RESUMEN

Purpose: To assess the sociodemographic profiles, teratogen exposures, and ocular congenital abnormalities in Brazilian patients with Möbius sequence. Method: Forty-four patients were recruited from the Brazilian Möbius Sequence Society. This cross-section comprised 41 patients (age, mean ± standard deviation, 9.0 ± 5.5 years) who fulfilled the inclusion criteria. The parent or caregiver answered a questionnaire regarding sociodemographic data and pregnancy history. Patients underwent ophthalmological assessments. They were subdivided into groups according to misoprostol exposure during pregnancy, and the two groups were compared. Results: Mothers/caregivers reported unplanned pregnancies in 36 (88%) cases. Of these, 19 (53%) used misoprostol during their first trimesters. A stable marital status tended to be more frequent in the unexposed group (P=0.051). Incomplete elementary school education was reported by two (11%) mothers in the exposed group and by three (14%) mothers in the unexposed group (P=0.538). The mothers' gestational exposures to cocaine, marijuana, alcohol, and cigarettes were similar in both groups (P=0.297, P=0.297, P=0.428, and P=0.444, respectively). One (5%) case of Rubella infection during pregnancy was found in the unexposed group. The main malformations in the exposed and unexposed groups were the following: strabismus (72% and 77%, respectively), lack of emotional tearing (47% and 36%, respectively), and lagophthalmos (32% and 41%, respectively). Conclusion: Stable marital statuses tended to be more frequent among mothers that did not take misoprostol during pregnancy. Exposures to other teratogens and the main ocular abnormalities were similar in both groups. .

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Objetivo: Descrever o perfil sóciodemográfico, exposição à teratógenos e anormalidades oculares congênitas em pacientes brasileiros portadores da sequência de Möbius Método: Quarenta e quatro pacientes recrutados da Sociedade Brasileira de Sequência de Möbius foram examinados. Este estudo transversal incluiu 41 pacientes que preencheram os critérios de inclusão do estudo (média das idades: 9,0 ± 5,5 anos). Mãe/responsável dos pacientes responderam a um questionário sobre perfil sóciodemográfico e história gestacional. Foi realizado exame oftalmológico de todos os pacientes. Eles foram agrupados em dois grupos de acordo com a exposição ao misoprostol durante a gestação e seus dados foram comparados. Resultados: Mães/responsáveis referiram gravidez indesejada em 36 (88%) dos casos. Destas, 19 (53%) fizeram uso de misoprostol no primeiro trimestre de gestação. Houve uma tendência do grupo de mães não expostas ao misoprostol de terem um estado civil estável (P=0,051). Duas (11%) mães do grupo de expostas ao misoprostol relataram primeiro grau incompleto e três (14%) do grupo de não expostas (P=0,538). A exposição das mães à cocaína, maconha, álcool e cigarro foi similar em ambos os grupos (P=0,297, P=0,297, P=0,428, P=0,444, respectivamente). Houve um caso (5%) de Rubéola no grupo de mães não expostas. As principais malformações associadas nos pacientes expostos e não expostos foram, respectivamente: estrabismo (72% e 77%), e diminuição da lágrima emocional (47% e 36%) e lagoftalmia (32% and 41%). Conclusão: Estado civil estável foi mais frequente em mães que não fizeram uso de misoprostol durante a gestação. Exposição à outros ...

Asunto(s)

Humanos , Complicaciones del Embarazo , Teratógenos , Anomalías Congénitas/etiología , Misoprostol/efectos adversos , Síndrome de Mobius/fisiopatología

RESUMEN

We report three cases of failed termination of pregnancy in which the children were subsequently born with arthrogryposis (AMC) (multiple congenital contractures). Arthrogryposis is a sign with many causes. We suggest that the multiple congenital contractures seen in these children are due to vascular compromise during the attempted termination with secondary loss of functional neurons leading to fetal akinesia and subsequent contractures. Two of the children have additional evidence of intrauterine vascular compromise. Limitation of movement secondary to the rupture of the fetal membranes and continuous leakage of amniotic fluid after the attempted termination may have compounded the contractures in two of the children.

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PIP: Three cases are reported of attempted termination of pregnancy in which the children were later born with arthrogryposis. These cases were seen at Children's Hospital in Vancouver, British Columbia, Canada. The mothers underwent therapeutic dilatation and curettage during early fetal life (8-12 weeks gestation) in all 3 cases. All children were delivered prematurely (31-32 weeks gestation). They were small for gestational age. The lower limbs were more involved than the upper limbs in all 3 cases. Limb involvement was asymmetrical. Hirsutism was common. In 2 cases, the mothers experienced amniotic fluid leakage. Two cases had anomalies probably due to vascular compromise (scar in patient 1 and abdominal wall defects and bowel atresia in patient 2). Two cases had decreased facial movement. Two cases are functioning surprisingly well. The 16-year-old walks without help, attends high school, and has normal intelligence. The 22-year-old attends college, works in a clerical position, lives independently, and has normal intelligence. Attempted termination of pregnancy likely decreased blood flow to uterine and/or placental blood vessels with possible loss of placental vasculature. The reduced blood flow probably caused fetal hypoxia leading to anoxic injury of tissue and/or blood clots or blockage of blood flow resulting in possible cell death, particularly anterior horn cell death or failure. Inferior anterior horn cell function would likely cause fetal akinesia and secondary multiple joint contractures. Thus, in all 3 cases, it appears that the cause of the contractures is vascular compromise that caused loss of functional neurons with secondary decreased fetal movement.

Asunto(s)

Aborto Incompleto , Aborto Inducido , Aborto Terapéutico , Artrogriposis/etiología , Adolescente , Adulto , Artrogriposis/fisiopatología , Niño , Consanguinidad , Dilatación y Legrado Uterino , Femenino , Humanos , Masculino , Embarazo , Útero/irrigación sanguínea

RESUMEN

A case-control study on different groups of isolated congenital limb deficiency was performed in a ten-year population-based and revised Hungarian data set. A higher rate of one contraceptive pill type with relatively high dose (ethynodiol diacetate 1.0 mg + ethinyloestradiol 0.05 mg) used in the periconceptional period was found in the mothers of cases with terminal transverse defect (adjusted relative odds 1.9 with 95% confidence interval of 1.1-3.4). This risk is minimised by the use of recent low-dose pills.

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PIP: In Hungary, researchers analyzed 1975-1984 population-based and revised data on 537 children with isolated congenital limb deficiency (CLD) (i.e., cases with at least 1 affected limb) and data on 537 age-matched controls with no CLD. They wanted to determine the association between periconceptional use of oral contraceptives (OCs) and CLD. Personal examination and/or medical documents confirmed reported diagnoses. They separated the isolated CLD cases into terminal transverse CLD, amniogenic CLD, radial and tibial CLD, ulnar-fibular CLD, split hand and/or foot CLD, and intercalary CLD. Periconceptional use of Bisecurin (relatively high dose of 1 mg ethynodiol diacetate and 0.05 mg ethinyl estradiol) was significantly associated with terminal transverse CLD (adjusted odds ratio [AOR] = 1.9; p = 0.03). It was also significantly associated with monomelic CLD (AOR = 1.6; 9.6% vs. 2.9%; p = 0.0015). The monomelic cases comprised 19 terminal transverse cases, 6 amniogenic cases, 7 radial cases, 3 atypical split hand cases, and 2 ulnar cases. 19 of the 20 terminal transverse cases were monomelic. Periconceptional use of Continuin (0.5 mg ethynodiol diacetate alone) was associated, but not significantly so, with terminal transverse CLD (6 cases vs. 1 control; p = 0.06). These findings suggest that use of OCs with a high dose of ethynodiol diacetate increases the risk of terminal transverse defect. Use of low dose OCs likely minimizes this risk.

Asunto(s)

Anomalías Inducidas por Medicamentos/epidemiología , Anticonceptivos Orales/efectos adversos , Deformidades Congénitas de las Extremidades , Adulto , Estudios de Casos y Controles , Relación Dosis-Respuesta a Droga , Etinilestradiol/efectos adversos , Diacetato de Etinodiol/efectos adversos , Femenino , Humanos , Hungría/epidemiología , Incidencia , Recién Nacido , Masculino

RESUMEN

PIP: Testicular aging, like ovarian aging, concerns not just the individual but also the quality of the gametes and hence of the offspring. The 1st signs of testicular aging appear early. Beginning around the age of 30, the vascularization begins to thin, with a progressive decline in the density of the capillaries. The membrane of the seminiferous tubules, an essential element of the hematotesticular barrier, begins to thicken and the number of Sertoli cells begins to decline. Endocrine effects usually appear a decade later, but individual variations are considerable. These modifications are accompanied by a slow decline in the number of sperm and alterations in their morphology and motility. Male fertility declines progressively with age. The quality of the gametes is lower among very young males and increases to a maximum at about age 30. Paternal aging may be responsible for well-defined syndromes in the offspring. Paternal aging has long been recognized as a factor in dominant autosomal mutations causing macroscopic malformations such as achondroplasia, Apert syndrome, Marfan's syndrome, fibrodysplasia ossificans progressiva, and others. The frequency of each disorder is very low, but the total number of recognized disorders of this type exceeds 1000, multiplying the risks so that the .3-.5% risk of anomalies due to paternal aging after 40 is comparable to the risk of trisomy 21 for women aged 35-40. Dominant autosomal mutations can also be responsible for less marked anomalies such as Recklinghausen's neurofibromatosis. Some authors believe that recessive mutations linked to the X chromosome causing hemophilia or Duchenne muscular dystrophy can also result from paternal aging. Some evidence suggests that for a given maternal age, paternal age results in subtle and continuous declines in cerebral functioning. A psychometric study of 1700 military recruits in Nancy, France, in 1985 who were 18 years old showed that sons of very young fathers and of older fathers did less well on the tests. The study is being repeated on 12,000 recruits in the Paris area in 1989-90 to verify the results. Efforts will be made to separate the influence of socioeconomic status and birth order on the results.^ieng

Asunto(s)

Anomalías Congénitas , Fertilidad , Inteligencia , Edad Paterna , Espermatozoides , Factores de Edad , Conducta , Biología , Enfermedades y Anomalías Neonatales Congénitas y Hereditarias , Demografía , Países Desarrollados , Enfermedad , Europa (Continente) , Francia , Genitales , Células Germinativas , Padres , Personalidad , Fisiología , Población , Características de la Población , Psicología , Reproducción , Sistema Urogenital

RESUMEN

Several studies have found no increase in the overall frequency of birth defects in association with the use of spermicides, but the possibility of an increase in specific defects remains. We evaluated this possibility in a large case-control study. Infants with certain malformations (265 with Down's syndrome, 396 with hypospadias, 146 with limb reduction defects, 116 with neoplasms, and 215 with neural-tube defects) were compared with 3442 control infants with a wide variety of other defects. Exposure to spermicides was assessed for three periods: use during the periconceptional period (one month before through one month after the last menstrual period), use during the first trimester (the first four lunar months of pregnancy), and any use during the lifetime. For the five groups of cases and for each interval, the odds ratios were close to 1.0 (range, 0.7 to 1.3); the upper 95 percent confidence bounds were 2.2 or lower. Risks did not increase with the duration of exposure. When each of the active ingredients in currently available spermicides was considered separately, no differences in odds ratios were apparent between the types of spermicides. With the possible exception of a subgroup of cases (limb reduction defects of unknown cause), these results suggest that risks for the five specific birth defects evaluated are not increased by exposure to spermicides.

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PIP: Several studies have found no increase in the overall frequency of birth defects in association with the use of spermicides, but the possibility of an increase in specific defects remains. This possibility was evaluated in a large case-control study. Infants with certain malformations (265 with Downs syndrome, 396 with hypospadias, 146 with limb reduction defects, 116 with neoplasms, and 215 with neural-tube defects) were compared with 3442 control infants with a wide variety of other defects. Exposure to spermicides was assessed for 3 periods: use during preconceptional period (1 month before through 1 month after the last menstrual period), use during the 1st trimester (the 1st 4 lunar months of pregnancy), and any use during the lifetime. For the 5 groups of cases and for each interval, the odds ratios were close to 1.0 (range 0.7 to 1.3); the upper 95% confidence bounds were 2.2 or lower. Risks did not increase with the duration of exposure. When each of the active ingredients in currently available spermicides was considered separately, no differences in odds ratios were apparent between the types of spermicides. With the possible exception of a subgroup of cases (limb reduction defects of unknown cause), these results suggest that risks for the 5 specific birth defects evaluated are not increased by exposure to spermicides.

Asunto(s)

Anomalías Inducidas por Medicamentos/etiología , Espermicidas/efectos adversos , Síndrome de Down/inducido químicamente , Femenino , Feto/efectos de los fármacos , Edad Gestacional , Humanos , Hipospadias/inducido químicamente , Recién Nacido , Deformidades Congénitas de las Extremidades , Neoplasias/congénito , Defectos del Tubo Neural/inducido químicamente , Embarazo , Riesgo

RESUMEN

It has been suggested that the maternal use of spermicidal contraceptives increases the frequency of certain congenital anomalies, including trisomy, but this issue is in dispute. This controversy led us to examine whether the use of spermicidal contraceptives is associated with an increased risk of fetal trisomy. A questionnaire concerning contraceptive use was completed by 13,729 women who were undergoing prenatal fetal chromosome studies but were as yet unaware of the results. Most women were at increased risk of having a trisomic fetus because of their advanced age. Of 154 fetuses with trisomy, 98 had trisomy 21. For each woman (case) with an affected fetus, four controls were selected from among women with chromosomally normal fetuses, matched for maternal age and medical center. Cases and controls were compared by matched-sample maximum-likelihood logistic regression, to examine the association between fetal trisomy and four measures of spermicide use: periconceptional use, timing of last use, duration of last use, and total lifetime use. No evidence was found for an association, either when all types of trisomy were combined or when trisomy 21 alone was considered. All point estimates of odds ratios relating spermicidal exposure to trisomy were approximately 1, and an effect greater than a twofold increase was excluded with 95 percent confidence in the combined-trisomy group for all measures of spermicide use.

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PIP: It has been suggested that maternal use of spermicidal contraceptives increases the frequency of certain congenital abnormalities, including trisomy, but this issue is in dispute. The controversy led to this examination of whether the use of spermicidal contraceptives is associated with an increased risk of fetal trisomy. A questionnaire concerning contraceptive use was completed by 13,729 women undergoing prenatal fetal chromosome studies but were as yet unaware of the trisomic fetus because of their advanced age. Of 154 fetuses with trisomy, 98 had trisomy 21. For each woman (case) with an affected fetus, 4 controls were selected from among women with chromosomally normal fetuses, matched for maternal age and medical center. Cases and controls were compared by matched-sample maximum-likelihood logistic regression, to examine the association between fetal trisomy and 4 measures of spermicide use: preconceptional use, timing of last use, duration of last use, and total lifetime use. No evidence was found for an association, either when all types of trisomy were combined or when trisomy 21 alone was considered. All point estimates of odds ratios relating spermicidal exposure to trisomy were approximately 1, and an effect a 2-fold increase was excluded with 95% confidence in the combined-trisomy group for all measures of spermicidal use.

Asunto(s)

Feto/efectos de los fármacos , Espermicidas/efectos adversos , Trisomía , Síndrome de Down/inducido químicamente , Femenino , Humanos , Edad Materna , Embarazo , Diagnóstico Prenatal , Espermicidas/administración & dosificación

RESUMEN

A study of congenital limb deficiencies in two Australian states indicated that use of an oral contraceptive during pregnancy by the mother was associated with an increased risk of limb defect in the child. The study included mothers of 155 children born with absence or reduction of the major long bones during a 12-year period from 1970 onward; 274 mothers with births of normal infants, matched for date of birth and area of residence, made up the control group. Compared with control infants, the case infants were more likely to have been conceived while the mother was using an oral contraceptive, especially when the deformity was a transverse or amputation type. It is too early in our state of knowledge of teratogenic mechanisms to exclude the possible existence of a biologic mechanism that would explain this statistical association.

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PIP: A study of congenital limb deficiencies in 2 Australian states indicate that use of an oral contraceptive during pregnancy by the mother was associated with an increased risk of limb defect in the child. The study included mothers of 155 children born with absence or reduction of the major long bones during a 12-year period from 1970 onward; 274 mothers with births of normal infants, matched for date of birth and area of residence, made up the control group. Detailed results are presented, including a multivariate analysis that incorporated as potential confounders maternal age, sex of infant, parity of mother, staus of father's occupation, and a number of pregnancy factors. Each mother was interviewed an average of 405 years after the birth of the child. Compared with control infants, the case infants were more likely to have been conceived while the mother was using an oral contraceptive, particularly when the deformity was a transverse or amputation type. Knowledge of teratogenic mechanisms is not advanced enough to enable exclusion of the possible existence of a biologic mechanism that would explain this statistical assocation. Low socioeconomic status judged by an unskilled occupation of the father, sex of the child (male), vaginal bleeding at any time during pregnancy, and a febrile illness in the 1st trimester were significant at the 0.05 level, while smoking during pregnancy, hormonal therapy, maternal age, and parity were mot.

Asunto(s)

Anomalías Inducidas por Medicamentos/etiología , Brazo/anomalías , Anticonceptivos Orales/efectos adversos , Pierna/anomalías , Niño , Anticonceptivos Orales/administración & dosificación , Humanos , Riesgo , Factores de Tiempo

RESUMEN

PIP: A recent court ruling has sparked concern about the future of spermicides as a contraceptive option. The 11th Circuit Court of Appeals in Atlanta recently upheld a multimillion-dollar award to a woman who claimed that Ortho Pharmaceutical's Ortho-Gynol spermicidal jelly caused her daughter's birth defects. Ortho was found negligent for failing to warn consumers through product labeling that birth defects could result if the jelly did not prevent conception. Ortho representatives maintain that no labeling is necessary since numerous studies have shown no association between birth anomalies and spermicide use. Although this is the 1st lawsuit over a spermicide-birth defects link, there is concern that an onslaught of litigation is upcoming. In the face of extended litigation, it is feared that the manufacturer will withdraw the product from the market. Family planning practitioners have expressed alarm about this possibility. Since teenagers and young adults, who tend not to visit family planning clinics, are the primary users of spermicides, a higher rate of unintended pregnancy is likely to result should the product be withdrawn.^ieng

Asunto(s)

Anomalías Congénitas , Enfermedades y Anomalías Neonatales Congénitas y Hereditarias , Jurisprudencia , Espermicidas , Cremas, Espumas y Geles Vaginales , Américas , Anticoncepción , Anticonceptivos , Países Desarrollados , Países en Desarrollo , Enfermedad , Servicios de Planificación Familiar , América del Norte , Estados Unidos

RESUMEN

PIP: The author reviews the fetal risks of various contraceptive methods and concludes that contraceptive methods do not pose substantive fetal risks. Oral contraceptives have been implicated as both teratogens and mutagens. Many prospective studies show no link between progestins and cardiac anomalies. A table presents studies, sample size, control size, anomalies, and comments. Problems with the retrospective studies include 1) recall biases, 2) no account taken of prior pregnancy outcome, 3) no account taken of reasons for wishing to continue the pregnancy, 4) the fact that hormones could have been administered in pregnancies already showing problems such as bleeding, and 5) analysis not being restricted to the period of embryogenesis when exposure could produce cardiac defects. Studies have also failed to show an association between progestins and hypospadias, limb reduction deformities, neural tube defects, and other anomalies. A further consensus exists that progestins do not predispose to chromosomally abnormal abortuses. Pregnancies of women with IUDs are known to be associated with increased frequencies of ectopic pregnancy and spontaneous abortion but do not show a greater frequency of anomalies. Vaginal spermicides are also not associated with increased malformations in the offspring of women using spermicides either during or prior to pregnancy. Pregnancies resulting from contraceptive failures--oral contraceptives, IUDs, spermicides, and barrier methods--do not appear to be at risk for congenital anomalies; the same conclusion applies to pregnancies that occur after a method is discountinued.^ieng

Asunto(s)

Aberraciones Cromosómicas , Anomalías Congénitas , Enfermedades y Anomalías Neonatales Congénitas y Hereditarias , Anticoncepción , Anticonceptivos Femeninos , Anticonceptivos Orales , Enfermedad , Servicios de Planificación Familiar , Inyecciones , Dispositivos Intrauterinos , Características de la Población , Espermicidas , Anticonceptivos , Investigación

RESUMEN

PIP: Longterm use of marijuana has been found to cause physiological changes that can alter individual reproductive potential. The effects of marijuana depend on the dose and can include death from depression of the respiratory system. Longterm effects are however particularly hard to assess. Marijuana is absorbed rapidly and eliminated very slowly. The active principle, delta-9-tetrahidrocannabinol (delta-9-THC), is highly liposoluble and fixes to the serum proteins, passing to the lungs and liver for metabolization and to the kidneys and liver for excretion. As with estrogens, there is an enterohepatic circuit for reabsorption and elimination. 90% is eliminated in the feces, 65% within 48 hours. Because of the enterohepatic circuit and liposolubility, elimination requires 1 week for completion. The other important biotransformation of the active principle is hydroxilation; the hydroxilated derivatives are responsible for the psychoactivity of cannabis. Cannabis affects both neuroendocrine function and the germ cells. Studies on experimental animals have indicated that THC can cause a decline in the pituitary hormones follicle stimulating hormone, luteinizing hormone, and prolactin, and in the steroids progesterone, estrogen, and androgens. Human studies have shown that chronic users have decreased levels of serum testosterone. Because steroidogenesis can be restimulated with human chorionic gonadotropin, it appears that THC does not directly affect steroid production by the corpus luteum, but that its action is mediated by the hypothalamus. Because of its potent antigonadotropic action, THC is under study as an anovulatory agent. The same animal studies have shown that ovulation returns to normal 6 months after termination of use. High rates of anovulation and luteal insufficiency have been observed in women smoking marijuana at least 3 times weekly. THC accumulates in the milk. Animal studies have shown that THC depresses the enzymes necessary for lactation and causes a diminution in the volume of the mammary glands. In recent studies, significant amounts of the drug have been detected in both mothers' milk and the blood of newborns. Animal studies indicate that THC crosses the placenta, achieving concentrations in the fetus as high as those in the mother. Animal studies also demonstrated increasing frequency of abortions, intrauterine death, and declines in fetal weight. The effects were probably due to an alteration in placental function. A human study likewise showed that marijuana use during pregnancy was significantly related to poor fetal development, low birth weight, diminished size, and decreased cephalic circumference. Congenital malformations have been observed in experimental animals exposed to THC. Declines in sperm volume and count and abnormal sperm motility have been observed in chronic marijuana users. In vitro studies show that THC produces a marked degeneration of human sperm.^ieng

Asunto(s)

Anomalías Congénitas , Enfermedades y Anomalías Neonatales Congénitas y Hereditarias , Enfermedad , Fertilidad , Genitales , Células Germinativas , Hormonas , Lactancia , Ovulación , Preparaciones Farmacéuticas , Hormonas Hipofisarias , Reproducción , Sustancias para el Control de la Reproducción , Problemas Sociales , Espermatozoides , Trastornos Relacionados con Sustancias , Sistema Urogenital , Biología , Anticoncepción , Demografía , Países Desarrollados , Sistema Endocrino , Europa (Continente) , Servicios de Planificación Familiar , Fisiología , Población , Dinámica Poblacional , Embarazo , España , Terapéutica

RESUMEN

PIP: Recently in Atlanta, Georgia, a US District Judge, Marvin Shoob, ordered Ortho Pharmaceutical Corporation to pay US$5.1 million in damages to a 3 year old girl, born with birth defects to a women who used a spermicide, manufactured by Ortho, when the child was conceived and for 4 weeks following conception. The child was born with a missing left arm, missing fingers on the right hand, a cleft palate, and impaired hearing. The spermicide, Ortho-Gynol, contains octoxynol, which prevents pregnancy by destroying the outer layer of sperm cells. The judge maintained that Ortho was negligent for failing to attach a label to the spermicide warning users that birth defects could occur if the product was used during pregnancy. In 1983, a Food and Drug Administration (FDA) advisory committee advised drug companies that is was unnecessary to attach such a label. The chairman of the committee, Ronald W. Nelson, still maintains that a warning label is unwarrented. "Contraceptive Technology Update" spoke with a number of family planning practitioners and several experts, including some who were involved in the case, concerning their views about the case. Most of the partitioners expressed surprise about the ruling, indicated that they did not plan to alter their counseling advise concerning spermicides, and believed that a warning label was not warranted. A representative for Ortho stated that the company still believes that there is no link between birth defects and the use of spermicides. Ortho does not plan to use a warning label. A spokesman from the judge's office said that the ruling pertained only to the specific case, and that the decision was not generalizable. Robert L. Brent, an expert witness for Ortho said that studies failed to find a significant association between birth defects and spermicides; however, he noted that researchers did not rule out the possibility that there was a slightly increased risk of birth defects among infants born to women who used spermicides. Bruce Buehler, an expert witness for the plaintiff, said that there was a probable link between the spermicide and the missing arm defect and a possible link between the spermicide and the missing fingers. He said that the damage probably occurred at some crucial developmental stage during the 4 weeks following conception rather than at the time of conception. A proponent for labeling is Herschel Jick. He and his colleagues conducted a study in 1981 of 763 women, who had prescriptions for spermicides filled within 600 days of pregnancy outcome, and of 3902 nonusers. 2.2% of the users, compared to 1.1% of the nonusers gave birth to infants with birth defects. The study has been criticized by experts for failing to isolate a well-defined syndrome among infants born to spermicide users and for failing to determine if and when those identified as users actually did use the prescribed spermicides. Jose Cordero of the Center for Disease Control noted that the Center does not have an official position concerning the issue, but that he did not feel that the evidence was strong enough to support claims of an association.^ieng

Asunto(s)

Anomalías Congénitas , Enfermedades y Anomalías Neonatales Congénitas y Hereditarias , Anticoncepción , Anticonceptivos Femeninos , Enfermedad , Jurisprudencia , Comercialización de los Servicios de Salud , Embalaje de Productos , Espermicidas , Américas , Anticonceptivos , Países Desarrollados , Países en Desarrollo , Economía , Servicios de Planificación Familiar , Agencias Gubernamentales , América del Norte , Organizaciones , Estados Unidos

RESUMEN

PIP: The type of birth defects ever seen or heard of and beliefs as to the causation and means of preventing the defects were investigated among 225 newly deliverd and nursing mothers through interviews. The majority were between the ages of 20 to 29 years; 9.3% were between 35 and 40 years. The bulk of the respondents are illiterates. More than 75% of the mothers had 2 or more children. The most common birth defects seen were amputated leg; dislocated hips; lamed hand or funny elbows or ankles; extra digits; and missing digits. Common perceptions of the causes were God's will (32.9%) and evil doers or evil powers due to witchcraft or sorcery (40.9%). Poor nutrition or poor antenatal care was reported by only 2.2%; while 1.3% attributed the cause to an excessive combination of native and modern drugs. The majority believed that avoidance of walking at night and midafternoon during pregnancy would prevent birth defects. 10.2% and 5.3% were of the opinion that praying to God and going to the herbalist respectively would prevent birth defects. Prevention of birth defects is an essential task for all health workers in Nigeria. The causes of birth defects should be brodcast on radio and television and published in national dialects in the newspapers. 83.6% claimed that they were not informed of various means of preventing birth defects during prenatal clinic visits. The schools should include prevention and causation of birth defects in a health education curriculum.^ieng

Asunto(s)

Anomalías Congénitas , Supersticiones , Adulto , Anomalías Congénitas/etiología , Anomalías Congénitas/prevención & control , Femenino , Humanos , Recién Nacido , Nigeria , Embarazo

RESUMEN

The article describes two methods used to reveal possible teratogenic factors involved in the aetiology of abdominal wall defects. Forty-six mothers to children with gastroschisis and omphalocele were questioned about heredity, occupation, use of drugs etc. during early pregnancy (case history study). Seventy-four mothers to children with gastroschisis and omphalocele were randomly selected from a national register and their maternal health service record forms were studied and compared with the forms of 144 matched controls (case control study). None of the analyzed factors was found to be of significant teratogenic importance in the aetiology of abdominal wall defects, nor was it possible to explain the increase in the incidence of gastroschisis taking place during the early 70s.

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PIP: This article describes 2 methods used to reveal possible teratogenic factors involved in the etiology of abdominal wall defects. 46 mothers of children with gastroschisis and omphalocele were questioned about heredity, occupation, and use of drugs during early pregnancy (case history study). 74 mothers of children with gastroschisis and omphalocele were randomly selected from a national register and their maternal health service record forms were studied and compared with the forms of 144 matched controls (case control study). None of the analyzed factors was found to be of significant teratogenic importance in the etiology of abdominal wall defects, nor was it possible to explain the increase in the incidence of gastroschisis taking place during the early 1970s. (author's modified)

Asunto(s)

Músculos Abdominales/anomalías , Anomalías Congénitas/etiología , Hernia Umbilical/etiología , Anticonceptivos Orales/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Femenino , Humanos , Recién Nacido , Paridad , Embarazo , Población Rural , Fumar , Encuestas y Cuestionarios , Población Urbana

RESUMEN

Fetuses present in 91 consecutive spontaneous or missed middle-trimester abortions were studied anatomically and tissue karyotyping was attempted. Anatomical abnormalities were found in 32 fetuses, two of these also had chromosomal abnormalities, six of these abortions were associated with other possible aetiological factors. In a further 23 pregnancies there were probably significant aetiological factors associated with the abortion and in 10, where the fetus had arrested growth, there were two with other possible factors. From a prospective analysis of subsequent pregnancies it would appear that if all the factors relating to middle-trimester abortion, including fetal autopsy, are analysed, better patient counselling and realistic prognoses can be given for subsequent pregnancy.

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PIP: Fetuses present in 91 consecutive spontaneous or missed midtrimester abortions were studied anatomically and tissue karyotyping was attempted. Anatomical abnormalities were found in 32 fetuses, 2 of these also had chromosome abnormalities, 6 of the abortions were associated with other possible etiological factors. In a further 23 pregnancies, there were probably significant etiological factors associated with the abortions and in 10, where the fetus had arrested growth, there were 2 with other possible factors. From a prospective analysis of subsequent pregnancies, it would appear that if all the factors relating to midtrimester abortion, including fetal autopsy, are analyzed, better patient counseling and realistic prognoses can be given for subsequent pregnancy.

Asunto(s)

Aborto Espontáneo/etiología , Anomalías Congénitas , Asesoramiento Genético , Aborto Espontáneo/prevención & control , Adolescente , Adulto , Aberraciones Cromosómicas , Trastornos de los Cromosomas , Anomalías Congénitas/prevención & control , Femenino , Humanos , Embarazo , Segundo Trimestre del Embarazo , Riesgo

RESUMEN

In a prospective study of some 20,000 pregnancies in the Child Health and Development Studies in the San Francisco East Bay area, 226 gravidas were tested for pregnancy with estrogen/progestogen preparations. The two control groups were women who were tested for pregnancy by either a serum or urine test. There were no statistically differences (p greater than 0.05) in the rates of severe congenital anomalies between the hormone test group and the two control groups. The relative risks and the 95% confidence intervals were 1.01 (0.47-2.19) for the hormone/serum test comparison and 1.60 (0.60-4.18) for the hormone/urine test comparison.

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PIP: Several retrospective and prospective studies have positively associated EPP (estrogen/progestogen preparations) with birth defects in the offsprings of exposed gravidas. Some 20,000 pregnancies of women in the Child Health and Development Studies (CHDS) in the San Francisco bay area between 1959 and 1966 were observed longitudinally. Congenital defects of children in the study (ascertained at birth and followed up in subsequent years) include structural aberrations and errors of metabolism. The CHDS study population includes 227 gravidas who were tested for pregnancy with EPP. 2 control groups consisted of those who were tested for pregnancy by either a serum or urine test. No statistically significant differences in the rates of severe congenital defects were observed between the hormonal test group and the 2 control groups (p 0.05). Relative risks and 95% confidence intervals were 1.01 (0.45-2.19) for the hormone/serum test comparison and 1.60 (0.60 to 4.18) for the hormone/urine test comparison. An insignificant increased risk for nonsevere genitourinary anomalies as observed in the male infants in the hormone group. Although this study did not confirm the hypothesized association between EPP and congenital anomalies in the CHDS population, the numbers in this series are not large enough to reject the hypothesis either. Further use of hormonal pregnancy tests appears unjustified in the light of the availability of non-risk pregnancy tests.

Asunto(s)

Anomalías Inducidas por Medicamentos , Pruebas de Embarazo/métodos , Adulto , California , Estrógenos/efectos adversos , Femenino , Muerte Fetal/etiología , Humanos , Embarazo , Progestinas/efectos adversos , Estudios Prospectivos

RESUMEN

Of 10 479 single births in South Glamorgan between January 1974 and June 1976, 27.3 per cent of infants were born to women who had used oral contraception in the three months prior to their last menstrual period (users) and 72.3 per cent were born to women who had not used oral contraception during the same period (non users). There were significantly more infants with neural tube defects among users compared with non users. Abnormalities of the digestive, genito-urinary and cardiovascular system, bones, muscle, skin and connective tissues, endocrine glands, blood chromosomes and oral clefts, were of similar incidence in the two groups.

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PIP: All women normally resident in the city of Cardiff and towns of Barry and Penarth who delivered a single child between January 1974 and June 1976 were studied retrospectively as a cohort to study without bias the effects of recent oral contraceptive use on the fetus. There were 10,479 births (single) during the period under study. Of these, 2859 (27.27%) were born to users and 7620 (72.72%) were to nonusers. Other factors compared, which were known to influence the incidence of malformation, were maternal age, parity, social class, and the smoking habit. 2.83% (n=81) infants were born with abnormalities among users and 2.95% (n=225) had abnormalities among nonusers (difference not significant). Users are defined as those who took oral contraception in the 3 months before their last menstrual period. 3 babies had Down's syndrome among users but there were no other chromosomal abnormalities in this group; however, a total of 14 nonusers' babies had chromosomal abnormalities (10 Downs and 4 others). 18 infants had neural tube defects among users and 19 among nonusers. Age, parity, social class, and smoking were not significantly different among those users and nonusers who had a baby with neural tube defect. Overall, incidences of abnormalities were similar except for neural tube defect, which was statistically significantly higher among users (.63% in users vs. .25% in nonusers).

Asunto(s)

Anomalías Inducidas por Medicamentos/etiología , Anticonceptivos Orales/efectos adversos , Defectos del Tubo Neural/inducido químicamente , Adolescente , Adulto , Factores de Edad , Aberraciones Cromosómicas/inducido químicamente , Trastornos de los Cromosomas , Femenino , Humanos , Embarazo , Estudios Retrospectivos , Fumar , Clase Social

RESUMEN

Exogenous female sex hormone exposure was studied in the mothers of 110 infants with conotruncal malformations of the heart, born in the years 1972-75. Cases were ascertained throughout the referral area of the Maryland State Intensive Care Neonatal Program. For each case, three normal controls were chosen from the birth population: Two matched on eight characteristics related to the likelihood of hormone-taking (race, maternal age, parity, fetal losses, gestational age, delivery mode, time of prenatal registration, private/service), and one also on the infant's sex and birthweight; the third control was chosen at random. In personal interviews, information was obtained on the mother's general health, family history, reproductive characteristics, pregnancy health, and environmental exposures. Identification of hormonal products was aided by a display of pills and packages. Maternal recall was examined in comparison to the responses of a group of mothers of infants with hypoplastic left heart ("disease controls"). Regression analysis on time elapsed since the infant's birth revealed no difference in recall between the mothers of cases and of controls. Multilogistic regression analysis, controlling for confounding variables and for scores constructed for reproductive, malformation, and exposure risks, showed no increase in relative risk for cases when compared with matched controls. When compared to random controls, the analysis suggested a possible increase in relative risk with increased environmental exposure scores; components of the risk score were excess smoking and alcohol intake, exposure to X-ray, drugs, paints, insecticides, and chemicals. The possible significance of this finding needs to be further investigated.

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PIP: Exogenous female sex hormone exposure was studied in the mothers of 110 infants with conotruncal malformations of the heart, born in the years 1972-5. Cases were ascertained throughout the referral area of the Maryland State Intensive Care Neonatal Program and for each case, 3 normal controls were chosen from the birth population. 2 matched on 8 characteristics related to the likelihood of hormone-taking (race, maternal age, parity, fetal losses, gestational age, delivery mode, time of prenatal registration, private/service), and 1 also on the infant's sex and birthweight. The 3rd control was chosen at random. In personal interviews, information was obtained on the mother's general health, family history, reproductive characteristics, pregnancy health, and environmental exposures. Identification of hormonal products was aided by a display of pills and packages. Maternal recall was examined in comparison to the responses of a group of mothers of infants with hypoplastic left heart (disease controls). Regression analyses on time elapsed since the infant's birth revealed no difference in recall between the mothers of cases and of controls. Multilogistic regression analysis, controlling for confounding variables and for scores constructed for reproductive malformation, and exposure risks, showed no increase in relative risk for cases when compared with matched controls. When compared to random controls, the analysis suggested a possible increase in relative risk with increased environmental exposure scores; components of the risk score were excess smoking and alcohol intake, exposure to x-ray, drugs, paints, insecticides, and chemicals. The possible significance of this finding needs to be investigated further.

Asunto(s)

Amenaza de Aborto/tratamiento farmacológico , Estrógenos/efectos adversos , Cardiopatías Congénitas/epidemiología , Progesterona/efectos adversos , Estrógenos/farmacología , Estrógenos/uso terapéutico , Femenino , Humanos , Embarazo , Progesterona/farmacología , Progesterona/uso terapéutico , Teratógenos

RESUMEN

PIP: A monitoring of congenital malformation statistics for Hungary during the years 1970-75 showed a somewhat higher incidence of congenital limb reduction malformations during 1973-74. A further increase was observed in 1975, with increases continuing in 1976-77. The observed higher incidence cannot be attributed to a better reporting system, changed evaluation of congenital malformations, or improved diagnoses. The question as to whether the higher incidence is attributable to an increased use of OCs (oral contraceptives) is investigated. The occurrence of different nosological types of CLRMs (congenital limb reduction malformations) is tabulated. A more restrictive abortion law went into effect in Hungary in 1974, followed by an increase in live births and a decrease in the number of abortions. As a result, more women began using OCs, even as a method of inducing abortions. Examination of the women who had CLRM infants showed that use of OCs within 3 months of conception was twice as high in this group as in a control group. No direct teratogenic effect of OCs, other than a masculinization of female fetuses, has yet been proven. It is suspected that the effect is indirect, operating only in predisposed patients. A 3-month interval between OC use and a planned conception is recommended. Research into predisposing factors to indirect teratogenic effects is necessary.^ieng

Asunto(s)

Anomalías Inducidas por Medicamentos/etiología , Anticonceptivos Orales/efectos adversos , Anomalías Inducidas por Medicamentos/epidemiología , Anomalías Múltiples/epidemiología , Femenino , Humanos , Hungría , Deformidades Congénitas de las Extremidades , Embarazo

RESUMEN

Copper-bearing intrauterine devices are being increasingly used for contraception. A growing number of pregnancies, which may subsequently carry to term, are therefore being exposed to high levels of copper at the critical period of organogenesis, with risk of possible teratogenesis. Two cases of anencephaly occurring in association with these devices are reported.

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PIP: The possible toxic implications of copper from copper-bearing IUDs in congenital abnormalities of fetuses conceived with the IUD in situ are supported by the presentation of 2 such case histories. In Case 1, the woman became pregnant with a copper IUD in place and the woman delivered, after labor induction at 39 weeks, an anencephalic, stillborn, infant male. Case 2 also had a copper IUD inserted 16 months prior to conception. At 7 weeks from the last menstrual period, an ultrascan was performed because of excessive bleeding, and the IUD was visualized posterior to the sac. At 30 weeks of gestation, the labor was induced and the patient delivered an anencephalic infant. The possible teratogenic effect of copper should be discussed with women who conceive with a copper device in place and elect to continue the pregnancy.

Asunto(s)

Anencefalia/etiología , Dispositivos Intrauterinos de Cobre/efectos adversos , Adulto , Femenino , Humanos , Embarazo

RESUMEN

Plasma 25-hydroxyvitamin D (25-OHD) was measured in cord blood taken at delivery and in fasting blood taken from 44 Asian mothers in the first day of the puerperium. Blood was taken from the baby 48 h after delivery. Cord-blood samples were also taken at 43 non-Asian deliveries. Plasma 25-OHD concentrations in Asians were low at delivery; in 81% of the mothers and 36% of the babies plasma 25-OHD was in the osteomalacic range. Asian lower than concentrations in non-Asian controls. 4 Asian babies had vraniotabes and 1 had neonatal tetany. 1 non-Asian baby had craniotabes. A review of 3327 deliveries in 1978 confirmed that neonatal tetany was significantly more common in Asian babies (2.3%) than in non-Asian babies (0.3%). In 44 other Asian mothers supplements of 1000 units of vitamin D daily during pregnancy significantly increased plasma-25-OHD concentrations at delivery.

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PIP: Asian babies were examined for signs of neonatal rickets, and plasma 25-hydroxyvitamin D (25-OHD) was measured in their mothers. 25-OHD was quantified in cord blood taken at delivery and in fasting blood taken from 44 Asian mothers on the 1st day of puerperium. Babies had blood drawn 48 hours after delivery. Cord-blood samples were also taken from 43 non-Asian deliveries. Plasma 25-OHD levels were low in Asian mothers and babies at delivery. In 81% of the mothers, 68% of cord bloods, and 36% of babies, concentrations were in the osteomalacic range ( 25 nmol/l). Cord-blood 25-OHD in Asians was significantly lower than in non-Asians (P .001); and in only 1/44 non-Asian cord bloods was 25-OHD less than 25 nmol/l. None of the Asian mothers had clinically detectable osteomalacia. A highly significant correlation was found between plasma 25-OHD in mother and cord (P .001), mother and baby (P .001), and cord and baby (P .001). Cord plasma calcium concentrations were significantly lower in Asians than in non-Asians (P .001). There was no relation between 25-OHD and calcium concentrations in maternal or neonatal plasma. 4 Asian babies had craniotabes and 1 had neonatal tetany. 1 non-Asian baby had craniotabes. A review of 3327 deliveries in 1978 confirmed that neonatal tetany was significantly more common in Asian babies (2.3%) than in non-Asian babies (.03%). In 44 other Asian mothers, supplements of 1000 U of vitamin D daily during pregnancy significnatly increased plasma 25-OHD concentrations at delivery.

Asunto(s)

Hidroxicolecalciferoles/sangre , Enfermedades del Recién Nacido/diagnóstico , Osteomalacia/sangre , Complicaciones del Embarazo/sangre , Asia/etnología , Femenino , Sangre Fetal/análisis , Humanos , Hipocalcemia/diagnóstico , Recién Nacido , Masculino , Intercambio Materno-Fetal , Embarazo , Raquitismo/diagnóstico , Tetania/diagnóstico , Reino Unido