Immunity to rubella among women of child-bearing age

The results of testing for rubella antibodies in over 6000 sera from women of child-bearing age are reported and analysed according to pregnant state, age, country of origin and social class. There was no difference between the rubella seroprevalence rates in women who were pregnant and in those who were contemplating pregnancy in the future. Likewise, women (either pregnant or non-pregnant) who were young enough to have been offered rubella vaccine at school were not more likely to be immune to rubella than were older women. Rubella seropositivity rates were not influenced by social class but significantly higher rates were found in women born in European or Arabian than in African or Asian countries. We conclude that the national scheme for rubella immunization has not reduced the number of women susceptible to rubella entering pregnancy in this Health District and that greater attention should be paid to immunization of women of child-bearing age from African or Asian countries.     

Immunity to rubella among women of child-bearing age

Summary. The results of testing for rubella antibodies in over 6000 sera from women of child-bearing age are reported and analysed according to pregnant state, age, country of origin and social class. There was no difference between the rubella seroprevalence rates in women who were pregnant and in those who were contemplating pregnancy in the future. Likewise, women (either pregnant or non-pregnant) who were young enough to have been offered rubella vaccine at school were not more likely to be immune to rubella than were older women. Rubella seropositivity rates were not influenced by social class but significantly higher rates were found in women born in European or Arabian than in African or Asian countries. We conclude that the national scheme for rubella immunization has not reduced the number of women susceptible to rubella entering pregnancy in this Health District and that greater attention should be paid to immunization of women of child-bearing age from African or Asian countries.     

Serum ferritin in women of reproductive age

Summary. Serum ferritin, measured by radioimmunoassay, was studied in a population of 154 women of reproductive age and during a menstrual cycle in a group of 22 women. Serum ferritin concentrations ranged from 4.7 to 169 μg/1 (median 21.3 μg/1). Recent childbirth was associated with low serum ferritin values, whereas oestrogen/progestogen oral contraception and normal menstruation appeared to have little effect. In the absence of iron supplements, it appears to take up to 2 years after pregnancy before pre-pregnancy serum ferritin values are regained.     

Screening for fragile X syndrome in women of reproductive age

We conducted a prospective intervention study of screening for fragile X syndrome in the general population. Antenatal and preconceptional screening were carried out in 9459 women aged between 19 and 44 with no known family history of fragile X syndrome. 80% were tested antenatally. 134 carriers were detected (a frequency of 1 in 70); 130 had a premutation (PM) and 4 had a full mutation (FM). Prenatal diagnosis was carried out in 108 concurrent or subsequent pregnancies among carriers involving 111 fetuses. Nine had an FM, a rate of 1 in 12; two of the affected embryos received the FM directly from the mother and in seven it was the result of expansion from a PM. In all cases with an FM the pregnancy was terminated. In PM carriers there was evidence of a selection against the mutated chromosome with a segregation ratio of 0.40. Owing to the high rate of premutated chromosomes in our population we conclude that screening for fragile X syndrome among women of reproductive age should be more widely available.     

Residential environmental risks for reproductive age women in developing countries

Published research suggests there is an association between maternal inhalation of common ambient air pollutants and adverse birth outcomes, including an increased risk for preterm delivery, intrauterine growth retardation, small head circumference, low birth weight, and increased rate of malformations. The air pollutants produced by indoor combustion of biomass fuels, used by 50% of households worldwide, have been linked to acute lower respiratory infections, the single most important cause of mortality in children under the age of 5. This report describes a hypothesis-generating study in West Wollega, Ethiopia, conducted to assess airborne particulate matter concentrations in homes that combust biomass fuels (biomass homes). Respirable suspended particulate matter was measured in biomass homes and nonbiomass homes using NIOSH method 0600. Measured airborne particulate concentrations in biomass homes were up to 130 times higher than air quality standards. These findings, in part, confirm that exposure to indoor air pollutants are a major source of concern for mother/child health. Midwives are encouraged to raise awareness, contribute to research efforts, and assist in interventions.     

Celiac disease. Risk factors for women in reproductive age

In the past coeliac disease, or intolerance to gluten, has been considered a rare disease in infancy, whose most important signs were chronic diarrhea with malabsorption and reduced growth. However, besides this classical form, there are a number of other clinical and subclinical forms which may appear even in the adult life and without any overt intestinal sign. The alterations may affect, e.g., the liver, thyroid, skin and the female and male reproductive system. The overall prevalence of the different forms of coeliac disease in Western Europe is at least 1:300. The aim of the present paper is to describe and evaluate the effects of coeliac disease on female reproduction. Such effects include delayed menarche, amenorrhea, infertility and early menopause. Epidemiological studies show that besides reduced fertility, affected women are at higher risk of reproductive problems such as pregnancy loss, low birthweight of offspring and reduced duration of breastfeeding. There are no adequate studies to evidentiate a possible increase of birth defects; nevertheless, coeliac disease induces malabsorption, with deficiencies of nutritional factors essential to prenatal development such as iron, folic acid and vitamin K. The mechanisms underlying the reproductive alterations are still awaiting clarification; however, an interaction among specific nutritional deficiencies, endocrine imbalances and immune disturbances is suspected. As for the other effects associated to the coeliac disease, the possible prevention or treatment of the reproductive effects is only the lifelong maintenance of a gluten-free diet.     

Assessing fertility in women of advanced reproductive age

Reproductive capacity in women declines dramatically beyond the fourth decade of life. Oocyte quality seems to be the primary determinant of reproductive potential, although age-related uterine changes may also contribute. Underlying reasons for reproductive decline in women remain unclear, and both ovarian and neuroendocrine mechanisms have been proposed.A number of age-related endocrinologic changes precede menopause and predict diminished reproductive capacity. Thus, "ovarian reserve" screening may identify patients in whom attempts at conventional assisted reproduction is warranted before proceeding with ovum donation. Techniques to preserve the maternal genetic contribution to offspring (in lieu of egg donation), including germinal vesicle transfer and donor ooplasm, are under investigation.     

Vascular reactivity in men and women of reproductive age

OBJECTIVE: This study was undertaken to document vascular reactivity in both phases of normal menstrual cycles and anovulatory cycles of women receiving oral contraceptives and to compare vascular reactivity of women in the follicular phase of the normal menstrual cycle with that of men of a similar age group. STUDY DESIGN: Forearm blood flow was measured with plethysmography in 15 women with ovulatory cycles during the follicular and luteal phases of the normal cycle, at equivalent times in 14 women receiving oral contraceptives, and in 15 age-matched men. Changes in forearm blood flow, an index of vascular reactivity, were measured during a randomly ordered brachial artery infusion schedule of norepinephrine, sodium nitroprusside, angiotensin II, and Nomega-monomethyl-L -arginine and were analyzed with repeated measures analysis of variance. RESULTS: Forearm blood flow responses were similar in the two phases of the normal cycle. Responses were similar between women with ovulatory cycles and users of oral contraceptives, apart from a significantly greater response to angiotensin II in the oral contraceptive group during the medication phase than during the withdrawal phase (P =.027). Basal forearm blood flow was higher in men than in women (7 +/- 1.6 vs 5 +/- 1.4 mL/100 mL per minute; P =.015), and men demonstrated a significantly greater vasoconstrictor response to norepinephrine (P <.05) than did women. CONCLUSION: Vascular reactivity is similar in the two phases of the normal menstrual cycle, but women who use oral contraceptives have an exaggerated response to angiotensin II during the medication phase. Men demonstrate greater vascular reactivity to norepinephrine than do women, perhaps because of the lack of estrogen-mediated protective effects and increased adrenergic activity.     

Contraceptive counseling of diabetic women of reproductive age

OBJECTIVE: To evaluate the impact of diabetes on provision of contraceptive counseling. METHODS: We compared counseling provided to diabetic and nondiabetic women on 40,304 visits made to U.S. ambulatory practices by nonpregnant women, 14-44 years of age, included in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1997-2000. Logistic regression, adjusting for age, race, ethnicity, insurance status, and provider characteristics was used to estimate the relationship between provision of contraceptive counseling and diabetes. RESULTS: Visits made by diabetic women of reproductive age were significantly less likely to include contraceptive counseling than visits made by nondiabetic women of reproductive age (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.21-0.81). Visits made by diabetic women under 25 years of age were less likely to include contraceptive counseling than visits made by older diabetic women (OR 0.17, 95% CI 0.06-0.54). Overall, only 4% of visits made by diabetic women documented contraceptive counseling. When family planning was the primary reason for a visit (OR 34.4, 95% CI 20.8-56.9) or women visited a gynecologist (OR 24.3, 95% CI 16.7-35.2), women were significantly more likely to receive contraceptive counseling. However, diabetic women made only 0.3% of all visits to gynecologists. CONCLUSION: Ambulatory physicians in the United States rarely provide contraceptive counseling to diabetic women. This may contribute to adverse birth outcomes for some diabetic mothers who conceive before optimal glucose control is obtained.     

Prevalence of varicella-zoster antibodies in pregnant women in Catalonia (Spain). Rationale for varicella vaccination of women of childbearing age

Objective  The objective of this study was to determine the prevalence of antibodies against varicella-zoster virus (VZV) in pregnant women in Catalonia (Spain).
Setting  The prevalence of antibodies against VZV was assessed in a representative sample ( n = 1522) of pregnant women of Catalonia obtained in 2003.
Method  The sample was obtained including all women attended for childbirth, during 2 months of 2003, in 27 randomly selected hospitals with maternity clinics.
Main outcome measures  Varicella-zoster antibodies were determined using the enzyme-linked immunosorbent assay test.
Results  The total number of women included in the study was 1522, corresponding to a participation rate of 83%. The prevalence of varicella-zoster antibodies in pregnant women was 96.1% (95% CI 95.1–97.1). The prevalence of antibodies was 94% in pregnant women aged 15–24 years, 95% in those aged 25–29 years and >95% in those aged 30–49 years. The prevalence of antibodies was not associated to the place of birth, place of residence (urban or rural), educational level and social class. The study showed that 6% of pregnant women aged 15–24 years and 5% of those aged 25–29 years were susceptible to varicella-zoster infections in Catalonia (Spain).
Conclusion  The study showed that a varicella-zoster vaccination programme aimed at women of childbearing age could be necessary in Catalonia to prevent all varicella-zoster infections during pregnancy.     

Uterine blood flow response to alpha-adrenergic blockade in nulligravid women of reproductive age

OBJECTIVE: Elevated uterine artery resistance has been associated with the development of preeclampsia. We sought to determine if the human uterine arterial circulation was more sensitive to alpha-adrenergic blockade than a control vascular bed. METHODS: We studied 38 healthy nulliparous women during the follicular phase of the menstrual cycle. Arteriolized venous blood was measured for plasma epinephrine and norepinephrine. Doppler ultrasound of the uterine and upper extremity radial artery was performed before and after intravenous administration of phentolamine. Heart rate and volumetric flow were calculated. Data are presented as means +/- SD. RESULTS: Mean heart rate before and after administration of phentolamine was 63 +/- 11 and 68 +/- 12 beats per minute (7.5% increase, P <.001). Mean radial artery blood flow before and after administration of phentolamine was 4.6 +/- 4.7 mL/min and 5.8 +/- 5.9 mL/min (19.9% increase, P =.071). Mean uterine blood flow before and administration of phentolamine was 15.4 +/- 10.1 mL/min and 27.3 +/- 17.5 mL/min (43.7% increase, P <.001). The uterine response (43.7% increase) and radial response (19.9% increase) were significantly different (P <.001). The increase in uterine blood flow after phentolamine administration was linked with resting norepinephrine (r = 0.394, P =.063). CONCLUSION: We found evidence that uterine alpha-adrenergic tone is more sensitive to blockade by phentolamine than upper extremity radial circulation. This provides evidence for a differential responsiveness and sensitivity to alpha-adrenergic blockade in different vascular beds. We theorize that the increased adrenergic tone associated with preeclampsia may contribute disproportionately to decreased uterine blood flow.     

Morphological changes in endometrium of hemodialyzed women of reproductive age

Aim. The aim of the study was to evaluate endometrial morphology and its correlation with hormonal profile in uremic women of reproductive age undergoing hemodialysis.

Materials and methods. Sixty-three hemodialyzed women aged 18–45 years were enrolled into the study, 38 of whom gave their informed consent to undergo endometrial aspiration biopsy and measurement of hormonal profile.

Results. Abnormal endometrial morphology was noted in 79% of the hemodialyzed women. Atrophic endometrium was observed in almost all uremic patients with secondary amenorrhea. Endometrial biopsy revealed one case of adenocarcinoma in situ. Analysis of the relationship between hormonal profile and endometrial morphology revealed the substantial influence of estradiol on endometrium.

Conclusions. Abnormal endometrial changes are often noted in uremic women of reproductive age undergoing hemodialysis. Endometrial biopsy should be carried out as a safe and convenient procedure for the detection of pathological changes in uremic women.