Development and validation of the Menopause-specific Quality of Life Scale for menopausal Thai women.

OBJECTIVES: To develop a new instrument, the Menopause-specific Quality of Life Scale (MS-QoLS), for Thai women and to study the experience of menopausal aspects in peri- and postmenopausal Thai women. MATERIALS AND METHODS: Item generation was developed from a focus group discussion and in-depth interview, and the content validity index (CVI) was computed, using item relevance ratings by content experts. Items with CVI values higher than 0.7 were selected. The draft questionnaire was tested for language, format and content. The final questionnaire was administered and the construct validity and reliability were then assessed. RESULTS: Fifty-seven peri- and postmenopausal women participated in the focus group discussion and in-depth interview. Sixty-eight items across eight dimensions were generated based on content analysis result. The dimensions included Physical health, Psychological health, Sexual health, Daily activity, Family, Social, Treatment, and Economics. A total of 280 menopausal women were recruited from four collaborative hospitals for psychometric validation. After factor analysis, 22 items remained with six dimensions identified, that is, well-being, emotionality, anxiety/fear, family, social and sexual health. Cronbach's coefficient α of each domain was between 0.61 and 0.83. CONCLUSION: The Thai MS-QoLS was systematically developed and validated for peri- or postmenopausal women. The initial assessment of the questionnaire showed an acceptable level of validity and reliability.

Nevirapine-associated toxicity in HIV-infected Thai men and women, including pregnant women.

OBJECTIVES: The aim of the study was to determine the incidence of, and risk factors for, nevirapine (NVP)-associated hepatotoxicity and rash in HIV-infected Thai men and women, including pregnant women, receiving NVP-containing highly active antiretroviral therapy (HAART). METHODS: NVP-containing HAART was prescribed to eligible men and women enrolled in the Prevention of Mother-To-Child Transmission of HIV (PMTCT) and MTCT-Plus programmes. All pregnant women received zidovudine (ZDV)/lamivudine (3TC)/NVP from >14 weeks of gestational age if their CD4 cell count was 28 weeks if their CD4 cell count was >200 cells/microL. Patients followed for at least 8 weeks after starting HAART or until delivery were included in the analyses. RESULTS: Of 409 patients, 244 were pregnant women, 87 were nonpregnant women and 78 were men. Hepatotoxicity occurred in 15.6% of all patients. Men had a significantly higher rate of asymptomatic hepatotoxicity (P=0.021). Pregnant women receiving HAART for PMTCT (92% had CD4 cell counts >250 cells/microL) had a significantly higher rate of symptomatic hepatotoxicity (P=0.0003) than pregnant women receiving HAART for therapy. Rash occurred in 16.1% of all patients. The patients' sex and baseline CD4 cell count were not associated with the risk of hepatotoxicity or rash. NVP was discontinued in 4.2% and 6.8% of patients because of hepatotoxicity and rash, respectively. CONCLUSIONS: The incidence of NVP-related hepatotoxicity and rash in Thai adults is similar to incidences reported for other populations. While larger studies are needed, our data support continued use of NVP-containing regimens as first-line treatment in developing countries for HIV-infected patients, including pregnant women. Pregnant women with high CD4 cell counts may experience higher rates of symptomatic hepatotoxicity and thus require careful clinical and laboratory monitoring.

Pneumococcal vaccination during pregnancy for preventing infant infection.

BACKGROUND: Each year at least one million children worldwide die of pneumococcal infections. The development of bacterial resistance to antimicrobials adds to the difficulty of treatment of diseases and emphasizes the need for a preventive approach. Newborn vaccination schedules could substantially reduce the impact of pneumococcal disease in immunized children, but does not have an effect on the morbidity and mortality of infants less than three months of age. Pneumococcal vaccination during pregnancy may be a way of preventing pneumococcal disease during the first months of life before the pneumococcal vaccine administered to the infant starts to produce protection. OBJECTIVES: To assess the effect of pneumococcal vaccination during pregnancy for preventing infant infection. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (June 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (January 1966 to June 2004), EMBASE (January 1985 to June 2004), and reference lists of articles. SELECTION CRITERIA: Randomized controlled trials in pregnant women comparing pneumococcal vaccine with placebo or doing nothing or with another vaccine to prevent infant infections. DATA COLLECTION AND ANALYSIS: Two authors independently assessed methodological quality and extracted data using a data collection form. Study authors were contacted for additional information. MAIN RESULTS: Three trials (280 participants) were included. There was no evidence that pneumococcal vaccination during pregnancy reduces the risk of neonatal infection (one trial, 149 pregnancies, relative risk (RR) 0.51; 95% confidence interval (CI) 0.18 to 1.41). Although the data suggest an effect in reducing pneumococcal colonisation in infants by 16 months of age (one trial, 56 pregnancies, RR 0.33; 95% CI 0.11 to 0.98), there was no evidence of this effect in infants at two months of age (RR 0.28; 95% CI 0.02 to 5.11) or by seven months of age (RR 0.32; 95% CI 0.08 to 1.29). AUTHORS' CONCLUSIONS: There is insufficient evidence to support whether pneumococcal vaccination during pregnancy could reduce infant infections.

Prophylactic oral betamimetics for reducing preterm birth in women with a twin pregnancy.

BACKGROUND: Twin pregnancies are associated with a high risk of neonatal mortality and morbidity due to an increased rate of preterm birth. Betamimetics can decrease contraction frequency or delay preterm birth in singleton pregnancies by 24 to 48 hours. The efficacy of oral betamimetics in women with a twin pregnancy is unproven. OBJECTIVES: To assess the effects of prophylactic oral betamimetics administered to women with twin pregnancies. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (May 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (January 1966 to May 2004), EMBASE (January 1985 to May 2004), and reference lists. SELECTION CRITERIA: Randomized controlled trials in twin pregnancies comparing oral betamimetics with placebo or any intervention with the specific aim of preventing preterm birth. DATA COLLECTION AND ANALYSIS: Standard methods of The Cochrane Collaboration and the Cochrane Pregnancy and Childbirth Group were used. Trials were independently assessed for methodological quality by at least two authors, who extracted data using a data collection form. MAIN RESULTS: Five trials (344 twin pregnancies) were included. All trials compared oral betamimetics to placebo. Betamimetics reduced the incidence of preterm labour (one trial, 50 twin pregnancies, relative risk (RR) 0.40; 95% confidence interval (CI) 0.19 to 0.86). However, betamimetics did not reduce preterm birth less than 37 weeks' gestation (four trials, 276 twin pregnancies, RR 0.85; 95% CI 0.65 to 1.10) or less than 34 weeks' gestation (one trial, 144 twin pregnancies, RR 0.47; 95% CI 0.15 to 1.50). Mean neonatal birthweight in the betamimetic group was significantly higher than in the placebo group (three trials, 478 neonates, weighted mean difference 111.2 grams; 95% CI 22.2 to 200.2). Nevertheless, there was no evidence of an effect of betamimetics in reduction of low birthweight (two trials, 366 neonates, RR 1.19; 95% CI 0.77 to 1.85) or small-for-gestational age neonates (two trials, 178 neonates, RR 0.92; 95% CI 0.52 to 1.65). Two trials (388 neonates) showed that betamimetics significantly reduced the incidence of respiratory distress syndrome but the difference was not significant when the analysis was adjusted for correlation of babies from twins. Three trials (452 neonates) showed no evidence of an effect of betamimetics in reducing neonatal mortality (RR 0.80; 95% CI 0.35 to 1.82). AUTHORS' CONCLUSIONS: There is insufficient evidence to support or refute the use of prophylactic oral betamimetics for preventing preterm birth in women with a twin pregnancy.

The international infections in pregnancy study: group B streptococcal colonization in pregnant women.

BACKGROUND: Heavy colonization with group B streptococcus (GBS) has been associated with increased risk of preterm birth and neonatal sepsis; the burden of neonatal GBS disease varies geographically. To determine whether variation in heavy colonization and GBS serotypes could contribute to geographic differences in disease burden, we assessed the prevalence of heavy colonization and the distribution of serotypes in asymptomatic pregnant women in multiple countries. METHODS: Cervical, lower vaginal and urine samples were collected from women attending seven prenatal clinics in six countries. Light colonization was defined as GBS isolation from Lim broth only; heavy colonization was isolation from urine or sheep blood agar plates. Isolates were serotyped using capillary precipitation. RESULTS: GBS was present in 11.3% of 1308 participants (range 7.1-21.7%); 5.0% were heavily colonized (0.4-18.8%) and 6.4% were lightly colonized (2.9-8.0%). Serotypes III and V were most common (both 17.2%). Serotypes VII and VIII were found in one study center. CONCLUSIONS: The prevalence of heavy colonization and GBS serotypes varied significantly among our study centers. Whether this variation could in part explain geographic differences in neonatal morbidity and mortality is a hypothesis that needs further study.

Birthweight-specific neonatal mortality in developing countries and obstetric practices.

OBJECTIVES: To evaluate birthweight-specific neonatal mortality and perinatal interventions in major medical centers in developed and developing countries. METHODS: A survey was developed and electronically mailed to 13 medical centers participating in the Global Network for Perinatal and Reproductive Health (GNPRH). The ability of a center to provide requested data was assessed. The mortality rates and use of specific perinatal interventions in centers in developing countries were compared with developed countries. RESULTS: Nine centers in developing countries responded to the survey, and three centers in developed countries were used for comparison. Data collection was highly variable. Most developing country centers were able to provide data by birthweight but not by gestational age. The differences in mortality rates between developing and developed countries were more pronounced at lower gestational ages and birthweights. A difference was found in perinatal interventions between developing and developed countries. In the former, viability was generally considered 28 weeks, and the gestational age at which cesarean sections were usually performed for the sake of the fetus at preterm gestations varied from 26 to 37 weeks. Most centers did not routinely induce for pPROM; only five out of nine centers used antibiotics to prolong latency. Most centers used tocolysis beginning at 26-28 weeks through 32-37 weeks, and a variety of tocolytic agents were used. Most centers routinely used corticosteroids for preterm infants, and all centers employed repeat weekly steroid dosing if undelivered. CONCLUSIONS: Despite the fact that the GNPRH centers included in this study represent some of the best health care available in these countries, they lag far behind centers in developed countries in neonatal mortality rates and their use of various obstetric practices. Furthermore, incomplete and inconsistent data collection complicates the evaluation of the factors contributing to high neonatal mortality rates.

Pharmacokinetics of stavudine and didanosine coadministered with nelfinavir in human immunodeficiency virus-exposed neonates.

We evaluated the pharmacokinetics of stavudine (d4T) and didanosine (ddI) in neonates. Eight neonates born to human immunodeficiency virus-infected mothers were enrolled to receive 1 mg of d4T per kg of body weight twice daily and 100 mg of ddI per m(2) once daily in combination with nelfinavir for 4 weeks after birth. Pharmacokinetic evaluations were performed at 14 and 28 days of age. For d4T, on days 14 and 28, the median areas under the concentration-time curves from 0 to 12 h (AUC(0-12)s) were 1,866 and 1,603, ng x h/ml, respectively, and the median peak concentrations (C(max)s) were 463 and 507 ng/ml, respectively. For ddI, on days 14 and 28, the median AUC(0-10)s were 1,573 and 1,562 h x ng/ml, respectively, and the median C(max)s were 627 and 687 ng/ml, respectively. Systemic levels of exposure to d4T were comparable to those seen in children, suggesting that the pediatric dose of 1 mg/kg twice daily is appropriate for neonates at 2 to 4 weeks of age. Levels of exposure to ddI were modestly higher than those seen in children. Whether this observation warrants a reduction of the ddI dose in neonates is unclear.

Short course zidovudine maternal treatment in HIV-1 vertical transmission: randomized controlled multicenter trial.

A multicenter randomized, double blind, placebo-controlled clinical trial was conducted to evaluate the effectiveness of a short course of oral zidovudine (ZDV) treatment in HIV-1 infected pregnant women, starting at 38 weeks of gestation plus ZDV infusion during labor until delivery, to reduce HIV-1 vertical transmission in non-breast fed infants. One hundred and eighty two asymptomatic antiretroviral naïve HIV-1 infected pregnant women were enrolled. Each patient was randomly allocated into either the ZDV or placebo group. The ZDV group received 250 mg ZDV orally twice a day initiated at 38 weeks' gestation until the onset of labor. During the intrapartum period, ZDV infusion at the rate of 2 mg/kg was administered within the first hour and then continuously infused at the rate of 1 mg/kg/h until delivery. The placebo group received an identical capsule during pregnancy and normal saline infusion during labor until delivery. HIV-1 transmission was documented by nested polymerase chain reaction in infants at birth and at 1, 3 and, 6 months of age. The estimated HIV-1 vertical transmission rate was 14.9 per cent (95% CI = 11.1 to 18.7) and 16.3 per cent (95% CI = 12.3 to 20.9) in ZDV and placebo group, respectively (p > 0.05). The short course ZDV in antiretroviral naïve pregnant women initiated at 38 weeks' gestation plus intrapartum ZDV infusion without treatment in the infants was not effective to prevent HIV-1 vertical transmission.

Serum human chorionic gonadotropin regression pattern in persistent trophoblastic disease during chemotherapy.

The objective of this study was to identify the regression pattern of serum beta-hCG in persistent trophoblastic disease patients after initiating chemotherapy. Eighty-nine women who were diagnosed as persistent trophoblastic disease in King Chulalongkorn Memorial Hospital between January 1985 and December 1998, and received single agent chemotherapy were included. The incidence was 20.2 per cent of total gestational trophoblastic disease patients. Seventy-two (80.9%) from 89 patients were recruited in our study. Sixty-four (88.9%) patients responded to first-line chemotherapy and 8 patients (11.1%) resisted. Suction curettage was done as initial treatment in 61 (84.7%) cases. Most of them (95.8%) received actinomycin-D as first line treatment. Total courses of chemotherapy averaged 4 courses, but increased to 8.5 courses in the resistant group. Mean time of serum beta-hCG to remission was 16.7 and 21.5 weeks in the chemo-sensitive and chemo-resistant group, respectively. Average time to start chemotherapy was in the tenth week, and in the resistant group it was started in the sixth week. Chemotherapy regimen was changed in the fifteenth week. Initial serum beta-hCG levels were not significantly different between the two groups. The reduction rates of beta-hCG were significantly different from the third to the seventh week in the chemo-sensitive and chemo-resistant groups, which was during the second and third course of chemotherapy (P<0.05). In conclusion, by using the reduction rate, the regression pattern of serum beta-hCG level in persistent trophoblastic disease patients was significantly different between the chemosensitive and chemoresistant group from the third to the seventh week after starting chemotherapy.

The role of maternal serum C-reactive protein and white blood cell count in the prediction of chorioamnionitis in women with premature rupture of membranes.

This study was performed to evaluate the diagnostic performance of maternal serum C-reactive protein, maternal white blood cell (WBC), and neutrophil counts in the detection of histologic chorioamnionitis. One hundred and twenty six pregnant women after at least 28 weeks of gestation with premature rupture of membranes (PROM) were studied. Blood samples for C-reactive protein, WBC and neutrophil counts were taken at delivery. Placental histology was evaluated for histologic chorioamnionitis. Maternal and neonatal complications were observed. Among women with and without histologic chorioamnionitis, the maternal WBC and neutrophil counts were different (P<0.05) but the maternal serum C-reactive protein was not. Cutoff values for C-reactive protein, WBC, and neutrophil counts were 0.5 mg/dL, 15,000 cell/mm3, and 80 per cent, respectively. Sensitivity and specificity were 56 per cent and 58 per cent for C-reactive protein, 60 per cent and 63 per cent for WBC count, and 62 per cent and 54 per cent for neutrophil count, respectively. In conclusion, the maternal serum C-reactive protein, WBC, and neutrophil counts have poor diagnostic performance for histologic chorioamnionitis.

Intrapartum zidovudine infusion alone failed to reduce both maternal HIV-1 viral load and HIV-1 infection in infant.

A pilot clinical trial to assess the efficacy of intrapartum zidovudine (ZDV) infusion alone in the reduction of maternal viral load and its potential role in preventing vertical transmission of HIV-1. Twenty six, asymptomatic antiretroviral naïve HIV-1 infected pregnant women who had no prior antenatal care and were in labor were enrolled. Each patient received ZDV infusion at the rate of 2 mg/kg within the first hour. ZDV was then continuously infused at 1 mg/kg/h until delivery. Maternal plasma HIV-1 RNA prior to the commencement of ZDV infusion and within an hour after delivery were measured. HIV-1 transmission was documented by nested polymerase chain reaction in infants at six months of age. Median maternal plasma HIV-1 RNA prior to the ZDV infusion and after delivery was 29,401 and 32,555 copies/ml respectively, (p>0.05). The estimated HIV-1 transmission rate was 19.2 per cent (95% CI = 4-34). This result suggested that in asymptomatic HIV-1 infected pregnant women who were antiretroviral naïve and had no prior antenatal care, intrapartum ZDV infusion alone failed to reduce maternal HIV-1 viremia and the transmission rate of HIV-1.

Pregnancy in amniotic band scarred woman.

Amniotic band syndrome is an uncommon syndrome. The incidence is 1:1,200-1:15,000 live births. This syndrome is variable malformation. Amniotic band scar of the abdomen seen in adulthood is rare. We managed a case of a 23 year-old pregnant woman who had suspected amniotic band scar of the abdomen since birth. The uterus could expand until term pregnancy despite no intervention. The healthy female baby was delivered by cesarean section because of obstetric indication. Both mother and baby were in good condition. She and her baby were well at six weeks follow-up. We know of no other reported case of maternal abdominal amniotic band scar who could continue pregnancy until term with good outcome.

An international survey of practice variation in the use of antibiotic prophylaxis in cesarean section.

OBJECTIVE: To examine the use of antibiotic prophylaxis in cesarean section in different countries and in relation to a reference regimen. METHOD: Fifty consecutive cesarean sections performed in eight centers in five countries were surveyed. Data from each center were compared to a regimen recommended by the Cochrane Collaboration (one dose of ampicillin or cefazolin administered to all women shortly before the procedure or immediately after cord clamping) using logistic regression with adjustment for procedure type. RESULT: Prophylaxis was used widely, but only four centers administered prophylaxis to all women. Ampicillin and cefazolin were the principal antibiotics used, but broad-spectrum agents and multidrug regimens were also used commonly. Only two centers reliably administered the antibiotic at the appropriate time. The majority of women received only one dose of antibiotic in only three centers. CONCLUSION: The use of antibiotic prophylaxis in cesarean section was variable and often at odds with published recommendations.

Prophylactic actinomycin D for high-risk complete hydatidiform mole.

OBJECTIVE: To evaluate the effectiveness of one course of prophylactic actinomycin D in reducing the malignant sequelae requiring chemotherapy in high-risk complete hydatidiform mole (CHM). STUDY DESIGN: A double-blind, randomized, controlled clinical trial was carried out at King Chulalongkorn Memorial Hospital. Sixty cases of CHM classified as high risk were recruited and randomly allocated to a chemoprophylactic or control group. Within one week after evacuation of molar tissues, actinomycin D was administered in the chemoprophylactic group. Patients in the control group were given only intravenous fluid and analgesic drugs. The number of patients with malignant sequelae who required therapeutic chemotherapy after evacuation of hydatidiform mole in each group was recorded. RESULTS: The incidence of malignant sequelae was 13.8% (95% confidence interval [CI] = 3.9-31.7%) in the chemoprophylactic group and 50.0% (95% CI = 31.3-68.7%) in the control group. The risk reduction of malignant sequelae with one course of actinomycin D chemoprophylaxis in high-risk CHM was 72.4% (95% CI = 26.7-89.6%) (P = .005). The side effects of prophylactic chemotherapy were stomatitis, nausea/vomiting, sore throat with oral ulcer and hair loss. CONCLUSION: One course of actinomycin D given as chemoprophylaxis decreased by 72.4% malignant sequelae after evacuation of molar tissue in patients with high-risk CHM. This may be particularly beneficial in patients with high-risk CHM who cannot be followed closely, whose compliance is in question and for whom hormonal follow-up is not available or unreliable.

Intrapartum and neonatal zidovudine treatment in reduction of perinatal HIV-1 transmission in Bangkok.

OBJECTIVE: To evaluate the efficacy of zidovudine (ZDV) administered during labor and to the infants in the first 6 weeks of life in reduction of perinatal HIV-1 transmission. DESIGN: Open label clinical trial. SITE: King Chulalongkorn Memorial Hospital, Bangkok, Thailand. MATERIAL AND METHOD: One hundred asymptomatic, antiretroviral naive HIV-1 infected pregnant women who had either late or no prenatal care were recruited from the obstetric service of King Chulalongkorn Memorial Hospital, Bangkok, Thailand. They were given ZDV 300 mg orally every 3 hours during the intrapartum period until delivery. ZDV syrup 2 mg/kg orally every 6 hours were given to the infants immediately after birth for 6 weeks. Breast feeding was not allowed. Infant's blood for HIV-1 PCR test was obtained at age 1 day, and 1, 3 and 6 months. HIV-antibody test was determined at age 18 months. Infants with at least one positive HIV-1 PCR test performed at or after 1 month of age or positive HIV-antibody test at age 18 months were classified as HIV-1 infected infants. RESULTS: There were 100 healthy infants delivered without complication. Fourteen infants were excluded due to; 13 lost to follow-up and 1 drug intolerance. Of the remaining 86 infants who were followed-up, 27 infants (31.4%) did not receive intrapartum ZDV treatment and 9 infants were HIV-1 infected. The perinatal transmission rate was 10.5 per cent, (95% CI 3.9, 17.1). CONCLUSION: The result of this study suggests that intrapartum oral ZDV treatment in asymptomatic HIV-1 infected mothers together with ZDV treatment in the neonates for 6 weeks can reduce the rate of perinatal HIV-1 transmission. This regimen may be an alternative treatment for prevention of HIV-1 infection in infants born to HIV-1 seropositive mothers who have had either late or no prenatal care.

Spinal cord compression: a rareness in pregnant thalassemic woman.

Thalassemia is a common hematological disease in Southeast Asia. Extramedullary hematopoiesis is common sequelae in thalassemic patients but extramedullary hematopoiesis in the spinal epidural space that leads to paraparesis in pregnancy is very rare. We managed a thalassemic patient with extramedullary hematopoiesis and spinal cord compression during pregnancy. The diagnosis was made on clinical features and magnetic resonance imaging (MRI) showing a paravertebral mass infiltrating the epidural space. She was treated successfully with repeated blood transfusions until delivery. Fetal growth restriction was found but otherwise the fetus was clinically normal. She had an uneventful recovery when she was seen 6 weeks after delivery.

Telomerase activity in complete hydatidiform mole.

OBJECTIVE: To investigate whether telomerase is activated in complete hydatidiform mole and whether it could predict the development of persistent gestational trophoblastic tumors (GTTs). STUDY DESIGN: For this prospective study, 21 patients with complete hydatidiform mole were recruited. Molar tissue was obtained for telomerase activity measurement using the telomeric repeat amplification protocol assay. Patients' clinical characteristics, telomerase activity and subsequent clinical outcome were analyzed. RESULTS: Telomerase activity was detected in 12 cases (57.1%) with varied intensity. Two of four patients who had telomerase activity, uterine size larger than expected and preevacuation serum beta-human chorionic gonadotropin (beta-hCG) levels > 10(6) mIU/mL developed persistent GTT. CONCLUSION: Telomerase activity is detectable in some complete hydatidiform moles and might be useful for predicting persistent GTT when combined with uterine size and preevacuation serum beta-hCG level.

Maternal risk factors for low birth weight newborn in Thailand.

The present study assesses the risk approach for maternal risk factors for LBW newborn in Thailand. This study can be considered as a managerial tool for developing local strategies and is particularly useful in the field of maternal and child health care. A summary of maternal risk factors for LBW newborn as listed in Table 7 and can be used as a health educational tool for pregnant women and as basic data for marital counseling. It can also be used to keep the public informed about the maternal risk factors for LBW newborn which will help Thai women of reproductive age avoid the chance of having such babies.

PIP: This multi-center, unmatched, case-control study was conducted at all the 5 maternal-child health care centers in Thailand by administering questionnaires by trained interviewers. Additionally, Chulalongkorn Hospital Medical School and the Maharaj Hospital were also included. The entire sample of 2000 cases were recruited from all pregnant women who delivered a low birth weight (LBW) newborn weighing 2500 gm. 4095 controls were selected from pregnant women in the same hospitals who delivered neonates weighing 2500-4000 gm. Among biological factors influencing LBW, small maternal stature and weight ( 45 kg) was highly associated with LBW neonates (113 cases and 50 controls, relative risk [RR] = 7.15). Maternal age of less than 18 years and 35 years and over ranked 2nd for relative risk (390 cases and 499 controls, RR = 1.75). The other risk factors were parity of 1 or greater than 4 (1379 cases and 2396 controls, RR = 1.68), Quetelet's index of less than 20 (1696 cases and 3259 controls, RR = 1.37). These were all statistically significant risk factors. An accident during the 2nd trimester (RR = 1.34) was also a risk factor. The maternal psychosocial risk factors for LBW newborns were: low family income (RR = 1.75), education ( 4 years of formal education, RR = 1.35), hard work such as agricultural labor (RR = 1.46), and the need to travel (RR = 1.50) or to walk more than 2 hours to the work place (RR = 1.29). Paternal status of being a laborer, an agricultural worker, unemployed (RR = 1.39), or under 19 years old (RR = 1.74) were also risk factors. Pregnancy weight gain of 10 kg had the highest degree of association with having an LBW newborn (RR = 2.21). Other risk factors were: decreased food intake during pregnancy, maternal hematocrit count below 30%, and interpregnancy interval of less than 12 months. Maternal obstetrical risk factors for LBW included: vaginal bleeding during early pregnancy (RR = 3.28), maternal hypertension (RR = 3.48), convulsion during pregnancy (RR = 3.29), no prenatal care or less than 4 visits, maternal drug addiction (RR = 5.13), cigarette smoking (RR = 2.04), coffee or tea drinking during pregnancy, and repeated induced abortions (RR = 2.16).

Decreased suppressor T-lymphocytes in women who received progestogen injections.

Decreased levels of suppressor T-cells (CD8+) were found in 17 normal women who received progestogen (Depoprovera) injection, 150 mg intramuscularly every three months for contraceptive purposes, for more than 30 months. The helper: suppressor T-cells (CD4+ : CD8+ ratio) was significantly elevated in this group compared to 30 normal female controls. No significant change of T-lymphocyte was found in 53 normal women who received the injection for less than 30 months or who received combined oral contraceptive pills. In conclusion, long term progestogen injection induced a lowering of suppressor T-cell levels, which is the same immunological change found in several autoimmune diseases.

Prevalence of Chlamydia trachomatis among women attending an antenatal clinic in Bangkok.

Cervical swabs from 140 Thai pregnant women were cultured for Chlamydia trachomatis twice during the first and the third trimester. Serum samples for antichlamydial antibodies was also studied from 126 women; 12 of women were culture positive on both occasions. Chlamydia was isolated from 24% of women aged 20-24 years, compared to only 9% of women 25-30 years. Antibody were detected to the genital serotypes (D-K) in 31 (25%) of 126 women who were tested. 70% of women who were culture positive had antibody titer greater than or equal to 1:64 compared to 7% of women who were culture negative.