The relationship between asthma and smoking during pregnancy.

Asthma is the most common and potentially serious medical problem encountered in pregnancy. The prevalence of asthma during pregnancy is generally quoted as being between 1% and 4% which is much lower than general population estimates. The aim of this analysis was to estimate the prevalence of asthma and smoking during pregnancy; and to describe the relationship between the two. A cross-sectional random sample survey of recently delivered Western Australian mothers was carried out in 1995 and 82% of mothers responded. In total 21.3% of women reported ever having asthma at some stage in their life and 12.4% currently had asthma. These results are consistent with general population estimates. Overall 22.7% of women smoked at some stage in pregnancy, which is consistent with the limited comparison data available. Current asthmatics were more likely to smoke during pregnancy than non-asthmatics, although this difference was not statistically significant. Continued vigorous efforts are required to discourage all women and girls from taking up smoking and to encourage those who smoke to quit. This is particularly pertinent for asthmatic women who are pregnant or planning a pregnancy.     

Increased risk of ectopic pregnancy with maternal cigarette smoking.

As part of a case-control study of ectopic pregnancy, we evaluated the potential etiologic role of cigarette smoking. Maternal cigarette smoking at the time of conception was associated with an increased risk of ectopic pregnancy with a dose-response relationship (adjusted odds ratios: 1.30 to 2.49). On the other hand, partner's smoking was not associated with ectopic pregnancy. The study provides a supplementary argument towards a causal effect of smoking in the development of ectopic pregnancy.     

The intrauterine device and ectopic pregnancy

Based on data given by case-control and cohort studies the relationships between current and past IUD use, duration of IUD use and the type of IUD were evaluated to determine the risk of ectopic pregnancy among IUD users. The results of this review indicate that current and past IUD users do not have an increased risk of ectopic pregnancy. No relationship was found between the duration of IUD use, for either current or past IUD users, and the risk of ectopic pregnancy. Pooled data from clinical studies of different types of IUD showed that the lowest risk of ectopic pregnancy was for users of copper-bearing IUDs, and the highest risk was for users of progesterone-releasing IUDs. Further research is needed to evaluate the ectopic pregnancy risks to past IUD users, especially in view of recent studies which have shown that these women may be at a higher risk of infertility.

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Resumen Basado en datos proporcionados por estudios de casos-controlados y de cohortes se evaluaron las relaciones entre el uso presente y pasado de DIU, la duración de uso, y el tipo de DIU, a fin de determinar el riesgo de embarazo ectópico entre las portadoras de DIU. El resultado de esta revisión indica que las usantes pasadas y presentes de DIU no tienen un riesgo aumentado de embarazo ectópico. No se observó ninguna relación entre la duración de uso de DIU, el uso presente o pasado de DIU y el riesgo de embarazo ectópico. Datos agrupados de estudios clínicos de diferentes tipos de DIU mostraron que el más bajo riesgo de embarazo ectópico fue para los DIU con cobre y que el más alto riesgo para los DIU liberadores de progesterona. Más investigación es necesaria para evaluar los riesgos de embarazo ectópico en usuarias antiguas de DIU, especialmente, desde que estudios recientes han demostrado que estas mujeres podrían sufrir un más alto riesgo de infertilidad.

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Résumé A partir de données obtenues par contrôle de cas individuels et études de cohortes, on a évalué les rapports entre emploi actuel et passé des stérilets, la durée d'emploi et le type des stérilets utilisés dans le but de cerner les risques de grossesse extra-utérine chez les utilisatrices de stérilets. Les résultats de ces études indiquent que le risque de grossesse extra-utérine augmente pas chez les femmes ayant utilisé ou utilisant un stérilet. II a été découvert aucun rapport entre la durée d'emploi du stérilet-actuel ou passé-et les risques de grossesse extra-utérine. Les données regroupées en provenance d'études clinques portant sur divers types de stérilet ont révélé que le risque de grossesse extra-utérine était moindre chez les utilisatrices de stérilets contenant du cuivre, et était le plus élevé chez les femmes portant des stérilets à dégagement de progestérone. II faudra procéder à des recherches plus approfondies afin d'évaluer le degré de risque de grossesse extra-utérine chez les femmes ayant utilisé des stérilets dans le passé, d'autant plus que des études récentes ont révélé que ces femmes pourraient éventuellement courir un risque accru de stérilité.

     

The intrauterine device and ectopic pregnancy

Based on data given by case-control and cohort studies the relationships between current and past IUD use, duration of IUD use and the type of IUD were evaluated to determine the risk of ectopic pregnancy among IUD users. The results of this review indicate that current and past IUD users do not have an increased risk of ectopic pregnancy. No relationship was found between the duration of IUD use, for either current or past IUD users, and the risk of ectopic pregnancy. Pooled data from clinical studies of different types of IUD showed that the lowest risk of ectopic pregnancy was for users of copper-bearing IUDs, and the highest risk was for users of progesterone-releasing IUDs. Further research is needed to evaluate the ectopic pregnancy risks to past IUD users, especially in view of recent studies which have shown that these women may be at a higher risk of infertility.     

IUDs and ectopic pregnancy

Ectopic pregnancies have risen dramatically in North America and in parts of Europe in the last 20 years. It has been suggested that the IUD may be 1 of the causes of the increase. This article examines data from studies in the United States, the United Kingdom, and Sweden and concludes that the risk of ectopic pregnancy for IUD users is not greater than, and possibly less than, that for nonusers of contraception. There are no data that support a causative relationship between nonmedicated or copper bearing IUDs and extrauterine pregnancy. Tables also summarize data from use effectiveness studies in the United States, Western Europe and Canada.     

Maternal smoking during pregnancy and smoking by adolescent daughters.

OBJECTIVES. Since cigarette smoking in adolescence represents a crucial entry point in the progression to illicit drugs, risk factors for adolescent smoking have public health implications. The influence of mothers on children's smoking appears to be greater than that of fathers. To explain the selective influence of mothers, we examined the consequences of maternal smoking during pregnancy in two longitudinal samples. METHODS. Analyses were conducted on follow-up interview data from two dyadic samples of mothers and firstborn adolescents for whom data on maternal smoking during and after pregnancy were available (192 mother-child pairs originating from New York State and 797 dyads from a national sample). RESULTS. In both samples, maternal smoking during pregnancy, when postnatal smoking was controlled, selectively increased the probability that female children would smoke and would persist in smoking (adjusted odds ratios of about 4). CONCLUSIONS. The findings suggest that nicotine or other substances released by maternal smoking can affect the fetus, perhaps through the nicotinic input to the dopaminergic motivational system, so as to predispose the brain in a critical period of its development to the subsequent addictive influence of nicotine consumed more than a decade later in life.     

北京地区宫外孕与节育方法使用关系的流行病学调查

本研究对北京地区1990年间272余万育龄妇女(15～49岁)进行宫外孕发生率监测,共收集确诊宫外孕1420例。在育龄妇女总人群中宫外孕发生率为0.52/1000育龄妇女年。使用节育方法人群中宫外孕发生率为0.54/1000育龄妇女;已婚未使用节育方法人群则为1.80/1000育龄妇女,为使用节育方法者三倍。又应用相对优势比(RO_(MH))与归因危险度(AR)定量综合评价宫外孕与节育方法使用的关系,结果显示有效使用各种节育方法均不增加宫外孕发生危险。各种节育方法因其避孕效果及在人群中使用比例不同,其降低宫外孕发生的程度亦不同。TCu IUD有效使用,明显降低宫外孕发生危险。     

IUD use and subsequent tubal ectopic pregnancy.

As part of a case-control study of tubal ectopic pregnancy (TEP), we sought to evaluate the possible etiologic role of use of an intrauterine device (IUD) prior to conception. We interviewed 155 women who had a tubal ectopic pregnancy treated at one of five Seattle, Washington hospitals between 1975-79 regarding their reproductive, contraceptive, and medical histories; 456 women who delivered a baby in King County during the same period were identified from vital records and interviewed as controls. An elevated risk of TEP was detected among former users of the Dalkon Shield (adjusted OR = 2.5; 95% CI = 1.3-4.7). Women who had used other IUDs did not have an excess risk of TEP.     

米非司酮在异位妊娠中的应用

目的以氨甲蝶呤(MTX)为对照,探讨米非司酮在异位妊娠保守治疗中的作用.方法将50例患者随机分为米非司酮组(A组)和氨甲蝶呤组(B组)进行比较.以氨甲蝶呤(MTX)为对照,观察米非司酮(Mif)治疗异位妊娠的效果.结果2组均于治疗后10d血人绒毛膜促性腺激素开始明显下降,治疗后15d包块平均直径明显缩小,与治疗前比较差异有显著性(P＜0.05).米非司酮和氨甲蝶呤治疗成功率分别为92%和76%.两者比较差异有显著性.结论米非司酮治疗异位妊娠的效果优于氨甲蝶呤,且MTX有一定的不良反应,而米非司酮无1例发生不良反应,给药方便,作为异位妊娠保守治疗的药物,有一定的临床意义和应用前景.     

妊娠早期被动吸烟与不良妊娠结局关系的队列研究

目的:分析城市孕早期妇女被动吸烟状况,探讨被动吸烟与不良妊娠结局的关系。方法:调查孕早期妇女被动吸烟状况,追踪其妊娠结局,采用卡方检验和Logistic回归分析的方法,分析被动吸烟与不良妊娠结局的关系。结果:城市孕早期妇女被动吸烟率为38.2%,被动吸烟与不良妊娠结局有一定的剂量反应关系,每日被动吸烟时间超过3 h对妊娠结局有显著影响。结论:被动吸烟可使不良妊娠结局发生的危险增加,每日被动吸烟时间超过3 h是不良妊娠的高危因素,孕妇应尽量避免暴露于吸烟环境,以减少不良妊娠结局的发生。     

Risk of ectopic pregnancy and previous induced abortion.

OBJECTIVES: This study investigated the role of prior history of induced abortion in subsequent ectopic pregnancies. METHODS: Data from two French case-control studies were used to examine the effect of induced abortion on ectopic pregnancy risk. Case patients (n = 570) were women admitted for ectopic pregnancy during the study period; controls (n = 1385) were women who delivered in the same center. RESULTS: The analysis among women with no previous ectopic pregnancy showed that, after control for the main ectopic pregnancy risk factors, prior induced abortion was associated with an increased risk of ectopic pregnancy (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.0, 2.0); there was a significant trend between number of previous induced abortions and ectopic pregnancy risk (ORs = 1.4 for 1 previous induced abortion and 1.9 for 2 or more). CONCLUSIONS: This study suggests that induced abortion may be a risk factor for ectopic pregnancy for women with no previous ectopic pregnancy, particularly in the case of women who have had several induced abortions.     

异位妊娠相关因素与早期诊断

目的:探讨异位妊娠的相关因素及早期诊断要点。方法:收集自2001年1月1日～2003年7月1日,在本院诊治的490例异位妊娠患者,对其临床资料进行回顾性分析。结果:异位妊娠好发年龄为21～25岁;曾有妇科病史、宫内节育器及盆腔手术史是其好发因素;下腹部疼痛、不规则阴道流血、肛门坠胀感是其常见症状,且常出现于停经后5～8周。结论:根据异位妊娠常见的相关因素对其做出早期诊断在临床工作中有着现实意义。     

The working-class context of pregnancy smoking

The risk of smoking during pregnancy in the US is strongly associated with women's individual socioeconomic status (SES) but little is known about the influence of local area context. The aim of this study was to examine whether local-area characteristics increase the risk of smoking during pregnancy above and beyond individual SES. In a hospital-based cohort of 878 pregnant women in California, who delivered between 1980 and 1990, we compared risk of smoking during pregnancy based on individual and local-area factors. Adjusting for individual SES, neighborhood social class was related to smoking in early pregnancy. Living in a predominantly working-class area significantly increased the risk of pregnancy smoking for both working-class and non-working-class women. However, local-area economic and demographic indicators were not related to smoking early in pregnancy. Individual and family characteristics alone may be insufficient to explain smoking during pregnancy; the social class context of the places in which pregnant women live may also influence this behavior.     

Contraceptive practice and ectopic pregnancy

The relationships between contraceptive practice and ectopic pregnancy were examined for users of barrier contraceptives, sterilization, steroidal contraceptives, and IUDs. Clinical studies on the outcome of pregnancy among diaphragm users indicated that they were not at any increased risk of ectopic pregnancy and may be at a reduced risk. Except for diaphragm users, there were insufficient published data to assess the risks of ectopic pregnancy for users of other barrier contraceptives. For all sterilization approaches, the International Fertility Research Program reported 6.9% ectopic pregnancies in over 20,000 voluntary sterilizations. Data provided by the United States Food and Drug Administration regarding rates of ectopic pregnancy for different types of IUDs suggested that copper-bearing IUDs were associated with a lower rate of ectopic pregnancy and that progesterone-releasing IUDs were associated with a higher rate than the non-medicated IUDs. No evidence as yet has demonstrated that IUDs cause ectopic pregnancy. Compared to women who use no contraceptive method, the use of IUDs greatly reduced the probability of intrauterine pregnancy but only somewhat reduced the probability of ectopic pregnancy. Recent data on the association between the duration of IUD use and the risk of ectopic pregnancy provided conflicting results. Women who have discontinued oral contraceptive or barrier contraceptive methods have not appeared to be at any increased risk of ectopic pregnancy.     

The power of policy: the relationship of smoking policy to adolescent smoking.

This study examined the effects of smoking policy on 4,807 adolescents in 23 schools over a two-county area in California. Amounts and prevalence rates of adolescent smoking were measured with a self-report survey and a biochemical measure; school smoking policy was measured with two independent surveys of school staff. Policy effects were evaluated with multiple and logistic regression analyses controlling for school-level socioeconomic status and environmental support for teaching and administration. Of the 23 schools, 100 percent had a formal written and regularly enforced policy component restricting student smoking on school grounds, 94 percent restricted students leaving school grounds, 65 percent restricted smoking near school grounds, and 57 percent had a smoking prevention education plan. Schools with policies having all four versus less than four components, high versus low emphasis on prevention, and a low versus high emphasis on cessation reported lower amounts of smoking in the last week and in the last 24 hours. Punitive consequences of policy violation had no effect. Results were compared to school staff observations of adolescent smoking, and school archival records of student smoking violations in the last year. Results suggest that school smoking policy is associated with decreased amounts of smoking in adolescents.     

Management of ectopic pregnancy. about 77 cases

We report a retrospective study of 77 ectopic pregnancies, collected over a period of 5 years and 4 months. The aim of this study was to analyse the epidemiology, the clinical and special investigation findings of this pathology, and to report our result as regards management of ectopic pregnancy, eectopic pregnancy affects young women (mean age : 31.8 years), whether multiparous or pauciparous (81.1%). The most important risk factors were endouterine maneuvres (42.8 %) and IUD (36.3%). Suspicion of the diagnosis was based on clinics findings, US examination and beta HCG dosage. Diagnostic coelioscopy was performed in 90 % of cases to confirm the diagnosis. 7 patient underwent immediate laparotomie. Ectopic pregnancy was ampullar in 80% of cases. Treatment was given through a coelioscopy in 44 cases (57%). A laparo-conversion was required in 26 patient (33.7%). Treatment was radical in 52% of cases. We didn't note any serious per-operative or post-operative complication. About eighteen percent (18.1%) of out patient who subsequently wanted to get pregnatn, got an intra-uterine pregnancy. Only one case of recurrence was noted in our series.