Fetal Environment OLD News

Extracts from EEIN 1991-1994. Latest news is at the bottom. Provided by Eubios Ethics Institute , at http://eubios.info/index.html.

One of the most cost effective methods for improving the health of fetuses, and new-borns is the increased use of preconception care. Unfortunately the access to such information, and counseling is in short supply, but it should be encouraged (Jack, B.W. & Culpepper, L. (1990) "Preconception care. Risk reduction and health promotion in preparation for pregancy", JAMA 264: 1147-1149). The problems in improving this care are many, but many are based on the unequal access to health care, and on use of false economy in setting health care priorities, away from primary prevention.
In the USA there are many people who are not covered by Medicaid for prenatal care, and the expansion of care to more mothers can aid the health (JAMA 264 (1990), 2219-23, 2264-5), as would naturally be expected. However, providing financial aid is necessary but not sufficient, education is also needed. The education can be overwhelming for many people, and there are a variety of books and kits for pregnancy testing and nutritional supplements available (FDA Consumer (Nov. 1990), 16-19).
Epidemiological studies of the incidence of cardiovascular disease have found that it appears to be significantly linked to the health of the mother, and the fetal environment may be even more important than conditions during later childhood life. This association is also suggested for some other diseases: Barker, D.J.P. (1990) "The fetal and infant origins of adult disease", BMJ 301: 1111; Bock, G.R. & Whelan, J., Eds., The Childhood Environment and Adult Disease (Chicester: John Wiley, in press). These studies have important implications for public policy, in improving living conditions and medical care, diet, and education of parents. The general education of the public about such matters, or reproductive health, is important (BMJ 301 (1990), 1180). In Brazil very basic information about child rearing and health care has been given to village leaders with significant reduction in infant mortality and hospital admissions within a year of such information (Lancet 336 (1990), 1370). Such basic information is very cost effective and beneficial.

A new fetal monitor for heart rate could reduce the number of caesarian operations by half in Britain, and more in the USA: NS (2 Feb 1991), 18. If the heart rate is monitorred than a better idea regarding oxygen consumption can be made, so that only if there is a real oxygen shortage would a cesarian be used. In the U.K. 10-15% of births are by caesarian, but in the USA about 25-30%, therefore the use of this scanner may save both those babies that are distressed but unnoticed, and the large surplus of caesarians that are currently preformed out of fear of fetal oxygen shortage during labour.
The results of a policy of giving pregnant mothers an extra food allowance in Gambia led to a reduction in the number of low birthweight babies being born (Lancet 337 (1991), 41. A brief letter that reports a decrease in observed fetal movements using ultrasound in women during the Christmas season (probably linked to the high food consumption) is in Lancet 337 (1991), 252. Another paper on feeding of children, and fetuses is in BMJ 302 (1991), 113. For papers on the eating habits of children see NEJM 324 (1991), 232-5, 262-3.
It is not yet widely recognised that identical twins can be different when they are born (Scientific American (Dec. 1990), 11-2). In about 10-20% of monozygotic twins fetal transfusion occurs, where one twin receives more oxygen and nutrients than the other, and twins can differ in birth weight by a factor of two. They can also differ in diseases or drug effects, and have altered genes or chromosomes. This suggests that the differences found between identical twins in behavioural studies may be even less due to the environment, and more because of genetic factors.
A letter which discusses the possible hazards of electromagnetic fields to human reproduction is in Fertility & Sterility 54 (1990), 955. The legal claims that a fetus may make on the mother for general disability are discussed in Lancet 336 (1990), 1572.
There are many outside nonmedical reasons that affect the repeat use of caesarian sections by women, found in a study by R.S.Stafford (1991) "The impact of nonclinical factors on repeat cesarian section", JAMA 265: 59-63. Cesarian sections are used in about 25% of US births, and there are concerns about the practice. This study has shown that there were more sections performed at formal teaching hospitals, with patients not under private insurance, and at high-volume and at private hospitals. As noted, these results do raise concerns about such practises. Several letters on the subject of court-ordered cesarean sections appear in NEJM 324 (1991), 272-3.

There are significant risks of birth defects when the sperm of men that are exposed to toxic compounds are used. Recently at an American Association for the Advancement of Science meeting some of these results were reported; NS (2 March 1991), 12. In animal experiments where male mice are exposed to biologically active or teratogenic substances the offspring showed damaging affects. These results challenge the exclusion of women from industrial sites where there are high concentrations of harmful substances out of fear of birth defects, the men should also be protected. The only satisfactory response is for the workplace and environment to be cleaned up, and such compounds excluded from all human contact. Related to the issue of mutagens in the environment is the epidemiological studies of East German health that are underway; Nature 349: 728, which one may hope may include study of any teratogenic effects as well. A legal paper is M.P. Duncan (1990) "Fetal protection policies: furthering sex discrimination in the marketplace", J. Family Law 28: 727-51.
There have been several papers that discuss teratogenic substances. A possible association between childhood leukemia and parental exposure to benzene, wood dust and radiation is reported in P.A.McKinney et al. (1991) "Parental occupations of children with leukaemia in west Cumbria, north Humberside, and Gateshead", BMJ 302: 681-7. Another paper reports found no association between leukemia and non-Hodgkin's lymphoma with living near the Dounreay nuclear installation, or parental employment there; BMJ 302: 687-92. Both these papers were based on small numbers. For comment on these, and on passive smoking see Lancet 337: 786. Also see P. Vineas & L.Simonato (1991) "Proportion of lung and bladder cancers in males due to occupation: a systematic approach", Archives of Environmental Health 46: 6-15, 5; and M.Gough (1991) "Agent Orange: Exposure and Policy", Amer. J. Public Health 81: 289-90.
If women have been exposed to potentially teratogenic agents they may believe that their fetus may have an abnormality and have an abortion. This problem was addressed by a survey of women in Canada and the results are presented in Y.Bentur et al. (1991) "Exposure to ionizing radiation during pregnancy: perception of teratogenic risk and outcome", Teratology 43: 109-112. A review on how to teach about these risks, as well as the risk factors is A.D.Robinson (1990) "Teaching about teratology", American Biology Teacher 52: 472-9. A related paper is F.W.Rosa (1991) "Spina bifida in infants of women treated with carbamazepine during pregnancy", NEJM 324:674-7.
The incidence of neural tube defects such as spina bifida in Britain has been decreasing in recent years, but not all due to the prenatal screening programs; BMJ 302 (1991), 612. Some of the decrease appears to be due to environmental factors, possibly vitamin supplements. The incidence of births of children with Down's syndrome is similar to it was in 1979, despite the widespread use of prenatal screening. Detailed study of these figures would be useful, to detect if there is any environmental factors.
A study by T.M.Schnorr et al. (1991) "Video display terminals and the risk of spontaneous abortion", NEJM 324: 727-33, has found no association between the electromagnetic fields associated with video terminals and higher abortion rates. More, recently the levels of two hormones have been linked to spontaneous abortion rate.
A series of discussion papers on antenatal care is in the BMJ 302 (1991), which discuss the organisation of antenatal care (p. 647-50, the management of antenatal care (p.774-9), and changes in the mothers body (p.719-22).
The incidence of congenital abnormalities in diabetic mothers ranges from 4-12% in the USA. However, by good care of the mothers before conception, and during pregnancy this figure can be lowered; J.L. Kitzmiller et al. (1991) "Preconception care of diabetes: glycemic control prevents congenital abnormalities", JAMA 265: 731-6.
PKU is a disease that can be treated by diets, but pregnancy by affected women needs careful planning to avoid birth defects. Discussing some of these is S.E. Waisbren et al. (1991) "Psychosocial factors in maternal phenylketonuria: prevention of unplanned pregnancies", Amer.J. Public Health 81: 299-304.
A U.K. study which suggests a link between intelligence and children's vitamin's supplements in Personality & Individual Differences 12 (1991), 329-66, is dismissed scientifically by a review in Nature 350 (1991), 2, 5, 13; but get more support in Lancet 337 (1991), 587-8, 728-9. A company is selling such vitamin formulas.
A special issue of The Pediatric Clinics of North America (Feb. 1991) Vol. 38 (1), 1-194, focuses on the issue of childhood AIDS with various contributers. Comments on neonatal care in Greece, including the successful newborn disease screening, are in Lancet 337 (1991), 545. The role of the pediatrician is the topic of a series of papers in Pediatrics 87 (1991), 396-409.
Of related interest is a paper Y.Ben-Shlomo & G.D.Smith (1991) "Depreviation in infancy or in adult life: which is more important for mortality risk?", Lancet 337: 530-3. It examines U.K. health records and suggested that there is little clear evidence for a direct influence of factors in early life affecting the rates of coronary heart disease mortality risk, and further study is required. A paper on social welfare maternity benefits in the U.K. is in BMJ 302 (1991), 342-3. A call for telling pregnant mothers a more definite date for expected birth is in Lancet 337 (1991), 600-1.
A review of fetal surgery is M.T.Longaker et al. (1991) "Maternal outcome after open fetal surgery: A review of the first 17 human cases", JAMA 265: 737-41. Only a few diseases are appropriate for such surgery, which involves hysterotomy. This surgery did not significantly reduce their ability to have subsequent pregnancies, but their was a problem of premature labour. Another method of fetal treatment is by drug or nutrient supplements and one case is described in K.M.Davidson et al. (1991) "Succesful in utero treatment of fetal goiter and hypothyroidism", NEJM 324: 543-6. Also see NEJM 324: 662-7 for the medical use of cesareans.

Some American courts have put women in jail because of their continued use of cocaine while being pregnant; USA Today (12 April 1992). For a review of these problems and attempted medical solutions see K.Bresnahan et al., "Prenatal cocaine use: impact on infants and mothers", Pediatric Nursing 17: 123-9, and S.J.Kelley et al., "Birth outcomes, health problems, and neglect with prenatal exposure to cocaine", Pediatric Nursing 17: 131-6. See also K.Graham & G.Koren, "Characters of pregnant women exposed to cocaine in Toronto between 1985 and 1990", CMAJ 144: 563-8. The subject of toluene abuse during pregnancy is discussed in Obstetrics & Gynecology 77: 504-9. Letters on the subject of legal interventions during pregnancy are in JAMA 265: 1953. Also see "Intensive prenatal care may deliver healthy babies to pregnant drug users" JAMA 265: 2773-4.
A review on the European maternity practice and payments and the hazards of work during pregnancy is in BMJ 302: 1070-3. On the hazards of work for physicians see M.A. Klebanoff et al., "Spontaneous and induced abortion among resident physicians", JAMA 265: 2821-5, 2859-60. On British maternity practice see BMJ 302: 1174, 1198-1200. The relationship between pregnancy outcome and the accidential exposure of a township in Cornwall, England to high levels of aluminium sulphate is analysed in BMJ 302: 1175-7.
The effect of labour on the intelligence of the children is the subject of a paper by F.J.Roemer et al., "Retrospective study of fetal effects of prolonged labor before cesarian delivery", and an editorial in Obstetrics & Gynecology 77: 653-8 and 777-8 respectively. They found a trend for lower intelligence on children born during longer labor periods, with about 12 hours being an important step. However further study is required as the definition of active labour is difficult to define. On the use of oxygen monitoring using pulse oximetry in labour see Lancet 337: 1265-7.
A study of the statistics of birth weight has shown how the birth weight of babies is rising in North America and Europe, which increases the survival rate; JRSM 84: 257-260. This will increase the health of the coming generations. A paper on the lack of clear factors except clinical judgement for predicting the outcomes and costs of neonatal intensive care for very low birthweight babies is in Public Health 105: 121-6.
On the topic of IQ and vitamins (EEIN 1: 40) see Science 251: 1566 252: 191-2; Nature 351: 263; BMJ 302: 1020-1, 1206. A book on the topic of nature/nurture is reviewed in Nature 350: 532.
Brain development can affect the incidence of neurological disorders. A particluar example of this is E.O"Callaghan et al., "Schizoprenia after prenatal exposure to 1957 A2 influenca epidemic", Lancet 337: 1248-50. The incidence of schizoprenia in people born during this epidemic was significantly higher than those born in different periods. On the question of psychological factors in breast cancer see BMJ 302: 1219-20.
A general review of universal application is A.S.Cunningham et al., "Breast-feeding and health in the 1980s: A global epidemiologic review", J. Pediatrics 118: 659-66. Breast-feeding contributes greatly to infant health and should be encouraged wherever possible, including in developed countries.

A paper reporting results from a survey of women who had entered a donor insemination program in the Netherlands is B.M. van Noord-Zaadstra et al., "Delaying childbearing: effect of age on fecundity and outcome of pregnancy", BMJ 302: 1361-5. The fall in fecundity was estimated to start at 31 years old, and the chance of a 35 year old women having a healthy baby was half that of a 25 year old woman. However, as noted in the section on Reproductive Technology, above, this may be due to oocyte quality decline, rather than the uterus.
On the effects of birth delivery, a survey of infants delivered by the use of forceps and vacuum, in Israel, is reported in Lancet 337: 1583-5. The mean intelligence scores of the infants delivered with these techniques were significantly higher than in the spontaneous delivery group, and that there was not any significant physical risk for children of age 17 years that had been delivered by these methods. A paper on fetal monitoring is in MJA 154: 576-8.
Another epidemiological paper is D.J.P. Barker, "The foetal and infant origins of inequalities in health in Britain", J. Public Health Medicine 13: 64-8. On the protection against neural tube defects by folic acid see MRC Vitamin Study Research Group, "Prevention of neural tube defects: results of the Medical Research Council Vitamin Study", Lancet 338: 131-7; BMJ 303: 209. They recommend folic acid supplements before pregnancy for women who have had an affected pregnancy, and diets of all women should contain adequate folic acid.
The results of a placebo controlled study are S. Uzan et al., "Prevention of fetal growth retardation with low-dose aspirin: findings of the EPREDA trial", Lancet 337; 1427-31. The possible connection between fish consumption and birth weight is discussed in BMJ 303: 166. Some effects on fetal growth with alcohol consumption during pregnancy are reported in F. Forrest et al., "Reported social alcohol consumption during pregnancy and infant' development at 18 months", BMJ 303: 23-6. It is recommended that no more than one drink a day be taken to ensure no known effects.
It has been found that there is a high rate of hepatitis C transmission in utero; Lancet 338: 17-8.
The trends in fertility and infant mortality in the USA are summarised in JAMA 266: 24-5. It points out that infants born to young and unmarried women are at high risk for low birth weight, which means higher mortality rate. See also JAMA 266: 114-5. There is also ethnic variation; JAMA 266: 327.

On the timing of HIV transmission from mother to infant see Lancet 338: 829-30, NEJM 325: 652-4. On maternal transfer of Hepatitis C virus see Nature 353: 609.
Letters on the use of folic acid to prevent neural tube defects (see EEIN 1: 67) are in Lancet 338: 379-80, 505-6, 639-40, 894-5; and US recommendations in JAMA 266: 1190-1. On whether there is any clinical value in measuring maternal weight gain in pregnancy see Lancet 338: 415. At a recent MRC news conference in Britain, studies linking small birth weight with the incidence of diabetes and impaired glucose tolerance of male 64 year olds, were announced; Guardian (25 Oct 1991), 2. It is believed that this may be linked to weight and height of mothers, and may be environmental rather than directly genetic. On detection of gestational diabetes (of the mother) see MJA 155: 112. In Japan, a survey reported by the Ministry of Health and Welfare has found some association between smoking of pregnant women and low birth weight. On the use of statistics and how to analyse them see Obstetrics & Gynecology 78: 710-20.
On an issue in legal medicine see W. Chavin, "Mandatory treatment for drug use during pregnancy", JAMA 266: 1556-61. On the neonatal costs of maternal cocaine use see JAMA 266: 1521-6; NS (28 Sept 1991), 15. On jail sentences for pregnant cocaine users in the USA see BMJ 303: 873. On the binding of cocaine to sperm, and possible teratogenic effects see JAMA 266: 1956-9. On drugs and alcohol effects on the fetus during pregnancy, and on the neonate; JAMA 266: 1567-8. On a lack of regulatory concern for substances that may have reproductive toxicity see Science 254: 25; see also a book review in AJHG 49: 244. On medicines in pregnancy; MJA 155: 214-5.
In Australia, a mother has been successfully sued by a child injured in utero by a traffic accident; Lancet 338: 687-8. Related to parental occupation see, S. Sanjose et al., "Low birthweight and preterm delivery, Scotland, 1981-84: effect of parents' occupation", Lancet 338: 428-31. They find little influence, and if any occupational influence it may be more associated with maternal than paternal factors. On a US legal case; G.J. Annas, "Fetal protection and employment discrimination - The Johnson Controls case", NEJM 325: 740-3. On current ideas of fetal surgery; Asia Oceania J. Obstetrics & Gynecology 17: 187-92.
Letters on a link between video display terminals and the incidence of spontaneous abortions appear in NEJM 325: 811-3. On the effect of employment on spontaneous abortion see Social Science & Medicine 33: 795-800. The fetal brain may signal the time for birth; Science 253: 1360. On cognitive deficits in premature infants see NEJM 325: 276-8.

A report on a previously reported study in the UK showing that folic acid reduces neural tube defects (Lancet 338 (1991), 131-7, is in MJA 155 (1991), 579-81. They recommend the use of folic acid supplements, especially in countries that do not have routine prenatal screening services. Also on neural tube defects see Lancet 339: 218-9. The procedure of ultrasonography has been found to have no noticeable effect on the intelligence of 8-9 year olds in Norway; K.A. Salvesen et al., "Routine ultrasonography in utero and school performance at age 8-9 years", Lancet 339: 85-9.
The causes of death for fetuses in a study of a hospital in Montreal is reported in R.C. Fretts et al., "The changing pattern of fetal death, 1961-88", Obstetrics & Gynecology 79: 35-9. It is useful to see the changing patterns of diseases. A letter claiming that there is no link between paternal or maternal exposure to vinyl chloride and spontaneous abortion is in Lancet 339: 127-8, though this may be due to current low levels of exposure. On the absence of a link of birth defects with dactinomycin treatment see NEJM 326: 137.
An apparent seasonal variation occurs in the rate of spontaneous abortions according results from a study of US statistics; J.E. Kallan & E.A. Enneking, "Seasonal patterns of spontaneous abortion", J. Biosocial Science 24: 71-5. The oocyte age may influence the risk of abortion also; Fertility & Sterility 56 (1991), 1091-4.
On the exposure of fetuses to cocaine, and later health effects see JAMA 267: 406-8. As noted above, the state of North Carolina has been criticised for avoidance of mention of the health hazards of tobacco to fetuses; BMJ 304: 73-4.
Not for fetal environment, but for nutrition during breast feeding, see A. Lucas et al., "Breast milk and subsequent intelligence quotient in children born preterm", Lancet 339: 261-4. See also D.K. Gjerdingen & D. Froberg, "Predictors of health in new mothers", Social Science & Medicine 33 (1991), 1399-1407; and a book review of Women, Work and Child Welfare in the Third World, in Social Science & Medicine 33 (1991), 1313-4. The case of "IQ pills" for children is still a controversy in the UK, the companies selling a vitamin and mineral dietary supplement that is claimed to increase the intelligence of children are facing charges of false advertising in Britain; Nature 355: 285. The supplements are claimed to be "Extraordinary news for parents", but may only have an effect in children with poor nutrition. On childhood cholesterol screening see JAMA 267: 100-2.
On sick building syndrome see Lancet 338 (1991), 1493-4.

Seat belts should be worn either under or above the bump of pregnant women, but not over it; BMJ 304: 586-7. Environmental influence on human reproduction is discussed in Eur. J. Obstetrics & Gynecology and Reprod. Biology 44: 17-21.
A British study of the social conditions of pregnant women has found little effect of social conditions on pregnancy outcome; L.D. MacDonald et al., "Marital status: association with social and economic circumstances, psychological state and outcomes of pregnancy", J. Public Health Medicine 14: 26-34. However, there continues to be increasing evidence for fetal origins of some adult diseases such as cardiovascular disease; BMJ 304: 789-90. Routine weighing of pregnant women is still useful medically; BMJ 304: 460, 487-9.
The mechanism of HIV transmission in the womb is discussed in NS (7 March 1991), 20. It appears that selected viruses may be transferred; S.M. Wolinsky et al., "Selective transmission of HIV type-1 variants from mothers to infants", Science 255: 1134-7, 1069. Research has found that HIV is carried in mother's milk; Times (25 April 1992), 16; see also NEJM 326: 642-4; Lancet 339: 364-5; SA (March 1991), 96. It appears that AZT can be taken safely by pregnant women; R.S. Sperling et al., "A survey of zidovudine use in pregnant women with human immunodeficiency virus infection", NEJM 326: 857-61, 887-8.

In a court settlement in Northern Ireland, a boy has been awarded 700,000 for the induction of cerebral palsy and severe brain damage following an accident that his mother had during late stages of pregnancy; BMJ 304: 1400. The boy was suing his mother, who will claim the money from insurer's, he will require constant care through his life. A similar case in Australia was also successful. Several other cases are also being contested currently in the UK; BMJ 304: 937-8. The abuse of pregnant woman and fetal damage is discussed in JAMA 267: 2370-2.
The benefits of folic acid in reducing the incidence of neural tube defects has been known for some time, a further US study is discussed in AJPH 82: 666-8. Evidence that there is an intelligence gain in infants that are breast feed is in Lancet 339: 926-7.
The risks associated with cocain use during pregnancy are reviewed in Obstetrics & Gynecology 79: 778-89.

The legal implications of fetal alcohol syndrome for insanity defense are debated by A.M. Capron, "Fetal alcohol and felony", HCR (May/June 1992), 28-9. The problems of parental alcohol use in terms of children's injuries can also be directly through violence; JAMA 267: 3166-71. Children whose mothers are problem drinkers are 2.1 times more likely to have serious injury than children of nondrinking mothers, and the rate increases if the men are also heavy drinkers. On a substance abusing mothers project in the USA see AJPH 82: 1166-7. A review is J.J. Volpe, "Effect of cocaine use on the fetus", NEJM 327: 399-407. Physical abuse during pregnancy is the topic of J. McFarlane et al., "Assessing for abuse during pregnancy. Severity and frequency of injuries and associated entry into prenatal care", JAMA 267: 3176-8.
An article on the factors that influence maternal mortality in Indonesia, Phillipines and Thailand is in World Health Forum 13: 59-63. A legal critique is J.A. Scutt, "When is a woman's body not her own? According to the law, when she's pregnant", IR&GE 5: 39-45. A recent book of interest may be A.L. Caplan et al., eds., Compelled Compassion. Government Intervention in the Treatment of Critically Ill Newborns (Totawa, N.J.: Humana Press 1992).
The content of dreams of pregnant women in an Israeli hospital is reported in S. Sered & H. Abramovitch, "Pregnant dreaming: search for a typology of a proposed dream genre", SSM 34: 1405-11.

A claim has been made that smoking mothers are at double the risk of having disobedient and conflictory children; Times (7 Sept 1992).
A report from the British Royal College of Radiologists has reported that radiology departments are a safe place for pregnant women to work in; BMJ 305: 669-70. Working in front of video-display units does not appear to be linked to spontaneous abortions; Brit. J. Industrial Medicine 49: 507-12; Lancet 340: 423.
The transmission of HIV via breast feeding is discussed in A.J. Ruff et al., "Breast-feeding and maternal-infant transmission of HIV type 1", J. Pediatrics 121: 325-9; D.T. Dunn et al., "Risk of HIV type 1 transmission through breastfeeding", Lancet 340: 585-8; BMJ 305: 788-9. There appears to be little evidence to suggest that HIV is transmitted by breast-feeding, and HIV is generally degraded in saliva and stomach. Pregnancy and HIV is discussed in letters in NEJM 327: 645-7; Lancet 340: 707-9. The survival time after AIDS in pregnancy is discussed in Brit. J. Obs & Gyn 99: 633-6. The future of breast milk banks is discussed in an editorial in BMJ 305: 433-4.
A link between consumption of cow's milk and incidence of diabetes has been suggested, see a discussion of this in SA (Oct 1992), 13. The advantages of breast feeding for diabetes is in Nature 359: 194-5. The question of whether diabetic pre-pregnancy clinics are worthwhile is answered yes in Lancet 340: 656-8. Serious fetal abnormalities are 3-4 times more common in diabetic mothers than in nondiabetic ones.
A report from Chicago has found that significant numbers of infants who had prenatal exposure to cocaine show persistent hypertension without evidence of renal, cardiovascular or endocrinologic abnormalities; J. Pediatrics 121: 288-91. The risks of using benzodiazepine during pregnancy are studies in Lancet 340: 694-6; and reported teratogenic effects appear to be due to alcohol or substance use rather than due to benzodiazepine. A mouse model for fetal alcohol syndrome is reported in AJMG 44: 168-76. The prevention of neonatal herpes is discussed in letters in NEJM 327: 647-8. There appears to be a relationship between cot death and smoking, M.H. Malloy et al., "Sudden Infant Death Syndrome ands maternal smoking", AJPH 82: 1380-2.
There appear to still be social class -related differences in infant mortality rates in Sweden, despite there strong welfare policy; D.A. Leon et al., "Social class differences in infant mortality in Sweden: comparison with England and Wales", BMJ 305: 687-91. A study has found that in pregnant women lacking food, energy supplementation during the last 90 days of pregnancy was effective in promoting postnatal life; J.A. Kusin et al., "Energy supplementation during pregnancy and postnatal growth", Lancet 340: 623-6. However, excessive maternal weight has some problems, J.W.C. Johnson et al., "Excessive maternal weight and pregnancy outcome", Amer. J. Obs & Gyn. 167: 353-72. A study on racial disparities in very low birth rate is A. Kempe et al., "Clinical determinants of the racial disparity in very low birth weight", NEJM 327: 969-73, 1022-4. Fetal growth monitorring is discussed in Brit. J. Obs & Gyn 99: 707-10; Lancet 340: 918.
The use of folic acid supplements in Spain to prevent neural tube defects is in a letter in Lancet 340: 620; and in the USA see Science 257: 1857. A link between heat and neural tube defects is reported in A. Milunsky et al., "Maternal heat exposure and neural tube defects", JAMA 268: 882-5. The use of hot water tubs during the first trimester is not recommended.
The European Community and maternity leave is discussed in Lancet 340: 781-2. Maternity leave can be argued for on medical reasons, for example: Commuting has some association with preterm births following a Paris study; Amer. J. Obs & Gyn. 167: 571-2. Delayed child-bearing is associated with more problems; S. Cnattingius et al., "Delayed childbearing and risk of adverse perinatal outcome", JAMA 268: 886-90.

A new study following up children suffering from fetal alcohol syndrome finds that there are long term negative effects; Science 258: 739. Prenatal factors may increase later risk of developing breast cancer; Lancet 340: 1015-8. A new book from the BMJ is D.J.P. Barker, ed., Fetal and Infant Origins of Adult Disease (BMJ 1992, 368pp., 25). On cocaine use see NEJM 327: 1393-4. The Dutch Supreme Court decision on liability for diethylstilboestrol damage is in Lancet 340: 1280.
The main risk factors for pregnancy identified by a US study are weight gain during pregnancy, smoking during pregnancy, and method of delivery; JAMA 268: 1831-2. Reducing smoking in pregnancy is discussed in Obs. & Gyn. 80: 738-44; and risks of low birth weight in MJA 157: 154-8; Lancet 340: 1021-3; Obs. & Gyn. 80: 745-9. The value of prenatal care programs is reviewed in Obs. & Gyn. 80: 867-72. A study of psychosocial support during high-risk pregnancies found that such special support did not lower the rate of low birth weight babies; NEJM 327: 1266-71. In general occupational radiation exposure is insignificant for fetuses; BMJ 305: 1172-3. The EC has agreed on maternity leave provisions, see BMJ 305: 980.
The use of midwives for antenatal care of low risk patients was found to be positive in terms of cost saving and public acceptance in a study in MJA 157: 158-61. A New York state study showed that in reviewed hospitals the rate of cesarians decreased during a period of monitoring and review of the practice; Obs. & Gyn. 80: 731-7. A study suggesting that obstetric complications is associated with schizophrenia is in BMJ 305: 1256-9.

A letter criticising the recent UK legal decision to allow a court-ordered cesarian is in BME (Dec 1992), 2. A new oxygen monitor may help reduce the uncertainty over fetal status that often results in cesarians; NS (9 Jan 1993), 21. A positive relationship between risk of malpractice and cesarians is reported in A.R. Localio et al., "Relationship between malpractice claims and cesarean delivery", JAMA 269: 366-73. A survey of forcep's deliveries in the USA and Canada in 1990 is in O&G 81: 307-11.
A risk of miscarriage of 14%, compared to 10% in control women, has been found in a study of "clean rooms" in the production of semiconductors; NS (12 Dec 1992), 6. It appears to be due to exposure to ethylene glycol ethers, which are also used in printing plants, the aerospace industry, and in applying paints. The problem of preterm birth is reported in Lancet 341: 301, following a new UK report. It calls for a population approach to reducing preterm birth, as has worked in France. Letters on the subject of infant birthweight are in NEJM 328: 285-6.
The need for folate during pregnancy is because there is increased folate metabolism in pregnant women; Lancet 341: 148-9. An extra demand of 200-300ug per day is suggested from this study. In an editorial in NEJM , they also make the call for more folate supplements during pregnancy; NEJM 327 (1992), 1875-7. A dose of 400ug is possible from diet, in a Hungarian study a 800ug daily supplement was used; A.E. Czeizel & I. Dudas, "Prevention of the first occurrence of neural tube defects by periconceptional vitamin supplementation", NEJM 327 (1992), 1832-5. The incidence of neural tube defects was significantly reduced.
A book review on Fetal and Infant Origins of Adult Disease is in Lancet 341: 37. There appears to be increased rate of limb defects following intrauterine alcohol exposure; AJMG 44 (1992), 782-5. Older smokers are at especially high risk for small babies; AJOG 108: 16-21. Cocaine may hamper maturation of the central nervous system of the fetus; AJOG 167 (1992), 1616-23. A review of Children of Drug Abusers is in NEJM 327 (1992), 1888-9. The very poor state of health of orphans in Romania, based on a study of adoptees entering the USA is reported in JAMA 268 (1992), 3446-51; and on a study in Romania, JAMA 268 (1992), 3489-90. A Paper on bone turnover in malnourished children is in Lancet 340 (1992), 1493-6.
A call for more breast-feeding in the USA is in JAMA 269: 243-5. The classification of low birth weight babies and reporting at birth may vary; BMJ 305 (1992), 1576-7. A link between nutrition during fetal and infant life and the development of diabetes is becoming clearer, BMJ 306: 283-4, 302-6. A paper discussing in utero exposure to glucocorticoid as a model for adult hypertension is in Lancet 341: 339-41, 355-7.
The psychological relationship of couples during pregnancy and infancy is found to deepen; Research in Nursing & Health 16: 45-56. Teenage antisocial behaviour and adult dysfunction may be caused by childhood nervousness and social isolation; JRSM 86: 13-7. A study of pregnancy and childbirth among the Amish is in SSM 36: 333-42.
Racial differences in the incidence of sudden infant death syndrome, or cot death , from New Zealand and UK , are in BMJ 306: 13-6, and 16-20. In New Zealand, the high incidence in Maori children could be explained by correlation with other known risk factors. In the UK, there is a higher incidence of cot death in white than Asian children (Bangladesh), and it is suggested that this may be due to the greater sensory stimulation in Asian families, and the long sleep periods in Caucasian families.

In a study from Hungary , fish poisoned with trichlorfon at levels 1000 times higher than permitted, were eaten and linked to birth deformities; A.E. Czeizel et al., "Environmental trichlorfon and cluster of congenital abnormalities", Lancet 341: 539-42;NS (6 March 1992), 11. In the village, from 15 pregnancies during 1989-90, 11 were affected by congenital abnormalities and 6 were twins. Four had Down's syndrome.
The figures for the number of mothers and fathers of newly born babies who took leave in Japan , since the legal establishment of 6 months paid leave for government servants who have a child less than 1 years old, reveals that few took advantage of it. In the six months since April 1992, 2539 women (out of 6415 possible), and 9 men (out of a much larger number!) took advantage of this leave; Yomiuri Newspaper (30 March 1992), 3. Letters on psychosocial support during high risk pregnancies are in NEJM 328: 887-8. A paper on health inequalities and concerns about the children of single mothers is in BMJ 306: 677-80.
A review article is P.J. Morgane et al., "Prenatal malnutrition and development of the brain", Neuroscience & Behavioral Reviews 17: 91-128. A comparative study of determinants of low birthweight in Cameroon and the USA found that common risk factors are unmarried motherhood, multiple and preterm births; J. Biosocial Science 25: 87-100. Outcome of the previous pregnancy is a positive risk factor only in the USA. Negative risk factors (benefits) include prenatal care visits. The effect of these factors was similar in both countries. Reducing smoking in pregnancy increases birth weight; JAMA 269: 1519-24. There is a negative effect of premature birth on lung function, as seen by wheezing; BMJ 306: 817-20. Letters on gestational diabetes are in BMJ 306: 581-2. Studies on the effects of beer on breast-fed infants are in JAMA 269: 1637-8.
The use of folic acid to prevent spina bifida and anencephaly is a simple measure that aids the fetus; M.M. Werler et al., "Periconceptional folic acid exposure and risk of occurrent neural tube defects", JAMA 269: 1257-61, 1292-3, 1233, 6, 8; BMJ 306: 584. A daily consumption of 0.4mg of folic acid (the dose in many over-the-counter tablets) reduces to incidence of neural tube defects by 60%. Other dietary factors are also associated with congenital abnormalities; AJMG 45: 398-9. Letters on the use of low dose aspirin in pregnancy are in Lancet 341: 396-400, 753-4, 412. An investigation of hazards among nurses is R.R. McAbee et al., "Adverse reproductive outcomes and occupational exposures among nurses", Amer. Ass. Occup. Health & Nursing J. 41: 110-9. A commentary on whether we need randomised trials of antenatal tests of fetal well being is in Brit. J. O&G 100: 197-200. Book reviews on the fetal environment are in JAMA 269: 802-3; Lancet 341: 480-1; NEJM 328: 977.
The use of dummy teets, or pacifiers , has been found to be associated with increased risk of early weaning; Lancet 341: 404-6. Letters on obtaining mother's consent to screening newborn babies for disease are in BMJ 306: 858-9. The improved 1990 infant mortality figures from the USA, 9.2 infant deaths per 1000 live births, are reported in JAMA 269: 1616, 8.
The use of fetal blood sampling is reported in NEJM 328: 692-6, 728-9. A monitor for babies at risk of cot death has been developed for home use in the UK; NS (13 Feb 1993), 19. Problems of teenagers second pregnancies are noted in JAMA 269: 1401-3; and factors involved in low birth infants are in S.K. Pope et al., "Low-birth weight infants born to adolescent mothers. Effects of coresidency with grandmother on child development", JAMA 269: 1396-1400. There continues to be criticism of a paper published in the Canadian J. Physics blaming the decline of Western civilisation on working mothers; Science 259: 1530-1.
A Scottish court decision has opened the way for legal suits in the UK for fatal pre-birth injury; Lancet 341: 886. A study finding no evidence of paternal age as a risk factor for Down's syndrome is AJMG 45: 679-82.
A study in Lancet 341: 407-8, suggests that fetuses that have long-chain 3-hydroxyacyl coenzyme A dehydrogenase deficiency may have adverse effects on the mother's liver. The effects of childbearing on breast cancer are hard to measure; Lancet 341: 502-3.

In California prosecutors have accused a woman of murder for the premature birth and subsequent death of her baby, because she used drugs during pregnancy; Reproductive Freedom News (18 June 1993), 4. This case would set a powerful precedent, and is being opposed by many groups. The effects of prenatal exposure to cocaine on health are reviewed in Pediatrics 91: 778-83; of alcohol induced permanent retardation Lancet 341: 907-10; and of caffeine consumption, AJOG 168: 1105-12.
A legal paper comparing Italy and the USA on parental leave is P. Wright-Carozza, "Organic goods: legal understandings of work, parenthood, and gender equality in comparative perspective", California Law Review 81: 531-92. On mother-infant bonding see a book review in JAMA 269: 2146-7. A study of psychosocial risk pregnancies in Sweden is in Acta Obstet. Gynecol. Scanadanavia 72: 320-2; and on illiteracy and maternal health see Lancet 341: 1063-4.
The positive effect of folates on fetal development is reviewed in Br. J. Obstetrics & Gynaecology 100: 307-9; see also Lancet 341: 1417; BMJ 306: 1123-4. A special issue of the Annals of the New York Academy of Sciences 678 (15 March 1993), 1-376, is on Maternal Nutrition and Pregnancy Outcome. Also on fetal nutrition and later cardiovascular disease see Lancet 341: 938-41.
A link between occupational exposure to antineoplastic drugs and ectopic pregnancies is hinted at in Lancet 341: 1169-71, but further studies are needed. A study on the link between exposure to fluoxetine in early pregnancy and miscarriage is in JAMA 269: 2246-8. There does not appear to be a link between exposure to topical tretinoin and birth defects; Lancet 341: 1181-2. The use of the dye methylene blue in amniocentesis is suggested not to cause birth defects in Lancet 341: 1352. On chickenpox in pregnancy see BMJ 306: 1079-80, 1478.
An increased risk of cardiovascular disease was found in women who had more pregnancies; NEJM 328: 1528-33. However, one wonders whether it is linked to poverty or other factors. A link between breast cancer and diethylstilbestrol prescribed in pregnancy is reported in a study of 6000 women; JAMA 269: 2096-100.
The positive link between reduced neonatal mortality and increased birth weight in the USA is discussed in Lancet 341: 1415. A record low birth weight baby in Japan, born at 368g is now 4.4kg after one year of life (the first 9 months being in hospital); Yomiuri Shinbun (5 June 1993), 31. The use of fibronectin to predict preterm delivery is reviewed in Br. J. Obstetrics & Gynaecology 100: 304-6. The affects of diabetes on prenatal health are negative; JAMA 269: 1932; as is hypertension, Acta Obstet. Gynecol. Scanadanavia 72: 318-9. On infant milk formulas see Lancet 341: 1337, 1526; BMJ 341: 1563-4.

The fingerprints are a marker of impaired fetal development, K.M. Godfrey et al., "Relation of fingerprints and shape of the palm to fetal growth and adult blood pressure", BMJ 307: 405-9. On HLA associations between mother and fetus, NEJM 329: 500-1. Hair analysis of newborns can detect drug abuse by the mother, Presse Med (France) 21 (1992), 2139-41.
The slow progress in introducing folic acid to prevent spinal cord defects is criticised in NS (17 July 1993), 24-5. It is still to be used in many foods, long after it has been shown to significantly lower risks of spina bifida and other diseases. A study of the nutrient intake of Dunedin (NZ) women during pregnancy found that improved diet was needed; NZ Med. J. 106: 273-6.
Paternal exposure to radiation in Seascale does not appear to be the sole factor in increased cancer rate; BMJ 306: 1718-21. On chemical damage, BMJ 307: 341-2. A possible link between ultrasound use in pregnancy and non-righthandedness is BMJ 307: 159-64.
Increased risk of complication of pregnancy is found in areas of social violence, AJPH 82: 685-90; and a Chinese study on the level of parenting stress and social support is SSM 37: 267-74. Psychological distress late in pregnancy is associated with preterm delivery; BMJ 307: 234-9. They appears to be no risk due to video use, J. Epidemiol Community Health 47: 265-8. On hypertension in pregnancy, MJA 158: 655. Home uterine monitoring for preterm labour is reviewed in JAMA 270: 369-70, 371-6.
Development of a surfactant to make premature lungs work better is in Science 261: 426. A call for monitorring the abilities of prematurely born babies is in BMJ 306: 1715-8, see also BJOG 100: 711-3; BMJ 307: 362; Lancet 342: 193-8. On still birth risk in Japan, Lancet 341: 1603-4. A study showing high incidence of congenital defects of the limb in still births is in AJMG 46: 479-82.
Breast feeding may protect against breast cancer, BMJ 307: 17-20; also see BMJ 306: 1628-9; JAMA 270: 830-1. The relationship between sleeping position of babies and sudden infant death is in NEJM 329: 425-6. Basically it is recommended not to lie babies on their stomach.
The expansion of health insurance in the USA was associated with increased cesarian rate, JAMA 270: 61-4; see also pp. 94-5, and AJOG 168: 1748-58.

Cesarian section births are the subject of a special issue of SSM 37 (10), 1177-1281. It includes a paper on psychosocial aspects on the family, and papers asking why there is a 24% rate in the USA and a 12% rate in the UK. On the topic of the ethics of deception to enable patients to include obstetric procedures under insurance, O&G 82: 475-8. Comments on the financial costs of labour induction are in Lancet 342: 858.
Also on the questioning of the "need" for regular ultrasound see J.P. Newnham et al., "Effects of frequent ultrasound during pregnancy: a randomised controlled trial", Lancet 342: 887-91, 878-9; Newsweek (27 Sept 1993), 53;BME (Sept 1993), 5; B.G. Ewigman et al., "Effect of prenatal ultrasound screening on perinatal outcome", NEJM 329: 821-7, 874-5; AJOG 169: 483-9. The study in Lancet suggested a possible restricted growth in frequent use of ultrasound, and the need for further study (see also EEIN 3: 6 on a possible relationship to handedness). The studies in AJOG and NEJM found no improvement in outcome from screening generally compared to clinician's discretionary use. Also on ultrasound see BMJ 307: 559-60, 588-91, 879.
An editorial in BMJ 307: 697-8, asks whether we need "Rituals in antenatal care". It reports the average British woman has 15 antenatal checks during pregnancy, but only 5 or so is really worthwhile. A survey looking at the satisfaction of women with maternity services in Finland is SSM 37: 633-8.
A study in New York found that prenatal care of pregnant women who were cocaine users still increased their health outcome and improved birth weight of the babies; JAMA 270: 1581-6. Racial differences in the smoking habits of pregnant women are reported in the US in AJPH 83: 1258-64. These results may explain some birth weight differences between black and white babies. A call for healthy families to make health babies is in World Health (May/June 1993), 23-5. A possible link between psychological distress and preterm delivery is discussed in BMJ 307: 934.
The statistics from South Australia found that there was an 84% fall in births of babies with spina bifida in 1986-91 compared to 1966, though the incidence was similar in pregnancy; BMJ 307: 703-6. The fall was due to prenatal screening and selective abortion. The debate over fortification of flour or other foodstuffs in the US with folic acid is expected to conclude soon with an FDA decision, Science 261: 1118. A meeting report on neural tube defects is in TINS 16: 381-3. A US study finding no association between neonatal vitamin K and cancer risk is in NEJM 329: 905-8, 957-8.

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