Showing papers on "Pregnancy published in 1983"
TL;DR: Cryopreservation procedures that allow a high survival rate of four- and eight-cell human embryos and the establishment of a pregnancy following the freezing and storage of an eight- cell embryo for 4 months in liquid nitrogen are reported.
Abstract: The widespread use of clomiphene citrate and exogenous gonadotrophins for in vitro fertilization (IVF) in human frequently results in the production of multiple embryos. Replacement of more than two embryos increases pregnancy rate but may result in multiple pregnancies with increased pre- and post-natal abnormality. Preservation of embryos for a limited time allows fewer embryos to be replaced on several different occasions and thus the problems of multiple pregnancy can be minimized, the effectiveness of a single IVF procedure increased and embryo replacement in adverse maternal conditions avoided. Preimplantation embryos have been successfully cryopreserved in many animal species. The sensitivity of embryos to cooling and freezing varies between species and stages of embryo development. We report here the cryopreservation procedures that allow a high survival rate of four- and eight-cell human embryos and the establishment of a pregnancy following the freezing and storage of an eight-cell embryo for 4 months in liquid nitrogen. The pregnancy terminated at 24 weeks' gestation due to development of a septic Streptomyces agalactiae chorion amnionitis after premature membrane rupture.
995 citations
Journal Article•
TL;DR: The recovery seen in late pregnancy suggests that the women mount a satisfactory immune response to malaria infection, reacquiring their prepregnancy immune status at about the time of delivery.
Abstract: This article summarizes information and specific evidence regarding the epidemiology of malaria in pregnancy in Africa. Malaria infection is more frequent and severe in primigravidae both during pregnancy and at the time of delivery. A study of pregnant women living under holoendemic conditions in western Kenya showed that the peak prevalence of infection in primigravidae (85.7%) and multigravidae (51.7%) occurred at 13-16 weeks gestation. There were a similar number of recoveries in both groups during the 2nd and 3rd trimesters. The loss of immunity in early pregnancy was equivalent to an 11-fold decrease in the rate of recovery from infection. The recovery seen in late pregnancy suggests that the women mount a satisfactory immune response to malaria infection reacquiring their prepregnancy immune status at about the time of delivery. The pattern of infection in pregnancy is comparable to that observed in infants and children. What the child achieves over several years the mother reachieves in 9 months; the pattern is repeated in successive pregnancies. The practical implications of this pattern of malaria in pregnancy are discussed. (authors modified)
838 citations
TL;DR: Results suggest that transfer of bovine embryos based on synchrony between day of recipient cycle and state of embryonic development provides higher pregnancy rates than transfers based on recipient-donor cycle synchrony.
617 citations
TL;DR: The findings strongly suggest that the prenatal environment of the offspring of diabetic women results in the development of obesity in childhood and early adulthood.
Abstract: We studied the relation in Pima Indians between obesity in children and diabetes during pregnancy in their mothers. Sixty-eight children of 49 women who had had diabetes during pregnancy had a higher prevalence of obesity than 541 children of 134 women who subsequently had diabetes (prediabetics) or than 1326 children of 446 women who remained nondiabetic. At 15 to 19 years of age, 58 per cent of the offspring of diabetics weighed 140 per cent or more of their desirable weight, as compared with 17 per cent of the offspring of nondiabetics and 25 per cent of those of prediabetics (P<0.001). Obesity in the offspring was directly related to maternal diabetes, since the association was not substantially confounded by maternal obesity. The findings strongly suggest that the prenatal environment of the offspring of diabetic women results in the development of obesity in childhood and early adulthood. (N Engl J Med. 1983; 308: 242–5.)
514 citations
Journal Article•
466 citations
TL;DR: It is indicated that reasonable metabolic control started before conception and continued during the first weeks of pregnancy can prevent malformations in infants of diabetic mothers.
Abstract: From April 1977 to April 1981, 420 deliveries of infants of insulin-dependent diabetic women were performed in our department. Of the infants delivered, 23 had congenital malformations (5.5%). The malformation rate was 1.4% for infants of 420 nondiabetic women. Strict metabolic control was begun after 8 wk gestation in 292 of the diabetic women who delivered 22 infants with congenital malformations (7.5%). Intensive treatment was begun before conception in 128 diabetic women planning pregnancy. There was only one malformation in infants of this group (0.8%), a significant reduction from the anomaly rate in the late registrants (X2 = 7.84; P less than 0.01). These observations indicate that reasonable metabolic control started before conception and continued during the first weeks of pregnancy can prevent malformations in infants of diabetic mothers.
430 citations
TL;DR: The incidence of placental malaria at parturition and its effects on the conceptus have been investigated in The Gambia and the widely prevalent view that pregnancy exacerbates maternal malaria by attenuating acquired immunity is discussed.
Abstract: The incidence of placental malaria at parturition and its effects on the conceptus have been investigated in The Gambia, West Africa. Malarious placentae occurred in 1300 (20.2%) of 6427 singleton births, in 32 (18.6%) of 172 sets of twins and in none of six sets of triplets. Plasmodium falciparum infections predominated; P. malariae or P. ovale infections were found in only nine instances. In the large group of single births placental malaria occurred less frequently (12.0%) in residents of urban than of other, more rural, communities (27.1%). In the former group incidence showed no clear change with season; in the latter group it was highest in the trimester following the end of the rains and lowest in the second half of the dry season. In both residential groups it was more frequent in primiparae (urban 16.1%; other 46.9%) than in multiparae (urban 8.9%; other 20.3%). The sex of the child did not influence malaria incidence. Dense placental infections were more frequent in primiparae. Stillbirth rates of singleton infants were significantly higher for males than for females, but no clear and consistent relationship between stillbirth and placental malaria was detected. Mean singleton birthweights were depressed by about 170 g in the presence of malaria; the deficits were statistically significant only among first born infants and tended to diminish progressively with increasing maternal parity. No distinct gradient linking birthweight with ascending density of placental parasitaemia was observed. Singleton birthweights of 2.5 kg or less occurred more frequently in association with malarious than non-malarious placentae and the association was more marked among first born than later birth rank infants. Differences between the weights of malarious and non-malarious placentae were small and not significant. The findings of the study are discussed in relation to the widely prevalent view that pregnancy exacerbates maternal malaria by attenuating acquired immunity.
425 citations
423 citations
TL;DR: The presence of the lupus anticoagulant was diagnosed in six pregnant women because they had prolonged activated partial thromboplastin and kaolin clotting times which could not be corrected by dilution of test samples with normal plasma.
406 citations
TL;DR: In two gestations in which chromosomal mosaicism was found, it was expressed exclusively in placental chorionic cells and was not detected in cells derived from the embryo proper.
Abstract: Placental and fetal tissues from 46 human pregnancies were cultured and cytogenetically analyzed in an attempt to document the existence of chromosomal mosaicism confined strictly to tissues of extraembryonic origin. In two gestations in which chromosomal mosaicism was found, it was expressed exclusively in placental chorionic cells and was not detected in cells derived from the embryo proper. This demonstration of confined chorionic mosaicism may have implications for the understanding of the fetoplacental unit and for prenatal diagnosis.
356 citations
TL;DR: Risk was lower among post menopausal women than among premenopausal women of the same age and increased with increasing age at menopause; bilateral oophorectomy reduced the risk more than hysterectomy alone.
Abstract: Since 1976, data were collected to evaluate risk factors for breast cancer in a hospital-based case-control study of 1185 women with breast cancer and 3227 controls. The risk of breast cancer increased with increasing age at first birth; this effect was not accounted for by parity. An early age at first birth appeared to reduce the risk relative to no pregnancy, whereas a late age at first birth was associated with a higher risk than not having a full-term pregnancy. High parity was associated with a reduction in the risk that was independent of that of age at first birth: for parity ≧5, compared with parity 1-2, the relative risk estimate was 0.7 (95% confidence Interval, 0.5-1.0). Late age at menarche was associated with a lower risk among premenopausal women but not among postmenopausal women. The relative risk decreased with increasing obesity among premenopausal women. Among postmenopausal women, the risk was higher among those who were obese, but there was no evidence of a trend with increasing body mass index. Risk did not vary materially according to history of abortion when gravidity was controlled. Risk was lower among postmenopausal women than among premenopausal women of the same age and increased with increasing age at menopause; bilateral oophorectomy reduced the risk more than hysterectomy alone. A positive history of benign breast disease, a positive family history of breast cancer, Jewish religion, and 12 or more years of education were each independently associated with an increased risk of breast cancer.
Journal Article•
TL;DR: The increased use of cesarean section and other obstetric advances did not reduce the risk of fetal asphyxia and trauma associated with large fetal size, and maternal factors were identified for risk categorization of fetal macrosomia during pregnancy.
TL;DR: A case of human pregnancy initiated by transfer of a donated embryo fertilised in vitro is reported, which will give useful information for further study of in vitro fertilisation, but also raises many ethical issues.
Abstract: In vitro fertilisation after stimulation of the ovulatory cycle has led to successful pregnancy. If more oocytes are recovered than are needed they may be left unfertilised, preserved, or donated to a recipient couple from whom oocytes cannot be obtained. A case of human pregnancy initiated by transfer of a donated embryo fertilised in vitro is reported. The donor was a 42 year old woman with primary infertility from whom six follicles were aspirated after stimulation of the ovulatory cycle. The recipient was a 38 year old infertile woman who had undergone several unsuccessful attempts for artificial insemination from a donor. Five oocytes were recovered from the donor9s six follicles, four of which were inseminated with spermatozoa of the donor9s husband and the fifth with a frozen sample of semen. Three of the four embryos fertilised by her husband were returned to the donor and the fifth was transferred to the recipient. No pregnancy was recorded in the donor, but pregnancy was confirmed in the recipient, though spontaneous abortion occurred after 10 weeks. This case will give useful information for further study of in vitro fertilisation, but also raises many ethical issues.
TL;DR: Pregnancy exerted a strong protective effect against ovarian cancer, which increased with the number of live-born children, and women with ovarian cancer had more frequently used menopausal hormones in cyclic fashion compared to controls.
Abstract: Reproductive experiences and family history were assessed in 215 white females with epithelial ovarian cancer and in 215 control women matched by age, race, and residence. Pregnancy exerted a strong protective effect against ovarian cancer, which increased with the number of live-born children. After adjustment for parity, an effect of age at first live birth and breast-feeding was not apparent. Menstrual events did not differ significantly between cases and controls, although cases were more likely to have had an earlier menopause and less likely to have had a surgical menopause. Women with ovarian cancer had more frequently used menopausal hormones in cyclic fashion compared to controls. Regarding family history, women with ovarian cancer more frequently reported consanguinity in their ancestry and a highly frequency of primary relatives with cancer of the colon, lung, ovary, and prostate gland.
TL;DR: Cancer and Pregnancy: Bioethical and Legal Dilemmas and Epilogue Cancer and P pregnancy: a Reason for Hope.
Abstract: I: Clinical Aspects: Diagnosis and Management.- 1 The Epidemiology of Cancer in Pregnancy.- 2 Placental and Fetal Cancers.- 3 Breast Cancer and Pregnancy.- 4 Gynaecologic Malignancies in Pregnancy.- 5 Hematologic Malignancies in Pregnancy.- 6 Melanoma in Pregnancy.- 7 Rare Tumours in Pregnancy.- 8 Colorectal Cancer in Pregnancy.- 9 Radiologic Diagnosis of Cancer in Pregnancy.- 10 Pregnancy Derived Tumor Marker.- 11 Chemo and Radiation Therapy During Pregnancy.- 12 Management of Cancer in Pregnancy (Case Reports).- 13 Transplacental Carcinogenesis: Role of Chemicals, Radiation and Viruses.- II Comparative Aspects of Pregnancy Development and Tumour Biology.- 14 Metabolism of Chemotherapeutic Drugs by Maternal and Conceptus Tissues.- 15 Adverse Reproductive Outcome Potential of Cancer Therapies During Pregnancy.- 16 Immunomodulatory Analogies Between Trophoblastic and Cancer Cells and Their Hosts.- 17 Protective Role of Human Chorionic Gonadotrophin and Luteinizing Hormone Against Breast Cancer.- 18 Proliferation, Differentiation and Apoptosis in Pregnancy and Cancer.- 19 Controlled vs Uncontrolled Angiogenesis: Color Doppler Studies.- 20 Angiogenesis and Vasculogenesis in Pregnancy and in Tumor Development.- 21 Trophoblast Implantation Versus Tumor Invasion.- 22 Pregnancy Derived Compounds that Control Proliferation.- 23 Cancer and Pregnancy: Bioethical and Legal Dilemmas.- Epilogue Cancer and Pregnancy: a Reason for Hope.
TL;DR: A modified hormonal milieu in the mother appears to be important in the later development of testicular cancer in her sons, and exposure of the mother to exogenous estrogen during pregnancy created a significant risk in the son.
Abstract: In this case--control study of 108 cases of testicular cancer in men under 30 years of age, cryptorchidism was a major risk factor [relative risk (RR) = 9.0]. Low birth weight was also associated with increased risk (RR = 3.2). Having severe acne at puberty was protective (RR = 0.37). Interviews with mothers of cases revealed that exposure of the mother to exogenous estrogen during pregnancy created a significant risk in the son (RR = 8.0). In first pregnancies, excessive nausea indicated an increased risk of testicular cancer (RR = 4.2). Increased body weight in the mother also increased the risk. The relation between these factors and testicular hypoplasia is discussed. Severe perimenopausal menorrhagia was a factor in the mother associated with reduced risk of testicular cancer in the son (RR = 0.10). A modified hormonal milieu in the mother appears to be important in the later development of testicular cancer in her sons.
TL;DR: It is concluded that the potential for a spontaneous cure of infertility is high, that treatment for many classes of infertility should be evaluated by randomized clinical trials, and that in such trials random assignment of subjects to untreated control groups would be ethically acceptable.
Abstract: We analyzed a two- to seven-year follow-up of 1145 infertile couples to determine the frequency of pregnancy occurring independently of treatment. Pregnancy occurred in 246 of 597 treated couples (41 per cent) and in 191 of 548 untreated couples (35 per cent). Thirty-one per cent of the pregnancies in treated couples occurred more than 3 months after the last medical treatment or more than 12 months after adnexal surgery. These pregnancies plus the 191 pregnancies in untreated couples constituted the category of "treatment-independent pregnancies" and accounted for 61 per cent of all pregnancies; for 44 per cent of those among couples with ovulation deficiency; for 61 per cent of those in couples with endometriosis, tubal defects, or seminal deficiencies; and for 96 per cent of those in couples with cervical factors or idiopathic infertility. We conclude that the potential for a spontaneous cure of infertility is high, that treatment for many classes of infertility should be evaluated by randomized clinical trials, and that in such trials random assignment of subjects to untreated control groups would be ethically acceptable.
TL;DR: Pregnancy does not necessitate any change in the usual medical treatment of ulcerative colitis, and women with ulceratives colitis should be advised preferably to conceive at a time when their bowel disease is inactive.
Abstract: The course of pregnancy in 97 women with ulcerative colitis was studied over a 12-year period. During this period they had 173 pregnancies and delivered 136 children. There were two gemellary deliveries. Nine women had a spontaneous and 16 an induced abortion, of which 4 were performed on therapeutic indication. For a woman with ulcerative colitis the risk of an exacerbation of the bowel disease was 32% per year in her fertile years, whereas it was 34% per year during pregnancy. This difference is not statistically significant. As compared with women with an inactive bowel disease, women in whom the disease was active at the start of pregnancy had a small but significantly greater risk of spontaneous abortion and premature delivery. The frequency of malformations, prematurity, and neonatal hyperbilirubinaemia was not higher in the children of ulcerative colitis mothers than in those of healthy mothers. Treatment with sulphasalazine, salazosulphadimidine, and corticosteroids had no influence on the course and outcome of pregnancy. Birth length and weight of the children of mothers with ulcerative colitis equalled those for children of healthy mothers. In conclusion, pregnancy does not necessitate any change in the usual medical treatment of ulcerative colitis. Women with ulcerative colitis should be advised preferably to conceive at a time when their bowel disease is inactive. Generally, ulcerative colitis constitutes no indication for induced abortion.
TL;DR: In an ongoing prospective study of "genetic prediabetes," conducted by one of us (J.S.S.) and co-workers at the Joslin Diabetes Center, a set of monozygotic triplets and a setof monozygotics initially discordant for Type I diabetes were identified, which were unique in that their beta-cell antibodies were unique.
Abstract: Type I diabetes mellitus has until recently been considered a disease that has an acute onset and is characterized by the sudden appearance of metabolic abnormalities in previously "healthy" people. Recent studies have suggested that there is a latent period before the development of overt diabetes, during which islet-cell antibodies arc present.1 2 3 4 In an ongoing prospective study of "genetic prediabetes," conducted by one of us (J.S.S.) and co-workers at the Joslin Diabetes Center, a set of monozygotic triplets5 and a set of monozygotic twins initially discordant for Type I diabetes were identified. These patients were unique in that their beta-cell . . .
TL;DR: Depressed and nondepressed women who had recently given birth were compared and predicted that depressed subjects diagnosed on the basis of Research Diagnostic Criteria would have experienced more stressful life events since the beginning of pregnancy and since delivery and would have fewer confidants and receive less instrumental and emotional support from their network members.
Abstract: Depressed (N = 11) and nondepressed (N = 19) women who had recently given birth were compared on several life stress measures and indices of structural and qualitative characteristics of their social networks. We predicted that depressed subjects diagnosed on the basis of Research Diagnostic Criteria would have experienced more stressful life events since the beginning of pregnancy and since delivery. We also predicted that depressed subjects would have fewer confidants and receive less instrumental and emotional support from their network members. These predictions were largely confirmed, except that the two groups did not differ on number of confidants. The social support provided by spouses appeared to be especially important. Implications of these findings for life events and social network research are discussed.
Journal Article•
TL;DR: Sclerotic lesions in the myometrial arteries are a possible cause of underperfusion because the proportion of arteries with these lesions increased from 11% at age 17 to 19 years to 83% after age 39.
TL;DR: Between October, 1980, and April, 1983, embryos fertilised in vitro were replaced in the uteri of 1200 women, and the "clinical" pregnancy rate rose from 16.5% to almost 30% in 1983.
TL;DR: It is shown that the importance of the placenta as a determinant of foetal growth rate has been greatly underestimated and that the survival of the foetus is jeopardized more by a small placentA than by maternal underfeeding.
TL;DR: Results clearly indicate that the milk ejection reflex, with release of oxytocin, occurs in most women before the tactile stimulus of suckling, and it is important that care is taken to protect breast feeding mothers from stress not only during suckling but also immediately before nursing, when conditioned releases of Oxytocin will occur.
Abstract: The oxytocin and prolactin responses to suckling were measured in 10 women in early (n = 5) and established lactation (n = 5). Oxytocin was released in a pulsatile manner during suckling in all women, but the response was not related to milk volume, prolactin response, or parity of the mother. In all 10 women plasma oxytocin concentrations increased three to 10 minutes before suckling began. In five women this occurred in response to the baby crying, in three it coincided with the baby becoming restless in expectation of the feed, while in two it corresponded with the mother preparing for the feed. There was no prolactin response to stimuli other than stimulation of the nipple associated with suckling. These results clearly indicate that the milk ejection reflex, with release of oxytocin, occurs in most women before the tactile stimulus of suckling. A second release of oxytocin follows in response to the suckling stimulus itself. Thus it is important that care is taken to protect breast feeding mothers from stress not only during suckling but also immediately before nursing, when conditioned releases of oxytocin will occur.
TL;DR: There may exist a feedback mechanism whereby fetal growth and, in particular, increasing steroidogenesis by the developing fetal adrenal gland result in the maternal cardiovascular adaptations to pregnancy that optimize further fetal development.
Abstract: During the course of gestation the increase of maternal total blood volume and cardiac output may result from two mechanisms acting in concert: 1) the production of several hormones by the fetus and the placenta, and 2) the uteroplacental circulation acting as an arteriovenous shunt. Plasma volume appears to increase as a consequence of renal Na+ reabsorption and water retention, which result from increased aldosterone production via the renin-angiotensin system, as a consequence of placental estrogen production. This estrogen production in turn results from increasing availability of the estrogen substrate dehydroepiandrosterone (chiefly from the fetal adrenal gland). Erythrocyte volume increases as a consequence of the erythropoietic effect of placental chorionic somatomammotropin, progesterone, and perhaps prolactin. In addition, maternal blood volume increases in response to the uteroplacental circulation functioning as a low-resistance circuit. In turn, this increases cardiac output and nutrient delivery for further growth of the products of gestation. Thus there may exist a feedback mechanism whereby fetal growth and, in particular, increasing steroidogenesis by the developing fetal adrenal gland result in the maternal cardiovascular adaptations to pregnancy that optimize further fetal development. In certain complications of pregnancy the less-than-normal maternal blood volume increase may result from failure of these mechanisms, while in turn contributing to the further genesis of these disorders.
TL;DR: In a prospective study of chlamydial and mycoplasmal infections in pregnancy, Chlamydia trachomatisoccurred in 8.0%, Mycoplasma hominisin 23.5%, and Ureaplasma urealyticumin 72.3% of 1,365 enrollees as discussed by the authors.
Abstract: In a prospective study of chlamydial and mycoplasmal infections in pregnancy,Chlamydia trachomatisoccurred in 8.0%,Mycoplasma hominisin 23.5%, andUreaplasma urealyticumin 72.3% of 1,365 enrollees. By multivariate analysis,C trachomatiswas correlated with lower socioeconomic status, age 23 years or younger, and 12 years or less of schooling.Ureaplasma urealyticumwas correlated with age 23 years or younger and lower socioeconomic status.Mycoplasma hominiswas correlated with more than one recent sexual partner, first intercourse at age 17 years or younger, and higher socioeconomic status. These cervical infections did not predict low birth weight, abortion, stillbirth, prematurity, or premature rupture of membranes. OnlyM hominispredicted endometritis/fever after vaginal delivery (relative risk, 7.3). IgM-seropositiveC trachomatis—infected women had more low-birth-weight infants and more premature rupture of membranes than either IgM-negativeC trachomatis—infected women orC trachomatisculture-negative women. Thus, only certain subgroups of infected women may experience adverse pregnancy outcomes. (JAMA1983;250:1721-1727)
TL;DR: Assessment of reproductive data from 4,225 women with breast cancer and 12,307 hospitalized women without breast cancer found that the age of approximately 35 years represents for every birth a critical point; before this age any full‐term pregnancy confers some degree of protection; after this ageany full-term pregnancy appears to be associated with increase in breast cancer risk.
Abstract: In an effort to assess the relative importance of age at first birth, age at subsequent births, and total parity to the occurrence of breast cancer, reproductive data from 4,225 women with breast cancer and 12,307 hospitalized women without breast cancer were analyzed by a multiple logistic regression model. Age at first birth was confirmed to be the most important reproductive risk indicator; it was associated with a 3.5 % increase of relative risk for every year of increase in age at first birth (the 95 % confidence interval of this estimate was 2.3 to 4.7 % increase per year). However, age at any birth after the first was also an independent and statistically significant risk indicator; it was associated with a 0.9% increase of relative risk for every year of increase in age at any (and every) birth (the 95 % confidence interval of this estimate was 0.4 to 1.5 % increase per year). There is evidence that the age of approximately 35 years represents for every birth a critical point; before this age any full-term pregnancy confers some degree of protection; after this age any full-term pregnancy appears to be associated with increase in breast cancer risk. The effect of parity is determined by the age of occurrence of the component pregnancies. While most pregnancies occur under the age of 35, the distribution varies from population to population, and this may account for the differences between populations in whether or not a protective effect is seen for births after the first, and if it is seen, its extent.