Susan Harlap

SHOULD COITUS LATE IN PREGNANCY BE DISCOURAGED

Coitus late in pregnancy has been thought to be a cause of premature rupture of membranes, preterm birth, and amniotic fluid infections. In this study, data on 10 981 singleton, low-risk pregnancies were examined. The mothers were asked at time of delivery if there were any months when they did not have sexual intercourse during pregnancy. Pregnancy outcomes were determined by medical record review. Those having intercourse showed no increased risk of premature rupture of membranes, low birthweight, or perinatal death at any gestational age. Women abstaining from intercourse had more unfavourable outcomes in the seventh and eighth months, but these differences were almost eliminated by adjustment for maternal age. Preterm delivery was no more frequent in those having intercourse than in those abstaining. These findings challenge the view that intercourse late in pregnancy is harmful.

Does grand multiparity affect fetal outcome

Low birthweight and stillbirth rates of 16,647 Jerusalem deliveries were examined by birth‐order comparing longitudinal to cross‐sectional data. Six hundred fifty‐seven complete sibships of 7 or more were assessed, including 95 sibships from the socio‐economically homogeneous ultraorthodox Jewish community of Mea Shearim. In both cross‐sectional and longitudinal studies grandmultiparas were not at increased risk for low birthweight, but did have a higher frequency of stillbirths.

Child-bearing after induced abortion: reassessment of risk.

We reviewed 1791 singleton pregnancies of women with a history of previous induced abortion and compared them with 14,857 pregnancies in mothers with no previous induced abortions. Therapeutic termination of pregnancy was associated with a statistically significant increase in the incidence of low birth weight infants and bleeding in the first trimester of pregnancy. When other variables were examined, no significant differences were found between the two groups, except for a significantly higher rate of stillbirths among women who had not had a prior induced abortion. There were no increases in major or minor congenital malformations.

Exposure to contraceptive hormones through breast milk — are there longterm health and behavioral consequences?

Lactating women who ingest contraceptive sex hormones secrete them or their metabolites in breast milk. The concentration of contraceptive hormones in milk varies from 10-100% of its concentration in the mothers plasma. After contraceptive injections very high plasma levels of hormone are found such that breast-fed children may be exposed to significant levels of hormones. Similar exposure may occur in children whose mothers receive hormone-impregnated intrauterine or vaginal contraceptives. Gynecomastia has been reported as an immediate consequence. Women also secrete natural sex hormones and gonadotrophins into milk. Little is known about what eventually happens to exogenous sex hormones in an infants body after being ingested through breast milk. It may be assumed that a proportion of the hormones is absorbed by the intestine and subsequently metabolized. Some portion of the hormones or their metabolites may however continue to circulate in the body of the infant where they may compete with natural hormones for receptor sites in sex organs brain and other tissue. The potential for ongoing circulation may be significant given the possibly lower metabolic rate of the infants immature liver. It is unknown whether a child will suffer any long-term consequences from breast milk exposure to contraceptive steroids. Of particular concern is the possible effect upon personality behavior sex organ anatomy reproductive ability immunologic function and neoplasia. Literature on animal research indicates the existence of long-term effects from exposure to certain hormones at critical periods of intrauterine and postnatal life and compatible results have been reported in limited research in humans exposed in utero suggesting that similar consequences may follow postnatal exposure to hormones in humans. The author summarizes existing knowledge on the effects of perinatal sex hormone exposure in animals and humans suggesting ways to study possible long-term consequences of exposure to contraceptives in breast milk.

Are there two Types of Postpill Anovulation

Anovulation, indicated by requiring treatment with clomiphene or gonadotropins to conceive, was studied in a cohort of 16,583 women interviewed postpartum. There were 2,853 former oral contraceptive users, and 2.2% of them reported anovulation, compared with 2.7% of controls. Among primigravidas, the rates were 4.2% and 4.4% in pill users and controls, respectively. A statistically significant excess of anovulation was reported by former pill users who had been underweight in relation to their height at the time of conception. Independently of pill use, the condition tended to be associated with obesity. Data from this and previous studies suggest that there may be two distinct entities of postpill anovulation: the first, identical with spontaneous secondary anovulation; the second, occurring in slender women who have used oral contraceptives. These findings need confirmation from prospective studies using standard diagnostic criteria.

A cohort analysis of cervical cancer in Israeli Jewish women

The incidence of squamous cell cervical cancer was studied in Jewish Israeli women between 1961 and 1981. The 1052 cases and the 27,832,272 women-years of observation were divided according to continent-of-origin, year-of-birth, and immigration-wave cohorts. Age-adjusted odds ratios were calculated for each cohort and compared. The incidence of cervical cancer was shown to have changed according to cohort year of birth, most significantly in women born in Europe and America. The highest risk in this group was seen in women born in 1891-1895 and 1941-1945 and the lowest in women born between 1926 and 1935. A high risk was also observed in all cohorts of North African women. There was a sharp rise in risk for women of all origins born after 1940. Immigration to Israel at a younger age was correlated with reduced risk for cervical cancer. It has been shown that epidemics of sexually transmitted diseases (STDs) are followed in time by epidemics of cervical cancer. Since there was an epidemic of STDs in Israel between 1967 and 1970, our results also suggest that there is a rise in the risk for cervical cancer in women who were sexually active during the epidemic of STDs. Because of the low rates for cervical cancer traditionally observed in Israeli women, routine screening was not done in Israel in the past. Should the relative risk for cervical cancer in women exposed during the 1967-1970 epidemic continue to be high, screening may prove worthwhile.

Patterns of Medication in Early Pregnancy: A Preliminary Report from the Jerusalem Perinatal Study

Since the thalidomide disaster, increasing attention has been focused on drugs as possible teratogens. Many commonly used drugs are teratogenic in animals but their role in the genesis of human malformations, within the usual range of dosage, remains in doubt (1). Human studies are beset with methodological difficulties, including the validity of retrospective investigation, the problems of selected populations and the difficulties of identifying malformations among early pregnancy losses (2,3). Furthermore, little is known of patterns of medication on large populations, or of the effect of demographic, cultural and health variables on the use of commonly prescribed drugs.

The relationship of sex and marital status to coronary heart disease risk factors in Israeli medical students.

Abstract We studied selected coronary heart disease (CHD) risk factors in three consecutive classes of Jerusalem medical students (N = 194). Males had higher cumulative risk scores compared with females because of higher mean systolic and diastolic blood pressures (123/80 vs. 113/74 mmHg), body mass (Quetelet index 23.1 vs. 21.9), more cigarette smoking (2.3 vs. 0.7 cigarettes/day), and despite lower mean cholesterol levels (205 vs. 213 mg/dL). Marital status did not alter total risk for males or for females, but singles smoked more than married persons (2.2 vs. 0.7 cigarettes/day), and married females had higher mean body mass index than singles (22.7 vs. 21.5). The identification of individuals and sub-groups at relatively higher risk for CHD may lead to improvement in risk in highly motivated students.

Risk factors for coronary artery disease in 124 Jerusalem medical students.

As part of an epidemiologic teaching exercise, we studied coronary risk factors in two consecutive classes of Jerusalem medical students (n=124) and calculated a summary coronary risk score for each student. Men were at higher risk than women because of greater body mass, higher blood pressure and more cigarette smoking. Married males were at lower risk than single males because they had lower cholesterol levels and smoked less. Married and single females were at equal risk. Jerusalem students smoked more than most groups of American medical students and less than their European counterparts. There is reason to believe that an exercise of this kind may result in risk-reducing behavior on the part of high-risk students.