IntroductionRegulationist approaches in geography have identified the emergence of a strong dynamic of spatial competition under conditions of heightened capital mobility and a ratcheting down of the regulation of key factors of production to the local scale. This dynamic pits cities and regions against one another, disciplining places and workers' attempts to organize within them. Progressive reregulation of labor markets, according to this thesis, requires recreation of an effective national scale of labor regulation, which would create homogeneity across places, and so end the destructive`race to the bottom' of labor standards in which localities are currently engaged. Two complementary sets of work contain similar prescriptions for collective action. First, Marxist geographers have problematized the militant particularism of class politics, highlighting the apparent inability of many local struggles to articulate with each other and create movements operating at higher levels of geographical resolution, as well as at higher levels of conceptual abstraction. The abstraction sought is a global ambition that recognizes and acts upon the`raw class content' of many forms of oppression. Second, labor geographers have examined the production of scale in US and UK labor relations by the state, firms, and unions, and identified the importance of transnational forms of union solidarity, with examples largely from the manufacturing sector.These arguments, and the political^economic analysis that underpins them, are convincing and demonstrate the importance of spatial patterns of capital accumulation and unionism in labor regulation and resistance. Yet there is an interesting lack of fit between the kinds of prescriptions and foci arising from geographical analyses of labor and class struggle, and developments in contemporary labor activism in the USA, which clearly do not reflect the`scaling up' so often advocated and examined. Rather, key labor-movement strategies including the organizing focus of the AFL^CIO (the peak body for unions in the USA), numerous`living-wage' campaigns around the country, and the efforts of labor^community coalitions, are targeting the city-scale,
This study aimed to assess the perinatal outcome, especially foetal growth, following the continuation of metformin during the first trimester of pregnancy. All women with polycystic ovary syndrome (PCOS) treated with metformin in the first trimester and who delivered a baby weighing 500 g or more between 2003 and 2005 were studied. Subjects were matched for age and parity with randomly selected controls. The perinatal outcomes studied were: growth parameters, gestational age, congenital defects, hypoglycaemia and neonatal unit admission. Sixty-six pregnancies were compared with 66 controls; all had singleton deliveries. There was no difference in mean birth weight between the metformin and the control groups (p=0.84). The percentage of small (<10th centile) and large (>90th centile) for gestational age babies was lower in the metformin group. In the metformin group, there were no major congenital malformations and 24% of the babies were admitted to the neonatal intensive care unit (NICU) compared with 27% of the babies in the control group (non-significant). Neonatal hypoglycaemia was less common in the metformin group (18.5% vs. 24.5%) and fewer babies required intravenous glucose therapy (6.3% vs. 12%). We found no evidence that the continuation of metformin in the first trimester of pregnancy was associated with an adverse foetal outcome.
The objective of this study was to review the first 50 clinical pregnancies of women with polycystic ovarian syndrome (PCOS) who had ovulation induced either with metformin alone, or in combination with clomifene. The study was confined to women with PCOS attending our infertility service. A register of clinical pregnancies was maintained of women who conceived after metformin therapy. The metformin was continued throughout the first trimester. The outcome of pregnancy was determined by individual chart review. Of the 50 women, 21 conceived with a combination of clomifene and metformin, and 29 with metformin alone. Seven women had a first trimester loss and 43 had a live birth. There were no perinatal deaths, no neonatal seizures and no congenital malformations. There were also no multiple pregnancies. The overall caesarean rate was 37%, and none of the babies had an Apgar score less than 7, at 5 min. This study found no evidence of any adverse clinical effects when metformin is continued in the first trimester of women with PCOS following ovulation induction. There was also no evidence of an increase in the rate of miscarriage or multiple pregnancy.
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