Background-Low birthweight (LBW) has been associated with an increased incidence of adult cardiovascular disease.Endothelial dysfunction and loss of arterial elasticity are early markers of hypertension and atherosclerosis. We studied the prevalence of these markers in 44 healthy, prepubertal (age 9Ϯ1.3 years) children, 22 with LBW for age. Methods and Results-Endothelial function in skin was tested with the local application of acetylcholine (inducing endothelium-dependent vasodilation) and nitroglycerin (endothelium-independent vasodilation), and local perfusion changes were measured with the laser Doppler method. The elastic properties of the abdominal aorta and common carotid artery were measured with an ultrasonic vessel-wall tracking system. Endothelium-dependent vasodilation was lower in children with LBW (88Ϯ33 perfusion units [PU]) than in normal-birthweight controls (133Ϯ34 PU, PϽ0.001).There was no difference in aortic or carotid elasticity between the 2 groups, but a negative correlation was found between birthweight and stiffness of the carotid artery wall (rϭϪ0.45, PϽ0.01). Endothelium-independent vasodilation and blood pressure were similar in the 2 groups. Conclusions-Schoolchildren with a history of LBW show impaired endothelial function and a trend toward increased carotid stiffness. These findings may be early expressions of vascular compromise, contributing to susceptibility to disease in adult life.

Hospital birth records were sought for 104 men from a pool of male army conscripts with "normal" or "high" blood pressure when measured at 28 years of age. Of 77 men whose birth weight and date of the mother's last menstrual period before the pregnancy could be found, 25 had a resting diastolic blood pressure of ¢90 mm Hg.

Objective Gestational diabetes is associated with increased risk of developing noninsulin-dependent diabetes (NIDDM) later in life. By the time that a diagnosis of NIDDM is established, functional disturbances in the vascular system may be observed. This study was planned to assess macro-and microvascular function in nonpregnant women without signs of diabetes two to four years after a pregnancy complicated with gestational diabetes.Design Cross-sectional study.Setting Vascular research laboratory in the obstetric unit of a university hospital. Participants Seventeen nonpregnant, healthy women with a history of gestational diabetes and 20 nonpregnant control women of similar age without previous diabetes.Methods For quantification of the mechanical properties in large arterial vessels the wall movements of the abdominal aorta and left common carotid artery were recorded with an ultrasonic tracking system. Microvascular perfusion in the skin of the hand and foot was recorded by a laser Doppler technique to assess the vasodilatory response induced by transcutaneous acetylcholine. Results Women in the gestational diabetes group showed evidence of increased wall stiffness in the common carotid artery and a lower maximum incremental velocity of the pulsatile vessel diameter change in both aorta and carotid artery compared with controls. Acetylcholine induced vasodilatation in both hand and foot was lower in women with previous gestational diabetes compared with controls.Conclusion Abnormal vascular function was found in asymptomatic women with a history of gestational diabetes. It is speculated that these abnormalities might be early evidence of vascular complications associated with subsequent NIDDM.

Studies of risk factors for abruptio placentae (AP) are partly conflicting and studies of risk factors for perinatal death in these pregnancies are scarce. Using the population-based Swedish Birth Registry from 1987 to 1993, we were able to study these risks in 795,459 singleton pregnancies. Logistic regression analysis was used to estimate odds ratios (OR) for risk of AP and risk of perinatal death in pregnancies with and without AP. Risk factors for AP were: age, primiparity, high parity, not cohabiting with infant's father, low education, smoking, infertility, pregestational diabetes, essential hypertension, pregnancy-induced hypertensive diseases, preterm premature rupture of membranes, preterm birth and small-for-gestational-age (SGA) births. Risk factors for perinatal death in pregnancies with placental abruption were smoking (1--9 and > or =10 cigarettes/day; OR 1.4 and 1.7 respectively), severe pre-eclampsia (OR 2.0) and SGA (OR 1.9), whereas in pregnancies without abruption, risks were also increased in maternal age > or =35 years, primiparity, infertility, essential hypertension and pregestational diabetes. These findings support the theory that, in cases of AP, a general impairment of the placenta and/or a defect placentation may be fatal.

Abstract. The present study describes the evolution over a 5‐year period of an ultrasonic routine screening programme of a pregnant population with participation of approximately 90 % of the pregnant women. One obvious result obtained in the screening programme is the pronounced improvement of early detection of twins, the incidence now approaching 95 % with the mean gestational age for the detection being 20 (median 19) weeks. Early detection in combination with clinical measures was associated with a decrease in the incidence of twins born preterm (before week 37) from 33 % to 10 %. The perinatal mortality rate of twins fell from 6 to 0.6 % after the introduction of this programme. The power of an early measurement of the fetal biparietal diameter (BPD) to predict the date of confinement was high. Of 848 pregnant women with an early BPD measurement (96.5 % were measured before the 21st gestational week), 95 % were delivered spontaneously within 12 days according to the estimates from the BPD, only 1.5 % being delivered later than the 42nd gestational week. The corresponding figures estimated from the last menstrual period was 79.3 % and 11.6 %. The experience gained from the programme recognized BPD for estimate of actual gestational age and the 17th gestational week was for practical reasons chosen for the first ultrasonic examination. As dating of the gestation is an important prerequisite in a screening programme for neural tube defect, the estimate of serum alphafetoprotein (AFP) was conveniently added to the ultrasonic screening programme. When ultrasound is used for exclusion of twins, dead fetuses, and erroneous dates, the percentage of amniocentesis occasioned by raised serum AFP value has hitherto been low (1.3 %). The introduction of ultrasound at our department has enabled us to reduce by 50 % the number of X‐ray examinations of pregnant women. The calculated cost for each examination made by midwives in our programme is Skr. 50:‐ (US $ 11).

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Abstract. Normal range curves for the growth of the fetal biparietal diameter (BPD) measured by ultrasound were calculated in three different ways; I. 93 selected women examined longitudinally with three‐week intervals from the 16th gestational week to term. II. Measurements for each week compiled with only the first measurement from each patient. From the 20th to the 30th week, 3,243 BPD determinations obtained in a routine screening programme was used. III. 157 BPD measurements from 60 women with known date of ovulation. The results revealed that the three growth curves obtained in different ways were almost identical. The daily BPD increase was 0.44 mm up to the 33rd week. Thereafter, the increment declined. The data were best explained by an equation of the third degree (98.9 %) for the whole investigated period (16‐40 weeks), and before the 33rd week, best fitted to a straight line. Reliability was assessed by the test‐retest method. The error introduced by the unreliability of measurements had a standard deviation of 0.9 mm. The mean difference between examinations performed with an interval of one day was equal to the BPD growth for one day: 0.44 mm. To assess accuracy, the ultrasonic BPD measurements were checked against caliper measurements of the fetal head, in the first half of pregnancy after hysterotomy, and at term after cesarean section. The mean difference was 0.44 mm and 1.3 mm, respectively (SD 1.5 and 1.3 mm). The variation of the normal curve obtained from longitudinal measurements was 3.4 mm (SD) and the variation of the curve obtained from patients with known date of ovulation was 2.2 mm (SD). By comparing the two curves (I and III), 52 % of the variance around the mean of the former curve could be explained by difference in gestational age; 11 % was due to lack of accuracy, 6 % to lack of reliability, and 31 % to individual difference.