Diet during pregnancy and the risk of cerebral palsy.

The role of maternal diet in the development of the fetal brain has not been adequately explored. Marine n-3 fatty acids have, however, been proposed to be important for brain development. The present case-control study aimed to investigate the relationship between dietary intake during pregnancy and the occurrence of cerebral palsy (CP) in the offspring. Children with CP (n 109), born between 1984 and 1988 to mothers residing in the Greater Athens area, were identified at any time in 1991 or 1992 through institutions delivering care and rehabilitation. Successful nutritional interviews were conducted with ninety-one of these children. Controls were chosen among the neighbours of the CP cases or were healthy siblings of children with neurological diseases other than CP, seen by the same neurologists as the children with CP. A total of 278 control children were chosen, and 246 of them were included in the nutritional study. Guardians of all children were interviewed in person on the basis of a questionnaire covering obstetric, perinatal socioeconomic and environmental variables. A validated semiquantitative food-frequency questionnaire of 111 food items was used to estimate maternal dietary intake during pregnancy. Statistical analysis was done by modelling the data through logistic regression. Food groups controlling for energy intake were alternatively and simultaneously introduced in a core model containing non-nutritional confounding variables. Consumption of cereals (mostly bread) and fish intake were inversely associated with CP (P < 0.05 and P < 0.09 respectively) whereas consumption of meat was associated with increased risk (P < 0.02). A protective effect of fish consumption and a detrimental effect of meat intake have been suggested on the basis of earlier work and appear to be biologically plausible. If corroborated by other studies, these results could contribute to our understanding of the nutritional influences on fetal brain development.

Prolactin levels in febrile and afebrile seizures.

Transient hyperprolactinaemia has been reported to follow unprovoked seizures, a finding proposed to be useful in the differential diagnosis of epilepsy. There is also evidence that patients with unprovoked seizures may have high baseline prolactin levels, which could be of value in detecting those predisposed to epilepsy after a first convulsive attack. The purpose of this study was to examine whether prolactin levels are elevated: (1) postictally in febrile seizures and (2) interictally in afebrile seizures. In 17 children with simple febrile seizures, mean postictal prolactin value (370 +/- 160 mU/l, mean +/- SD) was significantly higher (approximately 0.001) than the mean baseline value of 18 seizure-free controls (202 +/- 136 mU/l). The mean baseline prolactin values were not significantly different: (1) in ten children with afebrile versus ten seizure-free controls and (2) in 18 children with febrile seizures associated with high risk for subsequent afebrile seizures versus 23 children with febrile seizures but unlikely to suffer from afebrile seizures. CONCLUSION. Postictal prolactin levels may be a useful marker of recent febrile seizures, while baseline prolactin levels do not appear to have any prognostic significance in afebrile seizures.

Blood lipids in Greek adolescents and their relation to diet, obesity, and socioeconomic factors.

A study of blood lipid levels in adolescent students in rural and urban areas of Greece was undertaken. Blood samples were drawn from 307 adolescents aged 12 to 18 years attending two rural and two urban high schools of different socioeconomic level (urban/lower, urban/higher). Obesity among adolescents had statistically significant detrimental effects on the lipids profile, being associated with higher total and low-density-lipoprotein (LDL) cholesterol and lower high-density-lipoprotein (HDL) cholesterol levels. Adolescents living in urban areas had substantially and significantly higher levels of total and LDL cholesterol, but among urban residents, higher socioeconomic status was associated with lower levels of total and LDL cholesterol. There was no clear evidence that total, LDL, and HDL cholesterol levels were substantially affected by qualitative aspects of diet as evaluated through a food frequency questionnaire. The results of this study indicate that the traditional Mediterranean pattern of living and eating in the rural areas of Greece is associated with a favorable lipid profile in adolescents, which may explain the very low incidence of coronary heart disease (CHD) in these areas. In urban areas lipid profiles are satisfactory in children of high socioeconomic status but unfavorable in children of low- to middle-class families, which are known to be at higher risk for CHD.

The screening programme for congenital hypothyroidism in Greece: evidence of iodine deficiency in some areas of the country.

Newborn screening for Congenital Hypothyroidism, using TSH measurement in dried blood spots, was started in Greece in 1979. A total of 1,274,000 neonates have been screened and 377 cases of Congenital Hypothyroidism were detected, for an incidence of 1:3370. Employing a cut-off point of 30 mU/L of TSH in whole blood, 0.3% of the infants were recalled for repeat examination. The sensitivity of the screening test was 0.99 and the predictive value of a positive test 0.1. The frequency of "false positive" cases in the different geographic regions of Greece showed wide variation between the south and the north areas of the country. We suggest that these differences reflect the degree of iodine deficiency in the population and may be used as an epidemiological indicator of this deficiency.

Diabetes mellitus and exocrine pancreatic insufficiency in a girl with auto-immune haemolysis.

A 7-year-old girl developed diabetes mellitus and exocrine pancreatic insufficiency after 3.5 years of almost continuous treatment with azathioprine and/or prednisone for idiopathic auto-immune haemolytic anaemia. Although both drugs have been reported to preserve endogenous insulin secretion and to interrupt the diabetogenic process they may be responsible for diabetes and exocrine pancreatic insufficiency in our patient.

Maternal and infant health education in a rural Greek community.

PIP: Educational intervention programs in Florin, Greece, a mountainous rural area with a low (15-20%) attendance at prenatal clinics, were conducted to reduce perinatal and infant morbidity and mortality and to promote physical and psychomotor development. Prior community diagnostic surveys had identified low income, poor living conditions, and illiteracy as very closely linked with poor hygiene, poor nutrition, nonutilization of services, frequent infections and high perinatal and infant mortality. The objectives of the intervention were to assess the effects of health education on breast feeding practices and use of available medical services. 300 pregnant women participants were randomly identified by the clinic as the intervention group and 200 as controls. Both groups were similar with predominantly low socioeconomic status (69-73%) and peasant farmers. There were few basic housing amenities (13.1 with interventions and 12.7 for controls). 70% of the women lived in extended families. The intervention involved home visits on nutrition, general hygiene, breast feeding, and newborn care. Visits were scheduled every 2 weeks in the 1st 2 months of pregnancy and every month until the infant was 12 months old. It was found that nutrition counseling was positively associated with maternal weight between interventions and controls (11.33 vs. 10.30 p.05) but not on low birth weight. Prematurity was reduced (3.7% intervention vs. 8.3% controls, p.04). The perinatal mortality was 31% for interventions vs. 41% for controls, but there were a significantly higher number of fetal deaths (28 weeks) for interventions. There was no discernible impact on breast feeding practices except for demand feeding (61% interventions vs. 38% controls) perhaps because both groups considered breast milk the best. Overfeeding was affected by health counseling, but was reflected only after the 1st year (12.1% control vs. 6.7% intervention in the 90th percentile). The presence of anemia followed a similar pattern with intervention impact after the 1st year. There was no measurable impact in psychomotor development. Reported illness days had a significant lower mean 1 year for interventions. Illness reports checked against clinic visits showed underreporting for both groups. Colds, otitis, and gastroenteritis were the most common ailments. Both showed greater illness between 8 and 12 months with a slightly higher incidence of feverish episodes, gastroenteritis and otitis among controls. Hospitalizations were not significantly different. Both groups used the clinic for infant illness; home visits depressed the use of free routine checkups for interventions from 0 to 4 months. 5 neonatal deaths occurred among controls and interventions. It was anticipated that mortality is also affected by linkages to the community and improvement in medical services. The results were mixed but the program was partly successful.^ieng

Alpha-fetoprotein in congenital hypothyroidism.

alpha-Fetoprotein (alpha-FP) was measured in dried blood spots from normal, congenital hypothyroid (CH) and transient hyperthyrotropinemic (TH) newborns as well as in serum from CH and TH babies together with thyroxine, triiodothyronine and thyrotropin. The half-life of alpha-FP had a median value of 12 days in the CH cases and 4.9 days in the TH cases. alpha-FP was significantly higher in the CH group before treatment and showed a significant rise after discontinuation of thyroxine therapy. It would appear that thyroid hormones influence alpha-FP metabolism and that a hypothyroid environment results in increased alpha-FP levels.

Psychomotor development in congenital hypothyroidism. The Greek screening programme.

In 1979 a national screening programme for congenital hypothyroidism (CH) was introduced in Greece. Treatment with L-thyroxine was started immediately after confirmation of the diagnosis, at a median age of 28 days. A standardized development test (Griffiths) was given to a group of CH infants and to healthy controls at the ages of 5-7, 11-13, 17-19, and 23-25 months. Thirty-three infants with CH were also studied at the age of 35-37 months. The mean developmental quotient of CH infants was 103.8 +/- 12.0, 100.9 +/- 10.1, 103.3 +/- 7.1 and 99.8 +/- 10.2 from the ages of 5-7 to 23-25 months, and was not statistically different from those of the controls. Statistical analysis showed no significant differences between athyreotic children and those with an ectopic gland. Our findings show that the prognosis for psychomotor development of children with CH is quite good, provided that treatment starts in the first 6 weeks of life.

Hypothyroidism and sex chromosomes.

The observation of Campbell and Price in 1979 that their Unit had diagnosed four subjects with both Klinefelter's syndrome and congenital hypothyroidism raised the suspicion of an association between the two conditions. This, and the published reports of an XX male, five XXY males, and one mosaic XY/XXY with congenital or acquired forms of hypothyroidism, together with the higher incidence in women and the absence of sex difference among inherited congenital cases, suggested a possible sex chromosome effect in the aetiology of sporadic hypothyroidism. Various hypotheses can be tested either by examining the frequency of hypothyroidism in sex chromatin positive males or by establishing a higher frequency of sex chromatin positive males among hypothyroid cases than in normal males. We examined 57 boys with hypothyroidism for the presence of sex chromatin and found all to be negative. From this relatively small sample we can only exclude the possibility of a very large (100 fold) difference in frequency between the two populations and therefore more data are needed.

Factors related to perinatal morbidity and mortality. Risk factors in pregnancy influencing perinatal morbidity and mortality.

Perinatal and infant mortality is a serious public health problem throughout the world. Its prevention has major social, medical, and economic implications. Prospective and retrospective studies of pregnancy and infancy in many populations of the world have resulted in the definition of risk factors correlated with perinatal morbidity and mortality. Early recognition of these risk factors is extremely important for the prevention of perinatal morbidity and mortality. The most important risk factors are related to the age of the pregnant mother, parity, race, previous fetal loss, medical care, poverty, illegitimate or unwanted pregnancy, education of the mother, multiple births and maternal morbidity.

PIP: Perinatal and infant mortality are serious public health problems throughout the world. Their prevention has major social, medical, and economic implications. Prospective and retrospective studies of pregnancy and infancy in many populationsof the world have resulted in the definition of risk factors correlated with perinatal morbidity and mortality. Early recognition of these risk factors is extremely important for the prevention of perinatal morbidity and mortality. The most important risk factors are related to the age of the pregnant mother, parity, race, previous fetal loss, medical care, poverty, illegitimate or unwanted pregnancy, maternal education, multiple births, and maternal morbidity.

Neonatal screening for hypothyroidism in Greece.

One year's experience in screening for congenital hypothyroidism in Greece is reported. Thyroid stimulating hormone (TSH) determination by a radioimmunoassay on dried blood spots was selected as the screening method. During the first year of screening 75,879 newborn infants were tested from Guthrie blood spots taken on the 5th day of life. Eighteen cases of primary congenital hypothyroidism with serum TSH levels over 100 microIU/ml were detected, giving an incidence of 1: 4200. One case had already been diagnosed clinically. Replacement treatment was started between the 22nd and the 50th days of life.

Psychiatric disorders in 6- to 8-year-old children in the greater Athens area.

603 schoolchildren of the greater Athens area were screened for psychiatric disorders as expressed by a total score of 13 or more in the Rutter parents' questionnaire, and 10 or more in the Rutter teachers' questionnaire. Psychiatric disorder was negatively correlated with school marks. IQ (vocabulary, draw-a-man, visual-motor integration), motor coordination, and achievement in reading and arithmetic, and positively with size of family. The incidence of disturbance as assessed by the teachers' questionnaire was similar to that in other big cities in other countries, while the incidence of disturbance as assessed by the parents' questionnaire was greater in comparison to that of other countries. The incidence of hyperkinesis in our sample was considerably greater in comparison to other studies in other countries. Boys were found to be generally more disturbed than girls with the exception of neurosis.

Bone growth in thalassaemic children.

X-ray measurements were made of the length and width of the 3 middle metacarpal bones of both hands, in 61 thalassaemic and 35 control children of both sexes aged 5--13 years. Growth in length of the bone was normal until age 11 years but after this it was smaller in thalassaemic children. The growth of total width in thalassaemic children was greater than that of the controls until age 11 years and then became equal. The proportion of children with bone age retardation was greater after 7 years.