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Skeletal changes in multiparous, nulliparous and ovariectomized mice fed either a nutrient-sufficient or -deficient diet containing cadmium.

As a simulation of the etiological factors known for Itai-Itai disease, a syndrome characterized by osteomalacia and renal dysfunction in its Japanese victims, female mice were subjected to the individual and combined stresses of dietary cadmium, nutrient-deficient diet, multiparity and ovariectomy; the calcium-depleting effect of each factor was evaluated by determining Ca levels in femur and lumbar vertebrae. At age 68 days, female mice were given nutrient-sufficient (+) or -deficient (-), purified diets containing either 0.25 (environmental), 5, or 50 ppm Cd as CdCl2; the nutritional composition of (-) diet simulated that of food consumed by Japanese victims of Itai-Itai disease. At age 70 days, half of the females began a breeding regimen of six consecutive, 42-day rounds of pregnancy/lactation (PL mice); the remainder were maintained as virgin, non-pregnant controls (NP mice). Limited numbers of PL and NP mice were sacrificed at the end of each reproductive round. PL(+) mice taken at the end of round (R)-6 had successively borne litters in all six rounds, while PL(-) counterparts had nonsuccessively borne only three. At the conclusion of the 252-day reproductive period, remaining females entered the 392-day, post-reproductive phase of the experiment. At age 546 days (mid-R-12), PL females having successfully borne at least three litters were ovariectomized (OV) to mimic human menopause; at the same time, NP females were either ovariectomized or sham-operated (SO). After surgery, all females were maintained to age 714 days (mid-R-16), then sacrificed. During the post-reproductive period, food consumption by females of the same reproductive status was unaffected by elevated levels of Cd or nutrient-deficiencies in diet. However by R-16, Cd at 50 vs. 0.25 ppm had reduced body mass by 11% in both NP and PLOV females, femur and lumbar vertebral calcium content (TCa) by 20 and 25% in the respective groups, and femur and vertebral calcium/dry weight ratios (Ca/DW) by 12 and 11%. Alternative R-16 comparisons indicated that (-) diet also diminished skeletal Ca, but that the additional factors of (prior) multiparity and ovariectomy generated only small and non-significant effects. Comparison of skeletal status between the ends of the reproductive and post-reproductive periods indicated that (1) individual NP groups, regardless of Cd exposure, generally sustained small decreases in TCa and CaDW over time (consistent with aging), but PL groups without exception secured significant gains (consistent with cessation of multiparous activity), (2) skeletal integrity of PL groups was significantly more compromised by the combination of Itai etiological factors at the end of R-6 than R-16, and (3) among those factors, the most demineralizing over lifetime were chronic exposure to Cd followed by ingestion of (-) diet. Despite these findings, skeletal degeneration characteristic of the Itai-Itai syndrome was ultimately not duplicated in this mouse model suggesting that the full-blown disease required primary and profound skeletal demineralization secondarily supported and enhanced by renal dysfunction.

Animals↗

Risk factors for preeclampsia in multiparous women: primipaternity versus the birth interval hypothesis.

INTRODUCTION: To determine whether the risk of preeclampsia in multiparous women with a previous normal pregnancy is related to changing paternity or to prolonged birth interval, a retrospective study was conducted at the Lyell McEwin Health Service (University of Adelaide). METHODS: The study included all multiparous women known to the hospital because of their preceding 1st delivery in the same hospital followed by their 2nd and/or 3rd ongoing pregnancy resulting in a delivery in the period 2001 - 2003. Case records were analyzed for birth interval, pregnancy interval, paternity and recognized risk factors such as booking weight and smoking. For the analysis both the International Society for the Study of Hypertension in Pregnancy (ISSHP) definition and the more recently introduced classification by the Australian Society for the Study of Hypertension in Pregnancy (ASSHP) were used. RESULTS: In the 656 women in this study cohort, 148 (26.2%) women had a different partner in their 2nd and/or 3rd ongoing pregnancy. Using the ISSHP definition for preeclampsia, changing partners had an odds ratio (OR) of 1.304 (95% CI 0.43 - 3.99); using ASSHP criteria an OR of 1.556 (95% CI 0.6506 - 3721); and looking at the combined group of pregnancy-induced hypertensive disorders an OR of 1.99 (95% CI 1.01 - 3.89). A longer birth interval if anything was associated with a lower risk of preeclampsia (non-significant), whatever definition was used. Also the inter-pregnancy interval did not show a consistent relation with the risk for developing a hypertensive complication. CONCLUSIONS: The results of this study on risk factors for preeclampsia in multiparous women appear to be in line with the primipaternity hypothesis, but are in direct contrast with the so-called birth interval hypothesis.

Adult↗

Single-shot spinal block for labour analgesia in multiparous parturients*.

BACKGROUND: Intrathecal analgesia (ITA) is effective in late, rapidly progressing labour. In 1998, our hospital implemented the use of single-shot spinal block for pain relief in multiparous parturients. As part of a quality assurance programme, we assessed the analgesic efficacy, obstetric and neonatal outcomes and maternal satisfaction after this form of analgesia now in routine use in our labour ward. METHODS: Two hundred and twenty-nine consecutive multiparous parturients presenting for vaginal delivery and requesting analgesia were asked to participate in this prospective study. All parturients received our standard ITA: 2.5 mg bupivacaine (1 ml) + 25 microg fentanyl (0.5 ml) inserted via the L2-3 or L3-4 interspace. Routine monitoring included maternal vital signs, uterine contraction and fetal heart rate tracing. Pain scores (visual analogue scale (VAS) 0-10), sensory levels, motor block, side-effects and maternal satisfaction were recorded. Satisfactory analgesia was defined as a decrease in pain scores to three or less within 20 min after injection. The number of parturients requesting additional analgesia and the duration of spinal block (time from injection until request for additional medication after satisfactory analgesia had worn off) were recorded. RESULTS: Two hundred and nine parturients were included in the study. Satisfactory analgesia was achieved in 153 (73%) parturients. Fifty-five (26%) women requested additional analgesia: 38 (18%) because of unsatisfactory analgesia and 17 (8%) because analgesia ended before delivery. The duration of spinal block was 101 +/- 34 min. Pruritus occurred in 64%, fetal bradycardia in 7% and hypotension in 2% of deliveries. Pain relief was rated excellent by 65%, moderate by 20% and inadequate by 14% of the parturients. One hundred and sixty-nine (81%) women stated that they would like to have spinal analgesia again for pain relief during delivery. CONCLUSION: The majority of multiparous parturients found ITA adequate for pain relief during delivery. However, modifications are required in terms of improved timing, reliability and duration of analgesia.

Adult↗

Evaluating a policy of reduced consultant antenatal clinic visits for low risk multiparous women.

OBJECTIVES: To evaluate a change in antenatal care policy to reduce antenatal clinic visits, whereby low risk multiparous women were managed by the primary care team and seen at booking and at 41 weeks' gestation at the consultant antenatal clinic. DESIGN: Comparative study of low risk multiparous women retrospectively identified through the Oxford obstetric data system and cared for by three consultants who changed their policy (group A) or three consultants who maintained their routine care (group B). SETTING: Oxfordshire Health District. SUBJECTS: 2153 low risk multiparous women (1079 group A, 1074 group B) booked for consultant care at John Radcliffe Maternity Hospital between August 1985 and July 1987. MAIN MEASURES: Comparison of pregnancy outcomes, satisfaction with care, and clinic waiting times, during one year before and after the policy change (year 1, year 2). RESULTS: The proportion of women in group A with only one or two consultant clinic visits increased from 19.9% to 57.9% between years 1 and 2 (p < 0.001). Clinic waiting times did not improve. Of five perinatal deaths in group A, one (from postmaturity) could possibly be attributed to the policy change. The proportion of women reaching 42 weeks' gestation rose from 4.7% to 9.2% (p < 0.01); the proportion fully satisfied with their care rose from 68.4% to 82.1% (p < 0.025). No such changes were seen in group B. CONCLUSIONS: The change in policy was successful in reducing hospital antenatal clinic visits. The exercise identified dilemmas around evaluating changes in antenatal care settings. IMPLICATIONS: Criteria to test policy objectives should be selected carefully and rare events assessed prospectively in order to detect problems early.

England↗

Repeated pregnancies (multiparity) increases venous tone and reduces compliance.

In humans, multiparity (repeated pregnancy) is associated with increased risk of cardiovascular disease. In rats, multiparity increases the pressor response to phenylephrine and to acute stress, due in part to changes in tone of the splanchnic arterial vasculature. Given that the venous system also changes during pregnancy, we studied the effects of multiparity on venous tone and compliance. Cardiovascular responses to volume loading (2 ml/100 g body wt), and mean circulatory filling pressure (MCFP, an index of venomotor tone) were measured in conscious, repeatedly bred (RB), and age-matched virgin rats. In addition, passive compliance and venous reactivity of isolated mesenteric veins were measured by pressure myography. There was a greater increase in mean arterial pressure after volume loading in RB rats (+7.2 +/- 2.5 mmHg, n = 8) than virgin rats (-1.4 +/- 1.7 mmHg, n = 7) (P < 0.05). The increase in MCFP in response to norepinephrine (NE) was also greater in RB rats [half maximal effective dose (ED(50)) 3.1 +/- 0.5 nmol.kg(-1).min(-1), n = 6] than virgins (ED(50): 12.1 +/- 2.7 nmol.kg(-1).min(-1), n = 6) (P < 0.05). Pressure-induced changes in passive diameter were lower in isolated mesenteric veins from RB rats (29.3 +/- 1.8 microm/mmHg, n = 6) than from virgins (36.9 +/- 1.3 microm/mmHg, n = 6) (P < 0.05). Venous reactivity to NE in isolated veins was also greater in RB rats (EC(50): 2.68 +/- 0.37x10(-8) M, n = 5) than virgins (EC(50): 4.67 +/- 0.93 x 10(-8) M, n = 8). We conclude that repeated pregnancy induces a long-term reduction in splanchnic venous compliance and augments splanchnic venous reactivity and sympathetic tonic control of total body venous tone. This compromises the ability of the capacitance (venous) system to accommodate volume overloads and to buffer changes in cardiac preload.

Animals↗

Empirical investigation of multiparent recombination operators in evolution strategies.

An extension of evolution strategies to multiparent recombination involving a variable number [symbol: see text] of parents to create an offspring individual is proposed. The extension is experimentally evaluated on a test suite of functions differing in their modality and separability and the regular/irregular arrangement of their local optima. Multiparent diagonal crossover and uniform scanning crossover and a multiparent version of intermediary recombination are considered in the experiments. The performance of the algorithm is observed to depend on the particular combination of recombination operator and objective function. In most of the cases a significant increase in performance is observed as the number of parents increases. However, there might also be no significant impact of recombination at all, and for one of the unimodal objective functions, the performance is observed to deteriorate over the course of evolution for certain choices of the recombination operator and the number of parents. Additional experiments with a skewed initialization of the population clarify that intermediary recombination does not cause a search bias toward the origin of the coordinate system in the case of domains of variables that are symmetric around zero.

Algorithms↗

The clinical outcome in pregnancies of grand grand multiparous women.

OBJECTIVE: To longitudinally evaluate maternal and neonatal complications with relation to birth order, with specific emphasis on grand grand multiparity (at least 10th para). METHODS: The maternal and neonatal outcome of 1200 pregnancies/deliveries in 96 grand grand multiparas was longitudinally investigated in 4 stages of the mothers' life: the primiparas, the multiparas (2nd-5th paras), the grand multiparas (6th-9th paras) and the grand grand multiparas stage. RESULTS: The frequency of hypertension, diabetes, placental complications, operative interventions at delivery, macrosomic infants, chromosomal abbreviations and fetal/neonatal anomalies increased with increasing birth order, being at a maximum in grand grand multiparas. The preterm delivery and perinatal mortality rate did not differ between the 3 groups of multiparas. Perinatal outcome was good in each group. CONCLUSIONS: Grand grand multiparity carries the risk of hypertensive and diabetic complications, which, in turn, often lead to induced or operative deliveries and placental complications. However, grand grand multiparity is not a major problem in societies with a good maternal health care system.

Apgar Score↗

Performance and feeding behavior of primiparous cows loose housed alone or together with multiparous cows.

Lactating Holstein cows (52 multiparous and 90 primiparous) were monitored over a period of 10 mo to observe effects of grouping primiparous cows (PPC) separately from multiparous cows (MPC) on performance, feeding behavior, feed intake, feed efficiency, and milk production of PPC. Cows were kept in 2 symmetrical pens each equipped with a robotic milking unit, 2 waterers, and 28 feeding spaces. Typically, 100 lactating cows were present at a time, thereby ensuring 1.78 cows per feeding place in each pen. One pen (PP) was composed exclusively of PPC whereas the other pen (PM) included 30% PPC and 70% MPC. Primiparous cows were evenly distributed to each pen by days in milk and daily milk production. As they calved, additional primiparous cows were assigned sequentially to each of the 2 treatment groups; multiparous cows calving during the study were allocated to the PM group. Both PP and PM groups were managed equally and were fed the same basal ration twice daily plus 3 kg/d of concentrate during milking. Individual eating behavior and feed consumption at each visit were monitored electronically. Milk production was recorded daily, and milk composition monthly. Observed arithmetic means and standard errors are presented but application to other management situations is limited because animals within pen were not independent. Total dry matter intake (18.7 vs. 18.1 +/- 0.9 kg/d) and milk production (25.9 vs. 25.6 +/- 0.8 kg/d) of PPC were similar in both the PM and PP groups, respectively. Primiparous cows in the PP group had numerically more visits to the robotic milking unit (3.26 vs. 2.68 +/- 0.15) and to the feed troughs (4.91 vs. 4.02 +/- 0.43), but apparently spent less time eating (2.72 vs. 3.22 +/- 0.1 h/d) than did PPC in the PM group. Differences in feed efficiency were low but PPC in the PP group had numerically higher feed efficiency at times through 200 d in milk. Alternative grouping strategies illustrate potentially important differential responses among primiparous cows that warrant further study.

Animal Nutritional Physiological Phenomena↗

Swedish maternal mortality in the 19th century by different definitions: previous stillbirths but not multiparity risk factor for maternal death.

BACKGROUND: The high maternal mortality levels in today's developing countries were also found throughout the history of currently affluent countries. The parish information system in Sweden offers unique possibilities for research in historical cohorts. Furthermore, vital events surveillance systems are scarce in today's developing countries. METHODS: This cohort study covers 42,387 mothers who gave birth to 150,932 infants during the 19th century in the Skellefteå and Sundsvall areas. Among these women, 1,237 were dead within one year after delivery. The analysis of the cause of these deaths was done according to the various ICD definitions. Parity five and above was defined as grand multiparity. RESULTS: Maternal mortality ratios, deaths per 100,000 live births were as follows: 256.4 (direct obstetric deaths), 320.7 (direct and indirect obstetric deaths), 489.2 (pregnancy-related deaths), 347.8 (late maternal deaths) and 837.0 (maternal deaths and late maternal deaths). In this study, 59% of all maternal deaths occur within the first 42 days of delivery, two thirds of them having direct and indirect obstetric causes. Of the late maternal deaths, the bulk were infectious or other indirect deaths, mirroring more general female mortality and the pre-existent endemic situation of tuberculosis and other infectious diseases. The combination of previous stillbirth and infant death represented the highest risk ratios, RR 2.77-3.62, while grand multiparity was not associated with increased risk. Urbanized and industrialized areas tended to have higher maternal mortality. CONCLUSIONS: In conclusion, this study shows that the mother's reproductive history was the most important risk factor measured for all definitions of maternal death. Grand multiparity did not increase the risk of maternal death. Maternal mortality ratio varied threefold in the study population, depending on the definition used. The high mortality ratios found in this study, only declining by the end of the century, should be interpreted as a general condition of the society since no significant differences could be perceived regarding social class, while unmarried women were more at risk.

Cause of Death↗

Lymphoid-organ variations and blastogenic responses of splenocytes in estrogen-progestogen treated virgin and multiparous mice.

A moderate reduction in size and nucleated cell number was found in spleen and mesenteric lymph nodes from virgin and multiparous female mice on estrogen-progestogen treatment. Whereas the thymus of the multiparous animals did not show any change due to this treatment, the number of bone marrow cells in the treated virgin animals was higher than that in control mice. An enhancement of splenocyte blastogenesis in the presence of Con A, PHA, and LPS was produced by the hormone treatment; it was independent of the age and degree of thymic involution. In DXS-activated lymphoid cells a significant differential behavior was observed; thus a clear depletion of DXS-sensitive lymphocytes was detected in the spleen cell cultures from drug-treated multiparous females.

Aging↗

In vitro induction of MUC-1 peptide-specific type 1 T lymphocyte and cytotoxic T lymphocyte responses from healthy multiparous donors.

We have recently provided evidence that there is a natural immunization against human cancer-associated MUC-1 mucin epitopes during pregnancy by studying MUC-1 Ag-specific T cell lines established from multiparous women. Using this experimental model system, we now report that MUC-1 peptide-specific MHC class I-restricted CTLs can be generated in vitro using T cells from multiparous women stimulated with synthetic MUC-1 peptide-loaded, autologous APCs. The complexity of cytokines produced in response to the MUC-1 peptide by anti-MUC-1 T-cells was examined. IFN-gamma was generated by MUC-1-specific T cell lines in long term cultures, whereas in short term cultures, both IFN-gamma and IL-4 were produced. The presence of MUC-1-reactive T cells in multiparous women is consistent with their potential role in immune surveillance and provides a rationale for the use of certain synthetic MUC-1 peptides for active specific immunotherapy of human carcinomas.

Amino Acid Sequence↗

Induction of immune responses to ovarian tumor antigens by multiparity.

OBJECTIVE: Because epidemiologic data indicate a reduction in ovarian cancer risk with increased parity, the occurrence of maternal immunization against ovarian tumor-associated antigens during pregnancy was investigated. METHODS: Sera were obtained from nulligravid and multiparous women and from men. Cellular proteins were isolated from four ovarian tumor cell lines as well as from normal ovaries. These proteins were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and the presence of cellular proteins reactive with each individual's serum was assessed by Western immunoblot. Tumor-reactive antibodies from two multiparous women were used to prepare immunoaffinity columns for the isolation of reactive proteins from ovarian tumor cells. These immunoaffinity-purified antigens were transferred electrophoretically to nitrocellulose membranes, stained with Ponceau S, and identified by amino acid sequencing. RESULTS: Western immunoblot analysis of the cellular proteins from four established ovarian tumor cell lines using sera from multiparous women as the primary antibody indicated that these samples recognized multiple bands on ovarian tumors, ranging from 30 to 150 kD. Two commonly recognized proteins were isolated and subjected to microsequencing, which identified the 56-kD band protein as elongation factor-1 alpha and the 38-kD protein as nucleophosmin/B23 protein. Both of these proteins play integral roles in cell growth. CONCLUSION: These findings suggest that certain antigens expressed by the fetus immunize women during pregnancy. This immune response may protect these women from the subsequent development of cancer.

Adult↗

Detection of B cell antigens in multiple sclerosis. Use of serum from multiparous women.

Sera from two multiparous wives of patients with multiple sclerosis (MS) were used to detect B cell antigens in other patients. With serum X, 11 of 16 patients were positive as compared with ten of 16 controls (.05 less than P less than .1). With serum Y, a positive response was found in 11 of 16 patients and two of 23 controls (P less than .0005). Ten of the 11 patients who were positive with serum Y were also HLA-Dw2, which suggests that the B cell antigen detected by this serum is linked to Dw2. Three of four Dw2-positive controls were negative with serum Y, which raises two alternative hypothetical possibilities concerning the B cell antigen. These findings indicate that serum from multiparous wives may be an important tool in the investigation of the genetic components associated with MS.

Antigens↗

Pregnancy and labor of grand multiparous Sudanese women.

This study was part of an evaluation of maternity performance during the period 1975-1979 in the three major hospitals in Khartoum, Sudan. The larger study population consisted of 8858 patients who delivered in those hospitals; 3130 of them had five or more children. The obstetric complications and the fetal outcome were investigated, and comparisons were made between groups according to parity. There was a high rate of antenatal complications, such as anemia, antepartum hemorrhage and postpartum hemorrhage, among the grand multiparous patients. The stillbirth rate and neonatal mortality were higher for grand multiparous women than for the others.

Delivery, Obstetric↗

Effect of ovariectomy on bone histology and plasma parameters of bone metabolism in nulliparous and multiparous sows.

To investigate the suitability of the pig as animal model for postmenopausal osteoporosis, effects of ovariectomy (OVX) on bone metabolism and histology were studied in two groups of sows (9 months, nulliparous or 35 months, multiparous). A standard diet of about 1.5% calcium (Ca) was fed till sacrifice at either 12 or 20 months post OVX when mineral content and histology were studied in representative bone specimens of proximal tibia, iliac crest and lumbar vertebrae. At 4, 8, 12, and 18 months post OVX, total and bone-specific alkaline phosphatase (APt, APb) calcidiol, calcitriol and parathyroid hormone (PTH) were measured in plasma. In young sows OVX did not significantly affect plasma variables except for calcitriol, which was higher at 4 months post OVX. No significant differences between OVX or control animals were observed in the variables of bone chemical and histological analyses, neither 12 nor 20 months post OVX. In multiparous sows OVX significantly increased PTH plasma concentrations at 8 months post OVX and plasma calcitriol, APt and APb at 12 months post OVX. All effects were moderate and transient. OVX did not significantly affect the variables of bone chemical and histological analyses neither 12 nor 20 months post OVX. Although undoubtedly the clinical-chemical changes observed were not accompanied by any histomorphometric signs of osteopenia/osteoporosis, it must be left to future experiments as to whether this resulted from the ample calcium supply provided. This possibility is supported by recent observations showing that porcine osteopenia could be induced by OVX in animals maintained on only 0.75% dietary calcium but not on higher (0.9%) Ca regimens.

Aging↗

The prevalence and determinants of health care-seeking behavior for fecal incontinence in multiparous United Arab Emirates females.

PURPOSE: This study was designed to determine the prevalence and sociodemographics of fecal incontinence in United Arab Emirates females. METHODS: A representative sample of multiparous United Arab Emirates females aged 20 years or older (N = 450) were randomly selected from the community (n = 225) and health care centers (n = 225). Patients were interviewed about inappropriate stool loss in the past year using a structured and pretested questionnaire. RESULTS: Fifty-one participants (11.3 percent) admitted fecal incontinence; 26 (5.8 percent) were incontinent to liquid stool and 25 (5.5 percent) to solid stool. Thirty-eight patients (8.4 percent) had double (urinary and fecal) incontinence. Sixty-five patients (14.4 percent) were incontinent to flatus only but not to stools. The association between having fecal incontinence and chronic constipation was significant (P < 0.0001), but there was no significant association with other known risk factors such as age, parity, and previous instrumental delivery, episiotomy, perineal tears, or anorectal operations. Only 21 incontinent patients (41 percent) had sought medical advice. Patients did not seek medical advice because they were embarrassed to consult their physician (64.7 percent), they preferred to discuss the difficulty with friends, assuming that fecal incontinence would resolve spontaneously (47.1 percent) or was normal (31.3 percent), and they chose self-treatment as a result of low expectations for medical care (23.5 percent). Sufferers were bothered by the inability to pray (92.2 percent) and to have sexual intercourse (43.1 percent). Perceived causes of fecal incontinence were paralysis (90.2 percent), old age (80.4 percent), childbirth (23.5 percent), or menopause (19.6 percent). CONCLUSIONS: Fecal incontinence is common yet underreported by multiparous United Arab Emirates females because of cultural attitudes and inadequate public knowledge.

Adult↗

Is grand multiparity associated with offsprings' hospital-treated mental disorders? A 28-year follow-up of the North Finland 1966 birth cohort.

BACKGROUND: A child born to a grand multiparous (GMP) mother (i.e. a mother who has undergone six or more deliveries) is at increased risk of perinatal complications, but it is not known whether or not GMP status is associated with child's adulthood mental disorders. METHODS: The data were obtained from the unselected, general population Northern Finland 1966 Birth Cohort (n = 11,017). The cohort members (children) were followed up prospectively to the age of 28 years. Using the National Hospital Discharge Register, a total of 89 DSM-III-R schizophrenia cases were identified, as well as 55 other psychoses, 87 personality disorders, 36 cases of alcoholism, 53 depressive disorders, and 67 anxiety and other non-psychotic disorders. The association between the mother's grand multiparity and the offspring's adult hospital-treated psychiatric morbidity was analysed using a continuation ratio model, which is a modification of logistic regression. Odds ratios were adjusted for social class, maternal antenatal depression, and wantedness of pregnancy. RESULTS: A total of 1320 mothers (12%) were GMPs. Maternal GMP status was not associated with offspring's schizophrenia, anxiety or other non-psychotic disorders. The risk of other psychoses (OR 2.3; 95% CI 1.2-4.7), alcoholism (OR 2.0; 95% CI 0.8-4.7) and depressive disorder (OR 2.2; 95% CI 1.0-4.5) was elevated among offspring of GMP mothers. CONCLUSIONS: It is possible that the mother's GMP status and the large family size associated with this are causal factors in the development of other psychoses than schizophrenia, alcoholism and depression among adult offspring.

Adult↗

Risk factors in extreme grand multiparity.

OBJECTIVE: To study the obstetric performance and outcome of patients of extreme multiparity (Para 10 or more) compared to controls of parity 2-5. METHOD: Records were reviewed for 228 cases and 3349 controls at Security Forces Hospital 1986 and 1991. RESULT: Hypertension and cesarean section rate were significantly higher in the study group opposed to the control. Instrumental vaginal deliveries were significantly lower in the study group. There was no difference in the perinatal outcome between both groups. CONCLUSION: We conclude that with high socioeconomic state and high standard of antenatal care extreme grand multiparity does not carry any added special obstetric or perinatal risk.

Adult↗