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Aims: To monitor pregnancies in women with pregestational Type 1 diabetes for pregnancy loss, congenital malformations and fetal growth parameters, in a geographically defined area in the north west of England., Methods: Population cohort study of 547 pregnancies in women with Type 1 diabetes from maternity clinics in 10 centres over a 5-year period (1995-1999 inclusive). Main outcome measures were numbers and rates of miscarriages, stillbirths, neonatal and post-neonatal deaths; prevalence of congenital malformations; birth weight in relation to gestational age., Results: Among 547 pregnancies, there were six (1.1%) pairs of liveborn twins, 439 (80.3%) liveborn singletons; 72 (13.2%) spontaneous abortions, 14 (2.6%) stillbirths and 16 (2.9%) terminations. Four of the terminations were performed because of congenital malformations. Both the stillbirth rate (30.1/1000 total births (95% confidence interval (CI) 16.6-50.0)), and prevalence of congenital malformations (84.3/1000 live births (95% CI 60.3-113.8)) were significantly higher than the local population (P < 0.001). When corrected for gestational age, mean birth weight in the sample was 1.3 sd greater than that of infants of non-diabetic mothers (P = 0.12). Infants with congenital malformations weighed less than those without., Conclusion: In an unselected population, the infants of women with pregestational Type 1 diabetes mellitus have 6.4 times the reported risk of a congenital malformation and 5.1 times the reported risk of perinatal mortality than infants in the general population. Further improvements in the management of diabetes and pregnancy in these women are needed if the St Vincent's Declaration target is to be met.

Objective: To monitor pregnancies in women with pre-existent insulin dependent diabetes for pregnancy loss, congenital malformations, and fetal growth in a geographically defined area of north west England., Design: Population cohort study., Setting: 10 maternity units in Cheshire, Lancashire, and Merseyside which had no regional guidelines for the management of pregnancy in diabetic women., Subjects: 462 pregnancies in 355 women with insulin dependent diabetes from the 10 centres over five years (1990-4 inclusive)., Main Outcome Measures: Numbers and rates of miscarriages, stillbirths, and neonatal and postneonatal deaths; prevalence of congenital malformations; birth weight in relation to gestational age., Results: Among 462 pregnancies, 351 (76%) resulted in a liveborn infant, 78 (17%) aborted spontaneously, nine (2%) resulted in stillbirth, and 24 (5%) were terminated. Of the terminations, nine were for congenital malformation. The stillbirth rate was 25.0/1000 total births (95% confidence interval 8.9 to 41.1) compared with a population rate of 5.0/1000, and infant mortality was 19.9/1000 live births (5.3 to 34.6) compared with 6.8/1000. The prevalence of congenital malformations was 94.0/1000 live births (63.5 to 124.5) compared with 9.7/1000 in the general population. When corrected for gestational age, mean birth weight in the sample was 1.3 standard deviations greater than that of infants of non-diabetic mothers. Infants with congenital malformations weighed less than those without., Conclusion: In an unselected population the infants of women with pre-existent insulin dependent diabetes mellitus have a 10-fold greater risk of a congenital malformation and a fivefold greater risk of being stillborn than infants in the general population. Further improvements in the management of pregnancy in diabetic women are needed if target of the St Vincent declaration of 1989 is to be met.

The Liverpool Visual Assessment Team (VAT) was established in 1975 as a multidisciplinary service for the evaluation of the disabilities of visually handicapped children. Team membership and patterns of practice are described. Two hundred and fifty-four children have now been seen by the VAT over a 10-year period. The mean age of referral was 4.2 years; only 46% of the children had an isolated visual handicap. The aetiology of disabilities was known in 58% of the children. Genetically determined visual handicap was likely to be associated with normal intelligence. Ophthalmological diagnoses are described. In comparison to what would be predicted, there were fewer children with retinopathy of prematurity and more with cerebral (cortical) blindness. The educational needs and placements of the children are described and the implications of the implementation of the 1981 Education Act for visually handicapped children are discussed.

In a prospective survey neural tube defects and other congenital abnormalities were studied in the babies born to 510 mothers ascertained during pregnancy. The women were divided into two groups according to the outcome of their immediately preceding pregnancy. Those whose preceding pregnancy had resulted in a spontaneous abortion (256 women) formed the index cases; those in whom the outcome had been a normal baby (254 women) served as controls. There was a highly significant increased number of congenital abnormalities in the index cases. This may possibly be explained by the trophoblastic "rest" hypothesis and suggests that spontaneous abortions are more relevent to congenital abnormalities than has been thought.