Perinatal effects of amphetamine and heroin use during pregnancy on the mother and infant.

OBJECTIVES: To determine the perinatal impacts of heroin and amphetamine on both mothers and infants. MATERIAL AND METHOD: This is a retrospective study on the influence of amphetamine and heroin on pregnant women and their newborn infants at King Chulalongkorn Memorial Hospital in Bangkok, Thailand, between January 1997 and December 2002. The medical and demographic data of both mothers and infants were evaluated. Comparison of the consistent drug effects of these 2 drugs on the mothers and infants were also performed RESULTS: Two hundred and eleven women were identified There were 178 (84.4%) and 33 (15.6%) women addicted to amphetamine and heroin respectively. Sixty one (28.9%) of them were polydrug users. There were more polydrug users among heroin addicts than amphetamine addicts, (43.7% vs 27.2%, p < 0.05). Poor obstetric history were noted in both groups of women including lack of prenatal care (74.9%), a high incidence of previous abortion (22.3%), positive HIV serology test (11.1%), pre-eclampsia (5.2%), infection (3.3%) and antepartum hemorrhage (1.9%). Drug intoxication was found in 11 amphetamine addicted mothers, whereas 2 heroin addicts developed withdrawal symptoms during intrapartum and postpartum periods. All infants were singleton. There was one stillbirth and 2 neonatal deaths. There was no statistical difference in terms of sex ratio, mean birth weight, gestational age, length, head circumference and Apgar score between the groups of amphetamine and heroin exposed infants. The incidence of prematurity, low birth weight, IUGR and microcephaly were not statistically different between both groups of infants. The overall incidence was 31.7%, 31.7%, 9.5% and 8.6% respectively. Congenital anomalies were found in 5 (2.8%) amphetamine exposed infants. Thirty one out of 33 heroin exposed infants (93.9%) and 4 out of 178 amphetamine exposed infants (2.2%) developed drug withdrawal symptoms with the mean onset of 21.5 +/- 16.5 hours and 10.3 +/- 7.5 hours respectively, p > 0.05. All heroin withdrawal infants were successfully treated with Phenobarbital with the mean duration of treatment of 23.7 +/- 11.5 days. None of the amphetamine withdrawal infants needed specific treatment. They recovered spontaneously within 6.0 +/- 5.3 days. Eighteen infants were left in an orphanage or under the custody of their relatives. CONCLUSION: Amphetamine or heroin use during pregnancy can cause many serious adverse effects on both mothers and infants. The findings in the present study are consistent with previous reports, although they seemed to be more common and severe. Increasing awareness and improving understanding of drug abuse in the medical, legal and social aspects are needed in order to reduce these impacts.

The prevalence and risk factors of anemia in pregnant women.

OBJECTIVE: To determine the prevalence and risk factors of anemia in pregnant women. METHOD: The pregnant women were screened with complete blood count, hemoglobin electrophoresis and serology tests for hepatitis B, syphilis and HIV. In cases of anemia, serum for iron and ferritin were investigated. Anemia was defined as a hemoglobin level less than 11.0 g/dl in the first and third trimester of pregnancy or less than 10.5 g/dl in the second trimester. Factors associated with anemia were analyzed by using student's t-test and chi-square. The statistically significant factors were tested with the use of multiple logistic regression. RESULTS: A total of 1,304 pregnant women were recruited. The prevalence of anemia was 19.2 per cent (251 cases). Classified in each trimester, the prevalence was 14.8 per cent, 20.5 per cent and 38.6 per cent in the first, second and third trimester, respectively. One hundred and sixty-one cases of anemia were available for serum iron and ferritin levels. Iron deficiency anemia, by means of serum ferritin, was detected in 32 cases (19.9%). An abnormal pattern of hemoglobin electrophoresis was detected in 367 cases (28.1%). Gestational age at first prenatal visit, abnormal hemoglobin electrophoresis and educational status were associated with anemia during pregnancy. CONCLUSION: The prevalence of anemia in pregnant women who first attended the prenatal visit was 19.2 per cent. Factors associated with anemia during pregnancy were gestational age at first prenatal visit, abnormal hemoglobin electrophoresis and educational status.

The prevalence of Chlamydia trachomatis infection in pregnant Thai women.

Chlamydia trachomatis infection is the most common sexually transmitted infection. It can cause pelvic inflammatory disease and subsequently result in tubal infertility. Chlamydia trachomatis infection in pregnancy can also cause neonatal conjunctivitis and pneumonia. This descriptive study showed that Chlamydia trachomatis infection of the cervix among pregnant women, more than 37 weeks of gestation, attending the prenatal clinic at King Chulalongkorn Memorial hospital was found in 10 per cent by means of multiplex polymerase chain reaction (PCR) technique and 2 per cent by using culture method. The present study demonstrated that all the 182 newborn infants had no neonatal Chlamydia trachomatis infection by using multiplex PCR and culture method. All the babies had Apgar's score of more than 7. At 2 months follow-up, 155 infants were evaluated and had no evidence of Chlamydia trachomatis infection.

Single hydrogen peroxide vaginal douching versus single-dose oral metronidazole for the treatment of bacterial vaginosis: a randomized controlled trial.

OBJECTIVE: To compare the effectiveness of single hydrogen peroxide vaginal douching and a single oral dose of metronidazole for the treatment of bacterial vaginosis. METHOD: A randomized trial was performed at the outpatient clinic in King Chulalongkorn Memorial Hospital. 142 patients diagnosed as having bacterial vaginosis were randomly allocated into two groups. The subjects in the first group were douched with 20 milliliters of 3 per cent hydrogen peroxide and received an oral placebo. The subjects in the second group received oral metronidazole 2 grams orally and were douched with a placebo. The cure rate in each group was assessed using Amsel's criteria 2 weeks after treatment. RESULT: The cure rate in the subjects treated with hydrogen peroxide douching was lower than the cases who received oral metronidazole (62.5% versus 78.6%, p-value = 0.036). Rate of gastrointestinal side effects in metronidazole group was higher than in the hydrogen peroxide group (48.6% versus 13.9%, p-value < 0.001). CONCLUSION: Single hydrogen peroxide vaginal douching was less effective than a single oral dose of metronidazole in the treatment of bacterial vaginosis.