David Charles

Gestational diabetes and perinatal mortality rate

Significantly higher perinatal mortality rates were found in a prospective study of 187 gestational diabetic patients and 259 randomly selected negative control patients. Since the gestational diabetic patients were older and obese, further analyses were made to determine the role of these variables. Age was found to have a disproportionately adverse effect, enhanced slightly by obesity, on the pregnancies of gestational diabetic patients when compared with those of negative control patients. Two classes of gestational diabetic patients are outlined on the basis of age. The first includes those below 25 years of age who show no increased fetal wastage in pregnancy but may be more susceptible to this problem in unfavorable obstetric circumstances. The second class includes gestational diabetic patients 25 years of age or older who have high-risk pregnancies even in centers administering good prenatal care.

Birth Weight and Genital Mycoplasmas in Pregnancy

Abstract To ascertain the relation between mycoplasmas in the cervix and urine of pregnant women and the outcome of pregnancy, 485 patients were studied prospectively in the prenatal clinic of the Boston City Hospital. T-strains were recovered from 384 women who gave birth to babies whose mean birth weight was 202 g (7.1 oz) less than that of the babies of women from whom T-strains were not isolated (p less than 0.003). Mycoplasma hominis, which was often associated with T-strains in cultures of the urine and cervix, was less well linked with low birth weight (p equal to 0.054). The association of T-strains with low birth weight was not related to shortened gestational length. The presence of T-strains in the urine and cervix was independent of other risk factors for low birth weight. T-strains or M. hominis were not related to history of previous premature births, stillbirths or abortions or to the development of toxemia or third-trimester hemorrhage.

Preliminary data on the use of sodium aminohippurate to determine amniotic fluid volumes.

Abstract Numerous attempts have been made to determine the volume of amniotic fluid associated with normal and abnormal pregnancy, but no dilution method has been found to be clinically applicable in all instances. In view of the increased interest regarding the fluid surrounding the fetus, volumetric determinations will allow the accumulation of quantitative results concerning the various constituents of amniotic fluid. We have found sodium aminohippurate and ideal compound in view of its lack of toxicity, rapid diffusion throughout the amniotic cavity, and ease with which spectrophotometric determinations can be carried out. In a pilot study of 25 cases, 2 ml. of 20 per cent solution (400 mg.) gave satisfactory results. The results shown on the table confirm the inaccuracy of clinical estimations of amniotic fluid volume in all cases where hydramnios was considered to be present.

Erythromycin and clindamycin absorption and elimination in pregnant women.

Thirty‐nine pregnant women admitted for therapeutic abortions during early or mid pregnancy were given erythromycin estolate, erythromycin base, or clindamycin hydrochloride orally in single or multiple doses. Peak serum levels oj clindamycin were 3.4 to 9.0 µg/ml foliowing a single dose of 450 mg, whereas peak serum levels of erythromycin were 0.29 to 7.2 µg/ml foliowing 500 mg in a single dose. The individual variability of serum concentrations of erythromycin was greater than that reported in normal men and nonpregnant women, whereas the serum levels of clindamycin were rather uniform, and similar to what has been reported in nonpregnant individuals. Following multiple doses of each antibiotic, high serum levels were obtained in virtually all subjects, and urine levels were also higher. Following single doses the mean urinary recovery was 2% for erythromycin and 16.8% for clindamycin.

Clinical conditions associated with hydramnios.

Abstract In this communication, maternal, fetal, and placental factors in relationship to hydramnios have been considered. In a review of both 156 cases of hydramnios and the literature, only maternal diabetes and major congenital anomalies were found to be commonly associated with this entity. This study, however, emphasizes the necessity for prospective controlled studies in the evaluation of this enigma. Our preliminary studies with sodium para-aminohippurate indicate a method which could substantiate or refute a clinical diagnosis of hydramnios.

The significance of urinary free cortisol and progesterone in normal and anencephalic pregnancy.

Urinary free cortisol and progesterone were determined by radioimmunoassay in 18 normal and 16 anencephalic pregnancies and urinary free cortisol levels in 9 nonpregnant women. In normal pregnancy the urinary free cortisol (46.89 +/- 34.02 mug per 24 hours) was significantly higher (P less than 0.001) than that found with anencephaly (17.19 +/- 13.20 mug per 24 hours) and 2 1/2 times (P less than 0.001) the nonpregnant value (18.47 +/- 5.44 mug per 24 hours). In 12 of the anencephalic pregnancies, urinary free cortisol levels (11.05 +/- 5.56 mug per 24 hours) were significantly lower than in nonpregnant women (P less than 0.001). Urinary progesterone levels in normal pregnancy (15.57 +/- 9.66 mug per 24 hours) and anencephaly (18.54 +/- 12.69 mug per 24 hours) were comparable. The cortisol excretion values associated with anencephaly indicate that the normal fetus contributes substantially to the maternal plasma cortisol pool. Urinary free cortisol determinations may be a useful index of fetal adrenal dysfunction.

Quantitative extraction of steroid conjugates from urine by use of a liquid-liquid partition system

The present communication describes a method for the quantitative recovery of glucuronic and sulfuric acid conjugated urinary steroids.

The effect of dexamethasone on the urinary excretion of steroids during pregnancy.

The urinary excretion of oestriol, total 17‐oxosteroids, pregnanediol and Pettenkofer chromogens were studied in eight pregnancies before, during and after the administration of dexamethasone. Both the oestriol and 17‐oxosteroid levels declined during the period of drug administration. The change in Pettenkofer chromogens was less consistent but generally paralleled the 17‐oxosteroid values. Pregnanediol excretion greatly increased in three subjects, decreased in one and was relatively unchanged in the other patients. The present studies support the concept that placental pregnenolone is utilized by the fetal tissues for the biosynthesis of oestrogen precursors and by the placenta for progesterone synthesis.

Clinical and endocrinological studies with the isomeric components of clomiphene citrate.

ONE of the most important advances in the treatment of infertility has been the introduction of clomiphene citrate. The precise manner by which this substance produces its effects is still uncertain, but it is generally accepted that clomiphene is more likely to cause a satisfactory response in patients in whom ovarian activity is reasonably normal (Bell and Loraine, 1966; Loraine and Bell, 1968). Clomiphene citrate is now known to consist of a mixture of a cis and a trans isomer (Fig. 1). Nearly all the data reported in the literature has been obtained bv the use of such a mixture MATERIALS AND METHODS

Deuterium-Labeled Steroids for Study in Humans

6,7-Dideuterio-3-hydroxy-1,3,5(10)-estratrien-17-one (dideuterio-estrone) and 4-deuterio-1,3,5(10)-estratriene-3,17 β -diol (monodeuterio-17 β -estradiol) were used f