External Conjugate Research Articles

Internal Versus External Pelvimetry: A Validation Study With Clinical Implications

INTRODUCTION:Investigating the correlations between external pelvimetry variables and actual birth canal dimensions has important implications for clinical practice, especially for predicting dystocia. This validation study tests external and internal pelvimetry correlations.METHODS:This single-centered retrospective study included 142 women with records of computed tomography pelvimetry. The correlations between four internal variables (obstetric conjugate, transverse diameters of inlet, midplane, and outlet) and five external variables (intertrochanteric, inter anterosuperior iliac spines, external conjugate, transverse diagonal, and prepubic) were first studied individually. Then, the correlations between each internal variable and the seven external variables were jointly evaluated after adjusting for body mass index.RESULTS:As expected, the external conjugate correlated with the obstetric conjugate (r= .65;p< .01) but only weakly with the transverse outlet (r= .21;p< .05). In the simple correlation analysis, the intertrochanteric measure is also correlated with the transverse inlet (TRi), midplane (TRm), and outlet (TRo;r =.542–.672). The transverse diagonal measure marginally correlated with the TRi (r= .29;p< .01). In the multiple regression models, the intertrochanteric measure is associated with the TRi, TRm, and TRo, while the transverse diagonal is associated with the TRi (B= .27;p= .01). The prepubic diameter was not a predictor of birth canal dimensions in either simple or multiple regression models.CONCLUSION:Our study confirms that the reduction of the birth canal in some dimensions (i.e., obstetric conjugate and transverse diameters) is predictable with external, accessible pelvic diameters (e.g., external conjugate, transverse diagonal, and intertrochanteric).

Modeling of appropriate spirometric indicators in practically healthy young women from Podillia with ectomorphic somatotype

Many researchers emphasize the practical importance of using mathematical modeling to determine the reference values of spirographic parameters, but unfortunately, there are no works that study the complex influence of anthropometric and somatotypological indicators on spirometric parameters in healthy young people. The purpose of the work was to build regression models to determine the proper indicators of external breathing in practically healthy young women (YW) ectomorphs and to establish the total influence of the constitutional characteristics of the body on spirographic parameters. We conducted a spirographic examination of 109 practically healthy YW (from 16 to 20 years inclusive) according to the American Pulmonology Association and the European Respiratory Society (2019) method on the Medgraphics Pulmonary Function System 1070 series. The anthropometric examination was carried out according to the method of Bunak V. V. as modified by Shaparenko P. P. (2000). The component composition of body weight was assessed according to Matiegka method (1921), muscle mass according to the method of the American Institute of Nutrition (1991). Somatotypological research was carried out according to the Heath-Carter (1990) method. After somatotyping, it was found that 31 YW had an ectomorphic type of constitution. For them, we conducted a direct step-by-step regression analysis in the “STATISTICA 5.5” package. On the basis of multivariate regression analysis, the total influence of anthropometric, somatotypological and dynamometric indicators on the variability of spirographic parameters of the body was determined. Mathematical modeling was carried out to determine the appropriate individual spirographic indicators in practically healthy YW of the Podillia ectomorphic somatotype. 11 reliable regression linear models were built with the accuracy of the description of the feature in the range of 57.63–94.44 %. To the greatest extent, the value of the spirometric parameters was determined by the girth of the body (most often the girth of the hand), the diameters of the pelvis (most often the external conjugate and intercristal distance), the width of the distal epiphyses (most often the shins), the skinfold thickness (most often under the shoulder blade).

Dynamics of anthropometric indicators in girls within the pubertal period of ontogenesis

The harmony of the organism development in different periods of ontogenesis, and especially puberty, determines the future fate of women in both medical and social aspects. The aim of the research was to study the total and partial body sizes in girls of pubertal period of ontogenesis. We surveyed 128 schoolgirls of 5-8 grades. We evaluated the stages of development of secondary sexual characteristics by hair growth in the axilla and pubis, the development of the mammary glands and age of onset of the first menstruation. According to G.G. Avtandilov’s classification, all girls were divided into three groups – prepubertal (preceding the appearance of pubic hair), pubertal (puberty before menarche) and postpubertal period (fixed and completed pubertal maturation). The group of pubertal girls consisted of 106 schoolgirls, who were divided into groups according to calendar age: 13-year-old (n=29), 12-year-old (n=30), 11-year-old (n=24) and 10-year-old (n=23). Anthropometric survey was conducted according to the scheme of V.V. Bunak and contained the definition of total (length and body weight) and partial (longitudinal, transverse and anterior-posterior) dimensions. The analysis of the obtained results was performed in the license package Statistica 5.5 using non-parametric methods of evaluation of indicators. In our study, it was found that anthropometric indicators characterize the physical development, the level of its harmony and morphofunctional maturity of girls within the pubertal period of ontogenesis. We found a progressive age dynamics of total and partial body size in girls of this age period. The periods of the most intensive growth within the pubertal period of ontogenesis of total and partial sizes of a body are established. At the end of puberty there is the most intense age increase in body length: a rapid increase in body weight begins at the age of 12, the most intense processes of longitudinal growth of the torso and lower extremities in girls are observed from 11 years. Most of the transverse dimensions within the pubertal period of ontogenesis have a pronounced progressive age dynamic. Lower thoracic size, interspinous distance, and external conjugate did not differ statistically significantly between girls of different ages during puberty.

Comparing the pelvis of Tibetan and Chinese Han women in rural areas of China: two population-based studies using coarsened exact matching

This study aims to investigate the difference of pelvic size and shape between Tibetan and Chinese Han women. Data on pelvic dimension measures including interspinous diameter (IS), intercrestal diameter (IC), external conjugate (EC) and transverse outlet (TO) were acquired from two population-based studies amongst Tibetan women in Lhasa, and Chinese Han women in Shaanxi province in China. After coarsened exact matching, there was no statistical difference between any characteristics amongst Tibetan and Chinese Han women (p>.05). The generalised estimating equation models showed Tibetan women had significantly lower IS and IC means than Chinese Han women (IS: 24.39 cm vs. 24.77 cm, p<.001; IC: 26.35 cm vs. 26.93 cm, p<.001) but statistically higher in TO mean (9.12 cm vs. 9.03 cm, p<.001). This study showed Tibetan women have smaller pelvis compared to Chinese Han women. This should offer a useful literature on the comparison of pelvis between Tibetan and Chinese Han women although the difference is small. Impact Statement What is already known on this subject? Previous studies in China indicated different populations have different dimensions of pelvis, with the pelvis of Uighur women being bigger than Chinese Han women, and that of Zhuang and Tu women being smaller than Chinese Han women. Little research reports the specific size of Tibetan women’s pelvis. Living at high altitude, the Tibetan population have differentiated demographics and show local adaptions, such as unelevated haemoglobin, and significant catch-up growth for infants compared with Chinese Han infants. Therefore, there is a strong rationale for better understanding pelvic characteristics amongst this population. What the results of this study add? This study showed Tibetan women have smaller pelvises compared to Chinese Han women. Tibetan women have a smaller interspinous diameter and intercrestal diameter than Chinese Han women, which leads to relatively narrow hip. What the implications are of these findings for clinical practice and/or further research? This study provides useful comparative information on pelvic features between Tibetan and Chinese Han women although the findings of differences were small. In addition, during the formulation of women’s health policy, the results of this study can provide data to support the selection of appropriate indicators of obstetrics and gynaecology for different populations of pregnant women during antenatal care and delivery.

Dynamic External Pelvimetry Test in Third Trimester Pregnant Women: Shifting Positions Affect Pelvic Biomechanics and Create More Room in Obstetric Diameters.

Dystocia in labor is still a clinical challenge. The "contracted pelvis" is the absence of pelvic mobility, which leads to fetal-pelvic disproportion, obstructed labor, and operative delivery. Maternal pelvis biomechanics studies by high technological techniques have shown that maternal shifting positions during pregnancy and labor can create more room in the pelvis for safe delivery. The external and internal pelvic diameters are related. The present study aims to evaluate the external obstetric pelvic diameters in shifting positions using a clinical technique suitable for daily practice in every clinical setting: the dynamic external pelvimetry test (DEP test). Seventy pregnant women were recruited, and the obstetric external pelvic diameters were measured, moving the position from kneeling standing to "hands-and-knees" to kneeling squat position. Results showed modification of the pelvic diameters in shifting position: the transverse and longitudinal diameters of Michaelis sacral area, the inter-tuberosities diameter, the bi-trochanters diameter, and the external conjugate widened; the bi-crestal iliac diameter, the bi-spinous iliac diameter, and the base of the Trillat's triangle decreased. The test showed good reproducibility and reliability. Linear correlations were found between diameters and between the range of motion of the diameters. The maternal pelvis is confirmed to modify the diameters changing its tridimensional shape. The pelvic inlet edge's inclination is inferred to be modified, facilitating the fetal descend. The pelvic outlet enlarged the transverse diameter, facilitating birth. The DEP test estimates the pelvic diameters' modification with postural changes, as magnetic resonance (MR) and computational biomechanics studies have demonstrated.

Constitutional characteristics of adolescent girls with abnormal uterine bleeding

Annotation. The aim of the study is to find the possibility of predicting abnormal uterine bleeding depending on the constitutional features of the body structure at the outpatient level. 288 young girls were examined. The main group included 58 girls with abnormal uterine bleeding, the comparison group included 230 practically healthy girls of the same age. The constitutional affiliation of the girls was established according to the constitutional typology of W. Sheldon, considered the most reasonable and statistically confirmed. General clinical, anthropometric, somatotypological and statistical research methods were used. We considered only those parameters that can be measured by any general practitioner, namely: body mass index, and body surface area, chest circumference, interspinous, intercristal, intertrochanteric distances, the external conjugate. Analysis of the data obtained was carried out using the program “STATISTICA 5.5” using non-parametric methods for evaluating the results. It is established that the occurrence of abnormal uterine bleeding in girls adolescence in the vast majority of cases is related to their constitutional peculiarities of the body structure and most often this nosology occurs in girls of ectomorphic somatotype (46.60 %), and least often in girls of ecto-mesomorphic somatotype (22.40 %).

Obesity as a risk factor of in-hospital outcomes in patients with endometrial cancer treated with laparoscopic surgical mode

Obesity has been suggested to have a negative influence on procedural outcomes of endometrial cancer laparoscopic treatment. Obesity and other possible risk factors of laparoscopic endometrial cancer treatment has not been precisely described in the literature. The aim of the study is to determine the factors that have the greatest influence on the course of laparoscopic surgery for endometrial cancer, with particular emphasis on the influence of obesity. The study included 75 females who were treated for endometrial cancer by laparoscopic surgery. Preoperative body-mass index (BMI), waist circumference(WC), waist to hip ratio(WHR), and selected anatomical indices were measured. The duration of surgery and hospitalization stay, loss of hemoglobin, and procedural-related complications served as parameters of in-hospital outcomes. Multiple linear regression analysis indicate the body mass as most sensitive parameter of obesity which influence in-hospital outcomes in patients treated with laparoscopic procedure. Procedural-related complications occurred in the group of patients with significantly greater WC and BMI. Multiple linear regression indicates also histological grading (G1-G3), external conjugate, intertrochanteric distance as significant risk factors. The multiple linear regression analysis confirmed also that implementation of sentinel lymph node procedure is related with decreased hemoglobin loss in patients with cancer of endometrium compare to lymphadenectomy without sentinel node biopsy(Est.: 0.488; 95% CI: 0.083-0.892, p = 0.018). The most sensitive risk factor of in-hospital outcomes in laparoscopic treatment of endometrial cancer is body mass. The implementation of the sentinel node procedure is associated with reduced surgery time and reduced hemoglobin loss.

Somatometric Characteristics Of Women Of The First And Second Period Of Adulthood Using Different Contraceptives With Different Body Types

This article describes the characteristics of the anthropometric parameters of women of the first and second period of adulthood who use various contraceptives of different weights and physiques-in addition to height and weight, the characteristics of the pelvis size are presented – interosseous, intercostal, intervertebral sizes, external conjugate.

Does the McRoberts\u2019 manoeuvre need to start with thigh abduction? An innovative biomechanical study

BackgroundGuidelines and description about the achievement of the McRoberts manoeuvre are discordant, particularly concerning the need for abduction before the beginning of the manoeuvre. We sought to compare the biomechanical efficiency of the McRoberts’ manoeuvre, with and without thigh abduction.MethodsIn a postural comparative study, twenty-three gravidas > 32 weeks of gestational age and not in labour were assessed during three repetitions of two McRoberts’ manoeuvre that differed in terms of starting position. For the (i) McRoberts, the legs were initially placed in stirrups; for the (m) McRoberts, the legs were resting on the bed, with thighs in wide abduction. For each manoeuvre, flexion of the plane of the external conjugate of the pelvis on the spine (ANGce), hip flexion and abduction, were assessed using an optoelectronic motion capture system. Lumbar curve were assessed with Epionics Spine® system. Temporal parameters including movement duration or acceleration of the external conjugate were also computed. All values ​​obtained for the two types of manoeuvres were compared using a Wilcoxon matched-pairs signed-ranks test. The significance level was defined as p < 0.05.ResultsThe starting position of McRoberts’ otherwise had no effect on the maximum ANGce (p = 0.199), the minimal lordosis of the lumbar curve (p = 0.474), or the maximal hip flexion (p = 0.057). The other parameters were not statistically different according to the starting position (p > 0.005).ConclusionRegardless of the starting position, the McRoberts’ manoeuvre allows ascension of the pubic symphysis and reduction of the lumbar lordosis. This results imply that the McRoberts’ manoeuvre could be performed with the legs initially placed in the stirrups.

Biomechanical comparison of squatting and “optimal” supine birth positions

In obstetric science, it is unknown whether the inherent biomechanical features of the squatting position can be achieved and/or transposed to the supine birth position. In this study Biomechanical features of the squatting position were compared with 2 hyperflexed supine positions for giving birth. Thirteen pregnant women past the 32 weeks of gestational age not in labor were assessed first in the squatting position with the feet flat on the floor, then in the hyperflexed supine position, and finally in the optimal supine position “crushing” the hand of the caregiver onto the bed. For each position, the flexion of the spine associated with the plane of the external conjugate (ANGce) and the pelvis, hip flexion, and abduction were quantified using an optoelectronic motion capture system. A non-invasive strain-gauge-based measuring system was used to track the lumbar curve. An optimal position was defined with a flat lumbar spine and a pelvic inlet plane perpendicular to the lumbar spine (ANGce = 0° ± 5°). For the 13 participants, hip flexion, hip abduction, and the lumbar curve did not differ significantly for the three positions (squatting position, hyperflexed supine position, and OS) in the post-hoc analyses. The optimal supine position induced an ANGce closer to the perpendicular plane than the squatting position (p = 0.002). In the squatting position or in hyperflexed supine position positions, none of the subjects fulfilled the two conditions considered necessary to reach the optimal position. The squatting position was not significantly different from the supine hyperflexed supine position with or without voluntary lordosis correction.

Assessment of Pelvic-Lumbar-Thigh Biomechanics to Optimize The Childbirth Position: An \u201cIn Vivo\u201d Innovative Biomechanical Study

The study aimed to assess the associations between the pelvis orientation, lumbar curve and thigh postures throughout pregnancy in a population of healthy women. Additionally, optimal mechanical birth conditions in terms of the pelvic inlet and lumbar curve were researched. The individuals’ posture was assessed with three-dimensional motion analysis and the lumbar curve with the Epionics SPINE system. The association between the hip joint angles (flexion and abduction), the pelvis external conjugate, and lumbar curve position was assessed with a generalized linear mixed model (GLMM) adjusted to individuals’ characteristics. Joint laxity was assessed with a modified Jobbin’s extensometer. For all of the subjects, hip flexion and hip abduction were significantly associated with the angle between the external conjugate and spine, with higher correlation in the multivariate regression model. The association between hip flexion and the lumbar curve was less significant in multivariate than univariate regression analysis. Optimal birth conditions were never reached. The findings contribute to the understanding of the association between the hip position (flexion and abduction), pelvic orientation, and lumbar curve adjusted for joint laxity in healthy pregnant women. They lay the groundwork for future research in the field of obstetrical biomechanics.

Obesity as a risk factor of in-hospital outcomes in patients with endometrial cancer treated with traditional surgical mode.

Abdominal obesity is a risk factor for endometrial cancer. The negative impact of individual parameters of obesity on the procedural effects of endometrial cancer surgical treatment has been suggested. The aim of the current study was to estimate the relationship of particular parameters of obesity and in-hospital outcomes in patients treated surgically due to endometrial cancer. The study included 70 women treated surgically for endometrial cancer. Pre-operatively, mass, body mass index (BMI), waist circumference, waist-hip ratio and selected anatomical indices were measured. The duration of surgery, hospitalisation, and the loss of haemoglobin served as parameters of in-hospital procedure success. Also, procedural-related complications were estimated. There were 37 (52.8%) obese females in the current study. They were obese patients presenting more advanced clinical stages of endometrial cancer before operation. The duration of operation (94.9 ± 21.6 min. vs. 76.1 ± 13.5 min., p < 0.0001), hospitalisation (12.4 ± 3.4 days vs. 10 ± 2.3 days, p = 0.0009) and haemoglobin loss (2.5 ± 0.9 g/dL vs. 1.9 ± 0.8 g/dL, p = 0.004) were significantly greater in obese patients. Multivariate analysis, among the independent predictors of the duration of operation, has confirmed the correlation between BMI, waist circumference and weight and the duration of hospitalisation. Waist and hip circumference and BMI coupled with external conjugate dimension and intertrochanteric distance have been linked with haemoglobin loss. The strongest correlation for the duration of operation, hospitalisation and haemoglobin loss was noticed for waist circumference (r = 0.7, r = 0.57 and r = 0.59). Waist circumference and BMI are strong predictors of in-hospital outcomes among patients with endometrial cancer treated via traditional surgical operation.

Is there an impact of feet position on squatting birth position? An innovative biomechanical pilot study

BackgroundThe squatting birth position is widely used for “natural” birth or in countries where childbirth occurs in non-medical facilities. Squatting birth positions, like others, are roughly defined so a biomechanical assessment is required with the availability of noninvasive technology in pregnant women. In practice, we can observe spontaneously two kinds of squatting birth position: on tiptoes and with feet flat.ObjectiveTo compare the impact of foot posture on biomechanical parameters considered essential in obstetrical biomechanics during a squatting birth position: on tiptoes versus with feet flat on the floor.Study designThirteen pregnant women beyond 32 weeks of gestational age who were not in labor were assessed during squatting birth position firstly spontaneously and secondly with the foot posture that was not taken spontaneously (on the tiptoes vs with feet flat). For each position, ANGle of flexion on the spine of the plane of the pelvis external conjugate (ANGec), hip flexion and abduction, and lumbar curve were assessed using an optoelectronic motion capture system and a biomechanical model adapted from the conventional gait model as well as a measuring system of the lumbar curve.ResultsSpontaneously, 11 out of 13 women squatted on tiptoe at the first test. On tiptoes the hip flexion was lower than with feet flat (p < 0.02), whereas hip abduction was not significantly different (p = 0.28). A lower ANGec angle (p = 0.003) was noticed for the tiptoe position than feet flat. The lumbar curve (lordosis) was more marked for the squatting position on tiptoes than for the position with feet flat (p < 0.001). On tiptoes no woman had a pelvic inlet plane perpendicular to the spine and none had a flat back or kyphosis. No woman on tiptoes fulfilled the two conditions necessary for the position that we consider optimal.ConclusionIn squatting birth position, foot posture has a biomechanical impact on lumbar curve and pelvic orientation. When comparing squatting positions (on tiptoes vs feet flat), feet flat on the ground is closer to optimal birth conditions than on tiptoes.

Maternal pelvic size, fetal growth and risk of stroke in adult offspring in a large Swedish cohort.

Earlier research suggests that maternal pelvic size is associated with offspring's stroke risk in later life. We followed 6362 men and women from Uppsala, Sweden, born between 1915 and 1929 from 1964 to 2008 to assess whether maternal pelvic size was associated with incidence of thrombotic stroke (TS), haemorrhagic stroke (HS) and other stroke (OS). Offspring whose mothers had a flat pelvis had lower birth weight and birth-weight-for-gestational-age compared with those who did not. Inverse linear associations of birth-weight-for-gestational-age were observed with TS and OS. Female offspring whose mothers had a flat pelvis had increased risk of TS, but flat pelvis was not associated with other types of stroke. A smaller difference between intercristal and interspinous diameters and a smaller external conjugate diameter were independently associated with HS, whereas no pelvic measurements were associated with OS. We conclude that a smaller pelvis in women may impact the health of their offspring in adulthood.

A secretagogue-small interfering RNA conjugate confers resistance to cytotoxicity in a cell model of Sjögren's syndrome

Sjögren's syndrome (SS) is characterized by xerophthalmia and xerostomia resulting from loss of secretory function due to immune cell infiltration in lacrimal and salivary glands. Current therapeutic strategies for SS use secretagogues to induce secretion via muscarinic receptor stimulation. The purpose of this study was to create a secretagogue-small interfering RNA (siRNA) conjugate to deliver siRNA into cells via receptor-mediated endocytosis, thereby altering epithelial cell responses to external cues, such as proinflammatory or death signals, while simultaneously stimulating secretion. Based on our expertise with type 3 muscarinic receptor (M3), we used carbachol, a ligand specific for muscarinic receptor, as the secretagogue. Carbachol was synthesized with an active choline group and was conjugated with an siRNA that targets caspase 3. A human salivary gland (HSG) cell line was used to test the efficacy of this secretagogue-siRNA conjugate. Lipofectamine transfection of the conjugate into HSG cells resulted in a 78% reduction in the expression of the caspase 3 gene, while external conjugate treatment of HSG cells resulted in intracellular calcium release and induction of endocytosis at levels similar to those of carbachol stimulation, indicating that the siRNA and carbachol portions of the conjugate retained their function after conjugation. HSG cells treated with conjugate (without Lipofectamine transfection) exhibited a 50% reduction in caspase 3 gene and protein expression, indicating that our conjugate was effective in delivering functional siRNA into cells via receptor-mediated endocytosis. Furthermore, tumor necrosis factor α-induced apoptosis was significantly reduced in conjugate-treated cells. Our secretagogue-siRNA conjugate prevented cytokine-induced apoptosis in salivary gland epithelial cells, which is critical to maintaining fluid secretion and potentially reversing the clinical hallmark of SS.

Spontaneously broken ground states of theU(n)L×U(n)Rlinear sigma model at largen

Symmetry breaking patterns of the U(n)_L x U(n)_R symmetric meson model are investigated in a formulation involving three auxiliary composite fields. The effective potential is constructed at leading order in the 1/n expansion for a condensate belonging to the center of the U(n) group. A wide region is found in the coupling space where in addition to the condensate proportional to the unit matrix, also metastable minima exist, in which a further breakdown of the diagonal U_V(n) symmetry to U_V(n-1) is realized. Application of a moderate external field conjugate to this component of the order parameter changes this state into the true ground state of the system.

Maternal Pelvic Size Not Predictive of Daughter's Breast Cancer or Ovarian Cancer in a Large Swedish Cohort

Recent studies from Finland reported that maternal pelvic size predicted daughters' breast and ovarian cancer, possibly because maternal pelvic size is a marker for in utero hormone exposure. We sought to replicate this association in 3,845 women born between 1915 and 1929 in Uppsala, Sweden, and followed from 1960 to 2002. Archived obstetric records provided the standard measures of maternal pelvic size (intercristal distance, interspinous distance, the intercristal-interspinous difference, and the external conjugate distance). The Swedish Cancer Registry ascertained cancer incidence, with 273 cohort members developing primary breast cancer, and 52 developing primary ovarian cancer during the follow-up period. There was no evidence (P > 0.1) of an association between any measure of maternal pelvic size and incidence of either breast or ovarian cancer. This was true both before and after adjustment for various characteristics of the women and their mothers, and in analyses stratified by age at diagnosis (<50 versus >or=50 years of age, as a proxy for premenopausal and postmenopausal ages). There was also no evidence of an association in subgroup analyses restricted specifically to those groups in which the Finnish data found the greatest effect. Our study is of comparable size to the Finnish studies and was highly powered (>99%) to detect effects of the magnitude they reported. Our nonreplication therefore casts doubt on the link between maternal pelvic size and risk of breast and ovarian cancer in the offspring.

Maternal and Social Origins of Hypertension

We previously reported that in 2003 people from the Helsinki birth cohort whose blood pressures were measured, 2 different paths of growth preceded the development of hypertension. People already diagnosed with hypertension were small at birth but of average body size at age 11 years. People newly diagnosed with hypertension grew slowly in utero and through childhood. We have now examined how the mother's body size, placental size, and living conditions after birth, 3 influences that affect growth, affect hypertension. Diagnosed hypertension was associated with low placental weight and poor living conditions after birth. The odds ratios were 1.6 (95% CI, 1.1 to 2.3) in people with placental weights <550 g, compared with those with weights >750 g, and 2.2 (95% CI, 1.5 to 3.3) in people whose fathers were laborers compared with those in upper middle-class families. Newly diagnosed hypertension was associated with a small anteroposterior diameter of the mother's bony pelvis, a known consequence of rickets or lesser degrees of malnutrition in infancy. The odds ratio was 2.2 (95% CI, 1.4 to 3.5) in people whose mothers' pelvic external conjugate diameters were <18 cm when compared with people whose mothers' diameters were >/=19 cm. We conclude that one path of growth that leads to hypertension is initiated by fetal undernutrition, which may make a baby vulnerable to postnatal stress, whereas the other originates in a functional incapacity in the mother's metabolism, possibly protein metabolism, which she acquired through undernutrition during her infancy.

Infant Growth and Stroke in Adult Life

People who had low birth weight are at increased risk of stroke. Little is known about the effects of early postnatal growth on stroke risk. We followed-up 12 439 people born in Helsinki during 1934 to 1944. Their body size was measured at birth and, on average, 9 times between birth and age 2 years; 507 of them were hospitalized with stroke or died from the disease. Hazard ratios for stroke declined progressively with increasing gain in weight between birth and age 2 years. The hazard ratio was 0.85 (95% CI, 0.78 to 0.93; P=0.0004) per standard deviation increase in the difference between the weight attained at age 2 years and that predicted from birth weight. A 1-standard deviation increase in body mass index at 2 years of age was associated with a hazard ratio for stroke of 0.84 (95% CI, 0.77 to 0.92; P=0.0002). This association was little changed by adjustment for measures of socio-economic status. Change in body size after the age of 2 years had little effect on the risk of later stroke. People whose mothers had a small external conjugate diameter of the pelvis had an increased risk of stroke. The hazard ratio associated with a diameter of < or =18 cm was 1.62 (95% CI, 1.30 to 2.02; P<0.0001). Thinness during infancy is associated with an increased risk of stroke in later life. This association may be the result of maternal influences which originated in the mother's infancy when her pelvic shape was established.

Changes in anthropometric and metabolic parameters in pregnancy and neonatal physical development during last decades

To evaluate changes in anthropometric and biochemical parameters in pregnancy and their dynamics during last two decades and to determine the association between anthropometric and biochemical parameters, their influence on fetal and neonatal development. In 1985-2005, anthropometric (height, body mass, weight gain during pregnancy, pelvic measurements, skinfold thicknesses, passive body mass) and biochemical (cholesterol, triglyceride, protein, and iron levels) parameters, their correlation, changes in pregnancy were examined; also the correlations between these parameters and neonatal body mass indices were evaluated. In 1986-1987, 383 pregnant women were examined, in 1998--130, and in 2003-2005--133. During 20 years, the height of examined women increased on an average of 2.5 cm; they became thinner; body mass index decreased. The body composition became similar to "cylinder" shape due to decreased thickness of adipose tissue in the limbs. The dimensions of bony pelvis--external conjugate and bicristal diameters--decreased. Primiparous women became older (1995--22.5 years of age, 2004--27.6). At the beginning of investigation, the weight gain was on an average of 21.9% of body mass before pregnancy (13.3 kg) and at the end--23.9% (14.2 kg). The values of anthropometric parameters vary in a consistent pattern during pregnancy: the lower body mass and body mass index at the beginning of pregnancy, the higher weight gain at the end of pregnancy. Blood serum levels of cholesterol, triglycerides, and especially iron were decreased during the study. An inverse correlation between body mass index and lipid metabolism in pregnancy was revealed: the higher body mass index was at the beginning of pregnancy, the lower increase in lipid concentration was during pregnancy. At the beginning of investigation as well as after 20 years, women with low body mass index showed the most significant anthropometric and lipid metabolic changes in pregnancy.