Stig Kullander

A Prospective Study of Smoking and Pregnancy

A prospective study was performed on the effect of smoking on pregnancy, using information from 6 363 pregnancies with known smoking habits. Of these, 2806 (44%) smoked during pregnancy, and 2731 (97%) of the 2 806 reported that they smoked during the whole pregnancy. The well‐known effect on prematurity rate and mean birth weight was verified in this study. A 50% increase of prematurity rate was registered among smoking women compared with non‐smoking women. The mean birth weight reduction was 170 g among live‐born, non‐malformed children. These effects were found to occur irrespective of other variables studied: maternal age, parity, and whether the pregnancy was wanted. The body length, head circumference, and shoulder circumference were found to be reduced in children born to smoking women. Placental weight was also reduced, but the ratio placental weight over body weight increased with smoking. No effect on the malformation rate was observed, but the series is too small to exclude a teratogenic effect of smoking. Children were followed to 1 year of age. The death risk for a child of a smoking woman was found to be increased to 1.6 times that for a child of a non‐smoking woman. No significant difference in stillbirth rate was found, but an effect was found on neo‐natal death both before and after the age of 1 week, although only among non‐premature children. Among children dying before the age of 1 week, a significant increase in frequency of abruptio placentae was noted. No other specific cause of death was noted. An overall increased risk of spontaneous abortion among smoking women was verified; this was shown to be almost completely due to the association between the fact that the pregnancy was unwanted and smoking. An even higher incidence of smoking was seen among women with induced abortions. Spontaneous abortion is also associated with unwanted pregnancies, perhaps due to the presence of induced abortions among the group recorded as spontaneous abortions. Smoking was shown to be associated only with late spontaneous abortions. If there is an abortifacient effect of smoking, it must be very slight. The decreased rate of preeclamptic complications among smoking women, described by earlier authors, was verified. A similar decrease in frequency of morning sickness was also found. No effect of smoking on the mean Apgar score of surviving, non‐malformed children was seen. The sex ratio among children born to smoking women differed slightly from that born to non‐smoking women, but this difference was not statistically significant.

Effect of administration of a combined estrogen-progestin contraceptive on the level of individual plasma proteins.

Serum proteins of 30 women were estimated before, and 6 months after, regular intake of contraceptive pills (0.1 mg mestranol and 5 mg megestrol). A highly significant rise of increasing degree was observed for α2-macroglobulin, lipoproteins, transferrin, plasminogen, α1-antitrypsin, thyroxine-binding globulin (cortisol), and ceruloplasmin. The immunoglobulins were unchanged, but albumin, haptoglobins, and orosomucoid showed a highly significant decrease. The fall of orosomucoid and haptoglobins was greater than during pregnancy, while the rise of α1-antitrypsin, α2-macroglobulin, lipoproteins, and transferrin was less. It is concluded that the metabolic effects of contraceptive steroids has not been properly explored. This study implies that these metabolic effects are only in partial agreement with the alterations occurring during normal pregnancy.

Benefits of ultrasonic screening of a pregnant population.

Abstract. The present study describes the evolution over a 5‐year period of an ultrasonic routine screening programme of a pregnant population with participation of approximately 90 % of the pregnant women. One obvious result obtained in the screening programme is the pronounced improvement of early detection of twins, the incidence now approaching 95 % with the mean gestational age for the detection being 20 (median 19) weeks. Early detection in combination with clinical measures was associated with a decrease in the incidence of twins born preterm (before week 37) from 33 % to 10 %. The perinatal mortality rate of twins fell from 6 to 0.6 % after the introduction of this programme.

Do Estrogen and Progesterone Receptors (E2R and PR) in Metastasizing Endometrial Cancers Predict the Response to Gestagen Therapy

In a prospective investigation biopsy specimens were obtained of 150 women with primary, untreated endometrial carcinoma for determination of the content of estrogen and progesterone receptors (E2 and PR). After a varying interval 13 who developed metastases despite routine surgical and radiation therapy received treatment with gestagens. The clinical effect of the hormone was studied for any correlation with the initial content of E2 and PR.

A Prospective Study of Drugs and Pregnancy

Abstract. The results are presented of a prospective study on drug use during pregnancy involving antibiotics, analgesic drugs and iron and vitamin preparations. The study was conducted in Malmö between 1963 and 1965. No unfavourable effect of the use of antibiotics, mainly penicillin and sulphonamides, could be demonstrated. Among 15 women who had an infant with hypospadias, three had used penicillin during the first trimester, but this may well be coincidental. Analgesic drug use shows a variability which resembles that previously described for psychopharmaca. No effect on the malformation rate or infant survival could be found. A possible lengthening of the mean duration of pregnancy occurred after the use of analgesic drugs during the 2nd or 3rd trimesters. Women who are going to have a dead or malformed infant use iron and/or vitamin preparations less often during late pregnancy than women who prove to have a normal infant. When such drugs were used, the percentage of pregnancies ending in birth before the 38th week is reduced, and the birth weight among term babies is higher. The associations between pregnancy outcome and the use of iron and vitamin preparations is probably indirect, due to social factors associated with drug use.

The success rate of in vitro fertilization of human oocytes in relation to the concentrations of different hormones in follicular fluid and peripheral plasma

Seventeen infertile patients were stimulated with clomiphene citrate and human chorionic gonadotrophin (hCG). During laparotomy or laparoscopy, follicles were aspirated. At least one fertilizable oocyte was obtained from 13 patients, who had normal preovulatory plasma 17 beta-estradiol (mean 2.2 nmol/l) in contrast to the 4 patients with infertilizable oocytes (mean 0.4 nmol/l). A close association was found between the success rate of fertilization and the increment of plasma progesterone from the day before to the day after the operation. If the concentrations of 17 beta-estradiol and progesterone in follicular fluid were below an arbitrary limit (17 beta-estradiol less than 500 nmol/l in association with progesterone less than 2,000 nmol/l), no oocytes could be fertilized. Apparently aspiration of oocytes and follicular fluid did not disturb ovarian steroid production during the luteal phase. The results suggest that plasma 17 beta-estradiol and progesterone determinations may serve as useful predictors for oocyte fertilizability in an in vitro system, following clomiphene-hCG stimulation and multiple oocyte recovery.

Long-term experience of general ultrasound screening in pregnancy

Since January 1, 1974, 43,000 routine ultrasound examinations have been performed on 22,400 pregnant women in the Department of Obstetrics and Gynecology, Malmö General Hospital. At the present time, one examination is performed in the seventeenth week of pregnancy and one in thirty-third week. At the first examination, the number of fetuses, fetal anatomy, cardiac activity, and placental site are indicated. Fetometry is performed. Gestational age is adjusted according to the value of the biparietal diameter. The second ultrasound examination is aimed at detecting fetal growth deviations and malformations. In 15% of all pregnancies, ultrasound corrected gestational age by more than 14 days. Ultrasound appeared to be superior to the clinical assessment in 88% of these discrepant pregnancies in predicting date of delivery. The early examination detected 98% of the twin pregnancies, with no false positive results. If an ultrasound examination had been performed within 3 weeks of delivery, 92% of the fetuses with growth retardation were detected. Altogether, the program detected 60% of the growth-retarded fetuses. In 0.4% of the examinations, malformations were detected (0.6% during the last 2 years). A cost-benefit analysis suggested that large economical gains are to be realized by screening. However, organizational and educational problems must be properly solved before general screening is offered to a healthy pregnant population.

EXTRAPIGMENTARY EFFECTS OF MELANOCYTE-STIMULATING HORMONE IN AMENORRHŒIC WOMEN

Abstract Highly purified melanocyte-stimulating hormone (M.S.H.) was administered to six women with secondary amenorrhœa. Menstrual bleeding occurred in five of the patients approximately 13 days later. Transient electroencephalographic changes and akathisia-like symptoms developed in at least three of the women. The aqueous-flare phenomenon and increased visual dark adaptation were not observed, but statistically significant changes occurred in the concentrations of several components of serum.

Fetal Chromosome Analysis After Transcervical Placental Biopsies During Early Pregnancy

Abstract. With an endocervicoscope 5 mm in diameter, and a fibre‐optic system, it was possible to biopsy the chorion through the cervical canal, during early human pregnancies from 8 to 20 weeks of duration. 39 patients who applied for legal abortion were examined. Growth in tissue culture, with a sufficient number of mitotic figures for sexing and chromosomal analysis was obtained in 20 out of 41 tests after 2–3 weeks. The karyotypes from the biopsy specimens were found to be normal and agreed with respect to sex with the legally aborted fetuses. 19 cases observed for between 7 and 43 days following the biopsy did not show any disturbance of the pregnancy during that time. The practical usefulness of this technique, which was also tried in two cases of imminent abortion, is discussed.

On some Late Effects of Bilateral Oophorectomy in the Age Range 15–30 Years

Abstract. Between 1910 and 1940, 146 young females, aged 15–30 years, underwent bilateral salpingo‐oophorectomy as part of a radical operation for salpingo‐oophoritis. These women or their records were reviewed in 1971. 42 women had died in the meantime. More than half (22) of them had died from cardiovascular diseases, 5 from carcinoma of the uterus and 4 had committed suicide. None had died from carcinoma of the breast. Of 68 who were still alive, information by questionnaire was obtained and 32 were admitted to hospital for extensive examination. 32 age‐matched women to be operated on for prolapse but with no other known disease of the reproductive tract served as controls. A further control group was added as 11 of the 68 were found to have menstruated again after the operation which had evidently not completely removed the gonads. Complete oophorectomy was found to have been followed by: (a) an increased incidence of cardiac symptoms and nervous diseases as well as an increased use of drugs; (b) a significant increase in the frequency of coronary vascular diseases in ages up to 70 years; (c) an increase in the serum cholesterol and triglycerides, most significantly in the ages below 60‐65 years. Women with symptomatic coronary disease had a higher serum cholesterol level than women without and women with signs of peripheral vascular diseases had a significantly higher concentration of serum triglycerides: (d) an increased frequency of fractures (radius and femoral neck), increased osteoporosis and thinner cortical bone. The brittleness of the skeleton was correlated with low excretion of oestrogens in the urine. No vertebral compression or abnormal decrease in height was observed, (e) an increased adrenocortical activity with significantly increased excretion of 17‐ketosteroids, 17‐OH‐ketosteroids and low polar total oestrogens. This activity abated in women above 65 years. (f) a traumatic psychological experience of the accompanying sterility while sexuality seemed to be largely unaffected in many of them. Almost half of the women examined by the psychiatrist were unusually mentally active and agile and they had a lower excretion of estriol than the rest.