ABSTRACT
OBJECTIVES: To perform a neurophysiological follow-up at 48 or 60 months of age in children exposed prenatally to progesterone compared with a placebo and evaluate their medical histories up to 8 years of age. METHODS: In this study, Danish participants of the PREDICT study, including 989 surviving children from 498 twin pregnancies, were followed-up. PREDICT was a placebo-controlled randomized clinical trial examining the effect of progesterone for prevention of preterm delivery in unselected twin pregnancies. Medical histories of the children were reviewed and neurophysiological development was evaluated by the parent-completed Ages and Stages Questionnaire (ASQ) at either 48 or 60 months after the estimated date of delivery. We used the method of generalized estimating equation to account for the correlation within twins. RESULTS: A total of 492 children had been exposed prenatally to progesterone and 497 to placebo. There was no difference in the number of admissions to or length of stay in hospital between the treatment groups, and we found no overall difference in the rates of diagnoses made. However, the odds ratios (ORs) for a diagnosis concerning the heart was 1.66 (95% CI, 0.81-3.37), favoring placebo, among all children, 2.38 (95% CI, 1.07-5.30) in dichorionic twins and 8.19 (95% CI, 1.02-65.6) in all children when excluding diagnoses made at outpatient clinic visits. ASQ scores were available for 437 children (progesterone, n = 225; placebo, n = 212). Mean ASQ score was slightly higher in the progesterone group compared with the placebo group (P = 0.03). In dichorionic twins, the risk of having a low ASQ score (< 10(th) centile) was decreased in the progesterone group (OR, 0.34 (95% CI, 0.14-0.86)). CONCLUSION: Second- and third-trimester exposure of the fetus to progesterone does not seem to have long-term harmful effects during childhood, but future studies should focus on cardiac disease in the child. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Subject(s)
Pregnancy, High-Risk/drug effects , Premature Birth/prevention & control , Prenatal Exposure Delayed Effects/physiopathology , Progesterone/administration & dosage , Progestins/administration & dosage , Administration, Intravaginal , Adult , Child , Child Development , Child, Preschool , Delivery, Obstetric , Denmark/epidemiology , Female , Follow-Up Studies , Gestational Age , Humans , Infant , Pregnancy , Premature Birth/drug therapy , Prenatal Exposure Delayed Effects/epidemiology , TwinsABSTRACT
Functional Independence Measure (FIM) is a method for uniformly recording functional status in rehabilitation patients. It has been under development in the USA since 1985. In this study, the prognostic value of function tests by FIM on admission to the rehabilitation clinic was investigated in two groups (45 patients in all). Thirty-three patients were admitted for rehabilitation following apoplectic shock, the remaining 12 following treatment of fractures of the femoral neck by total hip replacement. A highly significant correlation was found between the total FIM score on admission and the patient's status on discharge. Of the individual functions studied, the activities "dressing and undressing" and "walking/riding in wheelchair" were found have the highest predictive value.
