Some epidemiological data on spontaneous abortion in Hungary, 1971-80

The long-term impact of restricted access to abortion on children's socioeconomic outcomes

We examine the long-term consequences of restricted access to abortion following a change in the Hungarian abortion law in 1974. Due to a change that restricted access to legal abortions, the number of induced abortions decreased from 169,650 to 102,022 between 1973 and 1974, whereas the number of live births increased from 156,224 to 186,288. We analyze the effects on the adult outcomes of the affected cohort of newborns (educational attainment, labor market participation, teen fertility). We use matched large-scale, individual-level administrative datasets of the Hungarian Central Statistical Office (population census 2011; live birth register), and we estimate the effects by comparing children born within a short timespan around the time the law change came into effect. We apply a difference-in-differences approach, building on the special rules of the new law that, despite the severe restriction, still made abortion permissible for selected groups of women. We control for the compositional change in the population of parents, rule out the effect of (unobserved) time trends and other potential behavioral responses to the law change, and draw causal inferences. We find that restricted access to abortion had, on average, a negative impact on the socioeconomic outcomes of the affected cohort of children. Children born after the law change have had worse educational outcomes, a greater likelihood of being unemployed at age 37, and a higher probability of being a teen parent.

The association between seasonal influenza-like illness cases and foetal death: a time series analysis

It has been reported that foetal death follows a seasonal pattern. Influenza virus infection has been postulated as one possible contributor to this seasonal variation. This ecological study explored the temporal association between the influenza activity and the frequency of foetal death. Time series analysis was conducted using weekly influenza-like illness consultation proportions from the Danish sentinel surveillance system and weekly proportions of spontaneous abortions and stillbirths from hospital registers from 1994 to 2009. The association was examined in an autoregressive (AR) integrated (I) moving average (MA) model and subsequently analysed with cross-correlation functions. Our findings confirmed the well-known seasonality in influenza, but also seasonality in spontaneous abortion. No clear pattern of seasonality was found for stillbirths, although the analysis exposed dependency between observations. One final AR integrated MA model was identified for the influenza-like illness (ILI) series. We found no statistically significant relationship between weekly influenza-like illness consultation proportions and weekly spontaneous abortion proportions (five lags: P = 0.52; 11 lags: P = 0.91) or weekly stillbirths (five lags: P = 0.93; 11 lags: P = 0.40). Exposure to circulating influenza during pregnancy was not associated with rates of spontaneous abortions or stillbirths. Seasonal variations in spontaneous abortion were confirmed and this phenomenon needs further investigation.

Sex ratio of congenital abnormalities in the function of maternal age: a population-based study

Maternal age effect is well-known in the origin of numerical chromosomal aberrations and some isolated congenital abnormalities (CAs). The sex ratio (SR), i.e. number of males divided by the number of males and females together, of most CAs deviates from the SR of newborn population (0.51). The objective of this analysis was to evaluate the possible association of maternal age with the SR of isolated CAs in a population-based large dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-1996. First, SR of 24 CA entities/groups was estimated in 21,494 patients with isolated CA. In the next step SR of different maternal age groups was compared to the mean SR of the given CA-groups. The SR of four CA-groups showed some deviation in certain maternal age groups. Cases with anencephaly had female excess in young mothers (<25 years). Cases with skull's CAs particularly craniosynostosis had a male excess in cases born to women over 30 years. Two other CA groups (cleft lip ± palate and valvar pulmonic stenosis within the group of right-sided obstructive defect of heart) had significant deviation in SR of certain maternal age groups from the mean SR, but these deviations were not harmonized with joining age groups and thus were considered as a chance effect due to multiple testing. In conclusion, our study did not suggest that in general SR of isolated CAs might be modified by certain maternal age groups with some exception such as anencephaly and craniosynostosis.

Experience of the Hungarian Preconception Service between 1984 and 2010

The objective of this historical account is to summarize the concept, objectives, methods, results and general experience of the Hungarian Preconception Service, Budapest, based on 27 years (1984-2010) and 25,313 women and couples. The service includes counseling and care (examinations and medical interventions) based on three steps: (1) preconception screening for reproductive risk factors ("reproductive health check-up"), (2) a 3-month preparation for conception, because conception is when some major developmental events, such as the sex of the conceptus and the foundation of health and many diseases, are determined, and (3) achievement of optimal conception and better protection of the embryo in early pregnancy. With normal prenatal care, pregnant women visit clinics between the 7th and 12th gestational weeks, but the embryo has passed through his/her most vulnerable period before the 10th week, and thus prenatal care is too late to reduce the risk of congenital abnormalities. The new primary health care infrastructure for preconception care is performed by qualified and trained nurses and midwifes. Couples at risk are selected and are referred to specialists who can reject or confirm the supposed risks and treat the couples if necessary as part of their secondary health care. The most important results of the Hungarian preconception service were (i) a significant reduction in the rate of preterm births (5.0% vs. 9.2%) which has been linked mainly to preconception screening of sexually transmitted infections of female participants followed by appropriate treatment, (ii) a very significant reduction of congenital abnormalities (2.9% vs. 4.0%), particularly neural-tube defects and cardiovascular malformations, due to periconception multivitamin supplementation, (iii) reduction of smoking among female participants, (iv) involvement of male partners in the family planning health system, (v) much improved identification of couples at high risk and greater access to the secondary care of specialists. In conclusion, the Hungarian experience demonstrates the feasibility and usefulness of preconception care in the prevention of adverse birth outcomes including congenital abnormalities and preterm births.

Preovulatory overripeness of the oocyte as a cause of ovarian dysfunction in the human female

A variety of gynaecological phenomena such as menstrual disorders, infertility and premature menopause are associated with ovarian dysfunction. In this paper, a factor is considered that may play a role in the aetiology of ovarian dysfunction. Animal research has shown that preovulatory overripeness of the oocyte may cause various developmental and chromosomal anomalies. Among the developmental anomalies observed in amphibia and fish are a number of gonadal aberrations, often occurring in otherwise normal specimens. This may be the consequence of a degeneration of the 'germinal cytoplasm', cytoplasmic structures located in the vegetative pole region of the oocyte, destined to become part of future primordial germ cells. Indirect evidence suggests that preovulatory overripeness of the oocyte also plays a significant role in human reproductive failure. An increased risk of preovulatory overripeness is expected during periods of endocrine irregularities, such as the first postmenarcheal years, the last premenopausal years, the first months after a pregnancy and, possibly, during certain seasons. If the overripeness-induced gonadal maldevelopment observed in animals also occurs in humans, this may explain variations in reproductive function according to month of birth, as observed in women. It is hypothesized that females conceived during periods of maternal endocrine irregularities face an increased risk of ovarian dysfunction through overripeness-induced gonadal maldevelopment.

Sociobiological risk factors for spontaneous abortion in Malaysia

OBJECTIVE

To evaluate the risk factors of spontaneous abortion.

METHODS

A case-control study was conducted by interviewing 350 women who were admitted to the university gynaecological unit for spontaneous abortion and 350 women who delivered normally at the university obstetric unit. Odds ratios, as the estimators of relative risks, were calculated.

RESULTS

The relative risk for spontaneous abortion among women in the age-group 30 to 39 years was 1.61 and among women above 40 years of age was 3.68 when compared to those below 30 years of age. In relation to career women, the relative risk of spontaneous abortion for housewives was 0.45. Ethnic group, parity, subfertility, previous induced abortion, ectopic pregnancy, contraception and menarcheal age did not influence the risk of spontaneous abortion.

CONCLUSION

Increasing age and a woman's career are significant risk factors of spontaneous abortion.

Conjoined twins in Hungary, 1970-1986

The total prevalence of conjoined twins (birth + prenatally diagnosed) was 1:68,000 in the study of 1970-1986. Symmetrical cases (the so-called siamese twins) have an obvious predominance (92.3%). Associated major malformations occurred in 80% of conjoined twins and more than 1/5 were discordant. The surviving time of liveborn conjoined twin sets was not more than two days except in two surgically successfully separated pairs. The family study did not indicate a higher recurrence risk. The case group was compared to two control groups and it appeared that the periconceptional use of oral contraception and ovulation induction were mentioned more frequently in pregnancies resulting in conjoined twins.

Birthweight of single livebirths and weight specific early neonatal mortality in Hungary and Norway

Comparisons of birthweights of single livebirths in Hungary and Norway reveal distributions to have similar shapes; however, in the case of Hungary the distribution is shifted to the left, i.e. towards lower weights. In the registration of pregnancy outcomes, almost identical definitions are applied in the two countries, and the observed difference in distributions of birthweights is taken to reflect that Norwegian livebirths, are on average about 300 g heavier than Hungarian livebirths. Employing the method of analysis of birthweight and perinatal mortality suggested by Wilcox & Russell, it can be demonstrated that the proportions of births in the residual distributions of birthweights in the two countries are of the same magnitude and that the relative differences in first week mortality risks are similar for all birthweights. These results are taken to support the conclusion that to use a cut-off point of 2500 g in defining low birthweight, which will result in a two fold higher proportion of such infants in Hungary compared to Norway, is unwarranted, as it will falsely convey the impression of relatively more obstetric and paediatric problems in Hungary.

Case-control cytogenetic study in offspring of mothers treated with bromocriptine during early pregnancy

The distribution of modal and non-modal karyotypes was examined in mitoses of lymphocyte cultures of 31 children who had been exposed to bromocriptine in utero, and in 31 matched controls. No mosaicism was diagnosed. Furthermore, no more hypomodal cells occurred in the study group than in the control group.

International Commission for Protection against Environmental Mutagens and Carcinogens. ICPEMC Working Paper No. 15/1. Genetic effects of ethanol

Alcoholics have a higher frequency of chromosomal aberrations and sister-chromatid exchanges (SCEs) in their peripheral lymphocytes. In human and mammalian cells in vitro, ethanol generally does not induce genetic damage, but it induces SCEs in the presence of an exogenous metabolic system. In human lymphocytes in vitro, ethanol induces SCEs in the presence of alcohol dehydrogenase. In animals in vivo, ethanol induces a variety of genetic effects, including SCEs, micronuclei, dominant lethal mutations and aneuploidy in mouse eggs. There is some indication that ethanol may lead to genetic damage in sperm. In bacteria, ethanol is at best marginally active. Ethanol leads to anomalous chromosome segregation in Aspergillus, to mutations in yeast, to chromosomal aberrations and SCEs in plant root tips and to disturbances of meiosis and micronuclei in tetrads in Zea and Tradescantia respectively. The first metabolite of ethanol, acetaldehyde is mutagenic in a variety of test systems. The mutagenic activity of acetaldehyde in bacteria is questionable, but there is no doubt of its mutagenic activity in a variety of eukaryotic test systems in vitro as well as in vivo.

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)

Recurrence risk after neural tube defects in a genetic counselling clinic

The recurrence of isolated neural tube defects in a population of women from a genetic counselling clinic was found to be 3.4%. After one baby with a neural tube defect the recurrence was 2.3%. Of the 15 pregnancies of women who had two previous babies with neural tube defects, there were three further recurrences. These findings show that the Hungarian recurrence risk of isolated neural tube defects has not changed with a declining birth prevalence, and that the rate in genetic counselling clinic patients is the same as in a previous population based epidemiological study.