SYNOPSIS It has been shown that the incidence of megaloblastic anaemia in a group of 463 randomly selected pregnant women receiving iron was 12 times as high as in a control group of 235 pregnant women receiving iron and folic acid. The incidence of all types of anaemia in the women receiving iron alone was more than three times the incidence in those having iron and folic acid. Some women who were not anaemic or who had normoblastic anaemia had serum folate levels in the same range as the women with megaloblastic anaemia, but none of the women with megaloblastic anaemia had high serum folate levels. The labile fraction of the serum folate was no more reliable than the total serum folate as a diagnostic criterion of megaloblastic crythropoiesis in the individual case. The blood group distribution in the women with megaloblastic anaemia was the same as in the general population. Babies born to mothers with megaloblastic anaemia tended to be smaller than the rest, although there was no difference in the placental weights.The significance of these findings is discussed.Megaloblastic erythropoiesis, with a varying degree of anaemia, is now known to be common in pregnancy. Although erythropoiesis is restored to normal by folic acid, estimation of the total serum folate is not a reliable guide to diagnosis, as it is in other folate-deficiency states such as steatorrhoea. It has been claimed that the level of the labile fraction of the serum folate (probably 5-methyl-tetrahydrofolic acid) is a reliable diagnostic criterion (Ball and Giles, 1964;Giles, 1966). If this is so, then an important factor in the pathogenesis of megaloblastic anaemia of pregnancy would seem to be an inability to metabolize folate compounds to their most useful form.There have been conflicting reports about the incidence of serious complications such as toxaemia, abortion, antepartum haemorrhage, and premature labour in pregnant women with megaloblastic anaemia (Gatenby and Lillie, iPresent address: Mill Road Maternity Hospital, Liverpool

Macroprolactinomas have a well-recognized potential for marked expansion during pregnancy. Measures advocated to minimize this risk include prior treatment with dopamine agonists, radiotherapy and pituitary surgery. We describe a patient who underwent transsphenoidal surgery with the removal of an histologically proven prolactin-secreting adenoma with the intention of rendering subsequent pregnancy safe. The patient remained hyperprolactinaemic and received prolonged therapy with metergoline and bromocriptine which suppressed prolactin to normal and she conceived after induction of ovulation with human menopausal gonadotrophin and human chorionic gonadotrophin. At 3 months gestation she developed headaches, vomiting, reduced visual acuity and bitemporal hemianopia caused by massive pituitary expansion. Reintroduction of bromocriptine rapidly abolished features of tumour expansion and after delivery of a full-term normal female infant, repeat CT scan documented tumour shrinkage.

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Background: Coffee is known to have a protective effect on liver enzymes. There are a limited number of Asian studies on this subject. We investigated the relationship between coffee and liver function tests in Korean men on a large scale. Methods: Study participants were consecutive men who had a regular health checkup in a university hospital in Korea. Information on coffee intake, alcohol drinking, and smoking was collected through selfadministered questionnaires. Results: A total of 3,844 men were enrolled in this study. Coffee drinking was positively associated with smoking and alcohol drinking. Coffee drinking was inversely associated with aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT) concentrations (r = À1.33, p = 0.008 and r = À6.35, p = 0.007, respectively). Also, increasing levels of coffee consumption was inversely associated with AST and GGT in a multivariate model ( p < 0.001 and p < 0.001, respectively). The relationship between coffee drinking status and alanine aminotransferase (ALT) did not reach statistical significance. However, heavy coffee consumption ( ‡ 3 cups/day) was significantly inversely related to ALT compared with mild coffee consumption ( < 1 cup/day) and non-coffee drinkers in multivariate analyses ( p = 0.032). All multivariate models were adjusted for age, body mass index, regular exercise, smoking amount, and alcohol drinking status. Conclusions: Coffee drinking was inversely associated with AST and GGT in apparently healthy Korean men. The relationship showed a dose-response pattern. It was suggested that ALT was lower in heavy coffee consumers ( ‡ 3 cups/day) compared with mild coffee consumers ( < 1 cup/day) and non-coffee drinkers.