Combined effects of maternal smoking status and dietary intake related to weight gain and birth size parameters.

OBJECTIVE: To investigate the interaction of smoking status and dietary intake during pregnancy and its relationship to maternal weight gain and birth size parameters. DESIGN: An observational prospective study. SETTING: Free-living conditions. POPULATION: Four hundred and eight healthy pregnant Icelandic women. METHODS: Maternal smoking status, lifestyle factors and dietary habits were evaluated with questionnaires. Intake of foods and supplements was also estimated with a semiquantitative food frequency questionnaire for the previous 3 months. All questionnaires were filled out between 11 and 15 weeks and between 34 and 37 weeks of gestation. Smoking status in relation to optimal and/or excessive weight gain during pregnancy was represented with logistic regression controlling for potential confounding factors. MAIN OUTCOME MEASURES: Maternal weight gain, smoking status, dietary intake and birthweight. RESULTS: Women who smoked throughout pregnancy were unlikely to gain optimal weight or more (OR 0.51, 95% CI 0.27-0.97), whereas smoking cessation in connection with pregnancy ('former smokers') doubled the risk of excessive weight gain (OR 2.03, 95% CI 1.24-3.35). The latter association was no longer significant after adjustment for dietary factors and other confounding factors. Former smokers ate the least amount of fruit and vegetables (fruit: 129 versus 180 and 144 g/day (median), P= 0.038; vegetables: 53 versus 76 and 72 g/day, P= 0.026 for former smokers, nonsmokers and smokers, respectively). Birthweight was lowest among infants born to smokers, but birthweight was similar for former smokers and nonsmokers (3583 +/- 491 g versus 3791 +/- 461 g and 3826 +/- 466 g, respectively; P= 0.003). CONCLUSIONS: Smoking cessation in early pregnancy or pre-pregnancy is not associated with low birthweight. It is, however, associated with excessive maternal weight gain and a low fruit and vegetable intake.

Relationship between high consumption of marine fatty acids in early pregnancy and hypertensive disorders in pregnancy.

OBJECTIVE: To investigate whether there is a relationship between maternal intake of cod-liver oil in early and late pregnancy and hypertensive disorders in pregnancy. DESIGN: An observational prospective study. SETTING: Free-living conditions in a community with traditional fish and cod-liver oil consumption. POPULATION: Four hundred and eighty-eight low-risk pregnant Icelandic women. METHODS: Maternal use of cod-liver oil, foods and other supplements was estimated with a semiquantitative food frequency questionnaire covering food intake together with lifestyle factors for the previous 3 months. Questionnaires were filled out twice, between 11 and 15 weeks of gestation and between 34 and 37 weeks of gestation. Supplements related to hypertensive disorders in pregnancy, i.e. gestational hypertension and pre-eclampsia, were presented, with logistic regression controlling for potential confounding. MAIN OUTCOME MEASURES: Gestational hypertension, pre-eclampsia, cod-liver oil and multivitamins. RESULTS: The odds ratio for developing hypertensive disorders in pregnancy for women consuming liquid cod-liver oil was 4.7 (95% CI 1.8-12.6, P= 0.002), after adjusting for confounding factors. By dividing the amount of n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) into centiles, the odds ratio for hypertensive disorders across groups for n-3 LCPUFA suggested a u-shaped curve (P = 0.008). Similar results were found for gestational hypertension alone. Further, the use of multivitamin supplements without vitamins A and D in late pregnancy doubled the odds of hypertensive disorders (OR 2.4, 95% CI 1.0-5.4, P= 0.044). CONCLUSIONS: Consumption of high doses of n-3 LCPUFA in early pregnancy, or other nutrients found in liquid cod-liver oil, may increase the risk of developing hypertensive disorders in pregnancy.

Maternal diet in early and late pregnancy in relation to weight gain.

OBJECTIVE: To identify dietary factors related to the risk of gaining weight outside recommendations for pregnancy weight gain and birth outcome. DESIGN: An observational study with free-living conditions. SUBJECTS: Four hundred and ninety five healthy pregnant Icelandic women. METHODS: The dietary intake of the women was estimated with a semiquantitative food frequency questionnaire covering food intake together with lifestyle factors for the previous 3 months. Questionnaires were filled out at between 11 and 15 weeks and between 34 and 37 weeks gestation. Comparison of birth outcome between the three weight gain groups was made with ANOVA and Bonferroni post hoc tests. Dietary factors related to at least optimal and excessive weight gain during pregnancy were represented with logistic regression controlling for potential confounding. RESULTS: Of the women, 26% gained suboptimal and 34% excessive weight during pregnancy. Women in late pregnancy with at least optimal, compared with women with suboptimal, weight gain were eating more (OR = 3.32, confidence interval (CI)=1.81-6.09, P < 0.001) and drinking more milk (OR = 3.10, CI = 1.57-6.13, P = 0.001). The same dietary factors were related to excessive, compared with optimal, weight gain. Furthermore, eating more sweets early in pregnancy increased the risk of gaining excessive weight (OR=2.52, CI=1.10-5.77, P=0.029). Women with a body mass index of 25.0-29.9 kg/m(2) before pregnancy were most likely to gain excessive weight (OR = 7.37, CI 4.13-13.14, P < 0.001). Women gaining suboptimal weight gave birth to lighter children (P < 0.001) and had shorter gestation (P = 0.008) than women gaining optimal or excessive weight. CONCLUSION: Women who are overweight before pregnancy should get special attention regarding lifestyle modifications affecting consequent weight gain during pregnancy. They are most likely to gain excessive weight and therefore most likely to suffer pregnancy and delivery complications and struggle with increasing overweight and obesity after giving birth.

Low back pain, smoking and employment during pregnancy and after delivery - a 3-month follow-up study.

Low back pain (LBP.), smoking and employment was studied among 111 consecutive women admitted to a maternity ward over a 6-week period, 40 were primiparas and 71 multiparas. LBP was defined as any pain in the low back, irrespective of the specific cause of the pain. Two specially constructed questionnaires were utilised. The first was a, 14-item questionnaire which all participants answered before leaving the maternity ward. It included questions on employment and smoking and self-rating Visual Analogue Scales used for rating LBP. LBP was rated during the pregnancy and 3 days after delivery. The second questionnaire was used in a 90-day follow-up interview. The mean age of participants was 28 years. The prevalence of LBP during pregnancy was 58.5% among the 111 participants. Of the 111, 75% continued to have LBP postpartum and at the 90-day post-delivery follow-up, 54% of those with LBP during pregnancy were still experiencing LBP. Previous births and birth weight were not found to correlate positively with LBP. LBP during pregnancy did not affect the length of employment during pregnancy. Smokers had LBP more frequently during pregnancy and also after (P <0.002). It is concluded that smoking does seem to contribute to LBP during and after pregnancy. Birth weight does not affect LBP and LBP does not affect the length of employment during pregnancy.

[Society must denounce violence against women]. / Samhället måste fördöma våld mot kvinnor.

In Iceland there is no established procedure for the care of adult victims of criminal assault (mainly women). There is no statutory obligation to make a report, such as is mandatory in the case of children. Most victims of assault do not figure in statistics. The establishment of an official facility for the care of adult victims is an urgent need.

Effects of a tocolytic oxytocin analogue on lipid and carbohydrate metabolism.

The effect of a newly developed tocolytic oxytocin analogue, 1-deamino-2-D-Tyr(OEt)-4-Thr-8-Orn-oxytocin on lipid and carbohydrate metabolism was investigated. Oxytocin and vasopressin both stimulated lipogenesis in isolated rat adipocytes, an effect which was dose-dependently inhibited by the oxytocin analogue. In vivo, intravenous injection of 10 nmol/kg body weight of the analogue to 11 healthy subjects caused an initial, but insignificant peak after 4 min in both plasma glucose and glycerol, which thereafter remained at basal level. It is concluded that although an antagonistic effect of the analogue on vasopressin- and oxytocin-stimulated lipogenesis could be demonstrated in vitro, the effect on lipid and carbohydrate metabolism in vivo in humans is insignificant.

The influence of a combined oral contraceptive on uterine activity and reactivity to agonists in primary dysmenorrhea.

The mechanisms underlying the therapeutic effect of an oral contraceptive (150 micrograms levonorgestrel and 30 micrograms ethinyl estradiol daily for 21 days) in primary dysmenorrhea were studied by recordings of uterine activity and reactivity to lysine (L) vasopressin (VP) and prostaglandin (PG) F2 alpha on the first day of menstruation in 14 women before and after one period of oral contraceptive treatment. During the first session, when all women had moderate to severe dysmenorrhea, intra-uterine pressure recording showed an intensive uterine activity, and bolus injections of LVP (6 pmol/kg body weight; 6 subjects) or PGF2 alpha (6 or 12 nmol/kg body weight; 4 subjects in each group) increased contractile activity and discomfort. After oral contraceptive treatment, spontaneous uterine activity, measured as total pressure area, decreased significantly (p = 0.02 and p = 0.03 in the VP and PG groups, respectively). The mean uterine responses to LVP and PGF2 alpha were on average smaller after oral contraceptive treatment and the women experienced minimal discomfort after this injection. It is suggested that inhibition of uterine activity could be an important mechanism for the therapeutic effect of gestagen-dominated oral contraceptives in primary dysmenorrhea and that reduced uterine reactivity to agonists might contribute to this effect.

Uterine blood flow and myometrial activity at menstruation, and the action of vasopressin and a synthetic antagonist.

Local endometrial blood flow was measured by a thermistor technique and myometrial activity by intrauterine pressure recording in 10 women before and during menstruation. The effect of lysine vasopressin infusion (1 pmol/kg body-weight per min) and of bolus injection of a synthetic oxytocin analogue, 1-deamino-2-D-Tyr(OEt)-4-Thr-8-Orn-oxytocin (10 nmol/kg body-weight), were studied. Spontaneous variations in blood flow were seen synchronous with clearly demarcated uterine contractions, the myometrial activity being significantly increased in early (day -1 to day +2) compared with late (day +3 to day +5) menstrual phase. The vasopressin infusion decreased blood flow, stimulated uterine activity and caused slight to moderate dysmenorrhoea-like pain. These effects were completely inhibited by the injection of the oxytocin analogue. In-vitro studies on uterine arteries confirmed that the analogue also inhibited the vasopressin-induced constriction of the uterine arteries. This antagonist was more effective than two other analogues, 1-deamino-2-D-Tyr(OEt)-4-Val-8-Orn-oxytocin and 1-deamino-2-Tyr(OEt)-oxytocin. The counteracting effect of 1-deamino-2-D-Tyr(OEt)-4-Thr-8-Orn-oxytocin on the vasopressin-induced decrease of blood flow and increase of contractions supports the therapeutic value of the drug in primary dysmenorrhoea and preterm labour.

Inhibition of uterine contractions of premature labour with an oxytocin analogue. Results from a pilot study.

A competitive inhibitor of the action of oxytocin on the uterus, 1-deamino-2-D-Tyr-(OEt)-4-Thr-8-Orn-oxytocin, was studied for the first time in 13 patients with established, uncomplicated premature labour. Intravenous infusion of 10-100 micrograms/min of the analogue was given for 1-10 h and the effect was monitored by external cardiotocography. In all women an inhibition of uterine activity was observed, and in the majority of patients infused with 25 micrograms/min and a total dose of about 5 mg or more of the drug total inhibition of uterine contractions was achieved. There were no effects on the maternal and fetal pulse rates, nor were there any other side-effects. The results of this preliminary study support the concept of an increased concentration of uterine oxytocin receptors being aetiologically important in uncomplicated premature labour. They also suggest that the present oxytocin antagonist could be an interesting therapeutic alternative in the condition, primarily because of the marked selectivity of its effect.

Plasma concentrations of vasopressin and a prostaglandin F2 alpha metabolite in women with primary dysmenorrhoea before and during treatment with a combined oral contraceptive.

Oral contraceptives reduce menstrual pain but the interaction with vasopressin and prostaglandin F2 alpha, two uterine stimulants related to the condition, is unknown. Ten women with a history of moderate to severe dysmenorrhoea were studied. Repeated blood samples were taken during a first menstrual cycle without treatment, during the first 21 days of a second cycle when they received an oral contraceptive (150 micrograms levonorgestrel and 30 micrograms ethynyloestradiol) and on the first or second day of the bleeding following hormonal withdrawal. Measurements were made of plasma concentrations of arginine vasopressin, 15-keto-13,14-dihydroprostaglandin F2 alpha, oestradiol-17 beta, progesterone, ethynyloestradiol, levonorgestrel, FSH, LH and prolactin, and serum osmolality was measured. Seven of the women rated their discomfort as moderate to severe on the first two menstruations, but as none or light at the withdrawal bleeding; with the rating scale for degree of pain that was used, this decrease in pain was significant (P less than 0.001). The plasma concentration of vasopressin in these seven women showed significant variation, with the highest concentrations being obtained at the beginning of the two painful menstruations (3.76 +/- 0.76 and 1.75 +/- 0.30 (S.E.M.) pmol/l) and at ovulation in the control cycle (1.91 +/- 0.58 pmol/l). During treatment the concentrations were consistently low, except on the first day of withdrawal bleeding (2.33 +/- 0.35 pmol/l). The concentrations of the prostaglandin F2 alpha metabolite showed less variation, but again the values at withdrawal bleeding (271 +/- 39 pmol/l) were not different from those obtained over the painful menstruations (255 +/- 24 and 217 +/- 25 pmol/l).(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: To learn more about the beneficial effect of combined oral contraceptives (OCs) on symptoms in primary dysmenorrhea, plasma levels of vasopressin and a prostaglandin F2-alpha metabolite in dysmenorrheic women were investigated before and during treatment with a gestagen-dominated OC. The 10 subjects were administered an OC containing 150 mcg of levonorgestrel and 30 mcg of ethinyl estradiol for 21 days. The 7 women with dysmenorrheic symptoms at the time of blood sampling during the 1st menstruation graded their pain as averaging 2.1 (moderate to severe) + or - 0.3; during the 2nd menstruation, the average value was 2.9 (severe) + or - 0.1, indicating a significant increase in pain at the start of the withdrawal bleeding. Vasopressin concentrations in samples obtained on days 1-3 of the control cycle were significantly higher than those on days 6-8, 20-22, and 24-26 of the control cycle and days 1-2 of the next menstruation. Thus, the highest concentrations were obtained at the beginning of the 2 painful menstruations and at ovulation in the control cycle. During treatment, vasopressin concentrations were consistently low, except on the 1st day of withdrawal bleeding. The concentrations of the prostaglandin F2-alpha metabolite showed less variation, again, values at withdrawal bleeding were not different from those obtained during painful menstruation. Plasma concentrations of ovarian and adenohypophysial hormones, as well as osmolality, were normal throughout. Thus, the present study provided no evidence that there is a reduced release of vasopressin and/or prostaglandin F2-alpha capable of accounting for the beneficial effect of OCs on dysmenorrhea. It is possible, however, that a difference in ovarian hormone concentrations is more pronounced in uterine tissue than in plasma.

An instrument for measuring endometrial blood flow in the uterus, using two thermistor probes.

An instrument was developed for continuous measurement of thermal conductance reflecting blood flow locally in the endometrium. The probe consists of two small thermistors, one sensing the tissue temperature, and the other working at 5 degrees C elevated temperature, sensing the heat loss caused by thermal conduction mainly due to the blood flow. The power needed to keep this temperature difference was recorded as a measure of flow. When the instrument was tested in model experiments, for measurement of flows at temperatures of 35 to 40 degrees C, stable recordings with high sensitivity were obtained and no influence of the surrounding temperature was observed. Recordings were also made in vivo in non-pregnant women by applying the instrument to the endometrium of the uterine fundus. Intrauterine pressure was recorded simultaneously. The blood flow recordings were stable over long periods in spite of changes in body temperature, but with fluctuations of up to 0.1 mW concomitant with uterine contractions. Pulse-syncronous variations in flow were recorded, indicating a high sensitivity and a short time constant of the instrument. The blood flow effects of vasoactive substances, i.e. vasopressin and a vasopressin antagonist, could readily be distinguished. It is concluded that this instrument can be used for semi-quantitative recordings of blood flow in cavities of the body, for example the uterus, which can be reached by small probes and that changes of body temperature do not effect the measurements.

A serious ovarian cystadenocarcinoma metastatic to both eyes.

A patient with a stage IV ovarian cystadenocarcinoma is described. She seems to constitute the first reported case of this kind of tumour metastasizing to the eyes.

Pharmacokinetics in the human of a new synthetic vasopressin and oxytocin uterine antagonist.

The pharmacokinetics in the human of 1-deamino-2-D-Tyr(OEt)-4-Thr-8-Orn-vasotocin (dE-TVT), was studied after iv and intranasal administration in 11 subjects at 12 experiments each route. The plasma concentration of the analogue was analysed by means of an arginine vasopressin antibody, which cross-reacted with dE-TVT to 4.7%. When given intravenously as bolus injection (10 nmol/kg/body weight), the total body clearance amounted to 0.623 +/- 0.099 (SEM) l/h kg and the half-life to 16.2 +/- 2.4 min. After intranasal administration (100 nmol/kg/body weight), the bioavailability was 10.5 +/- 2.9%. Peak concentrations in plasma appeared 2-8 min after iv and 10-45 min after intranasal administration. At the end of an observation period of 2 h measurable amounts in plasma were still found in one of the iv and seven of the intranasal experiments. It is concluded that the moderately long half-life is suitable for the treatment of hospitalized patients in premature labour where promising results with intravenous infusion (50 micrograms/min) of dE-TVT have been obtained. It is still uncertain whether or not the absorption of dE-TVT is sufficient for intranasal administration to out-patients with uterine hyperactivity in late pregnancy and to patients with primary dysmenorrhoea, where significant relief of symptoms were seen after iv administration (10 micrograms/kg body weight).

Splenic mesothelial cysts at laparoscopy.

One case of splenic mesothelial cyst formation fortuitously found and biopsied during laparoscopic operation is described.

Vasotocin analogues which competitively inhibit vasopressin stimulated uterine activity in healthy women.

Three analogues of posterior pituitary hormones, 1-deamino-2-D-Tyr(OEt)-4-Val-8-Orn-vasotocin(dE-VVT), 1-deamino-2-D-Tyr(OEt)-4-Thr-8-Orn-vasotocin(dE-TVT) and 1-deamino-2-D-Tyr(OEt)-oxytocin(dE-OXY) were compared for their inhibitory effects on vasopressin (VP)-induced uterine activity in healthy women. At menstruation, during recording of intrauterine pressure (18 recording sessions in 11 women), intravenous infusion of lysine vasopressin (LVP, 1 ng/min/kg/body weight) induced an increase of the uterine activity and dysmenorrhoea-like symptoms. Intravenous injections of all analogues (10 micrograms/kg body weight) caused relief of symptoms and inhibition of uterine activity, dE-TVT was the most effective and dE-OXY was least active. With dE-TVT almost complete inhibition of contractions was seen during the first 10 min after injection. The duration of effect was also greatest with that analogue (40-50 min). Only dE-OXY had an agonist effect on spontaneous uterine activity. Pharmacokinetic studies of intravenous dE-TVT (10 ng/kg body weight) showed that the plasma half-life was approximately 16 min and the clearance 30 l/h. The bioavailability of 100 ng/kg given intranasally was about 5.5%. Further studies are recommended.

High-dose metoclopramide in the treatment of cis-platinum induced emesis. A dose-finding study.

In 92 patients receiving 270 cytostatic courses which all included cis-platinum, the antiemetic efficacy of medium- or high-dose metoclopramide was investigated. Metoclopramide was given intravenously 4 times during a 6-hour period (1/2 h before and 1 1/2, 3 1/2 and 5 1/2 h after cytostatic treatment) in a total dose of 1, 2, 4, 6, or 8 mg/kg. Nausea, emetic episodes, and side effects were registered during 24 h. The 1 mg/kg dose was given in 20 courses for which the average of emetic episodes was 16. In the four higher dosed groups the averages were 8, 8, 5, and 6, respectively. The average number of emetic episodes was significantly higher (p less than 0.001) in the 1 mg/kg metoclopramide group than in the 250 higher dosed courses. The frequency of side effects seemed independent of the dose in the interval 2-8 mg/kg while diarrhoea and other side effects tended to be less frequent in the 1 mg/kg metoclopramide group. Since antiemetic effect of metoclopramide in the dose interval 2-8 mg/kg did not increase with the dose, it is recommended to treat cis-platinum-induced emesis with 2 mg/kg metoclopramide given intravenously as 4 doses during a 6-hour period.

Computed tomography in advanced carcinoma of the uterine cervix.

Computed tomography (CT) and clinical examination including complete evaluation of the true pelvis were performed in 32 patients of whom 2 had possible advanced primary and 30 possible recurrent carcinoma of the uterine cervix. Confirmation of the staging by surgery or autopsy was obtained in 22 patients and by repeat clinical examinations and CT in 10 patients. The CT diagnosis was correct in 29 and the clinical pelvic examination in 25 patients. The results confirm previous reports that CT is a complementary method to pelvic examination in advanced cervical carcinoma.