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During the past 30 years there has been great progress in perinatology. However, perinatal mortality has remained relatively high. To reduce perinatal mortality and morbidity, high risk pregnancy units have been established throughout the world. Our unit was established in 1976 for women with diseases complicating pregnancy, and in whom evaluation of fetal respiratory and metabolic function is indicated. The cesarean section rate during these 12 years was 33%. There was no maternal mortality. The intrauterine fetal death rate was 10.3 per 1,000 (very low for this unique population) and the corrected perinatal mortality was 3.4 per 1,000. The monitoring and treatment protocols, developed and applied in this unit, resulted in a significant decrease in fetal morbidity and mortality. These dramatically improved results demonstrate and justify the need for high risk pregnancy units.

A dietary history was obtained from 180 patients with preeclampsia and eclampsia, representing 92% of all cases occurring in the pregnant population of West Jerusalem over a defined period. The intake of nutrients and 78 items of diet was compared for each patient and two healthy control subjects who were matched for country of origin, parity, month of delivery, age, year of immigration and years of schooling. All diagnoses were made by the same research team and dietary histories were elicited by one of two experienced dieticians. Comparisons between the 180 patients and their respective control pairs showed a significantly reduced intake of calories, proteins and fats and an increase in consumption of sugar and sweets by the patients. The food items involved, including cheese, eggs, olives and nuts, did not appear consistently, however, in population subgroups defined by age, period of immigration and country of origin. Sixty-six patients reported not having changed their diets during pregnancy and these showed no significant differences in consumption of any of the foods or nutrients at the 1% level, when compared with their matched control subjects. All differences observed were confined to the 114 patients who, for one reason or another, had changed their diets. It is concluded that the differences in diet between patients and control subjects are the result, and not the cause, of the toxemia of pregnancy. Supporting and contradictory evidence in the literature is analyzed, and possible sources of the discrepancies are pointed out.

Blood pressure measurements were recorded in 95% of the men and 97% of the women aged 30 to 59 years in a small Israeli village populated by Jews of Kurdish origin and in which a high incidence of toxemia of pregnancy was previously observed. The prevalence of hypertension in the men, as well as in the women, was significantly higher in all age groups studied than in a sample of the general population. These findings support the hypothesis that toxemia of pregnancy is an expression of a preexisting hypertensive state rather than an etiological factor in the development of later hypertension in women.