Pregnancy outcome after age 40 and risk of low birth weight.

A historical cohort study was conducted to examine the pregnancy outcome in women aged 40 or older and determine the effect of age on low birth weight. The pregnancy outcomes of 789 mothers aged 40 years or older were analysed and compared with those of 20,852 mothers aged 20-34 years. There were differences in socioeconomic status and obstetric characteristics between the two groups. The older group had more medical and obstetric complications (diabetes mellitus, chronic hypertension, malpresentation, pregnancy-induced hypertension, placenta praevia, multiple pregnancies, pre-term labour, fetal distress, retained placenta, postpartum haemorrhage and endometritis), more adverse fetal outcomes (low birth weight, low Apgar scores and congenital anomalies) and a higher caesarean section rate. The multivariate logistic regression analysis confirmed that maternal age was an independent risk factor for low birth weight. These data will be useful in counselling patients about their expectations and the risk of adverse outcomes and in providing the appropriate necessary care.

Effects on acne of two oral contraceptives containing desogestrel and cyproterone acetate.

OBJECTIVE: To compare the effects of a low-dose oral contraceptive containing desogestrel (Marvelon) and an anti-androgenic preparation containing cyproterone acetate (Diane) in Oriental women suffering from acne. METHODS: In an open-label, bi-center, randomized study, 32 women using Marvelon and 34 using Diane were followed for 6 treatment cycles. The measured variables were objective and subjective severity of acne, and related biochemical variables such as sex hormone-binding globulin and free and total testosterone. RESULTS: In Center A, with both preparations a decrease in mean objective acne score was observed, reaching statistical significance with Diane (P < .05). In addition, there was a significant between group difference at cycle 6 (P < .05). In Center B, a consistent and significant decrease in mean acne score was observed with Marvelon after three and six treatment cycles (P < .05 and P < .01) and with Diane after six treatment cycles (P < .001). There were no significant between-group differences. The decrease in percentage of severe/moderate acne was statistically significant with Marvelon in Center B (P = 0.002) and with Diane in Centers A (P = 0.014) and B (P = 0.004). Both preparations increased plasma levels of sex hormone binding globulin and seemed to decrease those of total and free testosterone, but no statistically significant relationships between acne severity and biochemical variables could be detected. CONCLUSION: Both Marvelon and Diane are effective in the treatment of acne in Oriental women who also need reliable contraception, without marked differences between the preparations.

PIP: In Thailand, at the Prince of Sonkhla University in Sonkhla (Center A) and Rajvithi Hospital in Bangkok (Center B), researchers compared data on 32 women using a low-dose combined oral contraceptive (OC) containing 150 mcg desogestrel plus 30 mcg ethinyl estradiol (Marvelon) with data on 34 women using an OC containing 2000 mcg cyproterone acetate plus 50 mcg ethinyl estradiol (Diane) to examine their efficacy in acne treatment. All the women presented with acne and were between 16 and 30 years old. The study consisted of a baseline cycle and 6 successive treatment cycles. The mean objective acne score decreased with both OCs in Center A. This decrease was significant with Diane after 3 and 6 treatment cycles (p 0.05). At cycle 6, the mean objective score for Diane was much lower than that for Marvelon (p 0.05). At Center B, the mean objective score consistently and significantly decreased with Marvelon after 3 and 6 treatment cycles (p 0.05 and p 0.01, respectively) and with Diane after 6 treatment cycles (p 0.001). No significant between-group differences existed for Center B. The percentage of women with moderate/severe acne decreased significantly with Marvelon at Center B (p = 0.002) and with Diane in Centers A (p = 0.014) and B (p = 0.004). Both Diane and Marvelon significantly increased plasma levels of sex hormone binding globulin at 3 and 6 treatment cycles (p 0.01). They tended to reduce plasma levels of total and free testosterone. This decrease only reached significance with Marvelon, however (p 0.05). There were no significant associations between acne severity and biochemical variables. These findings suggest that both OCs cause significant improvement in acne in most Asian women who also may need a reliable contraceptive. There were no significant differences between the two OCs.

Symptomatology and hormonal levels among Thai women with natural menopause.

The hormonal levels and symptoms after natural menopause have been studied in 100 patients. The mean age was 56.8 years while menopausal age was 50.3 years. Postmenopausal symptoms presented 55.0 per cent with the three most common complaints of hot flushes, emotional lability and vaginal dryness, respectively. The levels of plasma FSH, estradiol and testosterone were also reported corresponding to the years after menopause. Both gonadotropins reach a maximum concentration at two to three years after the menopause and then gradually declined. The LH/FSH ratio was 0.6. The mean concentration of estradiol was 10.07 pg/ml, the level remained consistently low during the menopausal period. Testosterone concentration declined little in postmenopausal women.

Postmenopausal sexuality in Thai women.

We evaluate sexuality in 100 natural menopausal women as pertains to hormones, symptoms related to intercourse, and marital relationship with sexual desire, orgasm and coital frequency. The mean age was 56.8 years while menopausal age was 50.3 years. The postmenopausal syndrome presented 55.0% occurring 1 to 7 years after menopause (mean 3.4 years). The common sexual problems after menopause were loss of libido, orgasmic dysfunction, and dyspareunia. Both sexual desire and activity decreased when compared with premenopausal period. Ninety percent of the subjects had sexual desire less than once a month. Only 14% of the subjects occasionally reached orgasm while the other 86% never had orgasm after menopause. The levels of FSH, LH, estradiol and testosterone were also reported. There was no correlation of hormone estradiol and testosterone, symptoms related to intercourse and marital relationship with sexual desire, orgasm, or coital frequency.