R.H. Gray

REDUCED RISK OF PELVIC INFLAMMATORY DISEASE WITH INJECTABLE CONTRACEPTIVES

As part of a study on acute febrile pelvic inflammatory disease and IUDs, reported elsewhere, a significantly lower risk of PID was observed in women using injectable contraceptives. The World Health Organization coordinated the multinational case-control study in 1979-79. Diagnostic criteria were fever, suprapubic tenderness with guarding, cervical or adnexal tenderness or a pelvic mass. 319 cases and 639 matched controls were matched for age, parity, marital status and hospital status. Data were taken from questionnaires. 10 cases (3.1%) currently used injectable contraceptives, mainly Depo-Provera, compared to 38 controls (6.0%). Thus the risk of getting PID was half as great among injectable users, similar in magnitude to risks reported for women using oral contraceptives, barrier methods and sterilization in developing countries.

Community based study of treatment seeking among subjects with symptoms of sexually transmitted disease in rural Uganda

This paper presents a community based study of treatment seeking among people with symptoms of sexually transmitted diseases (STDs) in rural Uganda. The effects of asymptomatic infections and treatment seeking behavior on control of sexually transmitted disease were quantified. The study suggests that treating only individuals with STD symptoms results in only a small proportion of the infected population being reached. This situation leads to fewer people receiving effective health care. Thus, STD control programs in medically underserved populations must take into account the prevalence of asymptomatic infections and the health related practices of people with STDs symptoms to design strategies for reducing transmission of these diseases.

Pregnancy outcome in natural family planning users: cohort and case-control studies evaluating safety

Conceptions involving aging gametes are of relevance to natural family planning (NFP) because women using NFP to avoid pregnancy abstain from intercourse during the fertile time of the cycle. To help verify the safety of pregnancies occurring among NFP practitioners, our group has, since 1986, conducted a large cohort study involving six experienced NFP centers. Timing of conception was determined from NFP charts, in which women recorded days on which intercourse occurred. The number of days from the most probable conception intercourse to probable day of ovulation was first determined, and used as an estimate of the time gametes remained in the genital tract before fertilization. Several studies have already been completed, cohort as well as case-control in nature.1. Spontaneous abortions. Three hundred and sixty-one conceptions occurred during the optimal time (day -1 or 0 relative to ovulation), and of these 33 resulted in spontaneous abortion (9.1%). Five hundred and seven conceptions occurred at non-optimal times during the cycle, and of these 55 resulted in spontaneous abortions (10.9%). These differences were not statistically significant (relative risk 1.19, 95% CI, 0.79-1.80) [1].2. Anomalies. Among 780 singleton births in 868 cohort pregnancies, 24 infants had major anomalies (3.1%) as of the present analysis [2]. This frequency is comparable to the general population. To further assess anomalies we employed a case-control approach. All consecutive births (live and stillborn) weighing 500 g or more taking place in 18 participating South American hospitals were examined for minor and major congential anomalies. Mothers of malformed and control infants did not differ with respect to the reported frequency of NFP use, which overall was 6.3% of the 10 642 mothers interviewed (5277 having a malformed infant; 5371 controls). Of 262 discordant pairs, there were 28 or 10.69% mothers within the Down syndrome case group vs. 16/262 or 6.11% among matched controls [3,4]. The odds ratio was 1.84; 95% CI, 0.99-3.96; however, even this non-significant difference narrowed substantially when adjusted for maternal age (OR, 1.78; 95% CI, 0.84-3.75); parity (OR, 1.68; 95% CI, 0.87-3.24); maternal educational level (OR, 1.71; 95% CI, 0.86-3.44); or all three together (OR, 1.74; 95% CI, 0.83-3.64).Conclusions. Our findings should be reassuring to natural family planning users. The overall rate of spontaneous abortion was not increased in NFP users who became pregnant, nor to date was the rate of anomalies. Any contribution to Down syndrome or abortion due to aging gametes would have to be small.

ORAL CONTRACEPTIVES AND BREAST CANCER

The association between the use of oral contraceptives and the development of breast cancer was re-examined at a 3-day conference in which research from the US, the UK, Scandinavia and New Zealand was presented. It was agreed that earlier use of oral contraceptives did not appear to increase the risk of breast cancer in women over 45. However, no consensus was reached on whether an increased risk was present in women under age 35. Evidence from the UK suggest the overall chance of a women developing breast cancer at any time in her life was 1 in 14, while in women under 35 it was 1 in 500 in the absence of oral contraceptives, and 1 in 350 for women under 35 using the pill. Another study from the UK revealed that the risks were lower in those women taking the newer low-dose pills with less estrogen. Furthermore, it was suggested that progestagen-only pills might have a protective effect against breast cancer. Also discussed at the conference were the benefits of the pill, such as its great efficacy, good acceptability, and its role in a 50% decrease in both ovarian and endometrial cancers. No definitive view on the matter of oral contraceptives and breast cancer was reached. It was concluded that more research is needed in the developed countries, as well as in the developing world. In the meantime, the International Medical Advisory Panel and the British Committee on Safety of Medicines agree that no change in oral contraceptive prescribing practice is currently necessary. The association between oral contraceptives and breast cancer, however, should remain under regular review.

Risk of recurrent spontaneous abortion for pregnancies discovered in the fifth week of gestation

3 Wood DA, Riemersma RA, Butler S, Thomson M, Macintyre C, Elton RA. Linoleic and eicosapentaenoic acids in adipose tissue and platelets and risk of coronary heart disease. Lancet 1987; i: 177-82. 4 Katan MB, Van de Bocenkamp P. Eicopentaenoic acid in fat. Lancet 1987; i: 862-63. 5 Riemersma RA, Wood DA, Butler S, et al. Linoleic acid content in adipose tissue and coronary heart disease. BMJ 1986; 292: 1423-27.

Effects of timing of conception on birth weight and preterm delivery of natural family planning users.

Objective: Various birth defects and untoward perinatal outcomes have been claimed to be associated with pregnancies conceived by gametes aged in vivo before fertilization. Thus, these outcomes were systematically assessed in pregnancies occurring in natural family planning (NFP) users. Our international multicenter cohort study of NFP pregnancies (n = 877) is by far the largest systematic study designed to assess pregnancy outcome and is of sufficient power to allow us to address the concern of low birth weight (< 2500 g) and preterm delivery (< 37 weeks gestation).Study design: In addition to gathering baseline medical data, evaluation was performed at 16 weeks, 32 weeks and at term. Data were collected in a systematic cohort fashion, verified by the five collaborating international recruiting centers, and analyzed by investigators in the US. Most recruiting center principal investigators are obstetrician-gynecologists and, if not, have integral relationships with such specialists. Standard criteria could thus be applied within and among centers. In our cohort, birth weight was recorded accurately at delivery. Almost all of the deliveries occurred in hospitals; thus, data should be quite reliable. Neonatal examination for anomalies was usually conducted immediately after delivery, when birth weight was recorded.Results: Analysis of risk factors for low birth weight and pretern delivery showed that this population had a low risk profile. Low birth weight infants (< 2500 g) and preterm deliveries were increased among women with a history of either prior low birth weight or preeclampsia in the index pregnancy. However, mean birth weight was unaffected by the timing of conception vis à vis ovulation or pregnancy history. Mean birh weight for the 877 singleton NFP pregnancies was 3349.6 g. The risk of preterm delivery was increased among older women who drank alcohol, but there were no significant effects of timing of conception vis à vis ovulation on preterm delivery. Results held when analysis was stratified according to whether NFP was being used for contraception or to achieve pregnancy.Conclusions: Our data do not appear to show striking differences between 877 NFP pregnancies and the general obstetric population. The timing of conception vis à vis ovulation does not exert significant effects on the birth weight or preterm delivery of resulting pregnancies, a reassuring finding for NFP users.

Risk of ovulation during lactation

Exercise prescription in pregnancy: Weight-bearing versus nonweight-bearing exercise Artal R.; Masaki DI; Khodiguian N; Romem Y; Rutherford Department of Obstetrics and Gynecology, University of Southern Carlfornia School of Medicine, Women’s Hospital, 1240 NMission Road, Los Angeles, CA 90033, USA AM J OBSTET GYNECOL 1989,161/6 1(1464-1469) Bicycle ergometry (non-weight-bearing exercise) and treadmill (weight-bearing exercise) were compared to assess physiologic responses to similar work loads. A total of 22 subjects at 29.3 f 1.6 (+ SEM) weeks’ gestation who performed nonweight-bearing exercise were compared with 15 similarly fit subjects at 26.1 k 2.3 weeks’ gestation who performed weightbearing exercise at three submaximal levels. Measurements by indirect calorimetry indicate preferential carbohydrate use during non-weight-bearing exercise at submaximal levels.