Non-specialist professionals should have greater awareness of the existence of this uncommon complication of diabetes in the hope that earlier diagnosis will lead to lesser degrees of deformity.

Between 1961 and 1997, there were 15 reports of unusual secondary sex ratios related to paternal occupation. Thirteen of these documented a statistically significant predominance of female births (low secondary sex ratios) to fathers working in specific occupations. Findings are summarized, as are authors' suggestions about possible causes for the observed phenomenon. In addition, a new study is reported, replicating the findings of low offspring sex ratios in the children of male anaesthetists. Discussion focuses on four possible explanations of the findings -sampling error, differential damage to sperm, the Trivers and Willard hypothesis (Trivers and Willard 1973), and the maternal dominance hypothesis (Grant