SUMMARY Nine hundred and seventy-three white women attending an antenatal clinic completed a questionnaire on parity, social class, smoking habits, and consumption of alcohol and coffee. Forty-nine per cent said they were non-drinkers and none of their babies had a major congenital abnormality; whereas 1-2% of the babies of the women who did consume alcohol had major abnormalities. The babies of women who said they drank more than an average of 20 ml alcohol a day had significantly smaller head circumferences than the babies of non-drinkers in some gestational age groups. Maternal serum y-glutamyltransferase levels predicted abnormal fetal outcome in the 3 women in whom they were raised. There is no safe level of alcohol consumption in pregnancy and even moderate 'social' drinking is associated with abnormal fetal outcome.There is a substantial risk of the fetal alcohol syndrome in the offspring of women drinking the equivalent of 90 ml absolute alcohol daily (5-6 hard drinks).1 Pregnant women consuming half that amount have an increased risk of having an infant born preterm, or one below expected birthweight, length, and head circumference, or with major and minor congenital abnormalities.2 It has not been established if moderate 'social' drinking has any adverse effect on the fetus. We report the results of a survey of nearly 1000 pregnancies. MethodsDuring 1980, all white women attending the booking clinic at the Warneford Hospital, Leamington Spa, were invited to complete a self-administered questionnaire, marked only with the patient's hospital number. The study was closed when 1000 completed questionnaires had been received, 1120 women having been invited to participate. Data were collected on social class, smoking, and consumption during pregnancy of various beverages including coffee and alcoholic drinks. The women were also asked about 'binge' drinking of alcohol in pregnancy (excessive alcohol consumed on isolated occasions, as opposed to regular consumption of alcohol). Alcohol consumption was expressed as ml of absolute alcohol equivalent daily, averaged over one week's consumption. Serum Table. Twenty-seven women were lost to follow-up because they had moved from the area while pregnant. Of the 973 women, 479 (49%) said they had been non-drinkers during pregnancy, 359 (37 %) said they had drunk between 1 and 10 ml alcohol on average daily, 107 (11 %) between 10 and 20 ml daily, and 28 (3 %) women had drunk over 20 ml daily. The highest reported consumption was 80 ml daily and the baby was normal. There was no association between alcohol consumption and the number of abortions (22), stillbirths (7), multiple pregnancies (10), nor between gender, gestational 940

Elevated levels of haemoglobin F (Hb F) have been foudn in a wide range of haematological malignancies, but very high levels were found only in juvenile chronic myeloid leukaemia (JCML), and erythroleukaemia occurring in infancy. In both these disorders a reversion to a fetal form of erythropoiesis may occur, as judged by both the structure of the Hb F and by the disappearance of Hb A2 and the carbnoic-anhydrase isozymes during the course of the illness. The clinical picture of JCML is not always associated with a reversion to fetal erythropoiesis; there appears to be a heterogeneity of conditions with this clinical label. Thus the reversion to a completely fetal pattern of erythropoiesis seems to occur in a variety of leukaemias which start in early life. This change is associated with a uniformly bad prognosis. Of a group of 17 patients with acute myeloid leukaemia 15 developed an increase in the level of Hb F about 60 days after the commencement of treatment; significantly greater increases were observed in those achieving a clinical remission. The level of Hb F usually declined during remission but high levels persisted in a few cases. Increased levels of Hb F were found also in patients with other haematological malignancies who had undergone periods of marrow aplasia during treatment. In all cases the Hb F was heterogeneously distributed throughout the red cells. Analysis of gamma15 or gammaCB3 peptides of Hb F from a variety of leukaemias gave glycine compositions ranging from 0.20 to 0.85 residues with many values in the fetal range; all cases with a reversion to fetal erythropoiesis had values in the fetal range. Attempts to confirm the 'fetal' origin of the cells containing Hb F by means of other markers was possible only in the cases of JCML and in one child with erythroleukaemia. These studies indicate that in some forms of leukaemia there may be a genuine reversion to fetal erythropoiesis while in others the emergence of cells containing Hb F appears to be part of a rapid regeneration process occurring after a period of marrow aplasia. The diagnostic and prognostic value of these observations is discussed.

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