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Biomedical subjects

S Harlap

Publications and source records attributed to S Harlap.

17 recordsLinked to original sources
PubMed1979

A prospective study of spontaneous fetal losses after induced abortions.

The incidence of spontaneous abortions was observed among 31,917 women followed from their first prenatal visit. Life-table analysis showed that losses in the first trimester were not significantly affected by previous induced abortions, nor was any change in the risk of second-trimester losses detected among the 1493 parous women who reported having had induced abortions after childbirth. There was, however, an increase in the incidence of midtrimester losses among the 2019 nulliparous women with previous induced abortions; the age-adjusted rate of loss was 59.9 per 100,000 women at risk per day, as compared with 24.2 among the 12,042 control nulliparous women (P less than 0.001). The relative risk increased with the number of previous induced abortions and was not explained by the distribution of demographic and social variables. The risk decreased from 3.27 (95 per cent confidence limits, 1.72 to 6.23) after abortions induced before 1973, mainly by dilation and curettage, to 1.42 (0.76 to 2.65) after those done since 1973, when the more gentle technic of cervical dilation by use of laminaria was introduced. These findings indicate that there is little or no risk of spontaneous abortions after induced abortions when performed by current technics.

Abortion, Induced↗
PubMed1979

Gender of infants conceived on different days of the menstrual cycle.

The baby's sex was studied in 3658 births to Jewish women who observed the orthodox ritual of sexual separation each month and who resumed intercourse within two days of ovulation. The day of resuming intercourse relative to ovulation was estimated from the characteristics of each woman's menstrual cycle and the number of days of sexual abstinence observed after the last menstruation. The proportion of male babies was significantly higher (65.5 +/- 3.9 per cent, mean +/- S.D.) in the offspring of women who resumed intercourse two days after ovulation. This proportion tended to be lower on or near the day of ovulation than on the previous one or two days. These results, which were consistent in different demographic subgroups, demonstrate that insemination on different days of the menstrual cycle does lead to variations in sex ratio. Couples should be cautioned against attempting to conceive a boy by delaying intercourse until after ovulation, until further research has established whether delayed fertilization causes birth defects.

Educational Status↗
PubMed1979

Differences in maternal age-specific rates of Down syndrome between Jews of European origin and of North African or Asian origin.

Rates of Down syndrome in livebirths in West Jerusalem in 1964-1975 were studied in relation to the mother's continent of birth or, if she was born in Israel, to the maternal grandfather's continent of birth. In women of European origin the crude livebirth rate of Down syndrome was 1.3 per 1,000 livebirths. This crude rate and the maternal age-specific rates in this group were very close to those observed in a Swedish study and two studies of white livebirths in the United States. For West Jerusalem women of North African or Asian origin the crude rate was about 2.4 per 1,000 livebirths, and at all maternal ages except the youngest their rates were higher than for women of European origin. The summary adjusted relative risk for a Down syndrome livebirth for all those of North African or Asian origin, compared to those for women of European origin, was about 1.56. If attention is restricted to mothers born outside of Israel, the adjusted relative risk for mothers born in Europe, the Americas or English speaking countries of the British commonwealth compared to those born in North Africa or Asia was 1.97, consistent with a two-fold difference in the likelihood of a Down syndrome livebirth between thes two groups. To our knowledge this is the first report of ethnic differences in maternal age specific rates of Down syndrome that cannot be plausibly explained by differences in ascertainment.

Africa↗
PubMed1979

Use of contraceptives prior to and after conception and exposure to other fetal hazards.

In a large prospective study, set up to determine whether reproductive outcomes are affected by prior contraceptive use, 34,344 women were recruited at their first antenatal visit and followed until pregnancy termination. This paper summarizes the study methods and describes the demographic differences between subjects who used various contraceptives shortly before conception, and those who experienced contraceptive failures. Thirty percent of the women had used oral contraceptives (OCs) during the 5 months prior to conception and 2.4% had continued using them after their LMP. IUDs had been used by 5.8% of women before conception and 1.1% after. If these rates are also true for the whole population of the U.S., they indicate that approximately 70,000 babies are born each year following pill-failures and 30,000 following failures of IUD's. Exposure to other fetal hazards was common, with 48% of pregnant women drinking alcohol, 28% smoking, and 15% receiving diagnostic X-rays. OC use was more common among smokers and drinkers, and OC failures were significantly associated with the use of anti-epileptics, aspirin, and with exposure to radiation.

Adult↗
PubMed1979

Are there two types of postpill anovulation?

Anovulation, indicated by requiring treatment with clomiphene or gonadotropins to conceive, was studied in a cohort of 16,583 women interviewed postpartum. There were 2,853 former oral contraceptive users, and 2.2% of them reported anovulation, compared with 2.7% of controls. Among primigravidas, the rates were 4.2% and 4.4% in pill users and controls, respectively. A statistically significant excess of anovulation was reported by former pill users who had been underweight in relation to their height at the time of conception. Independently of pill use, the condition tended to be associated with obesity. Data from this and previous studies suggest that there may be two distinct entities of postpill anovulation: the first, identical with spontaneous secondary anovulation; the second, occurring in slender women who have used oral contraceptives. These findings need confirmation from prospective studies using standard diagnostic criteria.

Adult↗
PubMed1979

Multiple births in former oral contraceptive users.

Multiple births were studied in a cohort of 2953 former oral contraceptive users and 13,630 controls, all the women were interviewed post partum. There were 238 multiple births, a rate of 14.4/1000 deliveries. Former oral contraceptive users had 13.5/1000 sets of multiple births compared to 14.5/1000 in the controls. When women who had received treatment for anovulation were excluded, these rates were 11.1 and 12.7/1000 respectively, a difference which is not statistically significant. There was, however, a significant deficit of multiple births among the small group of former pill users who were underweight in relation to their height at the time of conception. Multiple births were also increased after stopping sequential pills and preparations containing high doses of oestrogen, and there was an excess of multiple births following breakthrough pregnancies. These findings, although statistically significant, are based on small numbers, and require confirmation from other studies.

Adult↗
PubMed1978

Rubella in Jerusalem. 1. Seroepidemiologic findings in children born after the 1972 rubella epidemic.

Nine hundred and sixty-nine babies born after a severe rubella epidemic were tested at the age of eight months for the presence of hemagglutination inhibition antibodies to the disease. There were 208 (21.9%) seropositive babies with titers of greater than or equal to 1:16. Seven cases of congenital rubella were diagnosed at birth, 14 were confirmed by eight months and two babies, who were considered normal at the age of eight months, developed late signs of the disease. Less than 3% of the mothers of the seropositive babies had had clinically recognized rubella in pregnancy. If positive hemagglutination inhibition antibody to rubella accurately reflects congenitally acquired rubella infection, between 8.1 and 21.9% of the 969 babies had serologic evidence of the disease. For cases of congenital rubella diagnosed by the age of three years, the limits are between 8.9 and 23.7 per 1,000 live births for the risk of the disease at the height of the epidemic. Rubella vaccine was not available in Israel until after the 1972 epidemic, the effects of which justify the continued search for and immunization of seronegative women of childbearing age, in addition to routine immunization of young girls.

Adult↗
PubMed1977

The Jerusalem perinatal study: the first decade 1964--73.

This paper summarizes the main findings concerning Jewish births in the record-linked Jerusalem Perinatal Study. In the decade 1964--73 there were 63,638 births in which the birth weight was at least 1,000 g. The late fetal mortality rate was 9.1/1,000, and the neonatal and infant death rates were 10.1 and 15.5/1,000, respectively. The demographic characteristics of births changed over the decade, with a decrease in the proportion of high birth orders, of mothers with little education, of immigrants from Asia and North Africa, and of marriages within the same group of origin. Fertility fell, especially at the extremes of reproductive life. Illegitimacy was 1.2%. Year-by-year variations in mortality are discussed and the relationship of mortality to maternal age and education, birth order, social class, group of origin and birth weight are described. Frequencies of specific congenital malformations, infant and child admissions to hospital and various obstetric complications are also reported. Changes in obstetric interventions over the decade included an increasing proportion of induced labors, cesarean sections, forceps and vacuum deliveries, and interventions in the third stage of labor. The paper briefly indicates ways in which the data bank of the Jerusalem Perinatal Study is being exploited for a wide variety of health studies.

Adolescent↗
PubMed1977

Maternal, perinatal and infant health in Bedouin and Jews in southern Israel.

A study has been made of 3,745 Bedouin and 9,422 Jewish babies born in 1972-73 to residents of the Beersheba district of southern Israel (the Negev). Newborn infants weighing less than 1 kg were excluded. Thirty-seven percent of the Bedouin babies were born at home; their mothers tended to be older and of higher parity than those choosing to deliver in hospital. Less than 6% of Bedouin mothers had been to school, compared with 90% of the Jews; 30% were aged under 20 or over 34 years, compared with 18% of the Jews, and 23% were having their seventh or later baby, compared with 12% of the Jews. Mean birth weight of babies born in hospital was about 200 g lower in Bedouin than in Jews, and 11.4% of Bedouin and 6.5% of Jewish infants weighed less than 2.5 kg. There was little variation in complications of labor between the 1,959 Bedouin and 8,877 Jewish women delivered in Beersheba's Soroka Medical Center. The cesarean section rate was 1.8% in Bedouin and 4.3% in Jews, while in 0.3% of Bedouin and 1.4% of Jews labor was induced. Monozygous twinning rates were similar in the two ethnic groups (4.8 and 4.5 sets/1,000 deliveries, respectively) but dizygous twinning was twice as common among the Bedouin as among the Jews (13.0 vs 6.0 sets/ 1,000). Male births accounted for 0.526 and 0.512 of the total in Bedouin and Jews, respectively. Perinatal mortality rates for hospital births were 31.1 and 18.3/1,000 in Bedouin and Jews, respectively. Infant deaths among Bedouin (31.0/1,000) were underreported; the rate was 16.8/1,000 for Jewish infants. Although rates of all specific causes of death were higher in Bedouin than in Jews, patterns of mortality in subgroups based on birth weight, sex, twinning and maternal age were quite similar in the two ethnic groups. There were six reported deaths from tetanus among Bedouin babies. For the cohort of babies born in 1972, admissions to the Soroka Medical Center pediatric wards were recorded in 366 (195.5/1,000) Bedouin and 787 (174.3/1,000) Jewish babies younger than the age of one year. Bedouin admission rates were higher than those of Jews for gastroenteritis (119.1 and 64.5/1,000 respectively), infectious and parasitic diseases (29.4 and 21.9), malnutrition (25.6 and 8.0) and external causes (10.1 and 4.4). Admission rates for bronchitis and pneumonia were, however, lower among Bedouin than Jews in the first six months of life.

Birth Order↗
PubMed1976

Fertility and perinatal and infant mortality in the Jewish population of Beersheba and the Negev, 1972.

There were 4,569 Jewish births in the Negev (southern Israel) in 1972, the first year of birth registration by the Unit for Evaluation and Planning of Kupat Holim and the Ben-Gurion University center for Health Sciences. The crude birth rate was 28.8 per 1,000 population, with 130.7 live births per 1,000 women aged 15 to 44 years. Total fertility was 3.9 per woman, varying from 3.4 in the kibbutzim and 3.5 in Beersheba to 5.2 in the moshavim (collective settlements) and 3.7 to 6.3 in the development towns. Late fetal and perinatal death rates were 9.4 and 19.0/1,000, and the neonatal and infant mortality rates, 11.0 and 18.1/1,000 respectively. The proportion of males was 0.51, the twinning rate was 9.5/1,000 women delivered, and 1.1% of babies were illegitimate. Low birth weight (less than 2.5 kg) was recorded in 6.9% of births. Fifty-three percent of births were to immigrant mothers from North Africa; the remainder were divided equally among mothers born in Israel, the Asian Near East, and Western countries. The Asian immigrant group was at high risk for infant death, with a rate of 3.64/1,000 as compared with 14.8, 14.2 and 5.8 recorded for the offspring of mothers born in Israel, North Africa and Western countries, respectively. Patterns of mortality in relation to maternal age, birth order and education were similar to those reported for developed countries.

Adult↗
PubMed1975

Late sequelae of induced abortion: complications and outcome of pregnancy and labor.

The effects of previous induced abortion on pregnancy, labor and outcome of pregnancy were measured in a prospective study of 11,057 pregnancies to West Jerusalem mothers who were interviewed during pregnancy and who subsequently delivered a single live or stillborn infant. The 752 mothers who reported one or more induced abortions in the past were more likely, at the same interview, to report bleeding in each of the first 3 months of the present pregnancy. They were subsequently less likely to have a normal delivery and more of them needed a manual removal of the placenta or other intervention in the third stage of labor. In births following induced abortions, the relative risk of early neonatal death was doubled, while late neonatal deaths showed a 3- to 4-fold increase. There was a significant increase in the frequency of low birthweight, compared to births in which there was no history of previous abortion. There were increases in major and minor congenital malformations, but no significant changes in stillbirth or post-neonatal death rates, nor in mean birthweight or sex ratio. When the effects of other variables were taken into account, there were no significant changes in frequency following an induced abortion as to: ABO and rhesus isoimmunization, toxemia, hydramnios, premature rupture of membranes, induction of labor, breech or vacuum delivery, cesarean section, breech presentation, placenta previa, placental abruption, cord prolapse, cord anomalies, fetal distress or asphyxia, post-partum hemorrhage.

Abortion, Induced↗
PubMed1975

Characteristics of pregnant women who report previous induced abortions.

Associations between previous induced abortion and demographic and health factors in pregnancy were measured in 9 874 women who gave birth and who had been interviewed during pregnancy. Previous abortion was most rare among women having their first baby and increased with increasing birth order up to the fourth, thereafter decreasing. It was positively correlated with maternal age and negatively with age at marriage. There was no effect of years of schooling, when other variables were taken into account, but there were significant differences between ethnic groups, abortion being commonest among Jewish women from North African countries and more prevalent in those from western and Asian countries than in the second-generation Israel-born or in Arab women.Women who reported abortions were less likely to be strict as regards religious observance and less likely to have had a previous stillbirth or child death, other variables being equal. They were more likely to be smokers or former smokers and to be delivered of their babies in certain obstetric units. They more often reported vomiting, bleeding, and medication in early pregnancy. On the other hand, there was no significant association with diabetes, anaemia, blood groups, or season of birth.The findings show that women reporting previous induced abortions differ significantly from other pregnant women in a wide range of demographic and health characteristics. Such women may also be biased for complications of pregnancy and outcome, particularly if selected from a clinic population. Observations that indicate a deleterious effect of induced abortions on subsequent pregnancy outcomes must therefore be interpreted with considerable caution.

Abortion, Induced↗