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The increasing obesity rates among women of reproductive age create a major obstetrical problem as obesity during pregnancy is associated with many complications, such as a higher rate of caesarean sections. This medical record-based study investigates the effects of maternal prepregnancy obesity on newborn parameters, birth mode, and miscarriage rate. The data of 15,404 singleton births that had taken place between 2009 and 2019 at the public Danube Hospital in Vienna were enrolled in the study. Newborn parameters are birth weight, birth length, head circumference, APGAR scores, as well as pH values of the arterial and venous umbilical cord blood. In addition, maternal age, height, body weight at the beginning and the end of pregnancy, and prepregnancy body mass index (BMI) (kg/m2) have been documented. The gestational week of birth, the mode of delivery, as well as the number of previous pregnancies and births, are included in the analyses. Birth length, birth weight, and head circumference of the newborn increase with increasing maternal BMI. Furthermore, with increasing maternal weight class, there tends to be a decrease in the pH value of the umbilical cord blood. Additionally, obese women have a history of more miscarriages, a higher rate of preterm birth, and a higher rate of emergency caesarean section than their normal-weight counterparts. Consequently, maternal obesity before and during pregnancy has far-reaching consequences for the mother, the child, and thus for the health care system.

Human birth represents a critical and life-threatening event in the life of mother and child and is therefore of special importance for anthropological as well as public health research.

ZusammenfassungWir berichten einen Fall von isolierter Kongenitaler Radiusköpfchenluxation (kRKL) bei einem Neugeborenen nach vaginaler Geburt aus Beckenendlage. Die Assoziationen dieser Geburtsmodalität führten zu der Fehldiagnose einer Ellbogenluxation. Die Ellbogenluxation ist eine häufige Fehldiagnose der kRKL, obwohl sie insbesondere bei Kindern unter einem Jahr bisher nicht berichtet wurde. Für den erfahrenen Kliniker führen jedoch die wiederholte klinische Untersuchung zusammen mit der geeigneten Bildgebung zum Ausschluß dieser Diagnose. Die kRKL kann bis in das Jugendalter asymptomatisch bleiben. Sofern keine Schmerzen oder funktionelle Beeinträchtigung vorliegen ist keine Therapie notwendig. Wir nahmen diesen Fall zum Anlass, neonatale Ellbogen-Auffälligkeiten in diesem Bericht zusammenzufassen.

The association patterns between maternal age and foetal growth parameters as well as newborn size were analysed using a dataset of 4737 singleton term births taking place at the Viennese Danube hospital. Foetal growth patterns were reconstructed by the results of three ultrasound examinations carried out at the 11th/12th, 20th/21th and 32th/33thweek of gestation. In detail, crown-rump length, biparietal diameter, fronto-occipital diameter, head circumference, abdominal transverse diameter, abdominal anterior-posterior diameter, abdominal circumference, and femur length were determined. Birth weight, birth length and head circumference were measured immediately after birth. Young teenage mothers (≤15 years), older adolescent mothers (16-19 years), mothers of optimal age range (20-35 years) and mothers of advanced age (>35 years) differed significantly in body height, pre-pregnancy weight status and gestational weight gain. Surprisingly, the foetuses of young adolescent mothers were the largest ones during first trimester. During the second and third trimester however, the foetuses of mothers of optimal age range (20-35 years) and mothers older than 35 years showed larger biometric dimensions than adolescent mothers. According to multiple regression analyses, maternal age was significantly related to Foetal head size (ß =-0.04; 95% CI = -0,08 – 0.01; p=0.034) and abdominal dimensions (ß= 0.03; 95% CI = 0.01-0.05; p=0,011) during the second trimester and to birthweight (ß= -0.03; 95% CI= -4.40 – 0.04; p=0.050). The associations however, are quite weak and the statistical significance is maybe due to the large sample size. At the time of birth, offspring of mothers of optimal age range (20 to 35 years) is significantly larger than that of adolescent mothers and mothers of advanced age. Mothers of advanced age showed the significantly highest (p=

The coexistence of underweight and obesity is commonly called the double burden of malnutrition, a phenomenon which can be found in most countries worldwide. During pregnancy maternal underweight as well as obesity have a profound impact on fetal growth patterns and consequently pregnancy outcome. In the present study the effects of maternal underweight as well as obesity on fetal growth and consequently newborn size were tested in a sample of 9214 term births which took place at Vienna Austria. It could be shown that maternal prepregnancy weight status was significantly positively associated with maternal age. Furthermore maternal prepregnancy weight status has a marked influence on fetal growth. With increasing maternal weight status birth weight, birth length, newborn head dimensions and acromial circumference increased significantly. Maternal obesity enhances fetal growth and increases the risk of giving birth to a large for gestational age offspring. In contrast underweight increases the risk of giving birth to a small for gestational age offspring. Additionally morbid obesity was positively associated with risk of caesarean section.

Objective To assess the cytogenetic and embryoscopic characteristics of primary and secondary recurrent pregnancy loss. Design Clinical prospective descriptive study. Setting Tertiary care center. Patient(s) Nine hundred and eighty-four women affected by first-trimester pregnancy loss; 145 patients with recurrent pregnancy loss (RPL) and 839 patients with nonrecurrent pregnancy loss as controls. Intervention(s) Transcervical embryoscopic examination of the embryo before uterine evacuation, and cytogenetic analysis of the chorionic villi by standard G-banding cytogenetic techniques. Main Outcome Measure(s) Aneuploidy frequency in the primary and secondary RPL group and the nonrecurrent pregnancy loss (non-RPL) control group. Result(s) Patients with RPL showed statistically significantly fewer aneuploid pregnancy losses (odds ratio [OR] 0.596; 95% confidence interval [CI], 0.40–0.88). Primary RPL was associated with lower aneuploidy rates compared with the non-RPL group (OR 0.423; 95% CI, 0.27–0.66) while secondary RPL was not (OR 1.414; 95% CI, 0.67–2.99). Patients with primary RPL had statistically significantly more morphologically normal embryos compared with non-RPL and secondary RPL. Conclusion(s) Patients' embryos after primary and secondary RPL show distinctive differences in aneuploidy and morphologic defect rates. These findings suggest different treatment approaches for the patients with primary and secondary RPL.

OBJECTIVE The aim of the study was to assess genotype-phenotype correlation of prenatally diagnosed fetal DGS and dup22q11 syndrome by fetal molecular genetic analysis, fetal ultrasound, and/or MRI. METHODS In this retrospective consecutive case series, pregnant women were screened for fetal anomalies during a period of 10 years. Fetal genotype was assessed in 72 cases upon the occurrence of five prenatal fetal phenotypic features: cardiac anomalies, hypo/aplastic thymus, craniofacial malformations, urinary abnormalities, or IUGR; genotype-phenotype correlation was tested to potentially improve prenatal diagnosis of fetal DGS and dup22q11 syndrome. RESULTS Fetal genotypes of deletions or duplications in proximal clusters of LCR22s (A-B) were associated with fetal cardiac anomalies in combination with hypo/aplastic thymus and craniofacial malformations, suggesting a correlation with deleted HIRA. TOF associated with aplastic thymus in combination with renal defects indicated a relevant correlation with TBX1 deletion. Deletions in central LCR22s (B-D) with the loss of CRKL supposed a trend of genotype-phenotype correlation with fetal urinary abnormalities. CONCLUSION Genotype-phenotype correlation might improve prenatal diagnosis of fetal DGS and dup22q11 syndrome. Hence, prenatal screening and counseling is highly enhanced by a combination of fetal molecular genetic analysis, fetal ultrasound, and/or MRI. The implications of these findings remain to be explored.

This is a case report of an isolated congenital radial head dislocation (CRHD) presenting after a breech delivery. The implications of this delivery mode led to the misdiagnosis of an elbow luxation. We found that elbow luxation is a common misdiagnosis of CRHD, although it has not been reported in children younger than one year. For the experienced clinician, repeated examinations and appropriate imaging usually lead to the exclusion of such misdiagnoses. CRHD itself usually remains asymptomatic until adolescence. Without pain or functional impairment of the joint, no specific therapy is needed. This case prompted us to provide an overview of elbow pathologies presenting at birth.Wir berichten einen Fall von isolierter Kongenitaler Radiusköpfchenluxation (kRKL) bei einem Neugeborenen nach vaginaler Geburt aus Beckenendlage. Die Assoziationen dieser Geburtsmodalität führten zu der Fehldiagnose einer Ellbogenluxation. Die Ellbogenluxation ist eine häufige Fehldiagnose der kRKL, obwohl sie insbesondere bei Kindern unter einem Jahr bisher nicht berichtet wurde. Für den erfahrenen Kliniker führen jedoch die wiederholte klinische Untersuchung zusammen mit der geeigneten Bildgebung zum Ausschluß dieser Diagnose. Die kRKL kann bis in das Jugendalter asymptomatisch bleiben. Sofern keine Schmerzen oder funktionelle Beeinträchtigung vorliegen ist keine Therapie notwendig. Wir nahmen diesen Fall zum Anlass, neonatale Ellbogen-Auffälligkeiten in diesem Bericht zusammenzufassen.

Caesarean section (CS) rates are increasing in many parts of the world, recently reaching about 20% worldwide. The postmodern lifestyle characteristics, obesity and delayed childbirth, have been put forward as the main reasons for high CS rates. The present study tests the association patterns between lifestyle parameters and delivery mode on a data set of 3786 births in Vienna between 2005 and 2013. The focus is exclusively on singleton term births. As well as maternal age, prepregnancy weight status, maternal body height and gestational weight gain, newborn size (birth weight, birth length, and head circumference), Apgar scores and child presentation were recorded. Planned as well as emergency CS rates increased significantly (p &lt, 0.0001) with increasing maternal age and decreasing maternal body height. Emergency CS rates, however, increased significantly with increasing maternal prepregnancy weight status and gestational weight gain. An especially high risk of emergency CS occurred among four groups of mothers: those older than 40 years (OR = 2.68, 95% CI 1.87&ndash, 3.86), those who were obese (OR = 1.44, 95% 1.15&ndash, 1.81), those experiencing a gestational weight gain above 15 kg (OR = 1.32, 95% CI 1.13&ndash, 1.54), and those shorter than 160 cm (OR = 1.216, 95% CI 1.02&ndash, 1.45). Emergency CS rates were significantly higher among low-weight newborns (&lt, 2500 g) and macrosome newborns (&gt, 4000 g) than among normal-weight newborns. Furthermore, breech presentation was associated with an increased risk of caesarean delivery (OR 6.97, 95% CI 6.09&ndash, 7.96). Logistic regression analyses reveal that maternal age, maternal body height, prepregnancy weight status, gestational weight gain, birth weight, newborn head circumference and child presentation show an independent, highly significant association with caesarean delivery. We conclude that maternal and newborn characteristics typical of recent lifestyle patterns, such as advanced maternal age, obesity, increased gestational weight gain and increased newborn size, are highly significantly associated with increased emergency CS rates. Moreover, maternal shortness and breech presentation are risk factors for emergency CS.

This retrospective study analyses sex differences in foetal biometry from the 1st trimester onwards, and sexual dimorphism in newborn size of 4260 singleton term births taking place at the Viennese Danube hospital between 2005 and 2013. Crown-rump length was determined at the 11th to 12th week, biparietal diameter, fronto-occipital diameter, head circumference, abdominal transverse diameter, abdominal anterior-posterior diameter, abdominal circumference and femur length were determined at the 20th or 21st gestational week and at the 32nd or 33rd week of gestation. Immediately after birth, birthweight, birth length and head circumference were taken, the Apgar scores 1, 5 and 10 minutes after birth were determined. Significant sex differences were found from the first trimester onwards. With exception of femur length, male foetuses exhibited always the significantly larger dimensions. At the time of birth, male newborns were significantly larger and heavier than their female counterparts. Sex had an...

PURPOSE: The aim of the study was to assess cytogenetic and embryoscopic characteristics in subsequent miscarriages of spontaneous pregnancy losses (SPL) and recurrent pregnancy losses (RPL). METHODS: A retrospective cohort of 75 women was affected by repeated pregnancy loss. Of those, 34 had SPL, 24 primary RPL, and 17 secondary RPL. Ploidy status and morphology was analyzed by transcervical embryoscopic examination of the embryo and cytogenetic analysis of the chorionic villi in subsequent miscarriages. RESULTS: Similar rates of recurrent ploidy status were observed between first and second miscarriage in SPL and RPL (82.4% recurrent ploidy status in SPL, p > 0.999; 73% recurrent ploidy status in RPL, p = 0.227). No difference was found regarding recurrent abnormal morphology between SPL and RPL (p = 0.092). However, secondary RPL resulted significantly more often in recurrent abnormal morphology compared to primary RPL (p = 0.004). CONCLUSIONS: High rates of recurrent normal/abnormal karyotypes were observed in all groups with a majority of embryos presenting with recurrent abnormal morphology. Secondary RPL presented significantly more often with recurrent abnormal morphology compared to primary RPL. These findings offer prognostic information for the affected patient and might impact treatment choice.

Objective The morphologic features of embryos with full trisomy 15 are described. Method A total of 1195 pregnancy losses were examined embryoscopically and cytogenetically. Results Of 1173 successfully karyotyped specimens, full trisomy 15 was diagnosed cytogenetically in 59 cases (5%). All 59 trisomy 15 embryos were diagnosed cytogenetically in the group of 962 embryonic miscarriages (6%). Trisomy 15 was not registered in 171 anembryonic or yolk sac miscarriages, and no case of full trisomy 15 was observed in 62 fetal miscarriages. Fifty-eight embryos with full trisomy 15 showed structural defects on embryoscopic examination. The most common defects were craniofacial anomalies (n = 73), retarded development of the limbs (n = 39), and abnormally short umbilical cords closely attaching the embryo to the chorionic plate (n = 27). Seven embryos were classified as growth disorganized. Limb reduction defects with a prevalence of 5.6/10 000 births, all affecting upper limb development (10 terminal transverse limb reduction defects and 3 embryos with split hand), were registered in 13 (22%) trisomy 15 embryos. Conclusion Limb reduction defects and craniofacial abnormalities are a typical feature of trisomy 15. Gene dosage imbalances related to trisomy 15 might be the main molecular mechanism underlying the developmental defects observed in the present study and require further investigation.

Aim of the study was to assess the correlation of first trimester serum afamin levels with three-dimensional placental bed vascularization in pregnant women and its prognostic value for predicting pre-eclampsia and future fetal and maternal complications during pregnancy.In this nested case-control study all pregnant women registered for delivery during a period of 3 years were routinely screened in the first trimester. Serum afamin levels were assessed in 764 women and correlated to 5 pregnancy outcome groups: gestational hypertension (n = 76), pre-eclampsia (n = 33), intrauterine growth restriction (n = 91), pre-term birth (n = 39), gestational diabetes mellitus (n = 170); In addition, measurements of first trimester myometrial vascularization index were performed and, in combination with afamin tested as a possible screening method to detect women at-risk for the development of adverse complications in low-risk pregnancies at the time of the first trimester.The results showed significantly higher serum afamin levels in women with pre-eclampsia (P.05) and gestational diabetes mellitus (P.05) compared to healthy pregnant women. There was no significant difference in serum afamin levels between all other pregnancy outcome groups and healthy controls. In women developing pre-eclampsia during pregnancy, afamin (OR = 1.0197, P .05) and myometrial vascular index (OR = 0.9235, P .001) were verified to have a significant prognostic value. Detection of pre-eclampsia in first trimester screening by a combination of afamin and myometrial vascular index performed best (AUC = 0.818).Hence, first trimester screening for pre-eclampsia could be provided by a combination of afamin and placental bed vascularization. Moreover, the combination of first trimester serum afamin levels with BMI could provide a possible screening for gestational diabetes mellitus.

An appropriate gestational weight gain is an essential factor of female reproductive success because gestational weight gain influences newborn size but also maternal and infant morbidity and mortality. This paper aims to analyze the impact of maternal somatic factors, first of all maternal stature height, on gestational weight gain. Additionally the effect of gestational weight gain and other maternal somatic factors on newborn size was tested. In the present study the data of 12,661 term birth which have taken place in Vienna, Austria were analyzed. Maternal and newborn somatometric features such as prepregnancy weight status, maternal stature height, birth weight, birth length and head circumference were included. Nearly 65% of the women gained appropriate weight during pregnancy. About 20% showed an excessive, less than 15% an inappropriate gestational weight gain. Gestational weight gain was influenced significantly by prepregnancy weight status, maternal stature height, maternal age, but also nicotine consumption during pregnancy. A significant association between gestational weight gain and newborn somatometrics could be stated. It could be shown that gestational weight gain is influenced by several maternal somatic but also behavioral factors. Newborn size is associated with gestational weight gain.

SummaryThe impact of maternal height, pre-pregnancy weight status and gestational weight gain on fetal growth patterns and newborn size was analysed using a dataset of 4261 singleton term births taking place at the Viennese Danube Hospital between 2005 and 2013. Fetal growth patterns were reconstructed from three ultrasound examinations carried out at the 11th/12th, 20th/21th and 32th/33th weeks of gestation. Crown–rump length, biparietal diameter, fronto-occipital diameter, head circumference, abdominal transverse diameter, abdominal anterior–posterior diameter, abdominal circumference and femur length were determined. Birth weight, birth length and head circumference were measured immediately after birth. The vast majority of newborns were of normal weight, i.e. between 2500 and 4000 g. Maternal height showed a just-significant but weak positive association (r=0.03: p=0.039) with crown–rump length at the first trimester and with the majority of fetal parameters at the second trimester (r>0.06; pr>0.09; pr>0.08; pr>0.17; pr>0.13; pr>0.13; ppp

This study investigated the satisfaction of women carrying the LNG-IUD and determined influencing factors, especially considering bleeding patterns and body mass index (BMI).Cross sectional study.Gynecological offices in a Central European district.1825 women aged between 18 and 60 years.While sitting in the waiting room, voluntary patients had to answer a questionnaire about their experiences with the levonorgestrel intrauterine device. One question was used to determine whether the women were current, former or not users of the intrauterine coil.415 women who had some experiences with Mirena were found. Overall, 266 (65.7%) were "very satisfied," 83 (20.5%) "quite satisfied," 18 (4.4%) "moderate satisfied," 19 (4.7%) "less satisfied," and the same amount "really not satisfied" with the hormonal coil. Women with amenorrhea were more often "very satisfied" in general, than women with hypermenorrhea (178 (67.9%) vs. 3 (1.1%) p0.001). Concerning bleeding patterns, 295 (74.1%) were "very satisfied" and 23 (5.8%) "really not satisfied". 203 (91.0%) of all amenorrhoeic women were "very satisfied" with their bleeding patterns, but only 2 (9.5%) of all women with hypermenorrhea (p0.001 for α = 0.05). Amenorrhea particularly occurred in women who had a significantly lower body mass index (24.4 ± 4.4 kg/m(2) vs. 27.6 ± 6.5 kg/m(2) in women with hypermenorrhea, p = 0.018 for α = 0.05). After allocating women to the widely used BMI-categories (underweight, normal weight, overweight, obese class I and II) it was evident, that normally weighted women tend toward amenorrhea as well at the beginning of LNG-IUD use as well after 4-5 years of use. In contrast to this, overweighed and obese women tend more often to amenorrhea at the end of use, but not at the beginning (72.7% and 55.6% vs. 25.0% and 0%). Women with a lower BMI were more often "very satisfied" concerning bleeding patterns, but not concerning the general satisfaction.Our study showed much evidence, that amenorrhea occurs more often in women with lower BMI contrary to women with a higher one-especially at the beginning of LNG- IUD use. Furthermore amenorrhea was mostly considered to be a positive menstrual change.

The male disadvantage hypothesis was tested based on a data set containing 3518 singleton term births, which took place at a German Clinic for Gynecology and Obstetrics. Gender differences in birth...

There is evidence that LDL oxidation may render the lipoprotein atherogenic. The myeloperoxidase–hydrogen peroxide (MPO/H2O2) system of activated phagocytes may be involved in this process. Chloride is supposed to be the major substrate for MPO, generating reactive hypochlorous acid (HOCl), modifying LDL. The pseudo-halide thiocyanate (SCN−) has been shown to be a suitable substrate for MPO, forming reactive HOSCN/SCN·. As relatively abundant levels of SCN− are found in plasma of smokers—a well-known risk group for cardiovascular disease—the ability of SCN− to act as a catalyst of LDL atherogenic modification by MPO/H2O2 was tested. Measurement of conjugated diene and lipid hydroperoxide formation in LDL preparations exposed to MPO/H2O2 revealed that SCN− catalyzed lipid oxidation in LDL. Chloride did not diminish the effect of SCN− on lipid oxidation. Surprisingly, SCN inhibited the HOCl-mediated apoprotein modification in LDL. Nitrite—recently found to be a substrate for MPO—showed some competing properties. MPO-mediated lipid oxidation was inhibited by heme poisons (azide, cyanide) and catalase. Ascorbic acid was the most effective compound in inhibiting the SCN−-catalyzed reaction. Bilirubin showed some action, whereas tocopherol was ineffective. When LDL oxidation was performed with activated human neutrophils, which employ the MPO pathway, SCN− catalyzed the cell-mediated LDL oxidation. The MPO/H2O2/SCN− system may have the potential to play a significant role in the oxidative modification of LDL—an observation further pointing to the link between the long-recognized risk factors of atherosclerosis: elevated levels of LDL and smoking.

The associations between cigarette smoking before and during pregnancy and maternal body size (pre-pregnancy weight status, end of pregnancy weight status, weight gain during pregnancy) and newborn size (birth weight, length, head circumference, arcomial circumference), as well as birth modus, were tested in 7803 single full-term births in Vienna. Nicotine consumption before and during pregnancy was found to be associated with smaller and lighter newborns, although maternal weight status and weight gain during pregnancy was signi.cantly higher in smokers. Furthermore, a higher incidence of Caesarean sections was found in smokers. A reduction in the number of daily smoked cigarettes was associated with a lower percentage of low weight newborns (

Pregnancies during early adolescence were commonly thought to represent special risks, such as preterm delivery or low-weight newborns, resulting in increased mortality and morbidity of mother and child. An important biopsychosocial interaction can be assumed. In the present study the impact of maternal age and maternal somatic characteristics such as prepregnancy weight, stature, or pregnancy weight gain on newborn somatometric features (birth weight, birth length, head circumference, and arcomial circumference) using a dataset of 8,011 single term births were analyzed. The offspring of 215 extremely young mothers ages 12-16 years were significantly (P < 0.0001) lighter and smaller in all body dimensions than the offspring of older adolescent mothers, ages 17-19 years, and the offspring of adult gravida, ages 20-29 years, although no increased incidence of low-weight newborns (

According to the male disadvantage hypothesis male foetuses react more sensitive to maternal stress factors during gestation. In the present study the gender typical impact of maternal prepregnancy overweight and obesity as well as gestational weight gain on newborn somatometrics was tested on basis of births records of 7565 births, which took place in Vienna Austria. Maternal weight status was determined at the beginning of pregnancy according to the WHO recommendations. Newborns were measured immediately after birth. With increasing maternal prepregnancy weight status and increasing gestational weight gain birth weight, birth length and head circumference increased too. Among male newborns however the increase was lower than among female ones. With increasing maternal weight status the prevalence of macrosome newborns increased significantly. Among girls however this increase was significantly higher. Male foetuses seem to react more sensitive to a higher maternal weight status in comparison to girls. These results can be interpreted in sense of the so called male disadvantage hypothesis.

To investigate the relationship between umbilical venous leptin concentration and gender in 20 pairs of newborns matched 1:1 for birth weight and gestational age at sampling. Blood samples were obtained from 40 women at delivery, identified as having an uncomplicated pregnancy. Umbilical venous blood samples were obtained from their newborns (20 females and 20females) at birth. Specimens were analyzed using a human leptin 125-I radioimmunoassay. Fetal leptin correlated positively with birth weight (rs= 0.541; P < .001). Umbilical venous leptin concentrations in female newborns (median: 10.7 ng/mL, range: 3.5−34.4 ng/mL) were significantly higher (P = .028) than in male newborns (median: 7.7 ng/mL, range: 2.0−19.3 ng/mL). There was no significant correlation between maternal and fetal leptin concentrations. Multiple logistic regression analysis revealed birth weight and gender to be independent factors influencing fetal cord leptin. Our results suggest that in the fetus, as in children and adults, gender and weight are the major determinants of circulating leptin levels.

The impact of maternal age at menarche on newborn size was tested using data from 4,996 single births taking place at Vienna, Austria, between 1985 and 1995--so-called teenager pregnancies were excluded from the present analyses. All women experienced pregnancies between the ages of 19 to 42 years. Maturational time was related significantly to infant weight and length independent of maternal age and behavioral variables such as smoking. Early maturation, i.e., age at menarche before the 12th birthday, was significantly associated with decreased newborn weight and size. The incidence of low-weight newborns was significantly higher in early-maturing mothers. The more favorable nutritional status of women whose menarche occurred relatively early was not able to compensate for the negative effects of early maturation on intrauterine growth. Higher circulating estrogen levels in early maturers preserved into adulthood are discussed as possible reasons for intrauterine growth retardation of the offspring of early-maturing mothers.

The aim of the study was to investigate cord blood leptin concentrations and their relationship to birth weight and gender in term pregnancies complicated by pre-eclampsia. Cord blood samples were obtained from 52 women, identified as having pre-eclampsia, and their newborns (31 males and 21 females) immediately after birth. Specimens were analyzed using a human leptin 125I radioimmunoassay. The relationship between leptin and anthropometrics was assessed by Spearman correlation. Differences in cord blood leptin levels between male and female infants were tested with the Mann-Whitney U test. The correlation between leptin and gender was computed using the product-moment-biseral correlation analysis for continuous and dichotomous variables. The multiple logistic regression analysis examined influences of sex, birth length, birth weight, birth weight/birth length ratio, ponderal index and maternal leptin as covariates on the fetal cord leptin level. Fetal leptin correlated positively with birth weight, length and weight/length ratio, in the total group and in the male subgroup and additionally with ponderal index in the female subgroup. Cord blood leptin concentrations in female newborns were significantly higher than in male newborns (p = 0.015), and concentrations correlated with gender (r = -0.315; p = 0.023). Multiple logistic regression analysis revealed four potential independent factors influencing fetal cord leptin: gender, birth weight, birth weight/birth length ratio and maternal leptin. In conclusion, cord leptin concentrations in pregnancies complicated by pre-eclampsia correlate positively with birth weight and gender. Leptin concentrations in female newborns are higher compared to male newborns.

The impact of maternal anthropometric characteristics, above all prepregnancy weight status and pregnancy weight gain, on newborn size was tested using 10,240 single births in the University Hospital of Vienna, Austria. Highly significant relations between maternal prepregnancy weight status and newborn size were observed. With higher maternal prepregnancy body mass index, higher birthweight, length, head circumference, acromial circumference and fronto occipitalis diameter occurred. Furthermore the incidence of low weight newborns (2500 g) was significantly higher in underweight women than in normal weight, overweight and obese women. Although the pregnancy weight gain was significantly higher in underweight women than in normal weight, this higher pregnancy weight gain was not able to compensate for the negative impact of poor weight status before pregnancy. These results indicate that even in a highly developed country such as Austria, where starvation is a nearly unknown problem and the medical and social system are well developed, a poor maternal weight status is a risk factor for growth retarded and low weight births.

With 23 postmenopausal and 33 premenopausal females the interactions between circadianic secretion patterns of estradiol, growth hormone, IGF I, prolactin, DHEA-S as well as cortisol and the amount and distribution of subcutaneous body fat, estimated by using 10 absolute body measures and 10 anthropometric indices were tested. Premenopausal and postmenopausal women differed regarding the secretion patterns of estradiol and growth hormone significantly from each other. Furthermore it turned out, that the daily secretion rate, estimated by using the area under the curve, of growth hormone and estradiol correlated significantly with the amount and the distribution of body fat. In both proband groups more corpulent women had lower growth hormone levels and higher estradiol levels. The age dependent reduction of growth hormone secretion may be co-responsible for the general weight gain with increasing age. The reduced estrogen secretion however, seems to be the major determinant of the expression of a more masculine type of fat distribution during climacteric and after the menopause.

Objective: To assess the effect of oral hormone replacement therapy (HRT) on body weight, insulin-like growth factor I (IGF-I), and GH response to exogenous GnRH in women with premature ovarian failure (POF). Design: Controlled clinical study. Setting: Outpatients studied in the department of endocrinology of the University Hospital in Vienna. Patient(s): Twenty-four women with POF (study group) and 24 volunteers with normal ovarian cycles (control group). Intervention(s): Pituitary GnRH stimulation was performed in all women at study entry and in patients with POF after 1, 6, and 12 months of standard oral HRT. Blood samples were collected from 15 minutes before to 120 minutes after GnRH administration. Body weight also was evaluated. Result(s): No differences in baseline and stimulated serum GH were found either between POF women and controls or in POF women during HRT. Women with POF without HRT had significantly higher IGF-I levels; a reduction in circulating IGF-I levels occurred during HRT. Body weight remained stable. Conclusion(s): Our results show the following: [1] Women with POF have similar GH secretion patterns as healthy age-matched women; [2] physiologic HRT has no impact on GnRH-induced GH stimulation; and [3] HRT has no impact on body weight in women with POF.

Objective To evaluate the literature on contraindications contained in pharmaceutical data sheets of five currently available oestrogen replacement preparations (HRT). These contraindications include cardiovascular disease, diabetes, liver diseases, otosclerosis, endometriosis, melanoma and hormone-dependent tumours. Design Systematic review. Interventions Oestrogen replacement regimens. Results The contraindications to the five HRT preparations have been taken uncritically from the data sheets of oral contraceptives. In some of these conditions not only is HRT not contraindicated, it is indicated. The data sheets for the HRT preparations all state that cardiovascular disease is a contraindication, but systematic review shows that ischaemic heart disease, hypertension and hyperlipidaemia are not contraindications, and in ischaemic heart disease HRT may actually be indicated. Similarly, systematic review shows that diabetes, chronic liver disease, endometriosis, some cases of treated cancer of the endometrium and breast, melanoma and otosclerosis are not contraindications to HRT. Conclusions The information in the pharmaceutical data sheets of HRT regimens should be modified as more accurate information could influence how these preparations are prescribed by doctors as well as affect patient compliance.

We investigated the relationship between the growth hormone and prolactin response to stimulation of growth hormone-releasing hormone (GHRH) and changes in body weight in pre- and postmenopausal women before and after 4 and 20 weeks of oral hormone replacement therapy (HRT). Ten postmenopausal women (with levels of follicle-stimulating hormone (FSH) of30 mIU/ml) were compared to ten premenopausal women suffering from post-pill amenorrhea (FSH10 mIU/ml). Both patient groups reported anamnestic body weight increases in the course of the former use of sex hormones. Additionally, ten postmenopausal women without anamnestic weight changes were studied. A significant reduction in the growth hormone response to GHRH was observed during the first month of HRT in women gaining weight, which was restored to pre-therapeutic levels after 6 months of HRT. A small but statistically significant increase in insulin-like growth factor (IGF)-I levels occurred in the course of HRT in all patients studied. These changes in growth hormone stimulation testing and IGF-I levels were accompanied by distinct changes in body weight. No reduction in the GHRH response was observed in those patients who did not gain body weight. Although GHRH stimulation induces a significant rise of prolactin concentrations in all patients before therapy no influence on prolactin levels could be demonstrated during HRT.

The purpose of our study was to examine androgen serum levels and bone density in women with premature ovarian failure (POF) compared to healthy normal controls.Thirty-three women 19-35 years of age with idiopathic POF were compared to 33 well-matched women with normal ovarian function and 32 healthy postmenopausal (PMP) women concerning 17-hydroxyprogesterone (17-OHP), androstendione (A), testosterone (T), dehydroepiandrosterone-sulfate (DHEAS), insulin-like growth factor 1 (IGF-1), as well as bone density (BD).Women with POF showed statistically significantly lower concentrations of 17-OHP, A, T (p0.001) and a reduced bone density (p0.001) compared to fertile controls. No differences were found between POF and PMP women concerning estradiol (E2), T, A and 17-OHP. Regarding DHEAS, no statistically significant differences were found between women with POF and fertile controls whereas PMP women proved to have significantly lower DHEAS concentrations than fertile controls. Women with POF had the highest IGF-1 serum concentrations and PMP women the lowest.An important decrement of ovarian steroids and bone density was noticed in women with POF, while the time since menopause had no influence on androgen concentrations. The hormone concentrations in women with POF are similar to those observed in normal PMP women with the exception of DHEAS and IGF-1 levels.

According to the male disadvantage hypothesis male foetuses react more sensitive to maternal stress factors during gestation. In the present study the gender typical impact of maternal prepregnancy overweight and obesity as well as ges- tational weight gain on newborn somatometrics was tested on basis of births records of 7565 births, which took place in Vienna Austria. Maternal weight status was determined at the beginning of pregnancy according to the WHO recommen- dations. Newborns were measured immediately after birth. With increasing maternal prepregnancy weight status and increasing gestational weight gain birth weight, birth length and head circumference increased too. Among male new- borns however the increase was lower than among female ones. With increasing maternal weight status the prevalence of macrosome newborns increased significantly. Among girls however this increase was significantly higher. Male foetuses seem to react more sensitive to a higher maternal weight status in comparison to girls. These results can be interpreted in sense of the so called male disadvantage hypothesis.

Plasma sex hormone-binding globulin (SHBG) levels are important in the regulation of plasma free and albumin-bound androgens and estrogens. In postmenopausal women associated to the decrease of estrogen production, a decrease of plasma SHBG levels occurs. Hormone replacement therapy (HRT) in postmenopausal women modulates plasma SHBG levels, in relationship with the different regimens and routes of administration. The present study aimed to compare the effect of different HRT on plasma SHBG levels in relationship with the changes of plasma androgen [dehydroepiandrosterone sulphate (DHEAS), testosterone (T), androstenedione (A)] and insulin-like growth factor-1 (IGF-1) levels. In a retrospective study 443 postmenopausal women were studied and divided into 2 groups. The group 1 (n = 170) was subdivided in 4 groups of women as follows: A) treated with transdermal 17-beta estradiol + medroxyprogesterone acetate, B) treated with oral conjugated estrogens, C) treated with sequential HRT (estradiol valerate (EV) + norgestrel), and D) treated with a combined HRT (micronized estradiol (E2) + noretisterone acetate). Women of group 2 (n = 273) did not receive HRT and served as controls. All groups of women treated with different HRT showed plasma estradiol levels significantly higher than controls (p0.01), showing the highest values in women treated with oral HRT. Plasma SHBG levels were not significantly different between patients treated with transdermal 17-beta estradiol + medroxyprogesterone acetate and controls. On the other hand, all the groups of patients treated with oral conjugated estrogen with or without progestagens showed plasma SHBG levels significantly higher than controls (p0.01). Plasma SHBG levels were higher in the group treated with estrogen alone than in groups of women treated with sequential or combined HRT. Plasma DHEAS, T and A levels in patients treated with different HRT regimens were in the same range of levels as control women. Plasma IGF-1 levels were not significantly affected by the various HRT regimens and remained in the same range as controls. In conclusion, plasma SHBG levels increase following oral HRT while are not affected by transdermal HRT. Plasma IGF-1 and androgen levels are not influenced from oral or transdermal HRT.

Objectives: The relationship between body build, androgen levels and changes in sexual interest after menopause was investigated in 171 postmenopausal women from Vienna, Austria. Methods: All women were interviewed using a structured questionnaire. Body build was determined by employing five absolute body dimensions and four anthropometric indices. Results: Body weight, as well as the amount of subcutaneous centripetal fat (such as in the chest, waist and hip region), were statistically significantly related to the degree of reduced sexual interest. Corpulent and heavy women suffered far more frequently from a severe decrease in sexual interest after menopause. Statistically significant associations between androgen levels and decrease in sexual interest could not be demonstrated. Conclusions: Reduced sexual interest is associated with a kin 1 of body type not corresponding to the culture-specific beauty ideals of our society, first of all evident in women whose menopause occurred relatively early.

Objectives: The aim of the present study was to investigate the influence of a continous estrogen, cyclic progesterone replacement therapy on the secretion of growth hormone (GH) and IGF I as well as of somatometric-GH correlation patterns. Methods: The study included 23 healthy postmenopausal women. Of the proband group 13 randomly selected women were treated with orally applicated 2 mg estradiol-valerat (E2V) and 10 mg dydrogesterone for 10 months. Ten women did not receive any hormonal treatment during this time. After 10 months all probands were reexamined and their GH and IGF I secretion, as well as their somatometric-hormonal correlation patterns, compared with those of a fertile control group. Results: It could be shown, that in postmenopausal women a 10-month oral hormone replacement therapy led to a significant increase of GH- and IGF I levels, however, the treated postmenopausal women did not reach the levels of the fertile controls. Those women who did not receive any hormonal treatment and the postmenopausal women before HRT showed nearly identical GH- and IGF I levels as well as somatometric-GH correlation patterns. Conclusions: The results of the present paper indicate a marked influence of estrogens on GH and IGF I secretion. Furthermore, hormonal replacement therapy (HRT) may influence somatometric GH correlation patterns too.

To assess the function of the hypothalamic-pituitary-gonadal (HPG) axis in major depression, a multihormonal study was carried out in 20 depressed premenopausal women. Serum concentrations of LH, FSH, estradiol, progesterone, testosterone, and GnRH-stimulated LH and FSH were measured before initiation of treatment (on the first day after menstruation) and during clomipramine treatment (same time one menstrual cycle later). Significantly higher blood concentrations of testosterone were found in untreated patients compared to normal controls. Furthermore, there was a significant negative correlation between Hamilton depression scores and estradiol concentrations of patients. The efficacy of clomipramine treatment was not related to hormonal parameters.

The package leaflets of hormone preparations used for Hormone Replacement Therapy (HRT) in hypoestrogenaemic women contain contraindications, which are taken from the package insert of oral contraceptives: Clots in the blood vessels (thrombotic disorders), high blood fats, severe diabetes, abnormal red blood cells, deterioration of inherited deafness and jaundice not explained by infections, disturbances of the liver function and of existing or treated hormone-dependent tumours of the breast or of the lining of the womb. Numerous epidemiologic, animal-experimental and also clinical studies proved that the cardiovascular risk, hepatic discomfort and the influence on the blood system of oestradiol 17-beta have to be evaluated completely differently compared to the ethinyloestradiol used in oral contraceptives; therefore, many of the listed contraindications must be reconsidered. In our review we try to emphasise this postulation by scrutinizing recent publications.

Die prophylaktische Ovarektomie, d.h. die Entfernung makroskopisch unauffälliger Ovarien im Rahmen einer Laparotomie oder vaginaler Hysterektomie, schützt nicht obligatorisch vor dem Auftreten eines Ovarialkarzinoms. In dieser Kasuistik berichten wir über eine 76jährige Patientin mit einer malignen Müllerschen Neoplasie nach prophylaktischer Ovarektomie und diskutieren die relevante Literatur.

To determine whether circulating levels of leptin differed between women with preeclampsia and women who had an uncomplicated pregnancy.Maternal and umbilical venous plasma leptin concentrations obtained at delivery were compared in 36 pairs of women with either preeclampsia or normal pregnancy, matched 1:1 for prepregnancy body mass index and fetal gestational age at delivery.Prepregnancy body mass index was 21.1 +/- 2.1 kg/m2 in either study group (range 17.6-25.3 kg/m2 and 17.7-25.3 kg/m2 in the normal and preeclamptic group, respectively). Mean fetal gestational age at delivery was 40.1 +/- 1.3 weeks and 40.1 +/- 1.2 weeks in the normal and preeclamptic group, respectively. Median leptin concentrations were significantly lower (P.0001) in women with preeclampsia (8.3 ng/mL, range 3.5-20.0 ng/mL) than in normal pregnant women (20.2 ng/mL, range 6.0-63.7 ng/mL). Median umbilical venous leptin was not significantly different between groups (preeclampsia 11.8 ng/mL, range 2.0-37.2 ng/mL; normal 7.6 ng/mL, range 1.6-24.3 ng/mL; P = .377). Umbilical venous leptin levels correlated positively with birth weight in both groups (preeclampsia rho = 0.501, P = .002; normal rho = 0.517, P = .001), whereas no correlations were found between maternal and fetal hormone concentrations. Maternal leptin concentrations did not correlate with birth weight.Our data suggest that the correlation between umbilical venous leptin concentration and birth weight is independent of the presence of preeclampsia. Given the inconsistency in literature concerning circulating leptin levels in preeclampsia, further studies should investigate the regulatory systems of leptin in preeclampsia.

TO determine whether there is a difference in maternal leptin concentration and cord blood concentration, consistent with the hypothesis of a noncommunicating, two-compartement model of fetoplacental leptin regulation. Blood samples were collected from 139 women, identified as having an uncomplicated pregnancy, from an antecubital vein at delivery. Cord blood samples were taken from the umbilical vein. Leptin was measured by radioimmunoassay, and its relationship to fetal and maternal anthropometrics was assessed by Spearman correlation. Differences in maternal and cord blood leptin levels between male and female infants were tested with the Mann- Whitney U test. Maternal and cord blood leptin were compared by the Wilcoxon signed rank test. The outcome measures were maternal and cord blood leptin at delivery, fetal birth weight, length, weight/length ratio, and ponderal index, maternal prepregnancy body mass index, pregnancy weight gain, relative weight gain, and body mass index at delivery. No correlations were found between maternal and cord blood leptin concentrations. Fetal leptin level correlated with birth weight (ρ = 0.665; P < .0001), length (ρ = 0.490; P < .0001), ponderal index (ρ = 0.260; P = .002), and weight/length ratio (ρ = 0.625; P < .0001). Median leptin concentrations were higher in female (9.3 ng/mL, range 1.5–34.4 ng/mL) than in male (8.2 ng/mL, range 1.6–38.3 ng/mL) neonates, but this difference was statistically not significant. Logistic regression analysis showed a significant influence on umbilical venous leptin concentration for birth weight (P < .0001) but not for gender. Maternal leptin concentrations were significantly higher than cord leptin concentrations (P < .0005 for the male and female neonates and the entire group). There was no correlation between maternal and cord leptin, which supports the hypothesis of a noncommunicating, two-compartment model of fetoplacental leptin regulation.

The purpose of this study was to determine the effect of maternal pre-pregnancy body mass index (BMI) and maternal smoking habits on neonatal birth weight. We reviewed 10,240 normal singleton term pregnancies between 1985 and 1995 at the University Department of Obstetrics and Gynecology, Vienna. Birth weights of infants of overweight smokers were greater than those of smokers in general and similar to birth weights of nonsmokers, but smoking did have a fetal growth-retarding effect in overweight smoking mothers. Infants of underweight mothers who increased their daily cigarette consumption during pregnancy had significantly lowest birth weight. Our results suggest that the negative effects of smoking during pregnancy cannot be mitigated by a higher pre-pregnancy BMI and/or an improved weight gain during pregnancy. Especially the infants of underweight mothers benefit from their mothers’ decision to cease smoking.