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A study of institutionalized mentally retarded patients in Manitoba: over-representation by Canadian Indian children.

During analysis of data on 406 severely and profoundly mentally retarded children and their families in Manitoba a marked excess of Canadian Indian children was observed. There was no evidence to suggest that the over-representation by native children was due to an increased propensity of Indian families to institutionalize their children nor were these patients more profoundly retarded or more physically handicapped than the non-Indian children studied. Further analysis showed that Indian children were primarily over-represented in the groups with acquired retardation, autosomal recessive genetic disorders, idiopathic retardation with seizures and idiopathic retardation with malformations or dysmorphic signs. Review of other demographic findings indicated that other factors potentially predisposing to retardation, including low socioeconomic status, illegitimacy, high birth order, poor maternal reproductive history and increased consanguinity, were more common in the histories of native children. Severe and profound mental retardation has been said to occur equally in all strata of society. This evidently was not so in this Canadian population and the Indian child may be at special risk. Health care workers should be aware of possible predisposing factors for retardation in this group if reduction of the incidence of this major problem is to be achieved.

Adolescent↗

Number of offspring and maternal allergy.

The consistent association seen between family size and childhood allergy has led to the 'hygiene hypothesis', namely that a lower frequency of infections in early childhood is associated with an increased risk of asthma and hay fever. Maternal atopy, however, is a strong predictor of childhood asthma and hay fever. If maternal atopy is inversely related to the number of siblings then the role of siblings in the development of childhood atopy, the basic tenet of the 'hygiene hypothesis', is challenged. We evaluated the association between number of pregnancies and number of live births with lifetime occurrence of maternal wheeze, asthma, allergic rhinitis, and allergic conjunctivitis in a cross-sectional study in four areas in Italy. A total of 1755 (35-74 year old) nonsmoking women filled a questionnaire on reproductive history as well as on lifetime occurrence of symptoms/diseases. The number of live births was inversely related to lifetime allergic rhinitis (P-value for trend=0.031) and allergic conjunctivitis (P-value for trend=0.011). The odds ratios for those with 4+ children (in comparison with those having 0-1) were: 0.53 (95% CI: 0.27-1.04) and 0.42 (95% CI: 0.22-0.81), respectively. A similar trend was seen for number of pregnancies, although not statistically significant. No association was found between number of pregnancies and number of live births with wheeze or asthma. The results may be interpreted as an indication that maternal atopy influences pregnancy outcomes or that pregnancy itself has an effect on maternal atopy.

Adult↗

Malaysian antenatal risk coding and the outcome of pregnancy.

OBJECTIVE: Measure the effectiveness of the colour coding system in Malaysia for the prediction of risk in pregnancy. METHOD: Cohort study of records and interviews of 253/279 women examined at first antenatal visit. RESULTS: Nurses' final coding showed poor concordance with guidelines; recoding produced a predictive value of high risk of 48%; 25% of those with low risk had 50% of complications. Complication rates were moderate and intervention rates low. The mothers had little appreciation of risk and preferred home delivery. Home deliveries gave excellent results except for the 17% requiring transfer to hospital during labour or delivery. CONCLUSION: The coding system is ineffective with Malaysia's relatively low reproductive risk. Women require more personalised counseling about risk to make appropriate choices. Better results depend on simpler but consistent selection for hospital delivery using reproductive history, combined with better communication and transport systems for home deliveries and a reorientation within hospitals to rapid emergency care.

Adult↗

The relationship of human papillomavirus (HPV) detection to pap smear classification of cervical-scraped cells in asymptomatic women in northeast Thailand.

OBJECTIVE: To correlate the detection of human papillomavirus (HPV) with the Pap smear classification of cervical-scraped cells from asymptomatic women living in northeast Thailand. METHODS: A total of 260 asymptomatic women attending the Obstetrics and Gynecology's Outpatient Clinic, Srinagarind Hospital, Thailand, were interviewed for risk factors and cervical scrapes were taken. The cells were examined by Pap smear for cytological changes and by PCR for HPV DNAs--nononcogenic (HPVs 6 and 11) and oncogenic (HPVs 16, 18 and 33) types. Cervical biopsies were taken from women with abnormal Pap smears for histological examination. RESULTS: Of the 260 cervical smear samples, the cervical cells were classified as normal and abnormal in 174 and 86, respectively. Twenty-three percent of all samples were positive for overall HPV DNA. HPV DNAs (mostly HPVs 6 and 11) were detected in 21% of normal cells, and the higher detection rate (27%) for HPV DNA in abnormal cells gradually increased in severity from 16% in Class 3 to 35 and 60% in Classes 4 and 5, respectively. Histologically 46, 90 and 100% of HPV detection was associated with CIS, SCC and adenocarcinoma, respectively. Almost all of the HPV DNAs detected were types 16, 18 or 33. There was no significant association between HPV infection and reproduction history, sexual behavior and demographic variables. CONCLUSION: We speculated that an abnormal Pap smear and the detection of an oncogenic type HPV may indicate the presence of neoplastic cells in asymptomatic woman who might be at risk for the development of cervical cancer.

Adult↗

Influences on the timing of first childbearing.

The author develops the hypothesis that women from different population subgroups respond differently to economic and background influences when timing initial childbearing. Data are taken from the National Longitudinal Survey of Labor Market Experience and concern some 5,000 U.S. women followed from 1968 to 1978. "Among all groups examined, age at first birth tends to increase as education levels increase, and married women with spouses present tend to be older than other women at first childbirth. Among whites, all economic influences considered--hourly pay rate, nonmarket income, and work during the year prior to childbearing--have a significant influence in deferring first childbirth, but family background does not. Among blacks, family background plays a significant role in determining age at first childbirth, but only one economic influence--the hourly pay rate--is significant."

Black or African American↗

Neurodevelopment in offspring of hairdressers.

The hypothesis that intrauterine exposure to hairdressers' chemicals adversely affects neurodevelopment of the offspring was investigated. Neurodevelopmental characteristics were analysed using a historical cohort study of reproductive disorders among hairdressers in The Netherlands. Because exposure in hair salons to agents toxic to reproductive processes might have changed over time, two specific study periods were examined: from 1986 to 1988 and from 1991 to 1993. Nine thousand hairdressers and 9000 clothing sales clerks (referent group) who were in the reproductive age in the defined study periods were selected by the trade association for service jobs. Frequency matching assured comparability with regard to age. All women were invited by mail to complete a short self-administered questionnaire on their reproductive history, including questions on the ages of their child at the times of the first words, first sentences, and first steps, and the occurrence of seizures during fever. The results showed that in 1986 to 1988 more children of hairdressers started speaking their first words after 15 months and their first sentences after 24 months. For 1991 to 1993 no increased risks of these outcomes were found. Seizures during fever had occurred more often among children of hairdressers in 1986 to 1988, and in 1991 to 1993, especially when women had been working until maternity leave. Although the quality of the data in this explorative study requires careful interpretation, the consistent results seem to indicate adverse effects on neurodevelopment among offspring of hairdressers in the earlier years (1986 to 1988). In the later years the effect seemed to be disappearing. However, these findings should be confirmed in more detailed studies.

Child, Preschool↗

Vascular anatomy of the human uterus and pregnancy wastage.

In uteri removed at hysterectomy the uterine arteries were injected with radioopaque media and the vascular configuration was correlated with reproductive histories. Patients whose uteri had two ascending uterine arteries on each side had significantly more abortions and smaller newborn infants than patients with a single ascending branch of the uterine artery.

Abortion, Spontaneous↗

Achalasia and pregnancy.

Forty-one women with achalasia diagnosed between the ages of 18 and 45 years were interviewed and 37 of them who had been married at some time were asked to provide details of their fertility and reproductive histories. Thirty-six agreed to do so and were compared with 36 healthy age-matched women. The mean age at the time of study was 44 and the women had been married, on average, for 21 years. The disease developed at a mean age of 27 years and was diagnosed and treated at a mean age of 32 years. For a mean period of 5 years the disease was untreated. There were no significant differences in the number of conceptions or live births before or after the onset of symptoms or during the period when the disease was untreated. In only three of the 20 women who became pregnant after the onset of disease did symptoms become worse. Achalasia during pregnancy is probably best managed by endoscopic dilatation and there is no reason to consider termination.

Adolescent↗

Pharmacology of the human ovarian vein: responses to putative neurotransmitters and endothelin-1.

OBJECTIVE: An investigation of excitatory vascular responses in the human ovarian vein, a blood vessel normally exposed to high concentrations of ovarian steroid hormones and capable of adaptation to circulatory changes associated with reproductive life. DESIGN: Pharmacological responses of surgical specimens of human ovarian vein to electrical field stimulation of sympathetic nerves, noradrenaline, alpha,beta-methylene adenosine 5'-triphosphate (alpha,beta-MeATP), endothelin-1 (ET-1), and 5-hydroxytryptamine (5-HT) were studied. Comparisons were made between in vitro pharmacological responses and the diagnostic category, age, smoking status, reproductive history and hormonal status of patients. SETTING: Research laboratory. RESULTS: Maximal contractile responses in longitudinal preparations, expressed as a percentage of the response to potassium chloride 125 mmol l-1, were 28% (SE 7.2) to electrical field stimulation and 107% (SE 15.1) to noradrenaline. In ring preparations, maximal responses to various agents were: noradrenaline 93% (SE 10.2); 5-HT 79% (SE 8.0); alpha,beta-MeATP 48% (SE 8.4); and ET-1 87% (SE 10.1). pD2(-log EC50) values for noradrenaline were 5.82 (SE 0.21) in longitudinal preparations and 5.65 (SE 0.10) in ring preparations; for ET-1 in ring preparations these values were 7.88 (SE 0.74). Responses to sympathetic nerve stimulation were attenuated by the adrenoceptor antagonist phentolamine; any residual responses were blocked by desensitisation of P2-purinoceptors with alpha,beta-MeATP or the addition of suramin, indicating that noradrenaline and adenosine 5'-triphosphate may be co-transmitters in these nerves. pD2 values for 5-HT were 5.97 (SE 0.12) in specimens from unsterilised patients (n = 19) compared with 5.20 (SE 0.24) in specimens from those who had previously undergone sterilisation (n = 6) (P < 0.05). No other relation between clinical characteristics and pharmacological responses were detected and, in particular, there were no apparent changes associated with ageing or hormonal status. CONCLUSIONS: Three main conclusions may be drawn from this study: (1) adenosine 5'-triphosphate is a co-transmitter in sympathetic nerves in the human ovarian vein; (2) tubal sterilisation affects vascular responsiveness to 5-HT; and (3) ovarian steroid hormones are likely to influence sympathetic vascular control via effects on catecholamine and adenosine 5'-triphosphate synthesis, storage, release, degradation or re-uptake, rather than via effects on vascular smooth muscle receptors.

Endothelins↗

Analgesia requirements and predictors of analgesia use for women undergoing medical abortion up to 22 weeks of gestation.

OBJECTIVE: To assess analgesia use and the predictors for requiring analgesia in women undergoing medical abortion at all gestations up to 22 weeks. DESIGN: Retrospective observational study. SETTING: Aberdeen Royal Infirmary, Scotland. POPULATION: Consecutive women undergoing medical abortion under the terms of the 1967 Abortion Act. METHODS: Analgesia requirements and characteristics of women undergoing abortion were analysed using logistic regression. MAIN OUTCOME MEASURES: The effect of age, gestation, reproductive history, route and dose of misoprostol administration on analgesia requirements. RESULTS: Of the total 4343 women included in this review, 3139 women (72%) required analgesia. Of these, 3054 women (97%) used oral analgesia, 75 women (2.4%) used opiates while 10 women (0.3%) had diclofenac sodium given rectally. There was no significant difference in analgesia use whether women used the vaginal or sublingual route of misoprostol administration. Logistic regression showed a significant positive association with gestation at termination (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.05-1.12), number of misoprostol doses used (OR 1.31, 95% CI 1.13-1.51) and induction to abortion interval (OR 1.08, 95% CI 1.03-1.12) and a negative association with the age of women undergoing abortion (OR 0.98, 95% CI 0.97-0.99) and previous live birth (OR 0.43, 95% CI 0.33-0.56). CONCLUSIONS: Analgesia requirement was significantly higher in women of younger age, higher gestation, longer induction to abortion interval and with increased number of misoprostol doses used while women with previous live birth were significantly less likely to use analgesia.

Abortifacient Agents, Nonsteroidal↗

Is induced abortion a contributing factor to tubal infertility in Mexico? Evidence from a case-control study.

OBJECTIVE: To determine the contribution of induced abortion to tubal infertility in Mexico. DESIGN: Population- and hospital-based case-control study. SETTING: Tertiary hospitals in Mexico City. SAMPLE: Women between 20 and 40 years with infertility and controls of the same age: 251 cases, 502 hospital controls, 502 neighbourhood controls. METHODS: A case-control study was conducted in four tertiary hospitals in Mexico City with 251 cases and 1004 controls (two hospital and two neighbourhood controls per case, matched by age [+/-2 years]). Cases were infertile women, aged 20-40, with tubal occlusion confirmed by laparoscopy. Controls were fertile women, who had carried a pregnancy to term within the last two years. Participants completed a previously validated questionnaire asking about reproductive history and induced abortion. RESULTS: Our study did not show an association between induced abortion and tubal infertility among women that did not relate both events (cases vs hospital controls: OR = 1.57, 95% CI: 0.29-8.65; cases vs neighbourhood controls: OR = 0.82, 95% CI: 0.07-8.99) using conditional logistic models adjusting by marital status, number of pregnancies, age at first sexual intercourse and history of pelvic inflammatory disease. In contrast, early age at sexual debut and history of pelvic inflammatory disease significantly increased the risk of tubal infertility. CONCLUSIONS: In Mexico, the lack of association between induced abortion and tubal damage causing infertility observed in this population might be explained by a shift toward "safer" abortion practices.

Abortion, Induced↗

The prevalence of polycystic ovaries on ultrasound scanning in a population of randomly selected women.

Polycystic ovaries (PCO) diagnosed by ultrasound have been commonly reported amongst healthy women. The study aimed to determine the prevalence of PCO in a population of women from the community, and to relate it to clinical and endocrinological data. Twelve hundred women chosen randomly from electoral rolls were invited to take part in the study. Two hundred and fifty five women (21%) who met eligibility criteria greed to participate and 183 women 916%) finally completed the study. Seventy two women did not attend. An ultrasound scan and blood tests were taken on day 5-9 of their menstrual cycles. Data about their menstrual periods and reproductive history was collected. The prevalence of PCO was 21% (39 of 183). No differences existed between women with PCO and normal ovaries with respect to uterine size, body mass index, luteinizing hormone levels, serum hormone binding globulin levels and fertility status. Hirsutism (Ferriman Gallwey score > 7), elevated testosterone levels and irregular menstrual cycles were significantly more frequent amongst women with PCO. Mean ovarian volume was larger in women with PCO irrespective of the use of hormonal contraception. Fifty nine per cent of women with PCO had irregular menstrual cycles or elevated Ferriman Gallwey scores or both. There was no detectable effect of PCO on parity or miscarriage although only 70% of women with PCO had evidence of an adequate ovulation compared to 95% of women with normal ovaries.

Female↗

Risk factors for gallstone-related hospitalization during pregnancy and the postpartum.

OBJECTIVES: Gallbladder disease is a leading nonobstetrical cause for hospitalization in the first year postpartum. The aim of this study was to define the incidence and risk factors for postpartum hospitalization as a result of gallstone-related disease. METHODS: We identified 6,670 women with discharge diagnoses related to biliary disease from linked birth certificate and hospital discharge databases for Washington State from 1987 through 2001. Cases were women with gallstone-related diagnoses at delivery or as primary diagnosis in the postpartum. Four controls who were within 1 yr postpartum were randomly selected for each case and matched for year of delivery. From the birth certificates, we obtained data about patient demographics, reproductive history, and pregnancy-related risk factors. In a retrospective case-control study, we developed multiple logistic regression models to identify independent risk factors for hospitalization. RESULTS: We identified 6,211 women as cases (0.5% of all births) during the study period. The median time to hospitalization was 95 days (interquartile range 46-191 days), with a median length of stay of 3 days. Seventy-six percent were diagnosed with uncomplicated cholelithiasis, 16% with pancreatitis, 9% with acute cholecystitis, and 8% with cholangitis. Seventy-three percent of hospitalized women underwent cholecystectomy, and 5% underwent endoscopic retrograde cholangiopancreatography (ERCP). On multivariate analysis, independent risk factors for hospitalization included maternal race, age, being overweight or obese prepregnancy, pregnancy weight gain, and estimated gestational age. CONCLUSIONS: Hospitalization for gallstone-related disease is common in the first year postpartum, most commonly for uncomplicated cholelithiasis. Risk factors for hospitalization include prepregnancy body mass index, race, Hispanic ethnicity, and maternal age.

Adult↗

Identification of rhesus macaques with spontaneous endometriosis.

Rhesus macaques (Macaca mulatta) with endometriosis were identified using reproductive histories, serum levels CA-125, pelvic ultrasonography, laparoscopy, and histopathology. All animals were evaluated from a large breeding colony and had a history of infertility and/ or spontaneous abortions. Laparoscopy and ultrasonography were performed on 40 macaques: 27 macaques from the breeding colony with elevated CA-125 levels, ten macaques from the breeding colony with normal or low serum CA-125 levels, and three macaques from another facility with previously diagnosed spontaneous endometriosis. Clinical endometriosis was diagnosed by laparoscopy in 16/37 (43%) macaques from the breeding colony and was confirmed by histologic examination in all animals biopsied. The disease was classified as minimal (40%), mild (25%), moderate (10%), or severe (25%). The most common sites of endometriosis were the serosal surface of the uterus (75%) and the posterior cul-de-sac (75%). In this study, CA-125 levels were useful in identifying animals from the breeding colony with endometriosis. The rhesus macaque provides a valuable animal model to study endometriosis and potentially to assess efficacy of therapeutic agents for this disease condition.

Animals↗

Maternal antipaternal immunity in couples predisposed to repeated pregnancy losses.

Maternal antipaternal immunity was compared between a group of 12 couples with normal reproductive histories and a group of 13 couples with obstetrical histories of more than one consecutive stillbirth or repeated pregnancy loss subsequent to having had successfully carried to term. Couples were studied for maternal-paternal HLA antigen sharing and for maternal antihusband immunity in tests detecting both complement dependent and independent antibodies as well as in an assay measuring direct cell-mediated cytotoxicity. There was no significant difference in the proportion of HLA antigen sharing between these two groups; however, the women in the pregnancy loss group demonstrated significantly more antipaternal immunity than their normal childbearing counterparts and more than previously described for aborting couples who share HLA antigens. Screening of the cytotoxic sera on a well characterized cell panel failed to reveal alloreactivity patterns consistent with paternal HLA antigen profiles. These data demonstrate that certain women who suffer recurrent pregnancy losses can mount vigorous immune responses to paternal lymphocyte antigens. We propose that the appearance of such lymphocytotoxins represents inappropriate maternal immune responses to fetal extraembryonic antigens that may subsequently result in fetal demise.

Abortion, Habitual↗

In vitro suppression of murine blastocysts growth by sera from women with reproductive disorders.

Early mouse embryos at the two-cell stage were cultured in medium supplemented with sera from women with primary and secondary multiple spontaneous abortions and with long term unexplained infertility as compared to sera obtained from normal fertile women and pooled human male sera. On the basis of microscopic observation and uptake of 3H-thymidine we report a relationship between reproductive histories and the presence of a serum embryo inhibition factor in eight of ten sera samples from women with primary habitual abortions, six of ten sera from women with secondary habitual abortions, and ten of ten sera from women with unexplained infertility. This activity occurs independently of positive maternal antipaternal lymphocytotoxicity. Fractionation of serum samples by ammonium sulphate precipitation, resulted in removal of the embryo-inhibition factor with the IgG fraction in four of five primary habitual abortion cases and in two of five secondary habitual abortion patients, but not in the case of unexplained infertility. We propose that the appearance of such inhibition factor may be of relevance in the etiologies discussed in this paper and may possibly provide the basis for a new classification of idiopathic spontaneous habitual abortions, i.e. positive or negative for the embryo inhibition factor.

Abortion, Habitual↗

Relation between habitual diet and canine mammary tumors in a case-control study.

In the present case-control study several dietary and nutritional factors were investigated to determine if a relationship exists between diet and development of mammary tumors in female dogs. Control female dogs (n = 86) were compared with a case group of dogs (n = 102) with dysplasias or tumors of the mammary gland. A questionnaire providing information on the dog's body conformation and dietary and reproductive histories was answered by the owners. Serum selenium and retinol concentrations and the fatty acid profile in subcutaneous adipose tissue were analyzed as indicators of nutritional status. Obesity at 1 year of age and 1 year before the diagnosis of mammary nodules was found to be significantly related to a higher prevalence of mammary tumors and dysplasias. The intake of homemade meals (compared to that of commercial foods) was also significantly related to a higher incidence of tumors and dysplasias. Other significant risk factors were a high intake of red meat, especially beef and pork, and a low intake of chicken. The subcutaneous fatty acid profile and the serum selenium concentration were not significantly different in the cases and the controls, with the exception of C18:1 fatty acid (oleic acid) content, which was significantly higher in the cases than in healthy controls. Serum retinol concentration was significantly lower in the cases than in the controls. In the multivariate analysis, older age, obesity at 1 year of age, and a high red meat intake were independently and significantly associated with the risk of developing mammary tumor and dysplasias.

Animals↗

Low urinary estrogen glucuronides in women at risk for familial breast cancer.

Daily (12-hour) urine collections taken throughout the menstrual cycle were obtained from 30 young women who by genetic analysis were at risk for familial breast cancer, and from 30 control women carefully matched for age, height, and reproductive history. Steroids in the urine were extracted by glucuronidase hydrolysis, and the primary glucocorticoid, androgen, and estrogen hormones and their metabolites were measured by radioimmunoassay. Highly significant differences were observed only in the case of estrone and estradiol, with the high-risk subjects exhibiting lower values that the controls. This endocrine abnormality in young women at risk for breast cancer may be a potential discriminant for identifying women at risk for the disease in the population at large.

Adult↗