The association of maternal social class with maternal diet and the dimensions of babies in a population of London women.

Records of the diets of 513 London mothers towards the end of the first trimester of pregnancy have been reported previously to show the maternal nutritional intakes associated with birthweight in the optimum range, which may be assumed to approximate to basic maternal needs for reproduction. The diets associated with low birthweight and small head size were also recorded and were found to be inferior. The present paper shows social class gradients for baby size and 35 essential dietary components, providing an indication of which basic maternal nutritional needs were not always met. There was no social class gradient for intake of total energy, or the energy carriers carbohydrate and fat. There were, however, statistically highly significant social class gradients for intake of protein, seven minerals and six B-vitamins, all of which were also highly significantly correlated with birthweight. Maternal intake of these 14 components of diet fell progressively as birthweight fell, but only for the mothers of smaller babies below 3270g, the median for the study. Further increase of maternal intakes of any nutrient by mothers whose babies were above median did not apparently further increase birthweight. The social and medical problem presented by maternal nutrition is that of a minority of women who enter pregnancy with qualitatively inadequate nutritional status. This minority is found in all social classes but increases from social class I to V, and further still among single mothers. The women comprising this minority eat foods not meeting basic maternal needs for a range of nutrients characteristic of whole grains, vegetables and fruit and dairy produce, which may partly be explained by their high cost.

Long-term follow-up of the Conaxial (Beck-Steffee) total ankle arthroplasty.

Between 1975 and 1977, 30 patients with traumatic arthritis or rheumatoid arthritis underwent 36 Conaxial (Beck-Steffee) ankle replacements (DePuy, Warsaw, IN). Thirty-two were primary replacements and four were revisions of previous ankle arthroplasties. Twelve patients had traumatic osteoarthritis and 18 patients had rheumatoid arthritis. The average age at operation of patients with rheumatoid arthritis was 61 years (range 28-67 years) and with osteoarthritis was 52.9 years (range 32-72 years). The average follow-up was 10.8 years, with a range of 10 to 13 years. Early postoperative complications included wound dehiscence in 39% of patients (14 patients), deep wound infection in 6%, fractures of the medial or lateral malleolus in 22%, and painful talofibular impingement in 14%. At 2-year follow-up, 27% of the ankle replacements were loose. Sixty percent were loose at 5 years and 90% were loose at the 10-year follow-up. Ten patients had implant removal and attempted fusion. Six, or 60%, fused in an average of 5 months. Of those patients who achieved ankle fusion, four had internal fixation and iliac crest autografting, one had a Charnley compression apparatus with allograft bone, and one had internal fixation with allograft bone. The constrained Conaxial ankle replacement should no longer be implanted because of a 90% loosening rate at 10 years and an overall complication rate of 60%.

Nutrition of women in anticipation of pregnancy.

A causal connection between maternal nutrient intake and birth outcome is not universally accepted. In this paper further empirical support is provided, particularly in relation to the impact of maternal nutrition around the time of conception or very early in pregnancy. It is argued that the hypothesis that maternal nutrition has no connection with birthweight is very easily refuted. It is suggested that there should be a new category of recommended dietary allowances; "women in anticipation of pregnancy". The diet of 513 pregnant London women were recorded for 7 days during the first trimester of their pregnancy. Birthweight and nutrient intakes were found to be significantly correlated but only over the lower half of the birthweight range. The optimum birthweight range with the lowest perinatal and infant mortalities is 3,500-4,500 g and it is suggested that the nutrient intake of th 165 women who had babies in this optimum weight range provide tentative values for nutrient intake recommendations in anticipation of pregnancy, but are not claimed to be representative. The need for adjustments of recommendations for the individual, for example for a low body mass index, is discussed. A body mass index of 24 kg/m2 is recommended based on the median of the 165 women.

Maternal magnesium intake and pregnancy outcome.

The magnesium intakes of 513 women towards the end of the first trimester of pregnancy were calculated from a record of food consumption for one week. Magnesium intake was found to be correlated with weight, length, and head circumference at birth as well as length of gestation up to a threshold of around 3200 g birthweight. Of the seven elements found to be significantly associated with these outcomes of pregnancy, magnesium was third in order of significance, after sodium and chloride. A subsample of mothers were given a supplement which provided 100 mg/day of magnesium during the second and third trimester: there was no effect on the outcome of pregnancy, suggesting that any influence of magnesium was confined to the first trimester or before. A maternal magnesium intake of 300 mg/day was compatible with observed optimum birthweight, length and head circumference.