Flupenthixol (FP), nortriptyline (NT) and zuclopenthixol, (ZCP) were determined in breast milk and plasma from 2 puerperal, lactating women with psychiatric disorders. The milk concentrations were equal to, higher and lower than those in plasma for FP, NT and ZCP, respectively. Variation in milk triglyceride concentration, but not milk pH, could partly explain between-breast differences in the milk concentrations. The study demonstrates the need for appropriate and representative milk sampling procedures. The estimated daily infant exposure averaged 0.5, 2.3 and 0.3% of the corresponding maternal weight related doses of FP, NT and ZCP. FP was also detectable in infant plasma. These drugs are not known to be harmful in small doses to breast-fed infants. However, concern about the effect of dopamine blocking agents on neurobehavioral mechanisms in animals warrants caution. If neuroleptics are required for a long period this risk must be weighed against the benefits of breast-feeding, also considering the psychological effects of the latter.
This longitudinal prospective study of hormonal changes during the transition from pre- to postmenopause indicates that not only estrogen hormonal changes, but androgen hormonal changes as well, precedes the menopause by several years.
During the years 1970-1977, 234 pregnant diabetics were treated in Oslo. A regimen of close metabolic and obstetric control was used. The total perinatal mortality was 4.3%, and 3.1% in 160 patients followed from before week 28. In 74% of patients mean blood glucose (determined 4 times daily) during the last 5-6 weeks of pregnancy was below 6 mmol/1 and in only one patient above 8 mmol/1. There was a low incidence of ketoacidosis (5 patients), pyelonephritis (3 patients), and severe preeclampsia (1 patient), although mild to moderate preeclampsia occurred in 28 patients. Preeclampsia was not associated with foetal loss. Macrosomia was rare. Respiratory distress occurred in 33 infants, in most cases light to moderate. Two foetal deaths were associated with respiratory distress. Progression of retinopathy was frequent, and appearance of or progression of proliferative changes occurred in 15 patients with retinopathy before pregnancy. Loss of visual acuity was rare, and reading vision was not lost by any patients. Induced vaginal delivery has been used in half the deliveries during the last years, whereas Caesarean section was preferred during the first years. Mean duration of pregnancy at delivery has been 260 days, 256 days during the first four years, and 262 days during the last four.
Amniotic fluid lecithin/sphingomyelin (L/S) ratios were examined in 74 samples from 65 patients with preeclampsia. The median values were comparable to those obtained in a reference series up to 36 weeks of gestation whereas the median values after 37 weeks of gestation were found to be significantly smaller in the preeclamptic group (p less than 0.01). According to the present results a L/S ratio greater than or equal to 2 would in fact guarantee no development of respiratory distress syndrome (RDS) in the infants of preeclamptic mothers. On the contrary L/S ratios less than or equal to 1.6 may be of limited predictive value in these women since only 1/3 of the children developed RDS. When preeclampsia was combined with intrauterine growth-retardation of the fetus, RDS was found to be less apt to develop. In 21 samples of amniotic fluid from 13 women with idiopathic intrauterine growth-retardation of the fetus the L/S ratios were significantly below those in the reference series (p less than 0.05). No case of RDS was observed.
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