women of reproductive age was linked with the Finnish birth, abortion, and hospital discharge registers to find out how many women who committed suicide had had a completed pregnancy during her last year of life. SETTING: Nationwide data from Finland. SUBJECTS: Women who committed suicide in 1987-94. RESULTS: There were 73 suicides associated with pregnancy, representing 5.4% of all suicides in women in this age group. The mean annual suicide rate was 11.3 per 100,000. The suicide rate associated with birth was significantly lower (5.9) and the rates associated with miscarriage (18.1) and induced abortion (34.7) were significantly higher than in the population. The risk associated with birth was higher among teenagers and that associated with abortion was increased in all age groups. Women who had committed a suicide tended to come from lower social classes and were more likely to be unmarried than other women who had had a completed pregnancy. CONCLUSIONS: The increased risk of suicide after an induced abortion indicates either common risk factors for both or harmful effects of induced abortion on mental health.     

Comparative study of the cytoplasmic domain of band 3 from human and rabbit erythrocyte membranes

OBJECTIVE: To identify sociodemographic characteristics associated with induced abortion of the first pregnancy and quantify the strength of association between them. MATERIAL AND METHODS: Data were gathered from a survey conducted in the district of Diez de Octubre, Havana, Cuba throughout 1991 and the beginning of 1992. The study population was divided into two comparable groups: one group of women whose first pregnancy terminated in induced abortion and a second group of women whose pregnancy terminated in childbirth. For the variables with statistically significant differences, both the crude and adjusted odds ratio were obtained for the one potentially confounding factor:age. Multivariate logistic regression analysis was employed in the final stage. RESULTS: The sociodemographic characteristic identified as risk factor for induced abortion during the first pregnancy is being younger than 24 years of age, a risk which increased with women who were less than 20 years old, whether single or in union. CONCLUSIONS: Recurrence risk of induced abortion during the first pregnancy is higher in younger women who have not achieved their professional, working or marrying expectations. This situation seem to be incompatible with maternity in the studied group.     

Differential effects of BMI on diabetes risk among black and white Americans

OBJECTIVE: To determine whether the associations of BMI and fat distribution with diabetes risk are modified by race. RESEARCH DESIGN AND METHODS: Data from the National Health and Nutrition Examination Survey, Epidemiologic Follow-up Study (1971-1992), were used to investigate potential interactions of BMI and fat distribution with race. Incident diabetes was defined by self-report of physician-diagnosed diabetes, hospital and nursing home discharge records, and death certificates. RESULTS: Among the 1,531 black and 9,852 white subjects who were nondiabetic at baseline, 1,139 (10.0%) developed diabetes during 20 years of follow-up. Although the cumulative risk of diabetes increased with baseline BMI in all four race-sex groups, the sex-specific odds ratios (ORs) for black:white subjects decreased with increasing BMI. In particular, for BMI of 22 kg/m2, the OR of diabetes for black:white individuals was 1.87 and 1.76 (P < 0.01) for men and women, respectively; for BMI of 32 kg/m2, the OR decreased to 0.99 and 1.20 (NS) for men and women, respectively. Skinfold ratio was also associated with increased diabetes risk in all race-sex groups, but did not modify the association between race and diabetes. CONCLUSIONS: These findings suggest that the effect of BMI on diabetes risk is different for black and white Americans, with a larger risk for blacks than whites at low BMI and an equivalent risk for both groups at high BMI. A lower degree of visceral adiposity among blacks at higher BMI or a greater impact of visceral adiposity among blacks at low BMI may help explain the interaction of race and BMI on diabetes risk.     

Assessing the relationship between maternal opiate use and neonatal mortality

We undertook a number of meta-analyses to estimate more precisely the relationship between neonatal mortality and use of opiates in three groups of women. First, women who continued to use illicit heroin throughout pregnancy; secondly, women stabilized on methadone at the time of conception or shortly after and thirdly, women who use heroin well into pregnancy with late entry into methadone treatment, or who continued to use illicit heroin during pregnancy while receiving methadone. FINDINGS: The pooled estimates of the relative risks of neonatal mortality for separate heroin and methadone use were both near unity: 1.47 (95% CI 0.88-2.33) and 1.75 (95% CI 0.60-4.59), respectively. The result for heroin may be due to the inclusion in the meta-analysis of a particularly large study, which, unlike the two other smaller studies included found a relative risk near unity. When this study was excluded from the meta-analysis the pooled estimate of the relative risk of neonatal mortality for heroin use was 3.27 (95% CI 0.95-9.60). In contrast to the results for use of methadone only, the pooled relative risk associated with heroin and methadone use was 6.37 (95% CI 2.57-14.68). CONCLUSIONS: The increased relative risk for neonatal mortality associated with women using heroin and methadone during pregnancy, compared to those stabilized on methadone, is probably due to the chaotic and high-risk life-style associated with illicit heroin use and not solely to the use of heroin and methadone per se. It is recommended tht women who use heroin well into pregnancy with late entry into methadone treatment, or who continue to use illicit heroin during pregnancy while receiving methadone, receive special attention over and above that provided to women stabilized on methadone.     

Patients with type 2 diabetes have a high frequency of the C282Y mutation of the hemochromatosis gene

Although maternal fever has been implicated as a human teratogen in several studies, no prospective study has adequately addressed the full spectrum of birth outcomes following such exposure in pregnancy. The purpose of this study was to determine whether or not maternal fever is associated with an increased risk for structural malformations, prematurity, growth retardation, or pregnancy loss. Using a prospective cohort study design, we ascertained women who had called the California Teratogen Information Service and Clinical Research Program between 1979-1996 with questions regarding fever in a current pregnancy. Of these women, 115 who reported a fever of at least 38.9 degrees C lasting for at least 24 h (high fever group) and 147 women who reported a fever of either less than 38.9 degrees C or lasting less than 24 h (low fever group) were enrolled in the cohort. An additional 298 pregnant women who reported having no fever at any time in pregnancy were enrolled in a control group. All pregnancies were followed in a similar fashion, and outcomes were compared among the three groups. The combined prevalence of all major structural malformations was increased, but not significantly so, in the offspring of women who had a high fever in the first trimester of pregnancy compared to those with a lower fever or to controls (relative risk 1.80 for high fever group compared to controls; 95% confidence interval, 0.54, 6.03; relative risk 1.21 for low fever group compared to controls; 95% confidence interval, 0.36, 4.03). However, 2/34 or 5.9% of women who had a high fever during the critical period for neural tube closure carried fetuses with anencephaly compared to none in the low fever group or controls. Specific minor defects were found more frequently in the high fever group compared to controls and were consistent with the pattern of defects previously reported in a retrospective case series. In addition, stillbirth occurred more frequently in the high fever group compared to controls (2.6% vs. 0%). These data support the conclusion that high maternal fever early in pregnancy is a human teratogen. Women who experience fevers of 38.9 degrees C or higher for extended periods of time in the first month of pregnancy should be considered at increased risk for neural tube defects and should be provided appropriate counseling.     

Individual differences in perceived riskiness of drinking in pregnancy: antecedents and consequences

OBJECTIVE: This study examined whether differences in perceived riskiness of alcohol consumption during pregnancy were related to self-reported alcohol consumption among a community sample of pregnant women. Further, this study examined the impact of prior experiences on risk perceptions, focusing on previous pregnancy experiences and on previous alcohol-related problems. METHOD: The hypothesized relationships among variables were tested simultaneously in a structural equation model. Subjects included 159 pregnant women, all of whom drank regularly before pregnancy recognition, who were recruited from prenatal clinics and through newspaper advertisements. RESULTS: Perceived riskiness of drinking during pregnancy was lower among women who had previously given birth to a healthy child and among women with greater numbers of previous alcohol problems. Prior adverse pregnancy experience did not predict perceived risk. Perceived risk negatively predicted actual alcohol consumption during pregnancy, suggesting that previous healthy pregnancy experiences and alcohol problems increase drinking in pregnancy indirectly, through perceived risk. A direct positive effect from previous alcohol problems to drinking in pregnancy also was observed. CONCLUSIONS: Findings suggest that risk perceptions play a role in drinking behavior among pregnant women and help to illuminate the relationship between parity and alcohol consumption. Interventions designed to reduce drinking among pregnant women, which have generally relied on providing information, may be improved by considering the impact of previous experiences and addressing erroneous beliefs.     

Ectopic bone formation in a child with a head injury: complete regression after immobilisation

OBJECTIVE: To study the correlation between microsurgical tubal reversal after tubal sterilization and ectopic pregnancy. METHODS: 1029 women who underwent microsurgical tubal reversal were followed up. The causes of ectopic pregnancy were analysed and discussed. RESULTS: 960 intrauterine pregnanciess and 12 ectopic pregnancies occurred. The 12 ectopic pregnancies were all tubal ones, among which 2 had intrauterine pregnancies. The rate of ectopic pregnancy in the 1029 women was 1.17%, and in the pregnant cases was 1.23%. The ratio of intrauterine pregnancy to ectopic pregnancy was 1:80. The rates of ectopic pregnancy in the 1st, 2nd year and 2 years later after tubal reversal were not significantly different respectively among the tubal reversal and among the pregnant cases. The rates of ectopic pregnancy in the 1st and 2nd 6 months after tubal reversal were not statistically different. The early tubal hydrapertubation could only increase the chance of ectopic pregnancy. The sterilization method, reversal mode, and interval between sterilization and reversal were not related to the ectopic pegnancy. CONCLUSION: When the lesion in the sterilized position is completely removed, the sutures being through the tubal mucosa and the early tubal hydrapertubation not carried out, the chance of ectopic pregnancy can not be increased after tubal reversal. The contraception 6 months after tubal reversal is not related to ectopic pregnancy.     

A genetic polymorphism of the peroxisome proliferator-activated receptor gamma gene influences plasma leptin levels in obese humans

OBJECTIVE: To determine whether adverse perinatal outcome is associated with asthma or asthma medication use during pregnancy. METHODS: A retrospective cohort study was conducted of women who resided in Halifax County, Nova Scotia, and delivered between 1991 and 1993. Asthmatic women were classified into three groups, according to medication usage: no medications, beta agonists only, and steroids with or without other asthma medications. Outcomes compared among asthmatic and nonasthmatic women included maternal complications (pregnancy-induced hypertension, cesarean delivery, gestational diabetes, preterm birth, and antepartum and postpartum hemorrhage) and neonatal outcomes (low birth weight, congenital malformations, hyperbilirubinemia, and respiratory distress syndrome). RESULTS: The cohort included 817 asthmatic women and 13,709 nonasthmatic women. Overall, the prevalence of pregnancies complicated by asthma increased from 4.8% in 1991 to 6.9% in 1993. Asthmatic women were at increased risk for antepartum and postpartum hemorrhage, independent of medication usage. Asthmatic women taking steroids were at increased risk for pregnancy-induced hypertension (odds ratio [OR] 1.7; 95% confidence interval [CI] 1.0, 2.9). The only significant difference in neonatal outcome between asthma medication groups and nonasthmatic women was of an increased risk of hyperbilirubinemia in infants of women taking steroids (OR 1.9; 95% CI 1.1, 3.4). CONCLUSION: Risk of antepartum and postpartum hemorrhage is increased in asthmatic women, independent of medication usage. The increased incidence of neonatal hyperbilirubinemia and the borderline increased risk of pregnancy-induced hypertension may be complications of steroid use or may be related to poorly controlled asthma.     

Maternal attitude toward pregnancy and the risk of neonatal death

OBJECTIVES: Reduced options for fertility control over the past decade have increased the rates of unwanted pregnancy. We evaluated whether a woman's negative attitude toward her pregnancy increased the risk of perinatal mortality, in a large, prospective cohort study. METHODS: The association between attitude toward the pregnancy and perinatal mortality was evaluated in a longitudinal cohort study of 8823 married, pregnant patients enrolled from 1959 to 1966 in the Child Health and Development Studies. RESULTS: Women who reported during the first trimester of prenatal care that the pregnancy was unwanted were more than two times more likely to deliver infants who died within the first 28 days of life than were women reporting accepted pregnancies. A positive attitude toward pregnancy was not associated with fetal death or post-neonatal death. CONCLUSIONS: These data, collected when induced abortions were illegal, may have important implications for the 1990s. If maternal attitude toward the pregnancy is associated with neonatal mortality and abortion laws change such that access is restricted, infant mortality may increase because a greater proportion of births will be unwanted.     

Diagnostic ultrasound in threatened abortion and suspected ectopic pregnancy

200 women threatened with abortion during the first 16 weeks of pregnancy were examined with diagnostic ultrasound to determine whether there were signs of intrauterine life. Of the 90 who showed positive signs, 8 aborted spontaneously later, the other 82 continued their pregnancy. The ultrasound investigation revealed no signs of intrauterine life in 110 patients. Of these, spontaneous abortion or later evacuation because of missed abortion 101 (histopathological examination showed degenerated villi in 98), not pregnant 4, mola hydatidosa 3, extrauterine pregnancies 2. An ultrasound examination was performed to ascertain whether 136 women with suspected ectopic pregnancy had intrauterine pregnancies. 61 of them had an intrauterine gestational sac, confirmed at clinical follow-up. One of the 61 was operated on with laparoscopy because of pain; no abnormalities were found. In 36 of the other 75, laparoscopy was performed. Ectopic pregnancy 21, ovarian or parovarian cyst 11, adhesions 2, salpingitis 1, and normal 1. Diagnostic ultrasound is excellent for accurate prognosis in threatened abortion. Unnecessary operations avoided; hospitalization in suspected ectopic pregnancies reduced.     

Selection and identification of single domain antibody fragments from camel heavy-chain antibodies

OBJECTIVE: Our purpose was to determine whether women who were themselves small for gestational age at birth are at risk of giving birth to a small-for-gestational-age child and whether women who were themselves preterm at birth are at risk for preterm delivery. STUDY DESIGN: Women born in Copenhagen as subjects in the Danish Perinatal Study (1959 to 1961) were traced through the Danish Population Register. Information was obtained on their pregnancies during 1974 through 1989. RESULTS: A total of 25% of the children of small-for-gestational-age women were small for gestational age compared with 11% of the children of non-small-for-gestational-age women. Eleven percent of the children of preterm women were preterm compared with 7% of the children of women born at term. The adjusted odds ratios were 2.0 (95% confidence interval 1.4 to 3.0) for women who were small for gestational age to have small-for-gestational-age children and 1.5 (95% confidence interval 0.9 to 2.5) for women who were born preterm to have preterm children. Small-for-gestational-age women were not at significantly increased risk of preterm delivery (odds ratio 1.2), and preterm women were not at significantly increased risk of having small-for-gestational-age children (odds ratio 1.3). CONCLUSIONS: Reduced intrauterine growth of the mother is a risk factor for reduced intrauterine growth of her children. However, preterm birth of the mother is not strongly associated with preterm birth of her children.     

Toxicology of the lung

This qualitative study explores how risk is determined by black women during pregnancy. A total of 17 women were assessed for risk; 7 were at risk for preterm birth, and 10 were not at risk. These women were interviewed by using an open-ended interview guide. The transcribed interviews were analyzed by using grounded theory. Risk was defined by the provider's assessment of a mathematical probability of the occurrence of preterm labor according to the risk screening tool developed by Creasy. Risk was also defined by black women on the basis of their experience of problematic change, on the counsel of other black women, and on the assessment of the provider. All of the women perceived their pregnancy as a normal process. For some, that perception never changed; for others, it did change. The change was precipitated by the occurrence of an unexpected event, indicated in this study as a critical moment. The critical moment is a dynamic interplay among biophysical changes, patterns of social interaction, and intersubjective reflection. These findings emphasize the black woman's reliance on herself in problematic situations and the significant role of sharing between black women in perpetuating their culture's normative expectations concerning pregnancy.     

Oral contraceptive use and protective behavior after missed pills

A three-month prospective study of 103 women initiating oral contraceptive use examined how consistently the women took their pills and whether those who missed pills employed other means to avoid pregnancy. The results showed that 52% took each active pill or never missed more than one pill at a time after the first week of the initial cycle, according to electronic devices that recorded the date and time each pill was removed from the blister pack. Another 21% were protected by behaviors that reduce the risk of pregnancy when two or more consecutive pills have been missed: avoiding coitus for the next seven days (18%) or using backup contraception during that period (3%). The remaining 27% were at increased risk of pregnancy. Predictors of increased risk were receiving low partner support for effective pill use, being unmarried and not considering it especially important to avoid pregnancy. Increased risk was most likely during the first seven days and during the third cycle of pill use.     

Women with little or no prenatal care during pregnancy. Results of a study of twenty departments

OBJECTIVES: To estimate the frequency of women who have little or no health care during pregnancy, to assess associated perinatal risk, and to identify the corresponding risk factors. METHODS: Women who consulted less than 4 times or who began consultation during the third trimester were identified in public and private maternity units in 20 French departments. These women were compared with a sample of women from the same institutions who consulted regularly. RESULTS: The percentage of pregnant women with little or no care was 1.1%. Risk of premature birth was increased 4-fold compared with women who consulted regularly. Women who consulted little were very young, multiparous or living alone with no health care insurance. These women stated that the reason for not consulting was that their pregnancy was not accepted, financial difficulties and administrative problems. CONCLUSION: The lack of regular medical care results from social obstacles, especially in foreign born women but is also related to personal problems which are difficult to identify and manage.