The effect of the introduction of prenatal diagnosis on the reproductive history of women at increased risk from neural tube defects

The reproductive history of 45 couples at increased risk for neural tube defect (NTD) who came for genetic counselling in 1970 and 1971 were compared with a similar number counselled in 1975 and 1976, when prenatal diagnostic tests were freely offered. They were subsequently interviewed in their homes and had their reproductive history recorded to the end of 1973 and 1978 respectively. Nearly all had a previous child with an NTD and none of the women were pregnant at the time of counselling. The effect of prenatal diagnosis was to speed somewhat the decision about further pregnancies, but the number of couples deciding on no further children and on having further pregnancies were almost identical in the two groups. The average number of pregnancies was 2·8 per family, with only 1·2 surviving children. The pregnancy outcomes are discussed as are the reasons for not attempting further pregnancies in both groups, which included very high risk of recurrence, a surviving spina bifida child, inability to accept the tests or its implications. Ninety per cent of the second group had tests. Their reactions to the tests were favourable but all complained of the waiting time between amniocentesis and obtaining the results. They all would have tests again in any future pregnancy. The reason for women not having prenatal diagnostic tests included inability to accept termination. It is concluded that couples in South Wales decide either to have no more children or to have further pregnancies regardless of tests. but tests speed a decision and enable the women to enjoy the pregnancy after obtaining the results, and that an NTD greatly reduces the number of children per family. A termination for an NTD is much more acceptable to most than an NTD at term. The reasons for this are discussed.     

通过调节汽油中铅的使用来控制人体血铅浓度

在20世纪60～70年代,铅排放一直保持着最大速率,之后,由于工业国家采取了日益严格的政策来限制铅作为防爆剂在汽油中使用,使得含铅汽油已经变得很少见了.我们利用欧洲铅排放量(PbE)和空气浓度(PbC)的重建及对约1980年以来德国人体血铅浓度(PbB)的重复测定,建立了一个可由铅排放量(PbE)估计人体血铅浓度(PbB)的经验模型.采用这一模型有两种用途[1]估计六七十年代德国的PbB水平,当时铅排放量最大而人体血铅水平监测尚未开始.结果显示,血铅峰值已经达到了卫生官员认为对胎儿和儿童有潜在危害的平均水平.[2]估计PbB水平将如何因有关汽油中铅使用的法规的实施而变化.模型估计,如果没有或延迟法规,PbB水平将远远超过临界水平.因此,自20世纪70年代以来,德国制定的法规已经明显降低了铅对健康的危害.