ABSTRACT
OBJECTIVE: To determine the functional development of children born after treatment of mild-to-moderate gestational hypertension with labetalol versus methyldopa, and no antihypertensive treatment. DESIGN: Historical cohort study. SETTING: Twelve Dutch hospital departments of obstetrics. POPULATION: Live-born children born in these hospitals and prenatally exposed to labetalol, methyldopa, or bed rest because of mild-to-moderate gestational hypertension. METHODS: Central nervous system development was measured with standard tests at 4-10 years of age. Linear regression techniques and Pearson's chi-square tests were used to compare the groups with regard to the outcome measures. MAIN OUTCOME MEASURES: Intelligence quotient (IQ), concentration, motor development, and behaviour at primary school age. RESULTS: A total of 202 children were included in the analyses. More children exposed to labetalol had attention deficit hyperactivity disorder (ADHD) than those exposed to methyldopa (OR 2.3; 95% CI 0.7-7.3), or those born to women who had been admitted for bed rest (OR 4.1; 95% CI 1.2-13.9). Sleeping problems seemed to be reported more frequently after prenatal methyldopa exposure than after exposure to labetalol (OR 3.2; 95% CI 0.6-16.7) or bed rest (OR 4.5; 95% CI 0.9-23.2), although the differences were not statistically significant. Test scores on other aspects of functional development did not differ between the three groups. CONCLUSIONS: In this hypothesis-generating study, labetalol exposure in utero seemed to increase the risk of ADHD among children of primary school age, whereas prenatal methyldopa exposure might influence sleep. Further studies with appropriate sample sizes are warranted to determine the long-term effects of antihypertensive medications.
Subject(s)
Antihypertensive Agents/adverse effects , Child Development/drug effects , Hypertension, Pregnancy-Induced/drug therapy , Labetalol/adverse effects , Methyldopa/adverse effects , Prenatal Exposure Delayed Effects/chemically induced , Attention/drug effects , Attention Deficit Disorder with Hyperactivity/chemically induced , Bed Rest , Child , Child, Preschool , Female , Humans , Intelligence/drug effects , Netherlands , Pregnancy , Psychomotor Performance/drug effects , SchoolsABSTRACT
The introduction of in-vitro fertilization (IVF) and prenatal diagnostics (PND) raised moral and ethical problems for Catholic universities. As expected, reproductive medicine research output was very low in departments that did not provide these facilities. It can be demonstrated that, by initiating IVF and PND under strong restrictions, a low scientific output in IVF and PND can be compensated for by increasing scientific output in new areas such as maternofetal physiology, primary prevention of birth defects and preconception care (folic acid and neural tube defects). This increase was mainly due to multidisciplinary efforts.
Subject(s)
Catholicism , Gynecology/organization & administration , Obstetrics/organization & administration , Religion and Medicine , Reproductive Health Services/organization & administration , Reproductive Medicine/ethics , Schools, Medical/organization & administration , Universities/organization & administration , Biomedical Research/ethics , Female , Fertilization in Vitro/ethics , Fertilization in Vitro/trends , Gynecology/trends , Humans , Netherlands , Obstetrics/trends , Prenatal Diagnosis/ethics , Prenatal Diagnosis/trends , Reproductive Health Services/ethics , Reproductive Health Services/trends , Reproductive Medicine/trendsABSTRACT
Altered maternal folate status and homozygous mutation in the methylenetetrahydrofolate reductase (MTHFR) and methionine synthase reductase (MTRR) genes can promote chromosomal instability and non-dysjunction resulting in fetal trisomy 21. Folate supplementation around conception therefore has the potential to reduce the frequency of Down syndrome. This finding, in addition to the prevention of neural tube defects, strengthens the recommendation to use folic acid around conception.