Reynir Tómas Geirsson

Death rates from ischemic heart disease in women with a history of hypertension in pregnancy

Background. Evidence about the influence of hypertension in pregnancy on later health and in particular the risk of cardiovascular disorders is conflicting, although a link has been suggested. In a population‐based study with a long follow‐up time the potential association between hypertension in pregnancy, preeclampsia and eclampsia with increased death rates from ischemic heart disease (IHD) was investigated.

Genetic and familial predisposition to eclampsia and pre‐eclampsia in a defined population

Summary. Familial predisposition and patterns of genetic inheritance of eclampsia and pre‐eclampsia were investigated through three or four generations in 94 families from the homogenous island population of Iceland. The families descended from index women delivered in the years 1931–47 and who had either eclampsia (n = 38) or severe preeclampsia (n = 69). Inheritance was followed both through sons and daughters. The prevalence of pre‐eclampsia and eclampsia in daughters was significantly higher (23%) than that in daughters‐in‐law (10%). No difference was noted in the prevalence of these diseases by whether the daughter was born of an eclamptic or pre‐eclamptic mother or whether she was a first or later born daughter. There was a non‐significantly higher occurrence of pre‐eclampsia among grand‐daughters than in grand‐daughters‐in‐law. No difference was seen by whether granddaughters descended through sons or daughters. With increasing numbers of affected daughters or grand‐daughters the probability rose of finding more affected women in a family. Hypotheses of single recessive and dominant gene inheritance were compared and maximum likelihood estimates for gene frequency obtained. For a single recessive gene model this was 0.31 reflecting a population prevalence of 9.6%, whereas a dominant model with incomplete penetrance gave 0.14 at 48% gene penetrance, corresponding to a population prevalence of 0.9% homozygous expression of severe disease and 11% heterozygous expression of milder disease. Either genetic model could fit the data.

Cardiovascular death in women who had hypertension in pregnancy: a case–control study

Objective  To determine whether an association exists between hypertension in pregnancy and later development of cardiovascular disease.

Analysis of Different Inheritance Patterns in Preeclampsia/Eclampsia Syndrome

Objective: To investigate how well various inheritance models would explain the familial tendency of the preeclampsia/eclampsia syndrome.Methods: The prevalence among seven groups of women with definite probabilities of exhibiting the disorder from six different family studies was used to obtain maximum likelihood estimates of the contributions to disease liability from major genes and multifactorial transmission.Results: Models involving a single major gene with incomplete penetrance or multifactorial inheritance offered considerably better fit to the observed data than no familial transmission at all or autosomal dominant and recessive inheritance models with complete penetrance. Of the major gene models, a dominant mode of transmission was preferred. From the extremes of the joint 95% confidence region for the gene frequency (p) and penetrance (f), the corresponding confidence limits for the best estimates were 0.06 f > 0.23, respectively.Conclusions: These results indicate that t...

Dyslipoproteinaemia in postmenopausal women with a history of eclampsia

Objective To test the hypothesis that postmenopausal women with a history of eclampsia manifest a more high risk lipid profile than postmenopausal women with a history of normal pregnancy.

Pelvic Endometriosis Diagnosed in an Entire Nation Over 20 Years

The annual incidence of pelvic endometriosis among women aged 15-49 years and up to age 69 years was ascertained for the Icelandic population between 1981 and 2000 by using Icelands extensive record linkage systems. Comprehensive, state-financed health care and unique personal identification numbers enabled care to be tracked from first diagnosis. To identify cases, a centralized discharge-code registry was searched, as well as all hospital databases and, for individual patients, all hospital records. Each case of visually diagnosed and histologically verified endometriosis was cross-checked against the nationwide pathology registry. The revised American Society for Reproductive Medicine classification system was used for staging. Recorded was type of operation at diagnosis and presence of disease at 5 sites: deep pelvis, appendages, central pelvis, vesicouterine pouch, and ovaries. A total of 1,383 women were diagnosed surgically, with histologic verification of 811 (58.6%). All but 6 cases could be staged; 297 (36.9%) had minimal/mild and 508 (63.1%) had moderate/severe disease. The estimates of crude annual incidence were 0.1% for visually confirmed and 0.06% for histologically verified endometriosis, and respective age-standardized annual incidence was 0.1% and 0.05% for women aged 15-49 years. The most common site was the ovary, followed by deep pelvis, central pelvis, appendages, and vesicouterine pouch.

Hormonal contraception and venous thromboembolism.

Background. New studies about the influence of hormonal contraception on the risk of venous thromboembolism (VTE) have been published. Aim. To evaluate new epidemiological data and to propose clinical consequences. Design. A literature survey. Methods. Studies assessing the risk of specific types of hormonal contraception were evaluated, compared and set into a clinical perspective. Results. The majority of newer studies have demonstrated a threefold increased risk of VTE in current users of medium‐ and low‐dose combined oral contraceptives (COCs) with norethisterone, levonorgestrel (LNG) or norgestimate compared with non‐users. The same studies have demonstrated a sixfold increased risk of VTE in users of combined pills with desogestrel, gestodene, drospirenone or cyproteroneacetate, and in users of the contraceptive vaginal ring, compared with non‐users. The rate ratio of VTE between users of COCs with newer progestogens compared with users of COCs with LNG was 1.5–2.8 in seven studies and 1.0 in two studies. Progestogen‐only contraception did not confer an increased risk of VTE in any study. The incidence rate of VTE in non‐pregnant women aged 15–49 years using non‐hormonal contraception is three per 10 000 years. Conclusions. For women starting on hormonal contraception, we recommend medium‐ or low‐dose combined pills with norethisterone, LNG or norgestimate as first‐choice preparations. For the many women who are users of COCs with newer progestogens, although the absolute risk of VTE is low, a change to combined pills with norethisterone, LNG or norgestimate may halve their risk of VTE. Finally, we recommend COCs with 20 μg estrogen combined with the older progestogens to be launched in the Scandinavian countries. Women at an increased risk of VTE should consider progestogen‐only contraception or non‐hormonal contraception.

Obstetric outcome of natural and assisted conception twin pregnancies is similar

Background. The risk of obstetric intervention and adverse fetal or neonatal outcome is considerably higher in multiple gestation than in singleton pregnancy. How assisted conception influences obstetric management and outcome in twin pregnancies has not been evaluated.

Urinary incontinence and urinary tract infections in octogenarian women

Background. Urinary incontinence and urinary tract infection are common problems among elderly women due to age-related changes in the urogenital tract, but information regarding prevalence and presentation among the aged is limited.Methods. A total of 97 randomly selected women aged 80-89 years, 47 living in homes for the elderly and 50 living at home, were asked about urogenital complaints in a structured interview. Medical records provided information about urinary tract infections and the use of estrogens.Results. Urinary incontinence affected 46%; half of them daily. Urge incontinence was most common (43%), then mixed incontinence (28%) and stress incontinence (26%). Urge and mixed incontinence caused significantly more discomfort than stress incontinence. During the past two years 33% of the women had experienced urinary tract infection and 11% had =5 infections. A total of 22 women were receiving estrogen treatment, more often in homes for the elderly (p<0.001). Paradoxically, these women had a hig...

Comparative study of the effects of a progestogen‐only pill containing desogestrel and an intrauterine contraceptive device in lactating women

Objective To evaluate the effects of desogestrel 75μg/day, as a progestogen‐only pill compared with a copper‐bearing intrauterine contraceptive device (IUCD) on lactation and to study the safety of both treatments in mothers and children. Transfer of etonogestrel to breast milk was studied in a subgroup of desogestrel users. The children were to be followed up until 2.5 years of age.