Maternal serum Down syndrome screening: free beta-protein is a more effective marker than human chorionic gonadotropin

Change in alcohol consumption and risk of death from all causes and from ischaemic heart disease

OBJECTIVE

To examine the association between alcohol consumption and mortality from all causes and from ischaemic heart disease with a focus on differentiating between long term abstainers and more recent non-drinkers.

DESIGN

Cohort study of changes in alcohol consumption from 1965 to 1974 and mortality from all causes and ischaemic heart disease during 1974-84.

SETTING

Population based study of adult residents of Alameda County, California.

SUBJECTS

2225 women and 1845 men aged 35 and over in 1965.

MAIN OUTCOME MEASURES

Alcohol consumption in 1964 and 1974 and mortality from all causes and from ischaemic heart disease during 1974-84.

RESULTS

There was a significantly higher risk of death from all causes and from ischaemic heart disease in women who gave up drinking between 1965 and 1974 than in women who continued to drink (relative risk 1.72, 95% confidence interval 1.11 to 2.66, and 2.75, 1.44 to 5.23, for all causes and ischaemic heart disease respectively). A significant increase in risk was not seen in men who gave up drinking (1.32, 0.87 to 2.01, and 0.95, 0.41 to 2.20, respectively). Among men, long term abstainers compared with drinkers were at increased risk of death from all causes and from ischaemic heart disease, though the associations were not significant (1.40, 0.98 to 2.00, and 1.40, 0.76 to 2.58, for all causes and ischaemic heart disease respectively).

CONCLUSION

Some of the increased risk of death from all causes and from ischaemic heart disease associated with not drinking in women seems to be accounted for by higher risks among those who gave up drinking. Men who are long term abstainers may also be at an increased risk of death. The heterogeneity of the non-drinking group should be considered when comparisons are made with drinkers.

Screening for Down's syndrome based on individual risk

OBJECTIVE

To evaluate the effectiveness of biochemical screening of individual pregnancies for Down's syndrome risk.

DESIGN

Retrospective determination of risk.

SETTING

Obstetric and cytogenetic services in Tayside, Scotland.

SUBJECTS

3436 pregnant women who had screening for neural tube defects in the second trimester during November 1988 to March 1990 and whose pregnancies were dated by ultrasonography. Three women with pregnancies associated with Down's syndrome reported later in 1990.

MAIN OUTCOME MEASURES

Individual risk calculated from age at estimated date of delivery; chorionic gonadotrophin and alpha fetoprotein concentrations in serum samples obtained at precisely determined gestational ages in second trimester. Results of karyotype determination and outcome of pregnancy.

RESULTS

During November 1988 to March 1990 karyotypes were determined for 5% of pregnancies for reasons of maternal age and genetic history and one of the eight affected fetuses was detected. Individual risk could not be calculated for 347 pregnancies, but screening on this basis would have detected five of the cases and required screening in 194 out of 3089 (6.3%) pregnancies; all three affected pregnancies reported later in 1990 would also have been detected, giving a success rate of 73% (95% confidence interval 39% to 94%). The age distribution of women according to individual risk suggests that women over 35 would be screened effectively.

CONCLUSION

Screening based on individual risk would use resources more effectively than screening based on maternal age and genetic history without affecting detection rates in older women.