524
Letters to the Editor
The Journal of Pediatrics March 1976
Editorial correspondence
"Editorial Correspondence" or letters to the Editor relative to articles published in the JOURNALor to topics of current interest are subject to critical review and, to current editorial policy in respect to publication in part or in full.
Indirect effect of sex hormones on the fetus To the Editor: The case of Janerich and associates ~as well as our own earlier observations,z- ~ suggests that the accidental or intentional use of oral contraceptives and other sex hormones Jn pregnancy may have undesirable consequences, i.e., fetal malformations. An important question is whether this association with sex hormones is causal or secondary. It is reasonable to assume that if exogenous sex hormones do cause fetal limb abnormalities, this is through the withdrawal effect rather than specific teratogenicity. Our assumption is that when hormone levels are raised and then rapidly lowered (by withdrawal of the hormone preparation), interstitial hemorrhage may occur in the choriodecidua, thus impairing the nutrition of the ovum. The organism could thus be subject to metabolic hypoxia at the time of its most rapid developments. The view that this does indeed happen is verified by our experiences with numerous interruptions of pregnancy carried out in our department; after injections of estrogenprogesterone preparations hemorrhages are common in the cboriodecidua. In our department between 1965 and 1970 four infants with congenital upper limb reduction defects-dysmelia, phocomeliawere born. In three of the cases we know that injections of Limovan (an estrogen-progesterone preparation) were given to the mother in the first weeks of pregnancy. After we had warned doctors in our locality of the dangers of this preparation, no cases of upper limb reduction defects have been found in our county in the last 4 years. Naturally prospective studies are obviously needed to evaluate the effects of exogenous sex hormones given during pregnan~,y. We have already begun an extensive prospective study on this problem.
Z Papp S. Gardo B. Dolhay GY. Ruzicska H-4012 Debrecen, Hungary
REFERENCES
1. Janerich DT, Piper JM, and Glebatis DM: Oral contraceptives and congenital limb-reduction defects, N Engl J Med 291:697, 1974. 2. Papp Z, and Crard6 S: Effect of exogenous hormones on the fetus, Lancet 1:753, 1971. 3. Papp Z, Crard6 S, and Walawska J: Probably monozygotic twins with discordance for Goldenhar syndrome, Clin Genet 5:86, 1974.
More on alkali therapy of the respiratory distress syndrome To the Editor: I read with interest the article by Baum and Roberton, entitled: "Immediate effects of alkaline infusion in infants with respiratory distress syndrome,''1 which appeared in the August issue of THE JOURYAL. The authors describe an immediate "pink flush" seen in infants given rapid infusions of bicarbonate. This clinical color change was not accompanied by an increase in the P a o . We have noted infants who appear "dusky" or "slightly cyanotic" clinically improve their color after infusion of bicarbonate. The bluish color of cyanosis is due to the increased amount of reduced hemoglobin in the capillaries. At least 5 gm of reduced hemoglobin must be present in the capillaries before clinical cyanosis is manifested. Perhaps the osmotic effect of a bicarbonate infusion is to dilute the level of reduced hemoglobin so that cyanosis cannot be clinically discernible and the infant appears clinically imoroved.
Gilbert L Martin, M.D. Department of Neonatology Magan Medical Clinic 420 W. Rowland St. Covina, Calif. 91723 REFERENCE
1. Baum JD, and Roberton NRC: Immediate effects of alkaline infusion in infants with respiratory distress syndrome, J PEDIATR87:255, 1975.
Letters to the Editor
The Journal of Pediatrics March 1976
Editorial correspondence
"Editorial Correspondence" or letters to the Editor relative to articles published in the JOURNALor to topics of current interest are subject to critical review and, to current editorial policy in respect to publication in part or in full.
Indirect effect of sex hormones on the fetus To the Editor: The case of Janerich and associates ~as well as our own earlier observations,z- ~ suggests that the accidental or intentional use of oral contraceptives and other sex hormones Jn pregnancy may have undesirable consequences, i.e., fetal malformations. An important question is whether this association with sex hormones is causal or secondary. It is reasonable to assume that if exogenous sex hormones do cause fetal limb abnormalities, this is through the withdrawal effect rather than specific teratogenicity. Our assumption is that when hormone levels are raised and then rapidly lowered (by withdrawal of the hormone preparation), interstitial hemorrhage may occur in the choriodecidua, thus impairing the nutrition of the ovum. The organism could thus be subject to metabolic hypoxia at the time of its most rapid developments. The view that this does indeed happen is verified by our experiences with numerous interruptions of pregnancy carried out in our department; after injections of estrogenprogesterone preparations hemorrhages are common in the cboriodecidua. In our department between 1965 and 1970 four infants with congenital upper limb reduction defects-dysmelia, phocomeliawere born. In three of the cases we know that injections of Limovan (an estrogen-progesterone preparation) were given to the mother in the first weeks of pregnancy. After we had warned doctors in our locality of the dangers of this preparation, no cases of upper limb reduction defects have been found in our county in the last 4 years. Naturally prospective studies are obviously needed to evaluate the effects of exogenous sex hormones given during pregnan~,y. We have already begun an extensive prospective study on this problem.
Z Papp S. Gardo B. Dolhay GY. Ruzicska H-4012 Debrecen, Hungary
REFERENCES
1. Janerich DT, Piper JM, and Glebatis DM: Oral contraceptives and congenital limb-reduction defects, N Engl J Med 291:697, 1974. 2. Papp Z, and Crard6 S: Effect of exogenous hormones on the fetus, Lancet 1:753, 1971. 3. Papp Z, Crard6 S, and Walawska J: Probably monozygotic twins with discordance for Goldenhar syndrome, Clin Genet 5:86, 1974.
More on alkali therapy of the respiratory distress syndrome To the Editor: I read with interest the article by Baum and Roberton, entitled: "Immediate effects of alkaline infusion in infants with respiratory distress syndrome,''1 which appeared in the August issue of THE JOURYAL. The authors describe an immediate "pink flush" seen in infants given rapid infusions of bicarbonate. This clinical color change was not accompanied by an increase in the P a o . We have noted infants who appear "dusky" or "slightly cyanotic" clinically improve their color after infusion of bicarbonate. The bluish color of cyanosis is due to the increased amount of reduced hemoglobin in the capillaries. At least 5 gm of reduced hemoglobin must be present in the capillaries before clinical cyanosis is manifested. Perhaps the osmotic effect of a bicarbonate infusion is to dilute the level of reduced hemoglobin so that cyanosis cannot be clinically discernible and the infant appears clinically imoroved.
Gilbert L Martin, M.D. Department of Neonatology Magan Medical Clinic 420 W. Rowland St. Covina, Calif. 91723 REFERENCE
1. Baum JD, and Roberton NRC: Immediate effects of alkaline infusion in infants with respiratory distress syndrome, J PEDIATR87:255, 1975.
