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Notes: Objective To identify the date of ovulation in pregnant women with Type 1 diabetes in order to assess the validity of the concept of early growth delay.Design Identification of ovulation by measurement of urinary luteinising hormone and assessment of fetal growth using ultrasound scan.Setting Diabetic pre-pregnancy and antenatal clinic in a teaching hospital.Subjects Twenty women with Type 1 diabetes who had attended a pre-pregnancy clinic.Measures Urinary LH, by laboratory and kit methods, during conception cycles. Human chorionic gonadotrophin measured in early pregnancy. Early ultrasound scans by a single observer blind to menstrual and ovulation dates.Outcome Gestation calculated from ovulation date and gestation estimated from menstrual dates, compared with gestation at age indicated by early ultrasound scan.Results When the date of ovulation was identified in 20 women with Type 1 diabetes there was no evidence of growth delay in any pregnancy. When gestation was estimated from menstrual dates there was apparent early growth delay in six pregnancies.Conclusion This study, together with others discussed, indicates that early growth delay is probably an artefact of incorrectly estimated ovulation date.

Notes: Objective To study a geographically defined population of women exposed to a drug-related risk for human immunodeficiency virus (HIV), together with carefully matched neighbourhood controls, in order to examine (1) the proportion of different groups having cervical cytopathology screening; (2) the association between HIV infection and cervical intraepithelial neoplasia; (3) the independent effect of CD4+ lymphocyte count and duration of HIV infection; and (4) the correspondence between cervical cytopathology and colposcopically directed biopsy.Design A population-based study.Subjects All women domiciled in Lothians with the following characteristics: between 1983 and 1987 they had a history of injection drug use or a seropositive partner with a history of injection drug use; they had a pregnancy after that exposure where their serostatus was known. In addition, neighbourhood controls were identified by computer matching for the following criteria—post-code sector, housing deprivation score, age, parity, pregnancy outcome, ethnic group, year of pregnancy, smoking.Main outcome measures Search was carried out for the cervical smear nearest in time to the index pregnancy end date, providing serostatus was known at that time. All identified smears were assessed by a cytopathologist without knowledge of clinical information, study group or serostatus.Results Of 376 women, appropriate cervical smears were identified for 336. The proportions screened in the different groups were similar. There were more abnormal smears in the seropositive group than in the drug-related seronegative (P 〈 0.01) or the neighbourhood control groups (P 〈 0.001). HIV-infected women with abnormal smears had lower CD4+lymphocyte counts (P 〈 0.0005). There was a reasonable correspondence between cytopathological classification and histological grading, and this was of similar strength in cases and controls (weighted kappa 0.72, 0.74).Conclusions There is a definite relation between HIV infection and cervical intraepithelial neoplasia. This is related to immune depletion but whether this is the sole mechanism for the association is unclear.

Notes: Objective To assess the reports that maternal phosphoglucomutase-1 (PGM 1) phenotype is highly related to macrosomia in diabetic pregnancy. This could be either a direct metabolic phenomenon, or the PGM1 locus could be a marker for a tightly linked gene involved in the maternal control of fetal growth.Design A comparative biochemical genetic study.Setting A large diabetic pregnancy clinic.Subject One hundred and fifty-two women who had diabetes during pregnancy, 136 being insulin dependent before pregnancy. Two hundred and thirty-six women without pre-existing medical or pregnancy complications who functioned as a control group.Measures PGM1 phenotype was assessed by conventional electrophoresis and subgroups were examined using iso-electric focusing.Outcome Standardised birthweight was corrected for sex, maternal parity and gestation confirmed in every case by early pregnancy ultrasound. Maternal diabetes control was assessed by glycosylated haemoglobin.Results No differences were found in the observed phenotype frequencies for diabetics and control pregnant women. No association between PGM1 phenotype and macrosomia in diabetic pregnancy was found. PGM1 did not make a significant contribution to birthweight, standardised birthweight, length or ponderal index of the baby as assessed by multiple regression.Conclusions Our study of a larger number of insulin dependent diabetics in Scotland makes the claim that macrosomia in diabetic pregnancy is associated with PGM1 phenotype unlikely to be of general significance.

Notes: Objective To assess the effect on obstetric practice of clinician access to umbilical artery Doppler ultrasound results.Design Randomised controlled trial.Setting A large teaching hospital.Subjects Two thousand two hundred and eighty-nine pregnancies defined as being at risk by referral for Doppler or fetal monitoring.Interventions Continuous wave Doppler studies of umbilical artery. Results immediately available to clinicians.Main outcome measures Fetal outcome: perinatal mortality, Apgar score and admission to the neonatal unit. Obstetric intervention: admission to hospital, induction of labour and caesarean section. Use of tests of fetal well being: cardiotocography, biophysical profile and ultrasound biometry.Results The treatment and control groups were comparable in age, parity, gestation at point of entry and risk features. There were no overall differences in perinatal outcome, obstetric intervention or use of fetal monitoring. Examination of a subset recruited only because of hypertension or suspected intrauterine growth retardation (n = 754) similarly showed no difference attributable to group randomisation. Comparison of only those pregnancies retrospectively defined as low risk and high risk showed more use of cardiotocography in the high risk group with access to Doppler (P= 0.007) but no difference in the low risk group.Conclusion Doppler umbilical artery recording has been shown to perform well in prediction power of antenatal fetal compromise. What has been examined in this study is the response of clinicians to the test. The results suggest that obstetricians do not use the test to modify their risk assessment, and, therefore, the need for fetal monitoring in particular pregnancies. There is a real need for accumulation of information from very large data sets, particularly in the prediction power of Doppler for antenatal fetal compromise from apparently chronic utero-placental cause to guide use of monitoring resources. If simply added to existing fetal monitoring techniques in a hospital where these are widely used, then umbilical artery Doppler recordings may at present simply involve extra resources of staff and expenses, without benefit.

Notes: Objective–To study thc prevalence and type of glucose intolerance in pregnancy and the effect of different types on perinatal mortality and fetal size. Design–A prospective case-control study with data collectcd by patient interview and examination of all available records during a 16-months period between 1984 and 1986. Setting–A large maternily hospital in Kuwait where diabetes in pregnancy is common. Subjects–Thc cases were a consecutivc sample of 731 women, delivered during thc study period, recorded in the labour ward register as being diabetic or having abnormal glucosc tolerance, thc control group was formed from the next woman in the regisler (provided she was not known to be diabetic). Main outcome measures–Type of diabetes followed the WHO classification, with subdivision depending on level of fasting plasma glucose. Type of perinatal death was examined in detail and birthweight ccntilc calculatcd. Results–Of the 731 cases, 22% were established diabeties, most werc treated with oral hypoglycacmic drugs bcfore pregnancy and insulin during pregnancy. Of those discovered during pregnancy, 43% were classified as gestational diabetes and the remainder as impaired glucose tolerance. Overall, 50% of cases were treated with insulin. Established diabeties had a perinatal mortality rate nearly four timcs greater than non diabeties (RR, 3.7, 95% CI 2.6 to 6.4) and for gestalional diabeties RR was 2.0 95% CI l.2 to 3.7). Unexplained deaths were particularly common, both in established diabeties (RR, 18.4, 95% CI 3.9 to 85.7) and in gestational diabeties (RR, 13.4, 95% (CI 2.9 to 61.6). Cases with impaired glucose tolerance had no stillbirths and had a lower perinatal loss than the controls, though this was not statistically significant. Heavier babies were seen in all case groups compared with controls, though the impaired glucose tolerance group had lower birthweights than the other two case groups. Conclusions–Type 2 diabetes was found to be common, most cascs being diagnosed in pregnancy. Under the conditions found in Kuwait. diabetes, in the sense of a raised fasling glucose, is accompanicd by a high rate of perinatal loss from unexplained stillbirth. This applies whether the condition was present before pregnancy or was discovered during pregnancy. Fetal macrosomia was also common in both situations. Impaired glucose tolerance, where fasting levels remain normal, does not appear to increase fetal loss, but may be associated with fetal macrosomia. As these women age they are likely to develop overt diabetes in the non-pregnant state, and subsequently to develop serious complications of this disease. Improving glycaemic control. both during pregnancy and subsequently, should be a priority.

Notes: Objective To examine the suggestion, based on theoretical considerations and case reports, that pregnancy decreases survival time after AIDS (acquired immunodeficiency syndrome).Design A total population study in Edinburgh.Setting A city with a moderately high prevalence of human immunodeficiency virus (HIV) infection in women.Subjects AIDS has been diagnosed in 22 women, five of whom had a pregnancy.Main outcome measures Clinical characteristics, disease presentation, lymphocyte markers, pregnancy outcome, subsequent progress and survival time.Results Pregnancy was not obviously associated with a difference in clinical findings. The mean survival time for the three women with a pregnancy who died was 24 months and for the 11 women without a pregnancy it was 15 months. (P= 0.63 log rank test).Conclusions The clinical presentation, severity of the illness and laboratory findings were not obviously different in pregnancy. All three women who had Pneumocystis carinii pneumonia for the first time in pregnancy survived this initial episode. Survival time was not obviously reduced by the conjunction of pregnancy with AIDS.

Notes: Objective To assess the effect of uncomplicated diabetes on umbilical artery flow velocity waveforms (FVWs); to investigate the relation between glycaemic control and FVWs and the predictive value of umbilical artery FVWs for antenatal fetal compromise.Design Prospective descriptive study.Setting A large diabetic pregnancy clinic in a teaching hospital.Subjects 128 pregnancies complicated by diabetes mellitus. 170 non diabetic women with no pre-existing or pregnancy complications.Interventions In diabetic pregnancies, umbilical artery resistance index (RI) Doppler recordings and glycosylated haemoglobin were measured every 2 weeks from 28 weeks.Main outcome measures Umbilical artery RI and antenatal fetal compromise defined as a non reactive, decelerative cardiotocograph and/or a biophysical profile score persistently 〈6 and leading to immediate caesarean section.Results Uncomplicated diabetic pregnancies had FVW values similar to those in the non-diabetic range. Glycaemic control was unrelated to umbilical artery FVW values. Abnormal umbilical artery RI was found in nine pregnancies, these were more likely to show evidence of fetal compromise and to be associated with birth weights of 〈50th centile. In seven pregnancies there was evidence of fetal compromise, but only three of these pregnancies had abnormal FVW values.Conclusions The non-diabetic range of umbilical artery RI values is appropriate for diabetic pregnancies. Long-term glycaemic control, within the range in this study, does not seem to affect umbilical artery RI. Abnormal umbilical artery RI is a significant predictor of fetal compromise in diabetic pregnancy, but fetal compromise can occur in association with normal RI values. Undue reliance should not be placed on normal FVW values in diabetic pregnancies.