Prenatal starvation and maternal blood pressure near delivery.

Maternities in cities exposed to the Dutch famine of 1944 to 1945 and in control cities were compared. Systolic blood pressure near the time of delivery was significantly reduced by exposure to famine late in the 2nd trimester and early in the 3rd trimester. Blood pressure correlated best with caloric rations in the 3rd month before delivery, and this relationship holds consistently below a ration level of 1900 cal. Above 1900 cal and up to 2200 cal (the upper limit of rations for the data analyzed) the relationship is inconsistent across cities. Edema, analyzed in one city, varied in a manner similar to blood pressure.

Creutzfeldt-Jakob disease: familial clustering among Libyan-born Israelis.

Creutzfeldt-Jakob disease was studied among Libyan-born Israelis, in whom the disease appears with unusual frequency. Interviews with relatives of deceased victims revealed statistically significant clustering within families. The results suggest either a common source of exposure or a genetic influence on susceptibility to the virus.

Epidemiological appraisal of the literature on the fetal alcohol syndrome in humans.

An evaluation of the evidence regarding the association between heavy maternal alcohol intake during pregnancy and the occurrence in offspring of that cluster of abnormalities called the Fetal Alcohol Syndrome is undertaken from an epidemiological perspective. Areas of concern in assessing the literature include the objectivity with which the maternal drinking history was obtained, the nature, systematic or not, of examination of offspring, the presence or absence of a comparison group, the control for potentially confounding factors and, perhaps most important of all, whether or not the identification of a case was made blind to knowledge of the maternal drinking history. While well-documented evidence that can implicate a hypothesized teratogen is difficult to obtain, the data available concerning the effects of in utero exposure to high doses of alcohol must be carefully and thoughtfully scrutinized so that valid inferences may be drawn. In this review particular attention is focused on the nature of the association between in utero alcohol exposure and mental retardation, certainly the most devastating of the FAS features.

How accurate are patient histories?

Recently there has been a large increase in the use of emergency rooms and screening clinics for the delivery of primary medical care. In these impersonal health care settings physicians must often rely on medical histories obtained from patients over the course of a few minutes without benefit of old records or previous acquaintance with the patient. Few data are available on the accuracy of these histories. In this preliminary investigation we used the history of past admission to the hospital as a marker for the validity of patient responses in an emergency room. Overall, 71 of 114 patients with known previous admissions gave accurate responses when asked why they had previously been admitted to the hospital (62 +/- 4.5 percent). Disease category appears to be a relevant factor in predicting the accuracy of the response, but the number of patients was too small to evaluate other subgroups of patients. Future studies should involve sufficient patients to evaluate the individual contributions of patient characteristics in predicting the accuracy of medical interviews.

Lack of association between spermicide use and trisomy.

It has been suggested that the maternal use of spermicidal contraceptives increases the frequency of certain congenital anomalies, including trisomy, but this issue is in dispute. This controversy led us to examine whether the use of spermicidal contraceptives is associated with an increased risk of fetal trisomy. A questionnaire concerning contraceptive use was completed by 13,729 women who were undergoing prenatal fetal chromosome studies but were as yet unaware of the results. Most women were at increased risk of having a trisomic fetus because of their advanced age. Of 154 fetuses with trisomy, 98 had trisomy 21. For each woman (case) with an affected fetus, four controls were selected from among women with chromosomally normal fetuses, matched for maternal age and medical center. Cases and controls were compared by matched-sample maximum-likelihood logistic regression, to examine the association between fetal trisomy and four measures of spermicide use: periconceptional use, timing of last use, duration of last use, and total lifetime use. No evidence was found for an association, either when all types of trisomy were combined or when trisomy 21 alone was considered. All point estimates of odds ratios relating spermicidal exposure to trisomy were approximately 1, and an effect greater than a twofold increase was excluded with 95 percent confidence in the combined-trisomy group for all measures of spermicide use.

PIP: It has been suggested that maternal use of spermicidal contraceptives increases the frequency of certain congenital abnormalities, including trisomy, but this issue is in dispute. The controversy led to this examination of whether the use of spermicidal contraceptives is associated with an increased risk of fetal trisomy. A questionnaire concerning contraceptive use was completed by 13,729 women undergoing prenatal fetal chromosome studies but were as yet unaware of the trisomic fetus because of their advanced age. Of 154 fetuses with trisomy, 98 had trisomy 21. For each woman (case) with an affected fetus, 4 controls were selected from among women with chromosomally normal fetuses, matched for maternal age and medical center. Cases and controls were compared by matched-sample maximum-likelihood logistic regression, to examine the association between fetal trisomy and 4 measures of spermicide use: preconceptional use, timing of last use, duration of last use, and total lifetime use. No evidence was found for an association, either when all types of trisomy were combined or when trisomy 21 alone was considered. All point estimates of odds ratios relating spermicidal exposure to trisomy were approximately 1, and an effect a 2-fold increase was excluded with 95% confidence in the combined-trisomy group for all measures of spermicidal use.

Duration of vaginal bleeding and trisomy at prenatal diagnosis.

In the case-control study of 118 women with autosomal trisomy identified at prenatal diagnosis and their 442 karyotypically normal matched controls, we found that there was no overall association between risk of trisomy and the presence of vaginal bleeding during pregnancy. However, a lengthy duration of bleeding appears to predict increased risk of trisomy.