A study of smoking and pregnancy with special references to fetal growth.
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Biomedical subjects
Publications and source records attributed to L Grennert.
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In the past five years gradual introduction of ultrasonic screening of pregnant women increased the ante-partum detection of multiple pregnancy from 60% in 1971 to 95% in the first half of 1975. At the same time the average gestational age for dection of multiple pregnancies diminished from thirty-three to twenty-five weeks. The corresponding figures for 1963 were 32% and thirty-six weeks. Plasma human-placental-lactogen concentrations were assessed for their value in selecting a smaller target group for subsequent ultrasonic screening. All but 2 of 39 twin pregnancies examined by single H.P.L. determinations had H.P.L. values more than 1 S.D. above the mean of the normal distribution. The use of plasma-H.P.L. screening might lower the proportion of patients requiring ultrasonography for antepartum diagnosis of multiple pregnancies to 16% of the total pregnant population.
Corticosteroid administration to pregnant women for attempted prevention of the respiratory distress syndrome in infants (IRDS) involves the hazard of seriously altering the endocrine status in the fetoplacental unit. The effect of a betamethasone load (12 mg. daily for three days) to 19 pregnant women in the last trimester was studied, and a comparison was made with 13 control subjects. Amniocentesis was performed twice in most patients. There was a sharp reduction of cortisol in maternal serum and a significant decrease in cortisol concentration in amniotic fluid (p less than 0.05) after betamethasone treatment. Maternal urinary estriol excretion decreased; this was strongly correlated to the basal estriol excretion (r equals 0.945). A residual fraction of estriol excretion, not less than 2 mg. per 24 hour urine specimen, remained despite the high corticosteroid dose. The origin of the nondepressed part of urinary estriol might be multifactorial, e.g., nonadrenal production of estriol precursors and functional inhomogeneity of the fetal adrenal in response to adrenocorticotropic hormone stimulation. The corticosteroid treatment for prevention of IRDS transiently excludes the use of urinary estriol for assessment of fetoplacental integrity but does not influence the plasma level of human chorionic somatomammotropin.
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