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Biomedical subjects

L Svanberg

Publications and source records attributed to L Svanberg.

At least 19 recordsLinked to original sources

Thyroid antibodies are not a risk factor for pregnancies with Down syndrome.

The observation that thyroid disease is frequent in mothers of children with Down syndrome (DS) has suggested that maternal thyroid antibodies could be a factor predisposing to trisomy 21 in their offspring. In this study, the incidences of thyroglobulin (Tg) and thyroid peroxidase (TPO) antibodies were analysed with a sensitive solid-phase immunosorbent radioassay in sera from 29 mothers giving birth to children with trisomy 21 and 87 control mothers. The serum samples were collected at delivery. There was no statistical difference regarding the proportion of thyroid antibodies (against Tg and/or TPO) in the two groups. Thyroid antibodies were detected in 6/29 (20.7 per cent) of the DS mothers and in 23/87 (26.4 per cent) of the control mothers. Among the women with thyroid antibodies, 4/6 (66.7 per cent) of the DS mothers and 12/23 (52 per cent) of the control mothers had antibodies against both Tg and TPO. There was no increase in the relative risk of having a child with DS if the titre of either Tg or TPO antibodies or both were positive, i.e. > or = 1/5. The results indicate that the presence of thyroid antibodies in the serum of a pregnant women has no prognostic value for the birth of an infant with DS.

Adult

Indications that maternal coxsackie B virus infection during pregnancy is a risk factor for childhood-onset IDDM.

In a population-based setting, we traced serum samples collected at time of birth from 55 mothers whose children later developed insulin-dependent diabetes (IDDM) and matched them pairwise to control subjects who gave birth at the same hospital during the same month. The sera were analysed for IgM antibodies to coxsackie B virus serotypes 2, 3 and 4 (CBV-2, 3 and 4) using a type-specific mu-antibody-capture radioimmunoassay. Despite a decreased power due to the close matching by time of birth we found a significantly higher frequency of CBV-3 IgM at delivery in mothers whose children later became diabetic compared to their matched control subjects. When using the presence of CBV-3 IgM as a risk factor the Mantel-Haenszel odds ratio estimate (95% confidence limits) was 2.57 (1.02; 7.31), p = 0.043. For CBV-2 and CBV-4, respectively no significant difference was found between mothers of patients and control subjects. According to the odds ratio estimate for CBV-3 and the proportion of exposed mothers among patients estimated in this study the aetiological fraction for this risk determinant would be 27%. In conclusion, this study indicates that children of mothers who expressed CBV IgM at delivery are at increased risk for developing childhood onset IDDM. A fetal infection with CBV similar to rubella virus may initiate autoimmunity or cause persistent infection that may lead to progressive beta-cell destruction.

Adolescent

A longitudinal study of the perimenopausal transition: altered profiles of steroid and pituitary hormones, SHBG and bone mineral density.

From a longitudinal prospective study, 160 women with spontaneous menopause and without steroid medication were followed during the transition from pre- to postmenopause. After 12 years 152 women were still participating in the study. Blood samples were drawn every 6 months until 1 year after the menopause and every 12 months thereafter. Measurements of bone mineral density (BMD) on the forearm were performed every second year. All women routinely completed a questionnaire concerning symptoms frequently attributed to the climacteric period. All data were grouped around the onset of the menopause, thereby allowing longitudinal evaluation of the changes in the variables from the premenopausal to the postmenopausal period. The beginning of the perimenopausal period was characterized by transitory elevations of follicle-stimulating hormone (FSH). A significant increase in serum levels of gonadotropins was observed for both FSH and luteinizing hormone (LH) from about 5 years before the menopause. Within the 6 month period around the menopause there was a further increase which culminated within the first postmenopausal year for LH and 2-3 years postmenopause for FSH. Thereafter, a continuous decrease in LH occurred over the following 8 years. With respect to FSH, there was a slight decline starting about 4 years postmenopause. During the premenopausal period an increasing frequency of inadequate luteal function or anovulation occurred and, in the postmenopausal years, the serum levels of progesterone (P) were invariably low. Gradually, the ratio between estrone (E1) and 17-beta-estradiol (E2) increased, reflecting the declining follicular steroidogenesis. A marked decrease in estrogen levels occurred during the 6 month period around the menopause, most pronounced in E2. During the next 3 years, the levels of E2 and E1 showed an essentially parallel, moderate decline. Around the menopause, serum levels of testosterone (T), delta 4-androstenedione (A) and sex hormone-binding globulin (SHBG) showed small but significant decreases. From about 3 years postmenopause, the levels were relatively constant over the following 5 years. A decrease in BMD was observed in the postmenopause, and from about 3 years postmenopause, estradiol correlated positively with BMD. Before, as well as after the menopause, body mass index (BMI) showed an inverse correlation with SHBG. Postmenopausal androstenedione correlated positively with E1, E2 and T. BMI correlated positively with E1 and E2. The concentrations of the free fraction of E2 and T are dependent on the levels of SHBG, which in turn has a negative correlation with BMI. The impact of this will influence the severity of symptoms, the degree of bone loss and the need for supplementary therapy.

Androstenedione

The prevalence of type 1 diabetes mellitus at follow-up of Swedish infants congenitally infected with cytomegalovirus.

In a Swedish prospective study of congenital cytomegalovirus (CMV) infection, 76 infants were shown to be infected among 16,474 newborns screened by virus isolation in urine. Seventy-three of the excreters were followed up and one developed Type 1 diabetes, as compared to 38 of the 19,483 children born during the same period (p = 0.14, Fisher's one-tailed test). Thus we found no evidence that the combined finding of congenital CMV infection and Type 1 diabetes mellitus was related.

Autoantibodies

Endonuclease cleavage pattern of cytomegalovirus DNA of strains isolated from congenitally infected infants with neurologic sequelae.

A prospective study of congenital cytomegalovirus infection in Malmö, Sweden, was performed from 1977 through 1985. The diagnosis was based on isolation of cytomegalovirus soon after birth. Congenital cytomegalovirus infection was identified in 76 infants, and as of September 1986 CNS symptoms have been experienced by nine of them. In at least seven of these infants, the disturbances can be referred to the cytomegalovirus infection. The strains from eight of the nine infants have been further studied by restriction endonuclease analysis of cytomegalovirus DNA. The cleavage patterns obtained with BamHI, EcoRI, and HindIII showed a unique pattern for each one of the eight strains. No common pattern could be associated with these eight strains in comparison with strains from postnatally infected children.

Child

Single dose bromocriptine microcapsules in postpartum lactation inhibition.

The clinical efficacy and safety of a single intramuscular injection of Parlodel LA, Pravidel 50 mg, were studied in the prevention of lactation in 10 postpartum women. The overall efficacy at the end of the 28 day observation period was very good in 8 postpartum women and good in 2 women and no rebound lactation occurred. The prolactin plasma levels decreased to normal levels within 4 days in 9 women. Menstrual bleeding occurred in 9 women 4 to 6 weeks after treatment. Laboratory data recorded in this study support that Pravidel is effective in suppressing postpartum lactation.

Adult

A prospective long-term study in women from pre-menopause to post-menopause: changing profiles of gonadotrophins, oestrogens and androgens.

To permit a more detailed hormonal characterization of the peri-menopause, 30 healthy women were examined at regular intervals over a 7-yr period, starting about 3 yr before the menopause. Even though most of the subjects periodically experienced climacteric symptoms, no hormonal supplementation was given. The serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), oestradiol and oestrone that were recorded essentially confirmed previous data obtained in cross-sectional studies. Within the 6-mth period around the menopause the serum levels of testosterone and androstenedione showed small but significant decreases of 18 and 16%, respectively. These decreases continued over the following years and amounted to about 30% after 3 yr. In contrast, neither the mean level of dehydroepiandrosterone (DHA) nor the DHA/DHA sulphate (DHAS) ratio changed significantly at the menopause, but DHA and DHAS concentrations declined slowly by about 20% over the 7-yr observation period. The mean level of DHAS showed an isolated increase during the last few months before the menopause. A similar, although not significant, increase was also seen in DHA and testosterone levels. After the first post-menopausal year a significant positive correlation was found between the levels of oestrone and androstenedione. This longitudinal study of individual women appeared to lend itself well to the investigation of even subtle hormonal fluctuations during the gradual transition to an established post-menopausal pattern.

Androstenedione

A prospective study of rotavirus infections in neonatal and maternity wards.

The occurrence and symptomatology of rotavirus infections was studied at three maternity wards and one neonatal unit. Rotavirus was identified in 12.7% of 553 infants and 1.3% of 542 mothers at the maternity wards. Infections were more frequent in a mixed obstetric/gynecology ward than in the pure obstetric wards. Only 10% of the infants had symptomatic infections. Subgroups of rotavirus was determined in 41 infants: 22 of subgroup I and 19 of subgroup II, which is the subgroup accounting for the majority of childhood gastroenteritis. Rotavirus was found in faecal samples from 37% of the infants at the neonatal unit during an eight-month survey. A seasonal variation with most infections during colder months was seen. Subgroup determination was possible in 29 cases, 14 subgroup I and 15 subgroup II. Fifteen per cent of the infections demonstrated diarrheal symptoms. No significant difference among other clinical data registered was seen among rotavirus infected compared to the non-infected infants. We conclude that neonatal rotavirus infections occur as an endemic infection at our maternity wards possibly combined with infections due to external sources of virus in mixed wards and neonatal units.

Adult

Neonatal chlamydial conjunctivitis.

Maternal chlamydial antibodies were determined in cord sera of 41 infants who developed neonatal chlamydial conjunctivitis and compared with the antibody profile of infants who had been exposed to Chlamydia trachomatis at birth by their isolation positive mothers but in whom conjunctivitis did not develop. No protective effect could be attributed to maternal antibodies transferred to the infants. Paired sera samples were collected from 18 infants with chlamydial conjunctivitis. Chlamydial IgM antibodies were detected in four of these 18 cases at the time diagnosis was established by isolation. An additional eight cases had developed chlamydial IgM at the time the convalescent sera samples were taken, on average on day 40. At that time symptoms had disappeared after systemic treatment had been given. Thus chlamydial IgM antibodies were eventually shown in two thirds of infants with chlamydial conjunctivitis who were all systemically treated and clinically healed. These data suggest a cautious assessment of chlamydial IgM in the diagnosis of chlamydial pneumonia.

Adult

On resorption and the effects of vaginally administered terbutaline in women with premature labor.

In a randomized, single-blind study, of a pilot nature, the administration of terbutaline sulphate was found to cause significant inhibition of contractions in premature labor. This effect became evident within 30 min when the dosage was 0.1 mg in 1 ml cellulose gel, applied vaginally, and within 2 h when released from a 5-g medicated vaginal polymer ring containing 10% terbutaline sulphate. No generalized effects of the terbutaline were noted (such as increased blood pressure or tachycardia) and the level of terbutaline in peripheral venous blood remained low. Vaginally administered terbutaline can obviously be quickly resorbed, giving a localized effect. Thus applied, terbutaline would appear to offer a number of advantages as regards treatment procedure.

Adult

Determination and characterization of immunoreactive trypsin in amniotic fluid from normal and cystic fibrosis fetuses.

High concentrations of immunoreactive trypsin (IRT) in the blood, and low concentrations of trypsin activity in fecal specimens have been found in newborn infants with cystic fibrosis (CF). The amniotic fluid concentrations of IRT and of IRT in complex with alpha 1-antitrypsin (alpha 1AT) were studied in 39 samples taken in about the 17th gestational week, and in 7 samples taken because the mothers had previously given birth to children with CF. The midtrimester samples contained trypsin in complex with alpha 1AT in a concentration of 30-200 micrograms/liter, and small amounts of trypsinogen, 0-50 micrograms/liter. Three of four amniotic fluid samples from CF fetuses had very low concentrations of trypsin in complex with alpha 1AT (less than 10 micrograms/liter), and only small amounts of trypsinogen (less than 10 micrograms/liter). Further prospective studies are needed to ascertain whether the determination of IRT in amniotic fluid may be of use in prenatal diagnosis of CF.

Amniocentesis

Congenital cytomegalovirus infection and disease in Sweden and the relative importance of primary and secondary maternal infections. Preliminary findings from a prospective study.

In a prospective Swedish study started in 1977 and still in progress 10 328 newborn infants in an urban district were investigated for cytomegalovirus (CMV) excretion in the urine by the virus isolation test. Congenital infection was found in 50 cases (0.5%). Of 47 infected infants with known clinical status at birth 9 (19%) had hepatomegaly, splenomegaly, jaundice and/or petechiae. The symptoms were moderate or mild. Of the infants followed up, 2 (25%) of 8 neonatally symptomatic ones and 3 (9%) of 35 asymptomatic ones developed neurologic sequelae. Altogether 5 (12%) of 43 had permanent neurologic symptoms corresponding to 0.06% in the general population. The children ranged in age from 6 months to 4 yr at the last examination. 21 mothers of the 47 infants with known status at birth had a confirmed or presumed primary infection, 15 a confirmed or presumed secondary infection and 11 an undetermined type of infection. Of the 5 infants with neurologic sequelae, 1 with a grave psychomotor retardation and deafness was born to a mother with a primary infection in the 1st trimester; 1 infant with a moderate retardation and 3 deaf infants were all exposed to confirmed or presumed secondary maternal infections. Prospective serological studies of maternal sera in early pregnancy would have suspected only the gravely retarded infant to be at risk.

Child, Preschool

Hygiene for the newborn--to bath or to wash?

Appropriate skin care of newborns is performed partly to prevent infection but also for aesthetic and cleansing purposes. Skin care should involve cleansing with a non-toxic, non-abrasive neutral material. This study compared the relative risks and benefits of washing versus bathing with regard to bacterial colonization rate, clinical infection rate, body temperature and crying. The results confirm our clinical impression that bathing and washing routines do not differ with regard to signs of infection or other clinical complications. However, the washing routine does increase the babies heat loss and make them less comfortable.

Bacterial Infections

Neonatal chlamydial eye infection: an epidemiological and clinical study.

Neonatal chlamydial eye infection was detected in 39 cases of 281 infants with purulent conjunctivitis seen at the Department of Ophthalmology. Most cases of neonatal chlamydial eye infection (90%) were detected during the first month of life, and no case was found after 2 months of age. C. trachomatis was not isolated from any of 161 healthy control infants at 3-4 weeks of age. Genital chlamydial infection was demonstrated in 50% of the mothers to infected infants. Two of these women developed post-partum complications possibly due to chlamydial infection. Mothers of infected infants tended to be younger than average. Of 23 cases examined 2 years later, late sequelae were identified in 3.

Adolescent

Teenage deliveries in a Swedish population in the 1970's.

The investigated material consists of all teenage deliveries in the city of Malmö, Sweden, during the 1970's. For the years of 1972 and 1976, before and after the new abortion act in Sweden, a more detailed study of the pregnancy and delivery has been performed. The study shows that the frequency of adolescent deliveries decreases by about 30% during the 1970's. However, the teenage proportion of the total number of pregnancies remains still unchanged. The investigation also confirms that there is an increased incidence of preterm delivery and low birth weight babies in teenagers, but in other respects there is no increased risk to mother or child in teenage pregnancy. 82% of the teenage mothers were primigravidae and during the first year after delivery, 10.5% of the teenagers fell pregnant again. This is higher than that in a contemporary abortion material, where the corresponding figure is 6.5%.

Abortion, Induced

Legal teenage abortions in a Swedish population in the 1970s.

The number of teenage abortions increased sharply in the early 1970s but gradually decreased from 1975, in absolute numbers as well as in relation to population figures. Teenage abortions now constitute 15% of the total number of abortions. However, the percentage of teenage pregnancies that are terminated by legal abortion is constantly increasing. As the preservation of childbearing function is of paramount importance in teenagers, a low complication rate is essential. Complications occurred in 7% of the cases studies, and the effects of complications of legal abortion on the later obstetric history are discussed. In 14% of the cases a second pregnancy was also terminated artificially. The repeat abortion rate is discussed, with special reference to the contraceptive method used.

Abortion, Induced