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Armed conflict brings about significant health-related consequences to the non-combatant population especially the elderly, women, and children. The consequences for women extend further than battle-related deaths. One important consequence of conflict is the population displacement resulting from individuals and families seeking safety in non-conflict zones. This forced migration places women at risk of gender-based violence during their journey and for this reason the host countries should ensure that the migrants are given access to reproductive health services, including providing emergency contraception and abortion. In the conflict zone, the collapse of all social support, including healthcare services, contribute towards a marked deterioration in the level of care provided to ensure reproductive health and safe motherhood. In addition, the community living the conflict zone is at an increased risk of community infectious disease and poor management of chronic illness. Women and children are almost always innocent victims of war. The international community must act effectively to primarily avoid conflict by sound diplomatic intervention and, when diplomacy fails, reduce the consequences of conflict.

Because of the fear of the use of pharmacological agents, many pregnant women are opting to use alternative management modalities either as primary management or to compliment standard contemporary medical practices. The traditional complementary physical interventions of acupuncture, acupressure, and electrostimulation have a long tradition of use in traditional Chinese medical practice and are advocated for the management of antenatal conditions such as spontaneous miscarriages, gastrointestinal, respiratory, and urinary problems. They have also been advocated as useful to help the process of labour in promoting a cephalic delivery, induction/augmentation of labour and pain relief. Postpartum these modalities have been said to help the secretion and production of milk. While a number of studies, some randomized controlled, have suggested a potential role for these traditional complementary physical interventions, systematic reviews have generally failed to show a definite conclusive beneficial role and all reviews generally suggest the need for further controlled research in the field. Since no adverse effects appear to be associated with the use of these modalities in pregnancy, such modalities of management can be considered but only as an adjuvant to standard pharmacological management after a full clinical assessment has ruled out underlying pathology.

Air travel and long distance travel may have adverse effect on the pregnancy-induced physiology and these effects are more marked among those with pre-existing medical conditions. There are significantly increased risks of deep venous thrombosis, inflight transmission of infections, preterm labour, and other significant obstetric and medical complications that may be exacerbated by the flight and may require emergency care. Transient changes in cardiotocographic tracings during third trimester of pregnancy have been reported following air travel. It has been suggested that pregnant members of the flight crew may be at a slightly higher risk of spontaneous miscarriages. There are no contra-indications for healthy pregnant women on air travel. Those with underlying medical conditions should only embark on long distance travel following consultation with their obstetrician. Pregnant women should be advised to familiarise themselves with the healthcare system in the country/region they will be visiting and draw up an emergency plan of how they will contact the healthcare system at their destination.

AIMS The reported frequency of monogenic defects of beta cell function in gestational diabetes (GDM) varies extensively. This study aimed to evaluate the frequency and molecular spectrum of variants in genes associated with monogenic/atypical diabetes in non-obese females of Maltese ethnicity with GDM. METHODS 50 non-obese females who met the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria for diagnosis of GDM and with a first-degree relative with non-autoimmune diabetes were included in this study. Whole exome capture and high throughput sequencing was carried out. Rare sequence variants were filtered, annotated, and prioritised according to the American College for Medical Genetics guidelines. For selected missense variants we explored effects on protein stability and structure through in-silico tools. RESULTS We identified three pathogenic variants in GCK, ABCC8 and HNF1A and several variants of uncertain significance in the cohort. Genotype-phenotype correlations and post-pregnancy follow-up data are described. CONCLUSIONS This study provides the first insight into an underlying monogenic aetiology in non-obese females with GDM from an island population having a high prevalence of diabetes. It suggests that monogenic variants constitute an underestimated cause of diabetes detected in pregnancy, and that careful evaluation of GDM probands to identify monogenic disease subtypes is indicated.

Pregnant women often resort to herbal medication to ameliorate the disturbing symptoms associated with pregnancy in the mistaken belief that these are safe and carry no potential harmful effects to the developing fetus. Healthcare personnel must be cognizant of the potential adverse side effects of these substances to be able to better advise their patients.

In this ten-year retrospective study we were able to show that Maltese substance-misusing mothers (SMMs) have significantly different socio-biological characteristics from mothers in the general population which seem to impact on neonatal outcomes. Significant differences from the general population were noted in the SMM's age, age at first pregnancy, marital status, educational background, number of cigarettes smoked, number of offspring and weight gained in pregnancy. SMMs booked their pregnancy in hospital later than the general population. On the other hand their infants had a lower mean birth weight and head circumference, had lower Apgar scores, were of lesser gestational age and premature. They were less breast-fed and stayed longer in hospital after their birth.

BACKGROUND: Infants born with a higher birth weight have long been associated with an increased incidence of developing the metabolic syndrome starting from early childhood and persisting into adult life. Such risk factors include genetic tendencies as well as environmental factors. Of these, certain maternal anthropometric characteristics such as obesity or carbohydrate intolerance alter the intrauterine environment to one of nutritional plenty, thus impacting on intrauterine development. This hypernutrition pathway has led to the hypothesis of 'fuel mediated teratogenesis' and an obesogenic environment. AIM: The aim was to identify a relationship across 3 generations relating to body weight and birth weight in order to identify whether a genetic and/or nutritional role are involved in the observed transmission. METHODS/MATERIALS: The study utilized 2 clinical databases. The first consisted of a cohort of 182 women born in 1987 and who delivered a child between 2004-2010 [2nd Generation]. A total of 233 infants were born [3rd Generation]. This was further linked to another database of women who had delivered a child in 1987 [1st Generation]. The birth weight of the 2nd and 3rd generations and the pre-pregnancy body mass index (BMI) of the 1st and 2nd generation were registered as was the development of features of the metabolic syndrome in the 1st generation population. The 1st generation population was subdivided into 2 groups based on the BMI: BMI =25 kg/m2 (n=106). The mean birth weights and pre-pregnancy BMI of the subsequent generations were compared using the student t-test. RESULTS: There was no direct transgenerational link between the first generation BMI and third generation birth weight. Rather, birth weight was directly linked to maternal BMI. Furthermore in this study we also studied the presence of metabolic syndrome in first generation mothers. The presence or absence of metabolic syndrome did not cause any statistically significant difference in the birth weight of 2nd and 3rd generations. CONCLUSIONS: This study supports previous reports that environmental factors play a key role in determining fetal birth weight. Identifying women with a higher pre-pregnancy BMI and educating them with regards to dietary modification in order to reduce body weight prior to pregnancy would contribute towards less adverse outcomes to the mother and her child in both the short and the long term.

Objective: This study aimed to investigate the role of genetic biomarkers in assessing risk for the eventual development of type 2 diabetes mellitus (T2DM). Methods: Three Maltese women with a history of previous severe GDM and with apparent similar clinical risk factors underwent anthropomorphic and metabolic reassessment 4–7 years post-partum. They were further genotyped for four specific genetic single nucleotide polymorphisms (SNPs) using the qPCR technique for the alleles of SLC2A2 (rs5393A/C), FTO (rs9939609A/T), PCK (rs2071023C/G) and CDKAL1 (rs10946398A/C). Results: While the previous obstetric history of all the caseswas similar, the biological statuswas characterized by an increasing degree of obesity correlating to increasing severity of current carbohydrate intolerance. Genotyping showed that all the tested SNPs were homozygous mutant in the T2DM woman and heterozygous in the impaired glucose tolerance woman. The woman with normal glucose tolerance was shown to be wild type for SLC2A2 (rs5393A/C). Conclusions: There appeared to be an interrelationship between eventual severity of carbohydrate metabolism abnormalities and the genetic allele status. It would appear that the specific allele-scoring can be used to identify further the potential risk of developing T2DM., peer-reviewed

Conjoined twinning is a relatively rare event in any community, with a rate of 1.58 per 100,000 maternities reported in the EUROCAT database. The present study reviews the historical records for conjoined twins born in a closed Central Mediterranean archipelago population with particular reference to the last three decades. While the natural monozygotic twinning rates in the Maltese Islands corresponds to that reported from other communities, the incidence of conjoined twinning in the Maltese Islands has been shown by the present study to be significantly 2.5-times higher than that reported by the remaining EUROCAT contributors. The rate reported from the Maltese Islands by this review is 3.98 per 100,000 maternities.

The Maltese population traditionally harbours Roman Catholic beliefs that have been gradually secularised. The present study sets out to quantify the consequences of more liberal sexual attitudes in this community.We reviewed the reproductive and sexual health indicators reported from Malta and from other selected European countries. We then analysed the findings of a questionnaire study which was carried out among 200 Maltese and 2200 other European individuals to investigate various aspects of their sexual history.A greater proportion of Maltese births occur in teenagers but the out-of-wedlock maternity rate in Malta appears to be the third lowest in Europe. However, the rate appears to have nearly trebled over seven years. Sexually transmitted infections rates in Maltese are either similar to or lower than those reported from the other European countries. The Maltese reported a higher mean age at first intercourse and a lower mean number of sexual partners mainly in women aged over 35 years. They received an earlier sexual education but they still predominantly resorted to unreliable contraception methods at their first sexual encounter.The study confirms that sexual behaviour has changed. The educational support to deal with these altered practices is in place but still needs to be reinforced.

The interplay of various nutrients provided to the developing foetus determines the growth potential of the conceptus. This study assessed the inter-relationship between these nutrients in a Mediterranean population including 1062 pregnant, previously non-diabetic women. These underwent an oral glucose tolerance test (oGTT) and were accordingly classified into gestational hyperglycaemic and normoglycaemic groups. Fasting insulin, HbA1c, and lipid profiles were further assessed, and the anthropomorphic characteristics of the mother and child at birth were measured. Lipid profiles were compared between the two groups and related to the biological characteristics of the mother and child at birth. Gestational hyperglycaemia was significantly associated with elevated triglycerides (P

Screening and diagnostic criteria for gestational diabetes (GDM) are inconsistent across Europe, and the development of a uniform GDM screening strategy is necessary. Such a strategy would create opportunities for more women to receive timely treatment for GDM. Developing a consensus on screening for GDM in Europe is challenging, as populations are diverse and healthcare delivery systems also differ. The European Board & College of Obstetrics and Gynaecology (EBCOG) has responded to this challenge by appointing a steering committee, including members of the EBCOG and the Diabetic Pregnancy Study Group (DPSG) associated with the EASD, to develop a proposal for the use of uniform diagnostic criteria for GDM in Europe. A proposal has been developed and has now been approved by the Council of the EBCOG. The current proposal is to screen for overt diabetes at the first prenatal contact using cut-off values for diabetes outside pregnancy, with particular efforts made to screen high-risk groups. When screening for GDM is performed at 24 weeks' gestation or later, the proposal is now to use the 75 g OGTT with the new WHO diagnostic criteria for GDM. However, more research is necessary to evaluate the best GDM screening strategy for different populations in Europe. Therefore, no clear recommendation has been made on whether a universal one-step, two-step or a risk-factor-based screening approach should be used. The use of the same WHO diagnostic GDM criteria across Europe will be an important step towards uniformity.

The use of illicit drugs has increased disturbingly in the last decades, this increase being reflected by an increase in the number of female drug abusers who present in the pregnant state. A total of 47 cases of current or past heroine abuse (0.24% of total maternities) were delivered at the Karin Grech Maternity Unit of St. Luke's Teaching Hospital in Malta. The socio-biological characteristics of these women were assessed and compared to similar parameters in the remaining pregnant population. These women have been shown to be generally of a younger age

Epidemiological observations have suggested a relationship between type 2 diabetes and a low or high birth weight. However, there are many confounding variables and problems with retrospective data collection. The study of women with gestational diabetes mellitus (GDM), who are likely to develop type 2 diabetes in the future, may help clarify these observations. Women diagnosed as suffering from GDM (n=162) were included in the study if their own birth weight data were available. The birth-weight distribution of the general population was obtained from published data for the same period. A family history of diabetes prevalence was assessed from medical records for the 162 GDM subjects, and by direct interview of 250 non-diabetic pregnant controls. The birth-weight distribution of women with GDM, when normalized to that of the general population, showed a statistically significant U-shape with a greater proportion of GDM women having low (1000–2000 g) or high (>4500 g) birth weight. Compared to non-diabetic pregnant controls, a statistically higher proportion of GDM women had a maternal family history of diabetes; the mean birth weight of these women was also statistically higher than that of GDM women with no family history of diabetes. No such differences were noted among women with a paternal family history. These data suggest that the intrauterine millieur Interieur, whether one of nutritional deprivation or one of nutritional plenty, results in changes in pancreatic development and peripheral response to insulin that may lead to adult-onset GDM and type 2 diabetes. Genetic predisposition, unless determined by mitrochondrial genetic material, does not apparently have any part in determining birth weight.

This study was carried out to quantify secular trends in seasonal variation in births in Malta, a small Mediterranean country where the vast proportion of births occur in wedlock due to a predominantly Roman Catholic population. It also related such variations to seasonal variation in marriages. Annual seasonal peaks of marriages and births were analysed over the period 1950–1996 by X11 ARIMA. A significant peak in marriages (n=111,932) in the third quarter of the year was found for almost the entire period under study. This was paralleled by a peak in births (n=299,558) for the period 1970–1996, which lagged after the peak in marriages by 13–14 months. For the period 1994–1996, when monthly data for monthly pregnancies were available by pregnancy order, the peak in births was caused by first pregnancies only. Seasonal patterns in births occur almost universally due to cultural and/or biometeorological factors. The best known patterns include those of the southern United States, where births decline in April and May, and in northern Europe, where births peak in March and April. In Malta, the late summer peak in births appears to be due to a practical and planned approach by Maltese couples to contraceptive planning, probably influenced by the Roman Catholic ethos and social pressures, with unprotected intercourse occurring only after marriage. In Malta, birth control, albeit by so-called natural methods, was introduced in the 1960s. Prior to this period, births peaked towards the beginning/end of the year, and this may be the more natural seasonality of births in Malta., peer-reviewed

Syndromic adiposity appears to have a predisposition to run in families suggesting a hereditary element in its transmission. Purely genetic defects and DNA sequence variants have been directly associated with the development of adiposity; however, these account for a very small proportion of cases. A stronger association has been made between the intrauterine and early childhood nutritional environment of the foetus and young child and the predisposition of childhood and subsequent adulthood obesity. The nutritional environments include both a situation of nutritional deprivation or excess working through the interplay of epigenetic changes, and pancreatic and hypothalamic development. This is further compounded by the nutritional and lifestyle attitudes of the particular at-risk family. Adiposity prevention measures must include reenforced intervention strategies stating with lifestyle education schemes during pregnancy followed through until infancy and early childhood especially in those families/individuals identified as being at a risk of developing significant adiposity.

The Mediterranean region is generally characterized by a patriarchal society that generally predisposes towards a higher prevalence of spouse abuse. The prevalence of domestic spouse abuse in a central Mediterranean closed island community was assessed to approximate 11.7% of the pregnant population. The abuse varied from psychological to physical abuse. There was a strong history of experience of domestic violence/abuse during childhood in both the victim and perpetrator suggesting that a “circle of abuse” may play a role in some cases. The socio-biological characteristics of the victim did not appear to statistically predispose towards a higher risk for domestic abuse, though single mothers were statistically more likely to report a history of domestic abuse. Abused women were more likely to smoke cigarettes during pregnancy than their counterparts. The perpetrator was statistically more likely to be unemployed, and smoke cigarettes and drink alcohol. There were no statistical correlation between a history of spouse abuse and educational level attained by both the victim and perpetrator. A history of domestic abuse appears to have an adverse effect on the pregnancy with a higher risk of premature birth and its attendant complications; although it is difficult to ascertain how much the reported poor obstetric outcome is a direct effect of violence itself or to other associated adverse social or biological co-factors. About a third of the women interviewed were unaware of the domestic violence services being offered in their community emphasizing the need of an information drive. The antenatal period, with the distribution of leaflets and antenatal classes, is an opportune time to promote the support services available in the community.

AimRecent studies have shown a correlation between environmental pollutants and increased risk of selected congenital malformations. The South-East area of the Island of Malta is much more industrialised than the more rural North-West area. The aim of this study was to test the null hypothesis that there are no regional differences in Malta in the prevalence at birth of congenital cardiac malformations. Methods: Live born infants with congenital cardiac malformations born between 1990 and 1994 were allocated to 10 areas, and thence to 2 regions of 5 areas each, so as to constitute North-West and South-East Malta. Official publications gave population totals and growth rates. Those infants with congenital cardiac malformations were then compared between the different regions using χ2and the Mann-Whitney U test.ResultsThe overall prevalence of congenital heart disease at birth was 8.8/1000 live births. The birth prevalence for the South-East region (10.1/1000 LB – 95% CI 8.4–12.3/1000 live births) was significantly higher than for the North-West (7.4/1000 live births – 95% CI 6.0–9.0/1000 live births) – p=0.03, Odds ratio 1.38 (95% CI 1.05–2.61). The Mann-Whitney U test showed a significant difference in the distribution amongst the 10 defined areas (p=0.016). The Central-East area had the highest prevalence of cardiac malformations in the entire Island – p=0.02, Odds ratio 1.70 (95% CI 1.10–2.61). Demography showed an efflux of individuals from the South-East of Malta.ConclusionThe higher prevalence of congenital heart disease noted at birth in South-East Malta is unlikely to be due to genetic factors, as these would have migrated North-West along with the population movement. An environmental factor, therefore, seems more likely to be responsible for the increased predisposition to congenital heart disease in the South-East of Malta.

The article by Zhu et al. published inDiabetes Care concludes that a fasting plasma glucose (FPG) at 24–28 weeks’ gestation can be used in low-resource regions as a screening test to identify gestational diabetes mellitus (GDM) in Chinese patients. However, in their experience, a screening protocol using FPG cutoff points of $4.4 and #5.0 mmol/L would fail to identify about 12% of the GDM cases and require a formal oral glucose tolerance test (OGTT) to be performed in about half of the pregnant population. These observations contrast with our findings in a circum-Mediterranean population., peer-reviewed

The aim of this study was to assess the level of knowledge and awareness related to preconception care among Maltese women of reproductive age with type 1 diabetes mellitus (T1DM).Thirty-seven T1DM women, aged 12-30 years, were self-administered a questionnaire related to diabetes self-management and preconception care. The participants then underwent an educational intervention and re-took the same questionnaire.Before the intervention, 26 participants (70%) claimed they did not have any knowledge about the preconception care of diabetes. Of the remaining 11 participants, the main reported source of information about diabetes care was the diabetologist (n = 8; 6.7%). The response rate was 70% (26 out of 37 participants completed the questionnaire after the educational intervention). Six of the participants who initially reported no preconception care knowledge claimed an increased awareness after the event. There was a statistically significant increase in the knowledge scores after the intervention.It is evident that there is a lack of awareness of the importance of pre-pregnancy planning to avoid pregnancy-related complications with diabetes. This emphasizes the need for more education and it is imperative for healthcare professionals to address these issues with adolescent female patients.

The literature relating to homozygous beta-thalassemia and the problems these patients have during their pregnancy is reviewed and another case report of a twin pregnancy in a homozygous beta-thalassemia individual is included. The majority of cases described refer to the intermedia clinical form of the hematological problem because patients with thalassemia major generally have poor sexual development. Although the reported cases had a greater frequency of delayed development, only one woman suffered from infertility and required ovulation induction agents. The thalassemia pregnant mother faces deleterious consequences resulting from chronic anemia and in nonsplenectomized patients there remains the risk of the onset of a hypersplenic crisis. The problems of splenectomized patients during pregnancy is also discussed. The chronic anemia of thalassemic patients predisposes to a poor fetal outcome with greater fetal loss, preterm labor, and intrauterine growth retardation.

Objective: This study is aimed to assess the influence of body shape on Body Mass Index (BMI) estimations by determining the Sitting Height to Standing height ratio. Methods: The study population included 291 non-pregnant premenopausal Maltese women aged 20-54 years. These women were assessed using the following anthropometric measurements: Body weight (Kg), standing height (cm) and sitting height (cm). The Sitting-to-Standing Height (SH/S) ratio, the observed BMI (oBMI) based on the standing height, and the SH/S ratio-corrected BMI (cBMI) were calculated. The SPSS package version 18.0 was used for statistical calculations. Results: The average SH/S ratio of the Maltese premenopausal women is 0.44. The mean oBMI is 25.06, while the mean cBMI is 34.49 (P value < 0.001). Applying the linear regression prediction model with either oBMI or cBMI as dependent variables and the SH/S ratio as independent variable proved that the sitting height is a significant predictor of both oBMI and cBMI (P value < 0.00001). Conclusions: The results suggest that the cohort of this study tend to have long legs relative to torso-length (low SH/S ratio). Thus, the oBMI will underestimate the actual BMI value. The correction of BMI for the sitting height in Maltese population will more correctly identify individuals at greater risk for chronic diseases.

Endometrial adenocarcinoma has been associated with prolonged oestrogen exposure causing endometrial hyperplasia and adenocarcinoma. Metabolic disorders and nutritional factors may contribute towards obesity and the increased adipose production of oestrogen. The study confirms the association between endometrial carcinoma risk and diabetes mellitus and increased total fat intake. It further relates the malignancy to a prolonged natural oestrogen exposure period and confirms the protective role of past pregnancies.

Gestational diabetes is often compounded by hypertensive disease of pregnancy. Women diagnosed as suffering from gestational diabetes were subdivided into two groups: those found to be suffering from some form of hypertension during their pregnancy [n=78]; and those who did not develop hypertension [n = 345]. The maternal characteristics and perinatal outcome of the two groups were statistically correlated. The results show that obesity was the only statistically significant correlate, and that obstetric outcome more often required planned delivery by induction of labour or caesarean section. The infant was more likely to be delivered prematurely. While the perinatal morbidity did not show any significant differences, this was only because of the more active intervention policy in these women., peer-reviewed

The collection and evaluation of obstetric data is essential for assessing the effectiveness of the health and social services in a country. A computerized system in use on a national level is described. The person-based system aims to include all patients who encounter government medical services, including obstetric and infant data. The scope of the service is to make individual patient records easily available to the practitioner, but is designed to allow statistical analysis of the data.

a Chinese population with the highest rate of MTHFR C677T mutation. The number of cases is rather low in the NTD group, as in the control group, and larger population studies are needed to confirm this association. These results suggest that the presence of MTHFR C677T in mothers with normal folate levels may be a risk factor for NTD development in our population and that consideration should perhaps be given to folate supplementation.

The significant threshold values for the 75-g oral glucose tolerance test (oGTT) during pregnancy have yet to be conclusively determined. This study aimed to identify the risk significance of various set thresholds for the oGTT result. Women undergoing a 75-g oGTT during the third trimester of pregnancy were classified into three groups: mild gestational impaired glucose tolerance (GIGT; 2-h postload glucose, 8.0-8.5 mmol/l; n=75), moderate-severe GIGT (8.6-10.9 mmol/l; n=167), and GDM (> or =11.0 mmol/l; n=76). Outcome indicators of these three groups of women were compared to the parameters of the women with a presumed normal carbohydrate metabolism (n=12,185). The results show that with increasing oGTT thresholds, there was an increasing risk of maternal morbidity in the form of hypertensive disorders complicating pregnancy, as well as obstetric intervention such as induction of labor, cesarean delivery, and preterm delivery. The infant was also at increasing risk with increasing oGTT thresholds from respiratory distress, macrosomia, and associated shoulder dystocia. It would appear, therefore, that abnormal glucose tolerance in pregnancy, even as defined by the World Health Organization criteria, has proportionate risks to both mother and child.

Diabetes mellitus is generally associated with a higher incidence of early pregnancy loss and congenital anomalies, though this relationship should be strictly restricted to patients with previously existing diabetes. In gestational diabetes mellitus, which often develops during the third trimester, no such relationship should exist, though the birth of a previous infant with a congenital anomaly is often assumed to be a risk factor for gestational diabetes. Objective: The study attempts to analyse the congenital anomaly rate in women with gestational diabetes and compare this to the rates in women known to have normal glucose tolerance. Results: The prevalence of infants/fetuses with congenital anomalies born to women with gestational diabetes amounted to 4.48%, a rate similar to that recorded in women with normal glucose tolerance (4.54%). Conclusions: The development of gestational diabetes, in contrast to pre-existing diabetes, does not appear to be associated with an increased risk for teratogenesis., peer-reviewed

Objectives: To identify any effects that lead, calcium, magnesium, and zinc may have on the development of gestational hypertension. Methods: Third-trimester 110 normotensive and 33 gestational hypertension cases were assayed for various metal levels, using standard techniques, including atomic absorption spectrometry. Results: Gestational hypertension cases showed significantly higher blood lead levels than normotensives. No differences were noticed regarding calcium (ionized and total), magnesium, and zinc levels. Blood lead was significantly related with blood pressure, even after correcting for the body mass indices and age. Blood pressure levels showed no relation to the other analyzed metals. However, the lead:ionized calcium ratio showed a stronger association with blood pressure, than lead alone. Blood lead showed a significant negative relationship with ionized calcium, but none with the other metals. Conclusions: Blood lead evidently influenced blood pressure increments and gestational hypertension development. This implies that all efforts should be made to reduce the population's exposure.

A previous study showed that significantly more boys were born in southern latitudes in Europe than in northern latitudes and the converse pattern was observed in North America.This study analyses secular trends in gender ratios for live births over the second half of the 20th century.Analysis was carried out from a World Health Organisation dataset comprising live births over the above period. This included 127034732 North American and 157947117 European live births.Analysis of trends in gender ratios for countries in both continents.The findings show a highly significant overall decline in male births in both Europe and North America (p0.0001), particularly in Mexico (p0.0001). Interestingly, in Europe, male births declined in North European countries (latitude40 degrees, p0.0001) while rising in Mediterranean countries (latitude congruent with 35-40 degrees, p0.0001). These trends produced an overall European male live birth deficit 238693 and a North American deficit of 954714 (total male live birth deficit 1193407).No reasonable explanation/s for the observed trends have been identified and the causes for these trends may well be multifactorial.

Severe forms of GDM have been conclusively associated with significantly increased risk of developing DM later on in life. The long-term significance of GIGT has not yet been definitely elucidated. The study was set up to compare the present carbohydrate metabolism status and anthropomorphic characteristics of women diagnosed as suffering from abnormal carbohydrate tolerance during pregnancy eight years previously with those recorded as having normal glucose tolerance. The prevalence of present abnormal glucose tolerance was significantly higher in women who had been noted to have carbohydrate intolerance during their pregnancy, the prevalence depending on the gestational severity (10.0% in normal glucose tolerance, 36.4% in borderline GIGT; 66.7% in GIGT). Women whose overweight or obese status persists or develops after their pregnancy were statistically more likely to develop abnormal glucose tolerance later on in life (11.9-12.5% in normal-overweight BMI, 38.2% in obese BMI). A maternal and sibling, but not paternal, family history of diabetes was also a statistically significant risk factor. GIGT appears to be a definite risk factor for the development of carbohydrate metabolism problems later on in life, this being related to the severity during pregnancy and the presence or development of obesity. It is proposed that women diagnosed to suffer from GIGT should be regularly monitored after the pregnancy, particularly if other risk factors such as obesity are also present., peer-reviewed

This letter to the editor focuses on the bias associated with online survey tools. It specifically describes a recent online survey which attempts to identify the pattern of contraceptive usage in the Maltese population. It discusses the survey findings and provides recommendations on how to better address the bias in these studies.

Multiple births have increased significantly in the last decades throughout the developed world including the Maltese Islands as a result of increasing use of artificial reproductive technology. In spite of advances in obstetric care seen throughout the second half of the twentieth century the perinatal outcomes associated with a multiple pregnancy remain associated with increased morbidity and mortality for the mother and infants. This study attempts to assess the characteristics and outcomes of these pregnancies in the Maltese population. The Maltese national maternity data for 2000-2004 were analyzed [19935 maternities; 20215 births] and various outcome parameters were statistically compared between twin and singleton births using the chi square test. (excerpt)

The conflicts created by the Church's teachings vis-'a-vis scientific advances and society's expectations have been strongly felt in a small traditionally Roman Catholic community like the Maltese Islands. These conflicts, particularly in issues related to reproduction, have throughout the centuries resulted in efforts by the ecclesiastical authorities in Malta to control medical matters. Therefore, this article portrays how the Roman Catholic church influenced Midwifery practice in Malta., peer-reviewed

Diabetes in pregnancy is associated with a higher mortality–morbidity for both the mother and child. The 1989 St. Vincent’s Declaration had set the goal of achieving ‘‘a pregnancy outcome in the diabetic woman that approximates that of the non-diabetic woman’’. The study aimed to assess outcome indicators of Maltese pregnant women suffering from diabetes and compare these with the remaining obstetric population. (excerpt)

Epidemic Meningococcal meningitis first made its definite appearance in Europe in the beginning of the nineteenth century. The first recorded epidemic in the Maltese Islands, which straddled the sea-routes of the Mediterranean, occurred in the late nineteenth century. This paper describes a manuscript report prepared at the request of the Lieutenant Governor regarding this epidemic in the light of the contemporary knowledge about the infection., N/A

In mammals, male live births exceed female ones. In humans, the ratio of male births to total births is expected to be 0.515. In Europe during 1990-5 this differed significantly with increasing geographical latitude.1 We analysed and compared the male to female ratio in Europe and North America over 50 years. We obtained annual data on male and female live births from the World Health Organization (WHO) for the North American continent for 1958-97 and for European countries for 1950-99. Overall

One hundred patients undergoing vaginal surgery for genital prolapse were randomly allocated to one of four post-operative management groups which included a control group and three groups receiving differently acting pharmacological agents (distigmine bromide, phenoxybenzamine hydrochloride, and prostaglandin F2 alpha) variously reported as being useful in preventing urinary retention after vaginal surgery. The incidence of an elevated residual volume in the control group was 10.7%. All the pharmacological agents appeared to increase by about three times the incidence of an elevated residual urinary volume with statistical significance (P less than 0.05) being noted for distigmine bromide and PGF2 alpha. While this increased incidence occurred irrespective of the type of surgery in the case of distigmine bromide and phenoxybenzamine . HCl, the increase was most marked (P less than 0.01) when PGF2 alpha was used after anterior repair surgery.

Pethidine levels in maternal and fetal blood were estimated at birth after variable periods of intramuscular administration--delivery intervals in forty pregnant women. The results suggest that maternal--fetal equilibrium occurs at a fast rate with a regression coefficient initially of 0.54. There appeared to be a tendency towards trapping of the drug in the fetal circulation resulting in a rise in the regression coefficient after 3 h reaching 0.85. The pharmacokinetics and the clinical significance of these observations are discussed.

This study analyses the multiple birth statistics for the Maltese Islands since 1959. Hospital twin births delivering during the period of 1983-1985 are analysed for a number of variables. The incidence of multiple pregnancy for the Maltese Islands appears to have decreased slightly since 1959 with an overall rate of 10.21 per 1000 maternities. The ratio of dizygotic to monozygotic twinning was computed to be 1.64. Patients with multiple pregnancies are shown to be generally elderly and multiparous. The pregnancy outcome is more likely to be complicated by an operative delivery, while the infant is more likely to be premature and of low birth weight. The perinatal mortality rate for multiple pregnancies is markedly in excess of that for singleton births.

Maternal mortality statistics from the Maltese Islands since 1935 are reviewed to show that there has been a marked decrease in maternal mortality rates. This decrease is probably related to reductions in family size and improvements in the perinatal care of mothers. Hypertensive disease is now the most important cause of maternal mortality.This study attempts to analyze national maternal mortality and morbidity statistics collected for the Maltese Islands since 1935 in order to identify the current major causes of maternal deaths on the Islands. In 1926, the maternal mortality rate was an estimate 387.3/100,000 live births, white the rate in 1982 was 32.9/100,000 live births. This reflects a sharp decrease in the last 45 years. This decrease is probably related to reductions in family size and improvements in the preinatal care of mothers. Maltese women are having fewer pregnancies, are beginning childbearing when they are in their 20s or early 30s and are spacing their pregnancies at longer intervals. Improvements in the socioeconomic status of pregnant women in the Maltese Islands have also played an important role in decreasing maternal mortality and morbidity. hypertensive disease is now the most important cause of maternal mortality.

Summary: Two cases of postmenopausal labial adhesions in patients with severe hip joint disease are presented. The aetiology of labial adhesions in the postmenopausal woman is discussed. Hip joint disease is shown to influence the formation of adhesions by interfering with perineal hygiene and decreasing sexual activity.