Omega-3 fatty acids have been shown to lower plasma cholesterol and triglycerlde concentrations In humans. However, the effects of these fatty acids on the Interactions among llpld concentrations, platelet activity, and atherogenesls have not been characterized In humans or In animals with low density llpoproteln (LDL) receptor deficiencies. To test the hypothesis that omega-3 fatty adds exert a protective effect In LDL receptor-deficient animals by lowering hyperlipldemla, reducing platelet aggregation, and reducing the severity of atherosclerosis, we evaluated young homozygous Watanabe heritable hyperlipidemic (WHHL) rabbits that were fed omega-3 fatty adds. One-month-old male and female WHHL rabbits were placed on either a control diet (standard laboratory rabbit chow) or a diet supplemented with Menhaden fish oil (MFO), which contained elcosapentaenolc acid (EPA). Consumption measurements during the 5 months of the study Indicated that the MFO-fed group received 150 to 200 mg/kg/day of EPA. Six-month-old, MFO-fed, female WHHL rabbits had significantly lower plasma concentrations of total cholesterol (582±20 mg/dl vs. 856±44 mg/dl, control, p<0.05) and triglycertdes (266±21 mg/dl vs. 459±15 mg/dl, control, p<0.05), with lower serum/plasma llpoproteln concentrations [very low density llpoproteln (VLDL), LDL, high density llpoproteln (HDL)] compared to control female WHHL rabbits. Male MFO-fed rabbits had only significantly lower VLDLs (46±9 mg/dl) compared to control male WHHL rabbits (156±9 mg/dl, p<0.05). The platelet fatty acid composition In MFO-fed rabbits had significantly greater amounts of omega-3 fatty adds and lesser amounts of omega-6 fatty acids. Additionally, the threshold concentration of collagen and arachldonate required to aggregate platelets In MFO-fed rabbits was nearly double that of controls. In contrast, the platelet aggregation response to the thromboxane analogue, U-46619, was similar in both groups of animals. Morphometric evaluation of intimal surface of the aortas failed to demonstrate significant differences In llpld accumulation or Intimal or medial thickening between MFO-fed and control WHHL rabbits, even when the potential effects of gender were considered. In conclusion: 1) omega-3 fatty adds exert hypdlpldemlc and antlplatelet effects In LDL receptor-defldent animals, and 2) despite these actions, omega-3 fatty adds do not reduce the severity of atherosclerosis In WHHL rabbits. (Arteriosclerosis 9:529-537, July/August 1989)

Summary: Coeliac disease is a gluten-sensitive enteropathy affecting up to 1% of the population. An accumulating body of evidence supports the association of coeliac disease with adverse pregnancy outcomes, including increased risk of miscarriage and intrauterine growth restriction. Reports differ regarding the extent and severity of these associations, in addition to the exact pathophysiology underlying these associations. Overall, coeliac disease is believed to be a significant condition in pregnancy and reproductive medicine with some advocating the screening of coeliac disease in all pregnant women or some specific high-risk groups.

The management of fetal macrosomia diagnosed antenatally is quite challenging to the obstetricians. The authors retrospectively reviewed charts of singleton pregnancies weighing 5000 g and over delivered between 2004 and 2008.This was to determine the maternal and neonatal morbidity and also whether lack of consistent management in two units infl uences the outcome.Over 5 year period there were 173 births out of 76 699 deliveries that weighed more than 5000 g. This gives incidence of 0.22%. The onset of labour was spontaneous in 52 (30.0%) cases, 69 (40%) were inductions and 52 (30.0%) were elective caesarean sections. Of 121 planned vaginal deliveries, 59 (48.76%) were spontaneous vaginal deliveries, 22 (18.8%) were operative vaginal deliveries and 36 (29.75%) were emergency caesarean sections. Only 104 cases that had ultrasound recorded estimated fetal weight (EFW). 84(48.5%) cases had EFW >95%, 29 had vaginal deliveries, 20 had emergency caesarean and 35 elective caesarean section contributing 52.8% to caesarean section rate. Of this group, 3 cases of shoulder dystocia (3.57%), 10 (11.9%) cases of post partum haemorrhage (PPH). 24 (13.87%) cases EFW<95%, nine had vaginal deliveries, nine emergency and six elective caesarean section. Of this group 1 case had shoulder dystocia (0.57%) and nine (5.2%) cases of PPH. The authors recommend when there is EFW >5000 g there is increase risk of caesarean section rate, Induction for fetal macrosomia alone did not improve the outcome. Variations in the care provided by different consultants did not have any infl uence on the outcome.