A 1 and 6 month follow-up of prenatal diagnosis patients who lost pregnancies

This paper reports results of an exploratory study of prenatal diagnosis patients who experienced voluntary terminations of pregnancy following the detection of an abnormality or spontaneous miscarriages. The 121 participants were part of the national collaborative Chorionic Villus Sampling and Amniocentesis Study. They completed semi-structured telephone interviews and mailed questionnaires at 1 month and 6 months after the pregnancy losses. Scores on the Profile of Mood States showed that mood levels improved significantly over time. However, there were some declines in loss-related support from partners and others. The persisting distress and difficulties of a minority highlight the variability in women's responses to pregnancy losses. Women who lost pregnancies later in gestation, showed the greatest mood disturbances at initial assessments, used professional mental health assistance after the loss, or reported less satisfactory loss-related support from significant others showed the greatest levels of mood disturbance at the six-month assessment. Follow-up contacts with patients who lose pregnancies should be used to inform women about the variation in possible grief reactions, to assess the extent of support the women are receiving from their partners and significant others, and to provide additional follow-up or referral of those experiencing the greatest distress.     

Nature and frequency of chromosomal abnormalities in pregnancies with abnormal ultrasound findings: An analysis of 117 cases with review of the literature

During a 7-year period, 117 fetal karyotypes were available from 131 genetic amniocenteses. These procedures were performed between 14 and 37 weeks' gestation for the following abnormal ultrasound findings: (1) intrauterine growth retardation (IUGR)—61 cases; (2) fetal malformation—71 cases; and (3) amniotic fluid volume (AFV) abnormality—60 cases. Chromosomal abnormalities were identified in 19 cases (16.2 per cent). Aneuploidy was 2.5 times as frequent in the presence of malformations than in their absence. No correlation was demonstrated between specific fetal malformations and specific chromosomal abnormalities. Aneuploidy was also twice as frequent in the presence of symmetrical IUGR than in its absence. No chromosomal abnormalities were found among eight cases of asymmetrical IUGR. Four cases of aneuploidy presented with isolated IUGR, three of these involving the X chromosome. The frequency of aneuploidy was the same with or without abnormalities of AFV (14.3 versus 16.4 per cent). No chromosomal abnormality was found associated with isolated AFV abnormalities.     

Easurements of placental,decidual, and fetal proteins before and after chorionic villus sampling

Circulating placental [human chorionic gonadotrophin (hCG), Schwangerschafts protein 1 (SP1), pregnancy-associated plasma protein A (PAPP-A), decidual (pregnancy protein) 12 (PP12), and fetal alphafetoprotein (AFP)] proteins were measured immediately before and within 1 h in 18 women undergoing diagnostic chorionic villus sampling (CVS) in the first trimester. An elevation of serum AFP levels was consistently seen, while fluctuations in excess of 10 per cent of the pre-CVS levels of SP1 and PP12 were seen in the majority of patients. Fluctuations in hCG and PAPP-A were consistently less than 10 per cent of pre-CVS values. Post-CVS changes in levels were not apparently associated with any feature of the technique, the pregnancy, or its outcome (one missed abortion). As feto-maternal haemorrhage is a common event, anti-D should be offered to rhesus-negative women undergoing CVS. In the prediction of subsequent miscarriage, only hCG and PAPP-A measurements should be considered.     

Maternal serum thyroid antibodies in early pregnancy and fetal Down's syndrome

Thyroid antibodies were measured in mid-trimester antenatal serum samples from 77 pregnancies affected by fetal Down's syndrome and 385 unaffected control pregnancies. Using a haemagglutination technique, thyroglobulin antibodies were detected in 5·2 per cent of cases (4) and 2·9 per cent of controls (11), and thyroid microsomal antibodies were detected in 22 per cent (17) and 15 per cent (59), respectively. Using an enzyme-linked immunosorbent assay (ELISA) for thyroglobulin antibodies and a cut-off level of 50 KIU/1, positive results were found in 25 per cent of cases (19) and 22 per cent of controls (84). Using an ELISA for thyroid microsomal antibodies and the same cut-off level, the proportions were 52 per cent (40) and 39 per cent (149), respectively. While not statistically significant, the differences were consistent with the previously reported increased levels of thyroid antibody found in nonpregnant women who had had pregnancies associated with Down's syndrome.     

Continuous subcutaneous insulin infusion (CSII) in pregnant diabetic patients

The efficacy of the insulin infusion pump (CSII) in pregnancy was examined in 12 diabetic patients and compared with intermittent insulin therapy (IIT). In patients poorly controlled on IIT constant and rapid equilibrium was achieved with CSII (mean of glucose levels: CSII versus IIT=84 versus 137 mg/dl; S.D. = 36 versus 63 mg/dl; mean amplitude of glycemic excursion (MAGE)=65 versus 112 mg/dl. In patients well controlled on IIT, CSII led to a reduction in the variation of glucose excursions (S.D.= 29 versus 36 mg/dl; MAGE=48 versus 76 mg/dl). CSII generally produced a reduction of 20–37 per cent of daily insulin dose (in three cases there was an increase of dose with the achievement of glycemic control). Furthermore in CSII treated-patients amniotic glucose, insulin and C-peptide concentrations werefound tobeinthenormalrange(22.1±10.1 mg/dl; 5.2±2.7μ/ml; 1.25±0.71 ng/ml, respectively). All infants were horn at or near-term, had no macrosomia or neonatal problems. It is concluded that CSII is a highly efficient way to achieve normal glucose levels in pregnancy, not only in type I, hut also in type II or gestational diabetes.     

Trace element levels in foetus-mother pairs of short-beaked common dolphins (Delphinus delphis) stranded along the French coasts

Tissues of foetus-mother pairs of common dolphins (Delphinus delphis) stranded along the French coasts (Bay of Biscay and English Channel) were analysed for their Cd, Cu, Hg, Se and Zn contents. In the kidneys, foetal Cd levels were extremely low, and strong relationships between Cu and Zn suggested the involvement of metallothioneins since early foetal life. The results also indicated a limited maternal transfer of Hg during pregnancy since levels in the tissues of foetuses were below 1 microg g(-1) w.wt. However, hepatic Hg levels in foetuses increased with body length, and were also proportionate to maternal hepatic, renal and muscular Hg levels. Lastly, affinities between Hg and Se in tissues would participate in Hg neutralisation in both mothers--through tiemannite granules--and fetuses--through reduced glutathione--counteracting the toxic effects linked to the particularly high quantities of methyl-Hg to which marine mammals are naturally exposed.     

Ambient nitrogen oxides exposure and early childhood respiratory illnesses

Acute respiratory infections are common in children below 5 years and recent studies suggest a possible link with air pollution. In this study, we investigated the association between ambient nitrogen oxides (NO_x) and bronchitis or upper airway inflammation.This longitudinal study was conducted in Teplice and Prachatice districts, Czech Republic. Children were followed from birth to 4.5 years of age. Data were compiled from medical records at delivery and at follow up, and from self-administered questionnaires from the same two time points. Air pollution monitoring data were used to estimate exposure over five different averaging periods ranging from three to 45 days prior to an episode. To quantify the association between exposure and outcome, while accounting for repeated measure correlation we conducted logistic regression analysis using generalized estimating equations.During the first 2 years of life, the adjusted rate ratio for bronchitis associated with interquartile increase in the 30-day average NO_x was 1.31 [95% confidence interval (CI): 1.07, 1.61] and for two to 4.5 year olds, it was 1.23 (95% CI: 1.01, 1.49). The 14-day exposure also had stable association across both age groups: below 2 years it was 1.25 (95% CI: 1.06, 1.47) and for two to 4.5 years it was 1.21 (95% CI: 1.06, 1.39). The association between bronchitis and NO_x increased with child's age in the under 2 years group, which is a relatively novel finding.The results demonstrate an association between NO_x and respiratory infections that are sufficiently severe to come to medical attention. The evidence, if causal, can be of public health concern because acute respiratory illnesses are common in preschool children.     

Exposure to strange adults does not cause pregnancy disruption or infanticide in the gray-tailed vole

A widely accepted paradigm in mammalian behavioral biology is that exposure to unfamiliar males causes pregnancy disruption in female rodents (commonly known as the Bruce effect). This behavioral phenomenon has been demonstrated in the laboratory with at least 12 species of rodents, primarily within the genus Microtus, and is supposedly an adaptation that provides male perpetrators with reproductive access to females, and functions, for females, as a counterstrategy to infanticide. However, neither the Bruce effect nor its adaptive significance have been tested experimentally in the field. In a controlled field study, we exposed reproducing female gray-tailed voles (Microtus canicaudus) to treatments in which males were removed and replaced by either unfamiliar males or females, and found no significant differences in intervals between parturitions, number of pregnancies, and juvenile recruitment among the treatment and control animals. Thus, we conclude that neither the Bruce effect nor infanticide occurred differentially as a consequence of the treatments in gray-tailed voles. Multimale mating to confuse paternity, and postpartum estrus resulting in simultaneous pregnancy and lactation may deter infanticide and functionally negate any benefits of pregnancy disruption in gray-tailed voles and perhaps other murid rodents with similar mating systems. In light of our results, we recommend field verification for other species of murid rodents that exhibit the Bruce effect in the laboratory before the results are applied to evolutionary theory. Received: 12 May 1998 / Accepted after revision: 6 September 1998     

Female guppies shorten brood retention in response to predator cues

Predation risk influences the duration of offspring development in many species where embryos develop from externally shed eggs. Surprisingly, such predator-mediated effects on offspring development have rarely been explored in live-bearers. In this paper, we use the guppy (Poecilia reticulata), a live-bearing freshwater fish, to test whether the duration of brood retention (the time from mating to parturition) is influenced by experimental changes in the perceived level of predation. Because the swimming performance of female guppies is impaired during late pregnancy, we predicted that females would withhold broods for shorter periods when they are exposed to cues that signal a heightened risk of predation on adults rather than on juveniles. We therefore simulated increased risk of predation on adults by using a combination of pike-shaped models (resembling natural predators that prey on adult guppies) and ‘alarm substances’ derived from the skin extracts of adult conspecific females. Our results revealed that, under simulated predation risk, female guppies produced broods significantly more quickly than their counterparts assigned to a control group where predator cues were absent. A subsequent evaluation of offspring swimming performance revealed a significant positive association between neonate swimming speeds and the duration of brood retention, suggesting that by accelerating parturition, females may produce offspring with impaired locomotor skills. These findings, in conjunction with similar results from other live-bearing species, suggest that the conditions experienced by gestating females can generate significant variation in the timing of offspring development with potentially important implications for offspring fitness.     

Maternal serum alfa-fetoprotein levels in the pregnancy complicated by hypertension

Maternal serum alpha-fetoprotein (MSAFP) was determined in patients 33 to 40 weeks pregnant, and the results were analysed with consideration of the presence and quality of hypertensive disease that complicated many of the pregnancies. Patients with incompletely controlled hypertension had significantly higher MSAFP levels than control patients with pregnancies uncomplicated by any risk factor. MSAFP elevation was greatest in pre-eclampsia (301·6 ± 147·6 kU/L, n = 35) > chronic hypertension with superimposed pre-eclampsia (240·4±74.7 kU/L, n = 30) > chronic hypertension (204·1± 105·3 kU/L, n=141). Each was significantly increased (P< 0·0001) over control pregnant patients' levels (104·3 ± 38·8, n= 187). At each gestational week from 33 weeks to term, MSAFP of combined hypertensive women was significantly greater than corresponding control levels (P< 0·003 to < 0·000l). The magnitude and time of onset of MSAFP increase may indicate severe fetal distress.