Anticonvulsant drugs and malformations is there a drug specificity?

The distribution of anticonvulsant drug therapy was studied in 318 malformed infants with known histories of maternal epilepsy. Data on the infants was collected from six birth defect monitoring programs in Europe and South America. Use of specific types of anticonvulsants varies widely among reporting countries. Heterogeneity of drug-malformation distribution, was analyzed to determine whether use of specific drugs were linked to specific malformations. A significant association was seen between maternal use of valproic acid and spina bifida, and a weaker, non-significant one between carbamazepine and spina bifida. Facial clefts were associated with both diphenylhydantoin and phenobarbitone use and also with polytherapy. These differences indicate that the actual drug used is significant for the teratogenic process. The technique may be useful in analysis of other drug-related teratogenic questions.

Fetal growth in the offspring of epileptic women: results of an Italian multicentric cohort study

An historical cohort study of the association between maternal epilepsy, anticonvulsant drugs and fetal growth was carried out among 47 hospitals collaborating in the Italian Multicentric Registry on Birth Defects (IPIMC). Birth weight, head circumference and body length were studied in 164 babies of epileptic women and compared to 185 controls. Seventy-nine epileptic women were treated by monotherapy, 59 by polytherapy and 26 took no anticonvulsant during pregnancy. An intrauterine growth retardation and a smaller head circumference was observed among babies of epileptic women. No effect was evident for body length. When specific anticonvulsant therapies were taken into account, only phenobarbital showed an effect on birth weight and head circumference; a reduction in head circumference was observed also in the babies of untreated epileptic women. The other antiepileptics (carbamazepine and valproic acid) showed no influence on the outcome considered. The observed effects on fetal growth can be interpreted as a result of an interaction between the effect of the maternal disease and that of the anticonvulsants.

Birth defects in the Seveso area after TCDD contamination

A study on the frequency of birth defects was conducted in the area around Seveso, Italy, which was contaminated by 2,3,7,8-tetrachlorodibenzo-p-dioxin in July 1976; this has been the largest population ever exposed to dioxin. From Jan 1, 1977, to Dec 31, 1982, a total of 15,291 births (still and live) were examined, and malformations were reported to an ad hoc birth defects registry. In the most highly contaminated area, 26 births were observed. None of these infants had any major structural defect. Two infants had mild defects. The frequencies of major defects detected in the areas of low or very low contamination were 29.9/1000 and 22.1/1000, respectively. A frequency of 27.7/1000 was registered in the control area. Relative risks were calculated for specific categories of birth defects and for grouped malformations. Although the data collected failed to demonstrate any increased risk of birth defects associated with 2,3,7,8-tetrachlorodibenzo-p-dioxin, the number of exposed pregnancies was not big enough to show a low and specific teratogenic risk increase.

Anticonvulsant drugs in monotherapy. Effect on the fetus

We describe a material of 577 infants born of epileptic women treated with anticonvulsants in monotherapy during early pregnancy and collected from France, Italy, and Sweden. The incidence of major malformations is increased compared with the general population but no definite difference in risk can be demonstrated between the various anticonvulsants, but valproic acid was associated with a doubling of the average risk. The increased risk for facial clefts and for cardiac malformations, described from most studies on epilepsy during pregnancy, cannot be seen in this material. Unusually many cases of penis abnormalities (micropenis, hypospadias) were noted. An effect on fetal growth can be demonstrated and is apparently more pronounced for carbamazepine than for the other drugs. It results in a reduced birth weight in spite of normal gestational length, reduced body length and head circumference. The possible biological significance of this finding is discussed.

Pyknoachondrogenesis: an association of skeletal defects resembling achondrogenesis with generalized bone sclerosis. A new condition?

A stillborn male with skeletal anomalies resembling achondrogenesis with remarkably sclerotic bones is reported. The term "Pyknoachondrogenesis" is suggested for this hitherto undescribed condition.

A joint international study on the epidemiology of hypospadias

A descriptive epidemiological study of hypospadias has been made utilizing data from seven malformation surveillance systems round the world: Denmark, Hungary, Italy, Mexico, South America, Spain, and Sweden. The joint material represents 8,122 boys with hypospadias, 7,419 of which were "isolated", that is, with no other known malformation except those obviously related to hypospadias (undescended testis, hydrocele, scrotum anomalies). The main study was based on the infants with isolated hypospadias, but an analysis of multimalformed infants with hypospadias was also made. The registered birth prevalence of isolated hypospadias varied much among the seven programs. For the years 1980-1981, the lowest recorded birth prevalence was 0.26 (Mexico) and the highest, 2.11 (Hungary). An analysis of ascertainment was made for three programs: Denmark, Hungary, and Sweden. While some uncorrect registration of infants as hypospadiac were detected, a strong underascertainment of varying degree was seen. In Hungary and Sweden, where the highest birth prevalences were recorded, there was a 30-40% underascertainment of cases later operated on; in Denmark underascertainment was still larger. When correction was made for underascertainment, the Danish and Swedish birth prevalences of isolated hypospadias were very similar. No information on ascertainment was available for the other systems, but it seems very unlikely that the low birth prevalences recorded in Mexico and South America can be solely explained by underascertainment. Therefore, it appears that true differences in the prevalence at birth of hypospadias do exist. There are no indications that the different birth prevalences depend on inclusion or exclusion of mild (distal) forms of hypospadias. There is an apparent inverse correlation between fertility in a population (estimated from mean parity in control women) and the birth prevalence of isolated hypospadias. Within each program geographical variations in birth prevalence could be seen, but the interprogram variation was larger than the intraprogram one. There is an effect of maternal age and parity on the intensity ratio of isolated hypospadias. This effect varies among programs. The variability for mothers under 20, parity 1, seems to be inversely related to the proportion of delivered women belonging to that age class. With increasing maternal age, especially within parity 1, an increased hypospadias intensity ratio is seen. Infants with isolated hypospadias show a lower birth weight and to some extent also a shorter gestational length than do controls.(ABSTRACT TRUNCATED AT 400 WORDS)

Maternal epilepsy and birth defects: a case-control study in the Italian Multicentric Registry of Birth Defects (IPIMC)

A case control study on the association between maternal epilepsy, anticonvulsants use during pregnancy and birth defects was carried out in the Italian Multicentric Registry of Birth Defects (IPIMC). In the period 1980-1983, 7,607 malformed babies out of 439,717 total births (still + live) were registered. Fourty-one malformed babies with maternal epilepsy were identified (5.39 X 1,000). The overall relative risk of having a malformed baby among pregnant epileptic women was 1.87. Spina Bifida, Congenital Heart Defects, Clefts, Diaphragmatic Hernia and Trisomy 18 were more frequent than expected among babies with maternal epilepsy. The different therapeutic regimens were also tested to identify the possible independent teratogenic effect of anticonvulsants. A statistically significant association between Spina Bifida and Valproic Acid (odds ratio 22.7; Fisher p value = 0.0364) was observed: no other anticonvulsant tested showed any association with any type of malformation.

Fibrochondrogenesis: radiologic and histologic studies

Fibrochondrogenesis is a distinct, neonatally lethal, short-limb skeletal dysplasia which was first described in a single patient in 1978. We report the radiographic and morphologic studies of 2 additional unrelated stillborn infants with fibrochondrogenesis. This syndrome has distinct radiographic and chondro-osseous morphologic defects different from those seen in the other known skeletal dysplasias. The long bones are short and dumbbell-shaped with metaphyseal flare. The spine is platyspondylic with superior-inferior clefting defects, and the ribs are short and distally cupped. The growth-plate cartilage is grossly disorganized and has a densely fibrous collagenous matrix when examined by light and electron microscopy. Light, transmission, and scanning electron microscopy shows diaphyseal and metaphyseal trabecular bone to be normal.

[Spondylocostal dysostosis. An easily recognizable syndrome with a difficult genetic counselling (author's transl)]

A case with spondylocostal dysostosis is reported. Main clinical finding are: short stature, as a consequence of short neck and trunk, due to vertebral body abnormalities, along with abnormal ribs. The clinical aspects and the family history are suggestive of the autosomal recessive form of the disease. The Authors discuss the possibility of neonatal diagnosis of this syndrome and underline the difficulty to give the family a correct genetic counselling. The possibility of prenatal diagnosis is also reported.

[Correlations between plasmatic alpha-tocopherol and lipids in male adults]

Plasma levels of alpha-tocopherol, beta-carotene, total lipid, total cholesterol, beta-lipoproteins, and triglyceride were measured in healthy italian male adults of various age groups. Alpha-tocopherol mean values varied from 0.96 mg/100 ml in the subjects of 18-24 years to 1,14 mg/100 ml in the subjects of 25-64 years and to 1,08 mg/100 ml in those above 55 years. No value lower than the generally accepted minimum of 0,5 mg/100 ml was found. Correlation coefficients of all the variables were also studied. Alpha-tocopherol was shown to be significantly related to age and plasma cholesterol. These data agree with other authors' results.

[Vitamin C in the plasma and leukocytes of Italians in different periods of the year]

After briefly mentioning the factors which influence the vitamin C levels in tissues, the findings are reported of an investigation, conducted on 11 volunteers, in which some variations were revealed in vitamin C concentrations in the plasma and in the leukocytes of the subjects examined during a period of one year. The lowest levels were found in the months of March and December.