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  1. 1

    Geographic variation in the incidence of hypertension in pregnancy.

    World Health Organization [WHO]. International Collaborative Study of Hypertensive Disorders of Pregnancy


    The Maternal and Child Health Unit of the World Health Organization undertook a series of prospective studies in the early 1980s in Burma, China, Thailand, and Viet Nam to determine how much variation in the incidence of hypertensive disorders of pregnancy there was and how much of it reflected differences in baseline blood pressures. Pregnant women in 3 urban and 2 rural centers in Burma, a part of the city of Shanghai, 1 urban and 1 rural center in Thailand, and 1 urban and 2 rural centers in Viet Nam were enrolled. Each mother was given a card recording weight, signs of edema, proteinuria, and blood pressure with diastolic pressure based on the 4th Korotkoff sound. Gestation was calculated from the 1st day of the last menstrual period, and all the women were primigravidas. There was wide variation in the distribution of highest diastolic pressure before the onset of labor. The proportion of mothers whose diastolic pressure was greater than 89 mm mercury at any time during pregnancy varied from 33% in China to 26% in Thailand, 7% in Burma, and 5% in Viet Nam. There as very little variation in the numbers of mothers with proteinuria. China had the lowest rate of eclampsia but the highest prevalence of hypertensive disorders, presumably because preeclampsia was treated. Hypertensive disorders were diagnosed among 31% of Chinese women, 5% of Burmese women, and 1% of women in Viet Nam and Thailand. Blood pressure measurements were analyzed for each country by week of gestation, and the mean diastolic pressure in the 2nd trimester was constant across all 4 populations; the difference between the lowest and highest was only 3.5 mm mercury. Thereafter the differences increased, with the greatest increases in China and Thailand and very little increase in Burma and Viet Nam. The differences thus appear to be racial, but whether they are genetically or environmentally caused remains to be determined.
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  2. 2
    Peer Reviewed

    Multinational comparative clinical trial of long-acting injectable contraceptives: norethisterone enanthate given in two dosage regimens and depot-medroxyprogesterone acetate. A preliminary report.

    World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction. Task Force on Long-Acting Systemic Agents for Fertility Regulation

    Contraception. 1982 Jan; 25(1):1-11.

    A multicenter phase 3 clinical trial compared norethisterone enanthate (NET-EN) given by 2 different treatment regimens and depot-medroxyprogesterone acetate (DMPA). After 18 months of observation, preliminary findings are reported for 790 women who received NET-EN 200 mg every 60 days; for 796 women who recieved NET-EN every 60 days (200 mg) for 6 months, then 200 mg every 84 days, and for 1589 women who received DMPA 150 mg every 90 days. Overall discontinuation rates and discontinuation for bleeding and personal reasons were similar for all 3 groups after 18 months observation (61.8-63.5/100 women). Terminations due to amenorrhea were significantly higher among DMPA users (12.1 and 17.4/100 women at 12 and 18 months) than among both NET-EN groups (6.8-8.2/100 women at 12 months and 10.4-10.9/100 women at 18 months). The only significant difference in pregnancy rates observed among the 3 groups was a higher rate at 18 months among NET-EN (84 days) users (1.6/100 women), than among DMPA users (0.2/100 women). There was no overall significant difference between the 2 NET-EN groups, although between the 6 and 18 month follow-ups when the 2 NET-EN regimens diverged, the NET-EN (84 days) users' pregnancy rates rose significantly, whereas in the NET-EN (60 days) group, the pregnancy rate did not change. Weight gain was significantly higher in those subjects using NET-EN at 60 day intervals than at 84-day intervals. (author's modified)
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