Sawnet: Pregnancy-Related Abstracts

TITLE: The influence of maternal vegetarian diet on essential fatty acid status of the newborn.
AUTHOR: Reddy S, Sanders TA, Obeid O
AFFILIATION: Department of Nutrition and Dietetics, King's College London, UK.
SOURCE: Eur J Clin Nutr 1994 May;48(5):358-68
ABSTRACT: OBJECTIVES: To evaluate whether a maternal vegetarian diet influences the essential fatty acid status of the newborn and whether this is related to outcome of pregnancy. DESIGN: Dietary intake and the fatty acid composition of plasma phospholipids were determined in 24 South Asian vegetarian and 24 white omnivore non-pregnant premenopausal women randomly selected from the general population of North London. Umbilical cords and cord blood were collected at delivery from 48 South Asian vegetarian women and 98 white omnivores from the same catchment area along with details of antenatal history and the outcome of pregnancy. The fatty acid composition of the cord arteries and that of cord plasma phospholipids were analysed in a subset of 32 pairs of subjects, who were matched for maternal age, gestational age, parity and sex of infant. RESULTS: Intakes of linoleic acid (18:2n-6) expressed as proportion of the dietary energy and the ratio of linoleic to alpha-linolenic acid (18:3n-3) were higher in the vegetarian women, and eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3) were absent from their diets. The proportion of linoleic acid, as well as the absolute concentration, was greater and those of EPA and DHA were lower in plasma phospholipids, plasma free fatty acid and total plasma lipids of the vegetarians compared with the white subjects. The proportion of DHA was lower (P > 0.001) but that of docosapentaenoic acid (22:5n-6) was greater (P < 0.001) in cord those from the omnivores. The ratio of 20:3n-9/20:4n-6 was elevated in cord artery but not in cord plasma phospholipids in both groups. Early onset of labour and the duration of gestation was 5.6 days shorter. Birth weight, head circumference and length were lower in the infants born to South Asian vegetarians even after adjusting for maternal height, duration of gestation, parity, gender of infants and smoking habits. Multivariate analysis did not reveal any relationship between the proportions of DHA in plasma or cord artery phospholipids and the birthweight or head circumference of the infants. CONCLUSION: This study demonstrates that vegetarians give birth to infants with less DHA in their plasma and cord artery phospholipids but this did not appear to be independently related to the outcome of pregnancy.

TITLE: Incidence and severity of gestational diabetes mellitus according to country of birth in women living in Australia.
AUTHOR: Beischer NA, Oats JN, Henry OA, Sheedy MT, Walstab JE
AFFILIATION: Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Victoria, Australia.
SOURCE: Diabetes 1991 Dec;40 Suppl 2:35-8
ABSTRACT: Gestational diabetes mellitus (GDM) was diagnosed in 1928 of 35,253 (5.5%) tested pregnancies at the Mercy Maternity Hospital in Melbourne between 1979 and the end of 1988. Compared with women born in Australia and New Zealand, the incidence of GDM was significantly greater in women born on the Indian subcontinent (15%); in women born in Africa (9.4%), Vietnam (7.3%), Mediterranean countries (7.3%), and Egypt and Arabic countries (7.2%); and in Chinese (13.9%) and other Asian (10.9%) women. There was no significant difference for women born in the United Kingdom and northern Europe (5.2%), Oceania (5.7%), North America (4.0%), or South America (2.2%). With the World Health Organization criteria as a guide to the severity of hyperglycemia, compared with mothers born in Australia and New Zealand, there were significant increases in the incidences of the more severe grades of GDM in parturients born in the Mediterranean region, Asia, the Indian subcontinent, Egypt, and Arabic countries. The incidence of GDM increased significantly in all racial groups, rising from 3.3% during 1979-1983 to 7.5% during 1984-1988.

TITLE: Congenital rubella in babies of south Asian women in England and Wales: an excess and its causes.
AUTHOR: Miller E, Nicoll A, Rousseau SA, Sequeira PJ, Hambling MH, Smithells RW, Holzel H
AFFILIATION:
SOURCE: Br Med J (Clin Res Ed) 1987 Mar 21;294(6574):737-9
ABSTRACT: The incidence of congenital rubella was found to be 2.3 times higher in Asian than non-Asian births in England and Wales. This was attributed in part to higher susceptibility to rubella in Asian than non-Asian women, as shown by antenatal serological data from public health laboratories in Leeds, Luton, and Manchester. Examination of the ethnic origin of pregnant women requesting laboratory testing after contact with rubella or rash and of women with laboratory confirmed rubella in pregnancy also suggested that the disease was being underdiagnosed in pregnant Asian women. Failure to prevent congenital rubella by termination of infected pregnancies may therefore contribute to the increased incidence of the syndrome in Asians. Health education programmes about the dangers of rubella in pregnancy and of the need for vaccination can readily be promoted in the Asian community through existing ethnic organisations. Protection of other ethnic minorities likely to be at similar increased risk may require a vaccination programme aimed at national elimination of rubella.

TITLE: Stereotypes of women of Asian descent in midwifery: some evidence.
AUTHOR: Bowler IM
AFFILIATION:
SOURCE: Midwifery 1993 Mar;9(1):7-16
ABSTRACT: The subject of this paper is part of a larger study which investigated the delivery of maternity care to women of South Asian descent in Britain (Bowler, 1990). An ethnographic approach was used and the main method of data collection was non-participant observation in antenatal clinics, labour and postnatal wards in a teaching hospital maternity unit. These observations were supported by data from interviews with midwives. It was found that the midwives commonly use stereotypes of women in order to help them to provide care. These stereotypes are particularly likely to be used in situations where the midwife has difficulty (through pressure of time or other circumstances) in getting to know an individual woman. The stereotype of women of Asian descent contained four main themes: communication problems; failure to comply with care and service abuse; making a fuss about nothing; a lack of normal maternal instinct. Reasons for stereotyping are explored. Effects on service provision in the areas of family planning and breast feeding are highlighted. Comments:

TITLE: High prevalence of gestational diabetes in women from ethnic minority groups.
AUTHOR: Dornhorst A, Paterson CM, Nicholls JS, Wadsworth J, Chiu DC, Elkeles RS, Johnston DG, Beard RW
AFFILIATION: Unit of Metabolic Medicine, St Mary's Hospital Medical School, Imperial College of Science, Technology and Medicine, London, UK.
SOURCE: Diabet Med 1992 Nov;9(9):820-5
ABSTRACT: The influence of ethnic origin, body mass index, and parity on the frequency of gestational diabetes was assessed in 11,205 consecutive women attending a multiracial antenatal clinic in London, where all women were screened for gestational diabetes. Logistic regression was used to model the relationship between gestational diabetes and ethnic origin, age, body mass index (BMI), and parity. Results were presented as adjusted odds ratios, where the reference categories are White women, age < 25 years, BMI < 27, and parity < 3. Ethnic origin was the dominant influence on the prevalence of gestational diabetes. Women from ethnic groups other than White had a higher frequency of gestational diabetes than White women (2.9% vs 0.4%, p < 0.001). Compared to White women the relative risk of gestational diabetes in the other ethnic groups was: Black 3.1 (95% confidence limits 1.8-5.5), South East Asian 7.6 (4.1-14.1), Indian 11.3 (6.8-18.8), and miscellaneous 5.9 (3.5-9.9). Increasing age was an independent risk factor. The relative risk was higher in women > or = 35 years in all ethnic groups other than in South East Asian women. Obesity (BMI > or = 27) was a further independent risk factor in all ethnic groups except in the Indian and South East Asian women. Parity > or = 3 increased the relative risk of gestational diabetes in the White, Black, and South East Asian women only.

TITLE: Epidemiology of malaria in pregnancy in central India.
AUTHOR: Singh N, Shukla MM, Sharma VP
AFFILIATION: Malaria Research Centre (Field Station), Jabalpur, India.
SOURCE: Bull World Health Organ 1999;77(7):567-72
ABSTRACT: Analysis of three years of data from a malaria clinic operated by the Indian Council of Medical Research (ICMR) in the Government Medical College Hospital in Jabalpur, central India, showed a high malaria prevalence among pregnant women, which was statistically highly significant (P < 0.0001) compared with the situation among nonpregnant women. Cerebral malaria was a common complication of severe Plasmodium falciparum infection, with a high mortality during pregnancy, requiring immediate attention. The study also showed that malaria infection was more frequent in primigravidae, falling progressively with increasing parity. Mean parasite densities were significantly higher in pregnant women compared with nonpregnant women for both P. falciparum (P < 0.001; df = 137) and P. vivax (P < 0.05; df = 72) infection. Pregnant women with falciparum or vivax malaria were significantly more anaemic than noninfected pregnant women or infected nonpregnant women. The average weight of 155 neonates from infected mothers was 350 g less than that of 175 neonates from noninfected mothers. This difference in birth weight was statistically significant for both P. falciparum (P < 0.0001; df = 278) and P. vivax (P < 0.0001; df = 223) infection. Congenital malaria was not recorded. We conclude that pregnant women from this geographical area require systematic intervention owing to their high susceptibility to malaria during pregnancy and the puerperium. PMID: 10444880, UI: 99373906

TITLE: Nutrient intake of rural pregnant women of Haryana state, northern India: relationship between income and education.
AUTHOR: Panwar B, Punia D
AFFILIATION: Department of Foods and Nutrition, CCS Haryana Agricultural University, Hisar, India.
SOURCE: Int J Food Sci Nutr 1998 Sep;49(5):391-5
ABSTRACT: The daily nutrient intake of 90 pregnant women from farming and non-farming communities in six rural villages of Haryana State, Northern India have been determined. As a result of questionnaires and interviews, nutrient intake for 3 consecutive days were calculated. Mean daily intakes of farming and non-farming pregnant women examined in this study were lower for energy, calcium and iron than the recently prescribed Indian recommended dietary allowances (RDAs). Protein intake of non-farming women was significantly lower and that of farming women was almost similar to RDA. Intake of fat by pregnant women was double the RDA. The mean daily intakes of thiamine, riboflavin and niacin by women of both the communities were found to be adequate. The diets of pregnant women could meet half the requirement of folic acid and even less than half for ascorbic acid. Income of pregnant women did not show any influence on nutrient intakes but educational level of women certainly reflected differences in vitamin intakes.

TITLE: Impact of maternal nativity on the prevalence of diabetes during pregnancy among U.S. ethnic groups.
AUTHOR: Kieffer EC, Martin JA, Herman WH
AFFILIATION: School of Public Health, University of Michigan, Ann Arbor, USA. ekieffer@umich.edu
SOURCE: Diabetes Care 1999 May;22(5):729-35
ABSTRACT: OBJECTIVE: This study examines the impact of maternal nativity (birthplace) on the overall prevalence of diabetes during pregnancy and among 15 racial and ethnic groups in the U.S. RESEARCH DESIGN AND METHODS: Birth certificate data for all resident single live births in the U.S. from 1994 to 1996 were used to calculate reported diabetes prevalence during pregnancy and to assess the impact of maternal birthplace outside of the 50 states and Washington, DC, on the risk of diabetes before and after adjustment for differences in maternal age, other sociodemographic characteristics, and late or no initiation of prenatal care overall and for each racial and ethnic group. RESULTS: Mothers born outside of the U.S. are significantly more likely to have diabetes during pregnancy. The impact of maternal nativity on diabetes prevalence is largely explained by the older childbearing age of immigrant mothers. However, adjusted diabetes risk remains elevated for Asian-Indian, non-Hispanic black, Filipino, Puerto Rican, and Central and South American mothers who were born outside the U.S. Conversely, birthplace outside the U.S. significantly reduces diabetes risk for Japanese, Mexican, and Native American women. CONCLUSIONS: Identification, treatment, and follow-up of immigrant mothers with diabetes during pregnancy may require special attention to language and sociocultural barriers to effective care. Systematic surveillance of the prevalence and impact of diabetes during pregnancy for immigrant and nonimmigrant women, particularly in racial and ethnic minority groups, and more detailed studies on the impact of acculturation on diabetes may increase understanding of the epidemiology of diabetes during pregnancy in our increasingly diverse society.

TITLE: Pregnancy wastage in rural Varanasi: relationship with maternal nutrition and sociodemographic characteristics.
AUTHOR: Agarwal DK, Agarwal A, Singh M, Satya K, Agarwal S, Agarwal KN
AFFILIATION: Department of Pediatrics, Institute of Medical Sciences, Varanasi, India.
SOURCE: Indian Pediatr 1998 Nov;35(11):1071-9
ABSTRACT: OBJECTIVE: To study the relationship between pregnancy wastage and matrnal undernutrition and other sociodemographic factors in rural Indian women. SETTING: Rural community of Varanasi. DESIGN: Longitudinal observation. METHOD: In 49 villages during 1988-92, 8111 pregnancies were registered to observe for wastage. The pregnancy outcome was correlated with various factors. RESULTS: There were 1321 abortions and 141 still births. Women's income < Rs. 250 per month, education < 10th class and protein intake < 50 g/day had significantly higher relative risks (RR) (4.1, 2.9 and 2.8, respectively) for abortions. Poor maternal nutrition was in additional important risk factor, for still births (RR 5.1 and 4.2 for maternal weight and height, respectively). A pregnancy interval over 2 years reduced both. CONCLUSION: Low socioeconomic status, chronic undernutrition and illiteracy in rural India are associated with high pregnancy wastage.

TITLE: Episiotomy and perineal tears in low-risk UK primigravidae.
AUTHOR: Williams FL, du V Florey C, Mires GJ, Ogston SA
AFFILIATION: Department of Epidemiology and Public Health, University of Dundee, Ninewells Hospital and Medical School.
SOURCE: J Public Health Med 1998 Dec;20(4):422-7
ABSTRACT: BACKGROUND: The aim of the study was to determine the rates and to describe the risk factors for episiotomy and perineal tears in low-risk primigravidae. METHOD: A cross-sectional survey of 101 randomly selected NHS hospitals in the UK was carried out between February 1993 and January 1994. Subjects were 40 consecutive low-risk primigravidae in each hospital. The main outcome measures were number and reasons for episiotomy, and number and degree of perineal tears. RESULTS: A large proportion of women (83 per cent) experienced some form of perineal trauma. Forty per cent of the women had an episiotomy only, 6 per cent an episiotomy and perineal tear, and 37 per cent perineal or other tears without episiotomy. The main reasons for performing an episiotomy were foetal distress (27 per cent), impending tear (25 per cent) and delay of the second stage of labour (21 per cent). Fifty-nine per cent of women with a delayed second stage had a spontaneous vaginal delivery and 41 per cent required instrumental assistance. The likelihood of having an episiotomy increased with the duration of the second stage of labour, irrespective of type of delivery. Episiotomy rates varied appreciably throughout regions and hospitals in the United Kingdom, ranging from 26 to 67 per cent. There was also a large regional variation in the rates of perineal trauma; generally, high rates of one outcome were associated with low rates of the other. Compared with white women, women from the Indian sub-continent were almost twice as likely and those from the Orient almost five times as likely to have an episiotomy. CONCLUSIONS: The magnitude of the geographical variation suggests a lack of uniformity in indications for performing episiotomies and that guidelines for performing episiotomies may need to be reviewed. The rates of episiotomy in women from the Indian sub-continent and Orient were very high compared with those for white women, and this requires clarification and explanation, as they are contrary to rates experienced in these ethnic groups in other countries.

TITLE: Associations between wife-beating and fetal and infant death: impressions from a survey in rural India.
AUTHOR: Jejeebhoy SJ
AFFILIATION: Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
SOURCE: Stud Fam Plann 1998 Sep;29(3):300-8
ABSTRACT: This report examines the linkages between wife-beating and one health-related consequence for women, their experience of fetal and infant mortality. Community-based data are used drawn from women surveyed in two culturally distinct sites of rural India: Uttar Pradesh in the north, in which gender relations are highly stratified, and Tamil Nadu in the south, in which they are more egalitarian. Results suggest that wife-beating is deeply entrenched, that attitudes uniformly justify wife-beating, and that few women can escape an abusive marriage. They also suggest that the health consequences of domestic violence--in terms of pregnancy loss and infant mortality--are considerable and that Indian women's experience of infant and fetal mortality is powerfully conditioned by the strength of the patriarchal social system. Results are tentative because of data limitations, but they are consistent and strong enough to warrant concern. They argue for the integration of services to identify, refer, and prevent domestic violence in the primary or reproductive health programs of the country and for the safe motherhood programs to be particularly vigilant, sensitive, and responsive to the conditions of battered women during pregnancy and the postpartum period.

TITLE: Maternal zinc indices and small babies.
AUTHOR: George SS, Swaminathan S, Kanagasabapathy AS, Seshadri L
AFFILIATION: Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
SOURCE: Natl Med J India 1998 May-Jun;11(3):120-1
ABSTRACT: BACKGROUND: Maternal zinc deficiency has been reported to be associated with foetal growth retardation. This study aimed to determine if zinc deficiency is associated with foetal growth retardation in south Indian women. METHODS: A prospective study was undertaken to evaluate the maternal zinc indices in those bearing small-for-gestational age babies and in those with appropriate-for-gestational age babies. Zinc levels in plasma, red blood cells and white blood cells in both groups were assayed in 65 patients with small-for-gestational age babies (regardless of cause) and 51 women with appropriate-for-gestational age babies. RESULTS: There was no significant difference in the mean (SD) plasma [67.5 (9) v. 70.67 (13.9)], red blood cell [47.26 (5.8) v. 45.69 (8.2)] and white blood cell [55.61 (10.5) v. 54.77 (12.4)] zinc levels in mothers who gave birth to small-for-gestational age babies and those who delivered appropriate-for-gestational age babies. The presence of predisposing factors for intrauterine growth retardation also did not influence the maternal zinc levels. CONCLUSION: Maternal zinc levels were not associated with intrauterine growth retardation in our population.

TITLE: An ethnographic study of night blindness "ratauni" among women in the Terai of Nepal.
AUTHOR: Christian P, Bentley ME, Pradhan R, West KP Jr
AFFILIATION: Division of Human Nutrition, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD, USA.
SOURCE: Soc Sci Med 1998 Apr;46(7):879-89
ABSTRACT: Night blindness is the most common ocular condition representing moderate-to-severe vitamin A deficiency in children. Very little, however, is known about maternal night blindness, which has recently been reported to occur frequently during pregnancy in parts of south-east Asia. In Nepal, the prevalence of night blindness is reported to be 16%. We carried out an ethnographic study of night blindness during pregnancy in the south-eastern, rural plains of Nepal as preliminary research for a case-control study of the determinants of this condition. The purpose of the research was to identify local terms and concepts of night blindness and to examine women's perceptions of its causes, symptoms, severity, and consequences during pregnancy. Data collection involved in-depth interviews, case studies, unstructured observations and structured anthropologic methods, such as free listing and quick sort ranking. Women considered night blindness to be an important illness of pregnancy, ranking it second (to vaginal bleeding) in perceived severity from a list of 15 "women's illnesses". Local terms for night blindness were identified in three different languages from the region. Informants described a complex ethnomedical model of night blindness that included causes, symptomatology, and treatment alternatives. However, there was no perceived link between food intake and the occurrence of night blindness. The major causes of night blindness were attributed to pregnancy, weakness, or "hotness". Some women sought treatment for the condition but most women chose not to treat it since they believed that it was a transient condition of pregnancy. Interviews with women who had previously experienced night blindness and home-based observations of women exhibiting concurrent night blindness showed that it adversely affected their activity patterns, especially those related to child care and food preparation. Night blindness increased reliance on family members to perform various domestic chores and was also associated with personal injury and accidents. The findings of this study have relevance for women's reproductive health and nutrition throughout the Indian sub-continent. A simple history of night blindness may be a practical tool to identify women with nutritional and health risks. Maternal night blindness should be more routinely investigated in vitamin A deficient areas of the world, both to define the magnitude of the problem, and to develop programs/interventions that specifically target this population.

TITLE: The relationship between maternal nutritional status and spontaneous abortion.
AUTHOR: Neela J, Raman L
AFFILIATION: National Institute of Nutrition, Indian Council of Medical Research, Andhra Pradesh, India.
SOURCE: Natl Med J India 1997 Jan-Feb;10(1):15-6
ABSTRACT: BACKGROUND: The incidence of pregnancy wastage is high among poor women. Though the aetiology of spontaneous abortion is multifactorial, nutritional deficiency is considered to be an important contributory factor. METHODS: A case-control study was conducted to assess the relationship between maternal vitamin status and spontaneous abortion. RESULTS: The incidence of anaemia (15%), and riboflavin (84%) and folate deficiency (24.5%) were similar among the cases and controls. Vitamin A levels were higher in the study group compared to those in controls. CONCLUSION: The results suggest that various nutrient deficiencies have no correlation with the occurrence of spontaneous abortion. The role of increased vitamin A levels needs to be studied further. PMID: 9069700, UI: 97222703

TITLE: Birthweight standards for south Indian babies.
AUTHOR: Mathai M, Jacob S, Karthikeyan NG
AFFILIATION: Department of Obstetrics & Gynecology, Christian Medical College Hospital, Vellore.
SOURCE: Indian Pediatr 1996 Mar;33(3):203-9
ABSTRACT: OBJECTIVE: To obtain birthweight standards for south Indian babies. DESIGN: Prospective cohort study. SETTING: A tertiary care hospital in south India. PATIENTS AND METHODS: Data from 11, 641 singleton live births between 1991 and 1994 were used to calculate smoothed gestation specific birthweight centiles for four categories based on sex of the infant and birth order. Smoothed gestation specific birthweight centiles were also calculated for all births between 37-41 weeks without adjustments for sex of infant or birth order. Data for births between 37 and 41 weeks were reanalysed using non-adjusted birthweight centiles and birthweight centiles adjusted for sex and birth order to determine misclassification of data. Multiple regression analysis was used to determine the influence of various variables on birthweight. RESULTS: Factors influencing birthweight were gestation at birth, sex of infant, birth order and maternal height. A quadratic equation including these variables and the square of the gestational age explained 18% of variation in birthweight. Female infants were on the average 113 g (95% CI 26-200 g) lighter than male infants. Later born babies were on the average 130 g (95% CI 40-220 g) heavier than first born babies. Therefore significant misclassification of infants occurred when non-adjusted birthweight centiles were used. Babies born to women whose heights were outside the interquartile range (150-158 cm) were 81 g lighter or heavier than those born to women within this range. CONCLUSIONS: Birthweight centiles for gestation when used should be adjusted for birth order, sex of infant and maternal height.

TITLE: Birth weights of infants of first generation Asian women in Britain compared with second generation Asian women.
AUTHOR: Dhawan S
AFFILIATION: Hull Maternity Hospital.
SOURCE: BMJ 1995 Jul 8;311(6997):86-8
ABSTRACT: OBJECTIVES--To compare birth weights of infants of first generation Asian women (women born in the Indian subcontinent) with those of infants of second generation Asian women (born in the United Kingdom). DESIGN--Retrospective case note study. SETTING--Bolton District General Hospital. SUBJECTS--331 Asian women who gave birth between January 1989 and December 1989: 220 of these women were first generation Asians and 111 were second generation Asians. MAIN OUTCOME MEASURE--Birth weights of babies born to first and second generation Asian women. RESULTS--At all gestational ages at delivery, babies born to second generation Asian women were heavier than those born to first generation women. The mean birth weight for babies of second generation women was 3196 g, 249 g more than the mean birth weight of 2946 g of babies of first generation women (P < 0.001). After a stepwise multiple regression analysis was carried out the adjusted difference in birth weights was 280 g, greater than the crude difference. CONCLUSION--Birth weights are important in relation to perinatal mortality, which is notoriously high among Asians. The results of this study indicate that there is hope for lowering of perinatal mortality and improving postnatal growth in babies of second generation Asians. Comments:

TITLE: Growth pattern of the Indian fetus.
AUTHOR: Mathai M, Thomas S, Peedicayil A, Regi A, Jasper P, Joseph R
AFFILIATION: Department of Obstetrics and Gynaecology, Christian Medical College Hospital, Vellore, India.
SOURCE: Int J Gynaecol Obstet 1995 Jan;48(1):21-4
ABSTRACT: OBJECTIVES: To determine the pattern of intrauterine growth and the gestation at birth of Indian fetuses. METHOD: One hundred twenty consecutive women who had reliable menstrual histories, low-risk pregnancies and who were booked for delivery at the Christian Medical College Hospital, Vellore, before 20 weeks' gestation were recruited to the study. Ultrasound fetal biometry was carried out at 4-weekly intervals from 20 weeks and at weekly intervals after 36 weeks until delivery. RESULTS: Growth patterns of fetal biparietal diameter and femur length were comparable to those reported in Western populations. However there was a lag in growth of abdominal circumference (AC) after 28 weeks in comparison with that reported in Western populations. The median gestation at delivery following spontaneous labor was 39 weeks. No association was observed between rate of growth of AC and gestation at birth. CONCLUSION: Slowing of growth of the fetal AC after 28 weeks and a shorter length of gestation result in the birth of smaller babies in this ethnic group. The implications of these findings are discussed.

TITLE: Extraovarian endocrine abnormalities in north Indian women with premature ovarian failure.
AUTHOR: Shah A, Mithal A, Bhatia E, Godbole MM
AFFILIATION: Centre for Endocrine Sciences, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
SOURCE: Natl Med J India 1995 Jan-Feb;8(1):9-12
ABSTRACT: BACKGROUND. Premature ovarian failure is a rare syndrome characterized by cessation of menstruation before 35 years of age associated with an elevated gonadotropin level (serum follicle stimulating hormone > 40 IU/L) and oestrogen deficiency. Premature ovarian failure is often the result of an autoimmune process and involvement of other endocrine glands has been reported but available studies are hampered by a lack of uniformity in diagnostic criteria. METHODS. The endocrine profile of 37 north Indian women with premature ovarian failure was studied. The investigations included measurement of serum follicle stimulating hormone, luteinizing hormone, oestradiol, prolactin, total thyroxine, total triiodothyronine and thyroid stimulating hormone. To assess adrenocortical reserve, adrenocorticotropic hormone stimulated plasma cortisol levels were estimated. RESULTS. Eighteen (49%) patients had extraovarian endocrine abnormalities. Eight (22%) had abnormal thyroid function tests and 12 of 29 (41%) patients tested for adrenocortical reserve showed impaired response of plasma cortisol to adrenocorticotropic hormone stimulation. CONCLUSION. Extraovarian endocrine (especially adrenocortical) involvement is frequent in patients with premature ovarian failure. Because none of the patients had overt clinical evidence of thyroid or adrenocortical disease, we suggest that tests for thyroid and adrenal function be performed routinely in females presenting with premature ovarian failure.

TITLE: Prevalence of diabetes in pregnant women--a study from southern India.
AUTHOR: Ramachandran A, Snehalatha C, Shyamala P, Vijay V, Viswanathan M
AFFILIATION: Diabetes Research Centre, Royapuram, Madras, India.
SOURCE: Diabetes Res Clin Pract 1994 Aug;25(1):71-4
ABSTRACT: This study was carried out to assess the prevalence of diabetes in southern Indian women during pregnancy. Nine hundred and fifty women having > or = 24 weeks of gestation, attending two general gynaecology centres for antenatal check-ups were screened. Initially, the screening test with 1-h plasma glucose sampling following 50 g glucose load was done and those with glucose values > or = 140 mg/dl were subjected to a 3-h oral glucose tolerance test (OGTT) with 100 g glucose load. Among the 950 women, 6 were known diabetic subjects. Of the other 944, 89 were positive on screening test and 67 of them reported for OGTT. Four were detected to have gestational diabetes mellitus (GDM) (O'Sullivan and Mahan's criteria). Therefore the prevalences of total diabetes and GDM were 1.19% and 0.56%, respectively.

TITLE: Blood and placental lead levels in an Indian city: a preliminary report.
AUTHOR: Saxena DK, Singh C, Murthy RC, Mathur N, Chandra SV
AFFILIATION: Neurotoxicology Division, Industrial Toxicology Research Centre, Lucknow, India.
SOURCE: Arch Environ Health 1994 Mar-Apr;49(2):106-10
ABSTRACT: A preliminary investigation was carried out in a hospital in the city of Lucknow, India, to provide information on the possible range of lead (Pb) exposure in pregnant women and fetuses, to correlate high Pb levels with various socioenvironmental factors, and to examine any possible association between reproductive outcome and Pb levels in this population. The results indicate that maternal blood lead levels were higher in those who experienced abnormal deliveries and in those who ate nonvegetarian diets or drank groundwater compared with the respective control groups. Placenta, cord blood, and fetal membranes from both normal and abnormal delivery cases showed no significant differences in their Pb content. Other socioenvironmental factors did not influence these Pb levels. However, incidence of higher Pb levels in maternal blood (17% and 38% with Pb > 25 micrograms/dl in normal and abnormal deliveries, respectively) and cord blood (> 10 micrograms/dl) reflect a need for regular monitoring and lowering of environmental Pb exposure.

TITLE: Diabetes in pregnancy in Pakistani women: prevalence and complications in an indigenous south Asian community.
AUTHOR: Ahkter J, Qureshi R, Rahim F, Moosvi S, Rehman A, Jabbar A, Islam N, Khan MA
AFFILIATION: Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
SOURCE: Diabet Med 1996 Feb;13(2):189-91
ABSTRACT: The aim of this study was to determine the prevalence and complications as well as to correlate maternal and fetal outcome with glycaemic control, in a community of Pakistani women. This was a retrospective study of 6830 deliveries over a 5-year period in a tertiary care hospital in Karachi. Either a 75 g glucose tolerance test or a screening 50 g glucose challenge was administered depending on risk factors for Gestational Diabetes Mellitus (GDM). Case records of deliveries during this period were analysed for presence of GDM or pre-existing diabetes; glycaemic control and complications were ascertained for those with diabetes. During this period 267 (3.9%) of the 6380 deliveries were identified as diabetic pregnancies. Of these 223 (3.3%) had GDM and 44 (0.6%) women had pre-existing diabetes mellitus. Overall maternal complications were high; pre-eclampsia (19%), polyhydramnios (4.6%), and threatened abortion (3.4%). Fetal complications of macrosomia (13.1%), intrauterine growth retardation (7.1%), intrauterine deaths (5.3%) were noted. Complications were higher in poorly controlled groups. We conclude that the prevalence of GDM in Pakistani women in our study was comparable to their Western counterparts but complication rates were higher, possibly due to poorer glycaemic control.