Maternal vitamin D insufficiency is associated with childhood rickets and longer-term problems including schizophrenia and type 1 diabetes. Whilst maternal vitamin D insufficiency is common in mothers with highly pigmented skin, little is known about vitamin D status of Caucasian pregnant women. The aim was to investigate vitamin D status in healthy Caucasian pregnant women and a group of age-matched non-pregnant controls living at 54 -558N. Vitamin D insufficiency: Vitamin D supplementation: PregnancyVitamin D is essential to maintain bone health, playing a key role in bone mineralisation (1) , with severe vitamin D deficiency in children resulting in rickets (2) . As stores of vitamin D in newborns are dependent on maternal vitamin D status (3) , vitamin D deficiency during pregnancy leads to infant vitamin D deficiency and thus to increased risk of rickets (4) . More recent evidence suggests that in addition to causing poor mineralisation of the skeleton, vitamin D insufficiency is linked to other non-skeletal health outcomes (5,6) . 25-Hydroxyvitamin D (25(OH)D) is the storage form of vitamin D and circulating plasma concentrations of 25(OH)D are an indicator of vitamin D status. There is a lack of consensus on definitions regarding adequate vitamin D status and various cut-off levels have been used to define levels of deficiency: severe deficiency ,12·5 nmol/l (7)

Objective To evaluate the safety and efficacy of thermal balloon therapy for menorrhagia.Design Prospective, observational study. Setting Fifteen centres in Canada and Europe.Population Two hundred and ninety-six eligible women for whom follow up data were available for three months or more. Eligible women included those for whom further fertility was not a concern, were not postmenopausal, suffered from intractable menorrhagia, had a normal uterine cavity, and who were fully informed regarding the investigational nature of uterine thermal balloon therapy.Methods Three hundred and twenty-one procedures of balloon endometrial ablation were performed using the same protocol between June 1994 and August 1996. Exclusion criteria included structural uterine abnormality or (pre) malignant lesions. Treatment entailed controlled heating of fluid in an intrauterine balloon. General anaesthesia was employed in the 61% of procedures while local anaesthesia with or without sedation was used in 39% of cases.Analysis Follow up data at 3 and/or 6, and/or 12 months were required for inclusion in the analysis. A paired t test, Wilcoxon signed-ranks test, and multiple and logistic regression analyses were used to evaluate the changes in bleeding and dysmenorrhoea patterns, and possible confounding variables, respectively. Success was defined as the subjective reduction of menses to eumenorrhoea or less.Results No intra-operative complications occurred, and post-operative morbidity was minimal. Success of the procedure was constant over the year (range 88%-91%). Treatment led to a significant decrease in the duration of menstrual flow and severity of pain (P < 0.0001). Increasing age, higher balloon pressure, smaller uterine cavity, and a lesser degree of pre-procedure menorrhagia were associated with significantly improved results. Pre-treatment with gonadotrophin releasing hormone agonists increased amenorrhoea and spotting rates (P = 0-03), but was only used in 5% of cases.Conclusion Thermal balloon endometrial ablation appears to be safe, as well as effective in properly selected women with menorrhagia and is potentially an outpatient procedure.

No abstract

Background:In many countries, current recommendations are that women take a daily 400-g folic acid supplement from before conception until the end of the 12th week of gestation for the prevention of neural tube defects. Low folate status is associated with an increased concentration of plasma total homocysteine (tHcy), a risk factor associated with pregnancy complications such as preeclampsia. Methods: In a longitudinal study, we determined tHcy and corresponding folate status in 101 pregnant women at 12, 20, and 35 weeks of gestation, in 35 nonpregnant controls sampled concurrently, and in a subgroup (n ‫؍‬ 21 pregnant women and 19 nonpregnant controls) at 3 days postpartum. Results: Plasma tHcy was significantly lower throughout pregnancy compared with nonpregnant controls, with values lowest in the second trimester before increasing toward nonpregnant values in the third trimester. Importantly, mean tHcy concentrations were lower in pregnant women taking folic acid supplements than in those not, an effect that reached significance in the third trimester (5.45 vs 7.40 mol/L; P <0.05). During the third trimester, tHcy concentrations were significantly higher in pregnant women with a history of miscarriage than in women with no previous history (8.15 vs 6.38 mol/L; P <0.01).

Summary. Between 1970 and 1983, 519 pregnancies in 405 women with heart disease were managed at the Royal Maternity Hospital, Belfast, Northern Ireland, a rate of 1·3 per 100 deliveries. In 312 (60%) the heart disease was of rheumatic origin, in 161 (31%) congenital, and the remaining 46 (9%) were a miscellaneous group that included arrhythmias, ischaemic heart disease and cardiomyopathies. The New York Heart Association (NHYA) grading was no greater than 1–2 in 445 (86%) pregnancies antenatally. Three maternal deaths occurred, all in the group whose antenatal NYHA grade was 3–4. Heart failure was present in 96 (18%) pregnancies antenatally, and six others developed failure during labour or in the puerperium. Prophylactic antibiotics were not used routinely and infective endocarditis did not occur. The perinatal mortality rate was 19/1000, and the rate of congenital malformations was not raised in the reviewed group.