Stuart C. Hartz

Diphenylhydantoin and Selected Congenital Malformations

Abstract In a cohort of 50,897 pregnancies, frequencies of malformations, selected on the basis of reports in the literature, were compared between four groups of children born to epileptic mothers and those born to nonepileptic mothers. The highest malformation rate (61 per 1000) was observed in 98 children exposed during the early months of pregnancy to daily diphenylhydantoin (phenytoin) use. The rate was lowest in 50,591 children born to nonepileptic women (25 per 1000). It was intermediate in children of epileptic mothers exposed before delivery to sporadic or late use of diphenylhydantoin, and in children of such mothers who were not exposed to the drug. Among epileptic women with varying or no exposure to diphenylhydantoin, the malformation rates did not differ significantly. The difference in the malformation rates between children exposed regularly to diphenylhydantoin during early gestation and children born to nonepileptic mothers could reflect the teratogenic effect of the drug, of epilepsy it...

Relation of Cigarette Smoking to Myocardial Infarction in Young Women

To examine the relation between myocardial infarction and cigarette smoking in young women, we investigated the smoking habits of women under the age of 50 who had survived a recent myocardial infarction. They had not been using oral contraceptives, and other identifiable risk factors were excluded. Among 55 such women and 220 control matched for age and area of residence, the proportions of cigarette smokers were 89 per cent and 55 per cent respectively (P less than 0.001). A dose-response relation was evident; among women smoking 35 or more cigarettes per day the rate of myocardial infarction was estimated to be some 20-fold higher than among those who had never smoked. This study demonstrates that cigarette smoking is a risk factor for myocardial infarction in young women who are otherwise apparently healthy.

Antenatal exposure to meprobamate and chlordiazepoxide in relation to malformations, mental development, and childhood mortality.

In a follow-up study of 50,282 pregnancies (lasting at least five lunar months) and the offspring, malformations identified before the first birthday, or at death before the fourth birthday, were identified in 3248 children (6.5 per cent). A total of 1870 children exposed in utero to meprobamate or chlordiazepoxide were compared with 48,412 children who were not. No significant differences were found either overall or in specific outcomes; rates were also similar when exposures occurred during the first trimester or at other times during pregnancy. Deaths (stillbirth to the fourth birthday) occurred in 2227 children (4.4 per cent), and there was no evidence that antenatal exposure to either drug increased the death rate. Finally, as judged by mental and motor scores at the age of eight months, and intelligence quotient scores at four years, there was no evidence that the drugs cause brain damage.

Factors associated with oral contraceptive use.

We studied factors associated with oral contraceptive (OC) use among 1,855 premenopausal women who were admitted to hospital with conditions unrelated to OC use. Among this group, 15 per cent reported having used OCs within the preceding year and 35 per cent reported having last used them more than a year previously. A higher estrogenic dose (more than 60 micrograms) was reported by past users; the relationship of numerous other variables to past and present OC use is reported.

The computation of maximum likelihood estimates for the multiple logistic risk function for use with categorical data

Abstract A computing technique is described for the maximum likelihood estimation of multiple logistic coefficients. The method makes use of the marginal iterative proportional fitting system commonly applied in the analysis of multidimensional contingency tables. The estimated logistic coefficients for two models fitted to a set of data are compared to those derived from the more traditional Newton-Raphson approach.