Hyperprolactinaemic Amenorrhoea in Hong Kong

In a retrospective study of 595 patients attending the Menstrual Disorder Clinic from January, 1978 to December, 1981, 92 patients (15.5%) had raised serum prolactin (PRL) levels (greater than 25 ng/ml) on 2 or more separate occasions with a mean (+/- S.E.M.) value of 67.1 +/- 2.5 ng/ml. Galactorrhoea was found in 27.2% of the hyperprolactinaemic patients. Primary amenorrhoea was observed in 1 patient (1.1%) with serum PRL level of 68 ng/ml. Secondary amenorrhoea of longer than 6 months' duration occurred in 61 patients (66.3%) with mean PRL level 84.2 +/- 3.3 ng/ml. The 30 patients (32.6%) with irregular menstruation had a mean PRL level of 47.2 +/- 3.3 ng/ml. Investigations revealed that 43 patients (46.7%) had idiopathic hyperprolactinaemia, 14 patients (15.4%) had drug induced hyperprolactinaemia and 1 patient (1.1%) had hypothyroidism; 18 patients (19.5%) had suspected pituitary microadenoma and 16 patients (17.2%) had abnormal radiographic findings. Bromocriptine treatment was given to 38 patients, 13 with abnormal tomographic findings (mean serum PRL greater than 100ng/ml); 18 with suspected pituitary microadenoma (mean serum PRL 94 +/- 2.7 ng/ml) and 7 with idiopathic hyperprolactinaemia (mean serum PRL 65 +/- 4.7 ng/ml). All patients (38/38) responded to treatment with restoration of menstruation and cessation of galactorrhoea within 1 to 3 months. Mean PRL level was 21.6 +/- 5.2 ng/ml at the time of response. Thirteen patients subsequently became pregnant and all delivered healthy babies.     

Human embryo cloning prohibited in Hong Kong

Since the birth of Dolly (the cloned sheep) in 1997, debates have arisen on the ethical and legal questions of cloning-for-biomedical-research (more commonly termed "therapeutic cloning") and of reproductive cloning using human gametes. Hong Kong enacted the Human Reproductive Technology Ordinance (Cap 561) in 2000. Section 15(1)(e) of this Ordinance prohibits the "replacing of the nucleus of a cell of an embryo with a nucleus taken from any other cell," i.e., nucleus substitution. Section 15(1)(f) prohibits the cloning of any embryo. The scope of the latter, therefore, is arguably the widest, prohibiting all cloning techniques such as cell nucleus replacement, embryo splitting, parthenogenesis, and cloning using stem cell lines. Although the Human Reproductive Technology Ordinance is not yet fully operative, this article examines how these prohibitions may adversely impact on basic research and the vision of the Hong Kong scientific community. It concludes that in light of recent scientific developments, it is time to review if the law offers a coherent set of policies in this area.     

Incidence of Preterm Delivery in Hong Kong Chinese

Summary: A retrospective analysis of the obstetric database between January, 1995 and December, 1996 was conducted to establish the rate of preterm birth and the incidence of babies with low birth-weight amongst Hong Kong Chinese in an obstetric teaching unit in Hong Kong, and to investigate possible risk factors for spontaneous preterm deliveries. In the series of 13,641 Chinese women who delivered during the study period, the incidence of preterm births before 37 weeks'gestation was 7.4% while the incidence of low birth-weight infants (<2,500g) was 6.4%. When only singleton pregnancies were included, the incidences of preterm births and low birth-weight were 6.5% and 5.1% respectively. This study has demonstrated results contrary to the belief that premature delivery is uncommon in a Chinese population. In addition, we have found that, similar to Caucasian populations, hypertensive disorders of pregnancy, gestational diabetes, antepartum haemorrhage and congenital malformation are significant risk factors for spontaneous preterm labour in singleton pregnancy in our Chinese population.     

Antenatal taboos among Chinese women in Hong Kong

Objective

to identify the antenatal taboos commonly practised by pregnant Hong Kong Chinese women; to explore the health beliefs behind these taboos; and to examine how pregnant women perceived and reacted to the cultural tradition.

Design

general ethnography and in-depth interviews, followed by a quantitative self-reported survey.

Setting

Antenatal clinic of a university-affiliated hospital in Hong Kong.

Participants

consecutive samples of 60 women for in-depth interviews, and 832 women for the survey.

Measurements

an inventory on the adherence and attitude towards antenatal taboos, and the Beck Depression Inventory that measures severity of depression.

Findings

antenatal taboos were still commonly observed by contemporary Chinese women. Miscarriage, fetus malformation and fetal ill-health were the key cultural fears that drove contemporary Chinese women to observe the traditional taboos. About one-quarter and one-tenth of the women, respectively, felt unhappy and disputed with their families about the taboos. These women had significantly higher levels of depression in late pregnancy and during childbirth.

Implications for practice

health-care practitioners should be aware of the benefits and risks of traditional antenatal taboos on maternal health. Although some taboos can be socio-morally protective, the tension created by the observation of cultural tradition in modernity may impair maternal psychological well-being. Health-care providers in Western countries should be vigilant of the complex cultural tension faced by migrant Chinese mothers.     

Maternal mortality in Hong Kong 1961-1985

The maternal mortality rate in Hong Kong fell from 0.45/1000 total births in 1961 to 0.05/1000 total births in 1985. During the period between 1961 and 1985 there were a total of 438 maternal deaths and 2,193,012 births. Of the 438 deaths 150 (34%) were due to haemorrhage during pregnancy and childbirth (ICD 640, 641, 666), 89 (20%) were due to pre-eclampsia (ICD 642, 643) and 60 (13.7%) were due to ectopic pregnancy (ICD 633). Comparison of maternal deaths by cause between the periods 1961-1965 and 1981-1985 showed an 86% reduction in deaths due to haemorrhage and pre-eclampsia and a 72% reduction in deaths due to ectopic pregnancy. Pulmonary embolism was not a major cause of maternal mortality.     

Breastfeeding Patterns of Primiparous Mothers in Hong Kong

Abstract: Background: An understanding of patterns of breastfeeding is necessary for the effective implementation of breastfeeding promotion and intervention programs. In Hong Kong, little current data have been gathered on women's breastfeeding rates. The objective of this study was to determine how patterns of breastfeeding, maternal demographics, and maternal employment affect continuation of breastfeeding in primiparous women in Hong Kong. Method: A longitudinal self‐report survey was used to collect data when first‐time mothers (n = 218) were in the hospital, at 1, 3, 6, 9, and 12 months postpartum, or until they weaned their infant. All data (self‐report survey, demographic data, and follow‐up telephone surveys) were collected in Cantonese and then translated into English. Data were analyzed by determining, first, the influence of individual variables on the length of breastfeeding using a simple Cox regression analysis, and second, by grouping variables according to time sequence and entering them into a Cox regression model in 4 sequential phases. Results: Factors that were significantly associated with continuation of breastfeeding were maternal age (HR = 0.97; p = 0.048); attendance at a prenatal breastfeeding class (HR = 0.69; p = 0.020); intended weeks of breastfeeding (HR = 0.97; p < 0.001); breastfeeding score in hospital (HR = 0.99; p = 0.009); and length of exclusive breastfeeding (HR = 0.93; p < 0.001). Similar results were obtained in the multiphase Cox regression analysis; only the breastfeeding score in hospital became marginally insignificant (p = 0.053) after adjusting for demographics, prenatal, and other immediate postpartum factors. Conclusions: Short periods of exclusive breastfeeding and early supplementation were common in this sample. Unlike previous research, maternal employment was not a statistically significant factor in length of continued breastfeeding. Study findings show that multiple factors influence continued breastfeeding in Hong Kong, suggesting further areas for investigation. Changes in practice may improve continued and exclusive breastfeeding rates. (BIRTH 30:3 September 2003)     

Smoking pattern during pregnancy in Hong Kong Chinese

Background: While the prevalence of young female smokers is rising among the Hong Kong Chinese population, data on their smoking pattern during pregnancy are limited.
Aims: To investigate the smoking habit of Hong Kong Chinese women and their partners during pregnancy.
Methods: Postal questionnaires were sent to 479 couples to explore their smoking patterns during pregnancy at one to two years after the index delivery.
Results: Questionnaires were completed by 247 subjects. Among 117 women who were ever-smokers, 26% had stopped smoking before the index pregnancy, while 60% stopped and 14% reduced smoking during the pregnancy. Most women stopped smoking in the first trimester (93%) and prior to the first antenatal visit (79%). Those who used to smoke fewer cigarettes before pregnancy were more likely to stop smoking during pregnancy but women with a history of recreational drug use were more likely to continue smoking during pregnancy. The post-partum smoking relapse rate was 59% in women who had stopped smoking before or during their pregnancy. Only 2.6% of the partners who were ever-smokers stopped smoking before the pregnancy while smoking habits remained unchanged in 52%.
Conclusions: Approximately one-fifth of an unselected sample of Hong Kong mothers had a history of smoking prior to pregnancy. Pregnancy is an opportune time to implement smoking intervention programs for female smokers and their partners with an emphasis on the maintenance of post-partum smoking abstinence.     

Folate status in pregnant Chinese women in Hong Kong

Hematologic and folate studies were carried out in 116 pregnant Chinese women in Hong Kong. Mean serum folate values fell progressively with pregnancy reaching subnormal levels during the puerperium. Mean red-cell folate values remained normal or high throughout, but showed a significant fall after delivery in women who carried out breast-feeding. Individually, 18 women showed hematologic abnormalities compatible with folate deficiency, but only four had subnormal red-cell folate values satisfying the strict criterion of folate deficiency, giving an overall frequency of 3.4%. Compared to primigravidae and other multiparae, gravida 2 women appeared to be at highest risk of folate deficiency.     

Developing professional responsibility in maternity care in Hong Kong

A simple questionnaire was used to document basic information surrounding all perinatal deaths in Hong Kong. Coordinators were appointed for every maternity unit. Replies were sent by mail to the Obstetrical and Gynaecological Society. Using volunteer time and minimum budget, the data were collated and analyzed. The main causes of death were congenital anomalies, intrauterine death of unknown cause and prematurity. There was significant difference in performance when the University units were compared with the private and Government units. Changes in resource allocation and modification of clinical practice may be recommended as a result of such audit.     

Intrauterine Growth Standards for Hong Kong Chinese

Intrauterine growth standards for Hong Kong Chinese were derived from birth-weight data between 28 and 42 weeks' gestation in 15,815 livebirths delivered in 1982 to 1984 at 2 maternity teaching hospitals in Hong Kong. Normal distribution of birth-weights was noted in each of the gestational weeks studied. The mean birth-weight was 3,237g at 40 weeks which was similar to the mean weights reported in other populations for this gestation. The trend of the median weight curve was also similar to that in other Caucasian and Asian reports. The growth pattern for males and females were similar and males were on the whole heavier than females throughout the gestational period studied. At 40 weeks, the 10th percentile weight also showed wide variations between reports, which would have important bearing on the studying of intrauterine growth retardation. When the mean weight at term as derived from the present study was compared to a previous report on birth-weight data in 1970-1972 in the same hospital, a significant increase in birth-weight was observed over the 12-year period. The importance of having up-to-date intrauterine weight standards for a specific population is discussed.     

Cost-effectiveness of prenatal screening for thalassaemia in Hong Kong

OBJECTIVES: To determine the cost effectiveness of a universal prenatal screening program for alpha- and beta-thalassaemia. METHODS: We retrospectively reviewed our program from 1998 to 2002, and calculated the direct and indirect costs of various components. RESULTS: 18,936 women were screened at our prenatal clinic and 153 couples were subsequently referred to our Prenatal Diagnostic Centre for counselling and further investigations. In addition, there were 238 tertiary referrals and 157 self-referrals. After investigations, 84 fetuses were at risk of beta-thalassaemia major/beta-E thalassaemia, 19 of them were affected and 18 were aborted. The total expenditure on our program (HK 10.0 million dollars) would be less than the postnatal service costs (HK 40.4 million dollars) for 18beta-thalassaemia major fetuses if they were born. Of 361 women at risk of carrying a homozygous alpha0-thalassaemia fetus, 311 (86.2%) opted for the indirect approach (using serial ultrasound examinations to exclude Hb Bart's disease), and 76 (24.5%) subsequently underwent an invasive test for a definitive diagnosis. The sensitivity and false positive rate of this indirect approach was 100.0% and 2.9% respectively. CONCLUSION: It is cost effective to run a universal prenatal screening program in an area where both beta-thalassaemia and alpha-thalassaemia are prevalent. The indirect approach can effectively avoid an invasive test in unaffected pregnancies.     

Maternal mortality in Hong Kong 1961–1985

Summary. The maternal mortality rate in Hong Kong feil from 0·45/1000 total births in 1961 to 0·05/1000 total births in 1985. During the period between 1961 and 1985 there were a total of 438 maternal deaths and 2 193 012 births. Of the 438 deaths 150 (34%) were due to haemor-rhage during pregnancy and childbirth (ICD 640, 641, 666), 89 (20%) were due to pre-eclampsia (ICD 642, 643) and 60 (13·7%) were due to ectopic pregnancy (ICD 633). Comparison of maternal deaths by cause between the periods 1961–1965 and 1981–1985 showed an 86% reduc-tion in deaths due to haemorrhage and pre-eclampsia and a 72% reduc-tion in deaths due to ectopic pregnancy. Pulmonary embolism was not a major cause of maternal mortality.     

Trends in perinatal mortality at a Hong Kong hospital

Causes of perinatal mortality at Tsan Yuk Hospital, Hong Kong, were classified into 14 categories from the "P" list of stillbirths and neonatal mortality in the International Statistical Classification of Diseases, Injuries and Causes of Death. Trends for each category over the period 1970-1979 were examined by regression analysis. Overall perinatal mortality fell from 17.80 in 1970 to 10.94 in 1979. A low incidence of deaths from congenital abnormality and medical complication in the mother was observed. Significant statistical correlations were obtained in the trends in mortality associated with placental hemorrhage, pre-eclampsia, difficult labor, hemolytic disease of the newborn, and prematurity. Improvements in perinatal mortality in these areas as well as inadequacies in perinatal care in other areas, are discussed.     

Whole blood mercury concentrations in sub-fertile men in Hong Kong

We aimed to investigate the association between whole blood mercury concentrations and semen quality in sub-fertile men. Fifty-nine male partners of infertile couples attending the Assisted Reproduction Unit of the Chinese University of Hong Kong between 1997 and 1998 were recruited into our study. Blood was taken from each subject for whole blood mercury concentration and hormone profile. Semen samples were obtained for computer assisted semen analysis using the Hobson sperm tracker. The semen parameters and hormone profile were compared between subjects with normal and those with elevated mercury concentrations. Twenty-one subjects (35.6%) had a whole blood mercury concentration higher than the normal range (0-50 nmol/l). All parameters of the semen analysis including the concentration of sperm, percentage of morphologically normal sperm, percentage of motile sperm, curvilinear velocity, straight-line velocity, average path velocity, and amplitude of lateral head displacement, were reduced in those with elevated blood mercury concentrations, although the difference was not statistically significant. We failed to demonstrate a statistically significant effect on the measurement of semen quality, but other adverse effects cannot be excluded. From a public heath perspective, these findings confirm that mercury toxicity is a potentially serious problem affecting the local community.     

Assisted reproductive technology

Several aspects of reproductive technology are discussed. In tubal infertility, the choice between surgery or in vitro fertilization and embryo transfer (IVF-ET) is addressed. In cases with bilateral distal occlusion or otherwise bad prognosis, IVF is probably more successful and less expensive. IVF in unstimulated cycles has given promising results, with pregnancy rates comparable to the results from the National IVF-ET Registry. If these results can be confirmed by more studies they will probably have a great impact on the choice of treatment in tubal infertility. The results obtained with various transfer procedures in nontubal infertility have still to prove tubal transfer to be a more effective procedure than IVF. Finally, studies on microinsemination in male infertility or unexplained infertility with previous fertilization failure in IVF show promising results with the subzonal insemination and partial zona dissection procedures.