Objective To provide a new outcome measure for pregnancy specifically related to the individual. Design Computer analysis of physiological factors affecting birthweight. Setting Two provincial teaching hospitals (University and City Hospitals, Nottingham) and an associated district general hospital (Derby City Hospital) serving a defined catchment area in the East Midlands. Subjects All women delivering in the above hospitals since the start of computerised obstetric records: 31 561 women with gestational age verified by early pregnancy ultrasound scan data. Main Outcome Measures Calculation of the predicted birthweight taking into account maternal and fetal physiological factors. Derivation of the individualised birthweight ratio (actual birthweight divided by predicted birthweight expressed as a percentage) for each individual baby. Results The individualised birthweight ratio redefines as normally grown 41% of babies below the 10th centile of crude birthweight for gestation. Other babies previously regarded as normal are redefined as growth retarded. At the upper end of the distribution 46% of those above the 90th centile of birthweight for gestation are redefined as normally grown. Conclusions The predicted birthweight can be calculated for an individual pregnancy at a given gestation. The standardised comparison between this predicted birthweight and the actual birthweight is a more logical reflection of the normality of intrauterine growth and therefore more logical as an outcome measure for pregnancy than crude birthweight for gestation.

Summary.-A series of 300 patients presenting consecutively with primary operable breast cancer has been studied. A significant correlation was found between oestrogen-receptor (ER) content and histological grade: the better-differentiated tumours rarely lacked receptor. This correlation was significant only in women defined as post-menopausal. Data on early recurrence of disease indicate a worse prognosis for women in whom primary tumours are ER-.

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Objective To study the effect of social deprivation on birthweight, excluding the effect of known physiological factors and exploring the effect of possible pathological factors. Design Retrospective analysis of computerised obstetric database. Setting Two teaching hospitals and an associated district general hospital which provided a defined catchment area in the East Midlands. Subjects The final analysis included 7493 women with complete datasets and gestations of between 259 and 300 days at delivery, dated by ultrasound scan. Main outcome measures Smoking habit, alcohol consumption, weight gain during pregnancy, systolic and diastolic blood pressures at booking, bleeding during pregnancy and Jarman score; also, the effect of these variables on birthweight, adjusted for the effects of physiological factors using the individualised birthweight ratio. Results Smohng during pregnancy reduced birthweight but the effect is not linear, becoming less marked as the number of cigarettes smoked increases. Alcohol intake, diastolic and systolic blood pressures at the booking visit and vaginal bleeding during early pregnancy were not significantly related to birthweight. Pregnancy weight gain was significantly positively related to birthweight especially in the normal weight range (60‐99 kg). A multivariate analysis including physiological and pathological factors found increasing Jarman score to be negatively related to birthweight. Conclusions In this central British population social deprivation is correlated negatively with birthweight: the most socially deprived mothers have the smallest babies. This association cannot be explained in terms of physiological differences in the population nor in a higher prevalence of known pathological factors.

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