Pregnant, alcohol-abusing women.

BACKGROUND: This paper reviews the literature on the identification and treatment of pregnant, alcohol-abusing women, with special emphasis on poor women who have access to treatment through Medicaid. METHODS: The paper discusses the gaps and controversies in the literature and suggests five priorities for future research. RESULTS: Studies that attempt to identify pregnant women who drink conclude that heavier drinkers enter prenatal care later than other women, that many health care providers fail to recognize alcohol abuse by pregnant women, and that research on screening techniques is still in the early stages. Treatment research suggests that comprehensive, holistic treatment approaches, as well as brief interventions and case management, have been successful in reducing prenatal alcohol use. Debate continues over whether treatment should be voluntary. CONCLUSIONS: The five areas identified as priorities for future research include (1) developing reliable and valid measures to identify alcohol abuse in pregnant women, (2) creating training programs for providers, (3) generating programs to reduce barriers to care, (4) determining which treatment programs are most successful, and (5) estimating the costs and benefits of various treatment approaches.

Genetic monitoring of aluminum workers exposed to coal tar pitch volatiles.

A group of 50 workers exposed to coal tar pitch volatiles (CTPV) in an aluminum reduction plant and a group of 50 non-exposed workers were selected to evaluate the genotoxic effects of CTPV exposure. A battery of tests was performed on 3 different body fluids; urine, blood and semen. Urine samples were evaluated for mutagenic constituents using the Ames/Salmonella assay. Cultured lymphocytes from blood samples were used to perform cytogenetic analysis. Semen samples were used to measure sperm count, percent abnormal sperm morphology and frequency of sperm carrying double fluorescent bodies (2-F). 14 of 28 (50%) exposed workers and 7 of 36 (19.4%) non-exposed workers had mutagenic urine. This difference was significant (p less than 0.01). Among the non-smokers a significantly higher percentage of workers who were exposed had positive urine (36%) compared to the non-exposed workers (5%) (p less than 0.05). Among the exposed group, more mechanics had mutagenic urine than did other types of workers. Overall chromosome aberration rates were similar in both exposed and non-exposed workers. Among exposed workers a significant inverse correlation (p less than 0.05) between age and chromatid aberration rate was observed. Results of semen analysis failed to detect differences between exposed and non-exposed workers. Results of these tests lend support to a battery approach to genetic monitoring and suggest a link between exposure to CTPV and genotoxic effects. Detection of exposure to mutagens at an early time offers an opportunity for disease prevention by the reduction of exposure.

Orthotopic ovarian transplantation in young and aged CBA mice.

Reproductive and hormonal changes associated with CBA mice which were orthotopically transplanted with ovaries from young or aged CBA mice were studied. Reproductive decline was defined by the number of mice mating and the number of implantation sites and resorptions in pregnant mice. A high percentage of resorptions was observed in aged mice receiving ovaries from young mice. An increase in the number of resorptions and a decrease in the number of implantation sites was observed in young mice transplanted with aged ovaries. Concentrations of LH, FSH and Prl were analyzed by radioimmunoassay from plasma of pregnant and nonpregnant transplanted mice, ovariectomized and sham-operated controls. Young ovariectomized mice had elevated concentrations of LH and FSH when compared to sham-operated controls. No differences were noted between the aged ovariectomized mice although the gonadotrophin levels in these animals were higher than those in comparable young groups. The highest LH and lowest FSH concentrations were found in young to young transplanted mice. The Prl concentrations in transplanted mice did not vary between groups. These data suggest that the hypothalamic-hypophyseal complex is functioning adequately in all transplanted groups and age-related changes in the ovary and uterus are responsible for embryonic mortality.