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Objectives. To study the efficacy of vitamin E supplementation for the reduction of preterm birth/low birth- weight newborns in pre-eclamptic pregnant women. Design. Comparison of the rate of preterm birth and low birthweight in pre-eclamptic pregnant women with or without vitamin E treatment. Setting. Hungarian Case-Control Surveillance Sys- tem of Congenital Abnormalities, 1980-1996. Population. Newborn infants in Hungarian population. Methods. Medically recorded pre-eclampsia and birth outcomes of pregnant women were evaluated. Main outcome measures. Preterm birth, low birthweight. Results. There was no lower incidence of pre-eclampsia after vitamin E treatment. Pregnant women with pre-eclampsia and without vitamin E treatment had a higher rate of preterm births (10.4% vs. 9.3%) and low birthweight newborns (7.8% vs. 5.6%) than the reference sample of 34,928 pregnant women without pre-eclampsia and without vita- min E treatment. The newborns of 936 pregnant women with pre-eclampsia and without vitamin E treatment had higher rate of preterm birth (10.4% vs. 8.6%; OR with 95% CI: 0.8, 0.7-0.9) than 81 pregnant women with pre-eclampsia but with vitamin E treatment. However, the rate of low birthweight newborns was somewhat but not significantly higher (8.6% vs. 7.8%; OR with 95 CI: 1.1, 0.8-1.4) in pregnant women with pre-eclampsia and with vitamin E treatment. There was very high rate of threatened abortion (45.7% vs. 15.3%) and threatened preterm delivery (27.2% vs. 13.5%) in 81 pre- eclamptic pregnant women with vitamin E treatment compared to the reference group. Conclusions. Vitamin E treatment reduced the rate of preterm birth in pregnant women with pre-eclampsia but not the rate of low birthweight newborns.

Human chorionic gonadotropin (hCG) is used for treatment of pregnant women with threatened and re- peated miscarriages/spontaneous abortions in Hungary. Thus the objective of the study was to evaluate the possible asso- ciation of medically recorded hCG treatment during the second and/or third gestational month in pregnant women with the risk of different congenital abnormalities in their offspring on the basis of comparison to pregnant women who were also treated with hCG and delivered control newborns without any defect in the population-based Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-1996. Of 22,843 cases with congenital abnormalities, 83 (0.36%), while of 38,151 controls without any defect, 97 (0.25%) had mothers with hCG treatment (adjusted OR with 95% CI: 1.6, 1.2- 2.1), though there was no association between any congenital abnormality group and a higher rate of maternal hCG treat- ment. In conclusion the detectable slight general risk for congenital abnormalities in the offspring of mothers with hCG treatment during early pregnancy may be connected with other factors, particularly the causes of previous miscarriages.

The prevalence of epilepsy is 0.3-0.6% in pregnant women and the higher rate of structural birth defects, i.e. congenital abnormalities (CAs) was recognized in their children. There are four aims of this review based on the popula- tion-based large data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA), 1980-1996 with the good validity of CA-diagnoses. (I) Most studies on the teratogenic/fetotoxic effects of antiepileptic drugs (AED) had too small samples therefore underpowered, thus the evaluation the findings of different studies together are appropri- ate to draw significant conclusions, therefore the data of HCCSCA are presented here. Of 22,843 cases with CA, 95 (0.42%), while of 38,151 controls without CA, 90 (0.24 %) had mothers with medically recorded epilepsy (OR with 95% CI: 1.8, 1.3-2.4) and AED in the prenatal maternity logbook. (II) Hungary had different spectrum of AED as in Western countries, thus the teratogenic potential of some less-known AED (e.g. sultiame) can be evaluated. (III) The efficacy of recent special medical care of epileptic pregnant women introduced in 1990 is worth checking. There was no significant increase in the proportion of monotherapy but the rate of total CAs decreased by 20% in the 1990s compared to the 1980s. (IV) Folic acid may reduce the teratogenic potential of some AED, nevertheless this analysis revealed that folic acid was used less frequently by epileptic pregnant women than by non-epileptic pregnant women. Thus an international consensus statement is an urgent task in this topic.