From November 1988 to December 1994, a total of 567 female volunteers were enrolled in Norplant implant studies at the National Taiwan University Hospital. After a median follow-up of 29 months, only 3 of the 529 available cases became pregnant (a cumulative rate of 1.2 pregnancies per 100 users over 5 years). Chromosome analysis of 2 of the 3 abortuses revealed 46,XX/46,XX,inv(3) and 46,XX. Menstrual problems were the most common adverse effects and were also the main reason for discontinuation (65%, 108/166). The continuation rate was 90%, 78%, 70%, 61%, and 42% at the end of 1, 2, 3, 4, and 5 years after insertion, respectively. In the 21 patients who wished to become pregnant, fertility recurred soon after removal of the Norplant implants. The data suggested that the Norplant implants system is a highly effective, safe, and long-acting method of reversible contraception. It would be worthwhile to introduce this contraceptive system to Taiwan\'s family planning program.
Between November 1988 and December 1994 health providers at the National Taiwan University Hospital enrolled 567 women aged 17-47 in the Norplant implant studies that aimed to evaluate the benefits and side effects of Norplant as another contraceptive method choice. They followed the women for a median of 29 months. 38 cases were lost to follow-up. The 5-year contraceptive effectiveness rate was 98.8%. The 3 pregnancies (2 intrauterine and 1 ectopic) occurred during the 24th, 45th, and 47th months of use. None of the women who became pregnant weighed more than 70 kg. Two of the aborted fetuses had chromosomal abnormalities (46,XX/46,XX,inv(3) and 46,XX). 29.9% of the Norplant users had menstrual problems. Even though irregular bleeding occurred to 19.7% of Norplant users, hemoglobin levels increased after Norplant use (p 0.05). Triglycerides and total cholesterol levels decreased (p 0.05). None of the women developed thromboembolism. The Norplant continuation rate was 89.7% at 1 year, 78% at 2 years, 70% at 3 years, 61% at 4 years, and 42.4% at 5 years. The leading reason for implant removal was menstrual problems (108). The implants were removed during one sitting without x-ray or ultrasound identification in all 166 women who stopped using Norplant before 5 years and the 16 women who stopped using it at the end of 5 years. 78% of women who discontinued Norplant to become pregnant were pregnant within one year following removal. All their infants were normal. These findings suggest that Norplant is a safe, effective, and acceptable contraceptive method and that the family planning program should introduce Norplant to its contraceptive mix.

Chromosome breakage can lead to teratology and neoplasia, although mutagenicity is not identical with carcinogenicity. The human chorionic villus micronucleus (CVMN) test was first developed in 1987 to study the mutagenicity of smoking, drinking, and contraceptives on offspring. 507 couples were studied, and human chorionic villi were taken from abortion material of women aged 18-43 with gestation of 10 weeks. None of these women drank; however, among their husbands there were 172 smokers (2-40 cigarettes/day for 2-20 years), 15 who drank (.5-3 liters of liquor/month for 2-20 years), 107 smoked and drank (1-40 cigarettes/day for 2-10 years and .5-3 liters of liquor/month for 2-15 years), and 115 nondrinking and nonsmoking controls. Micronuclei (MN) were scored according to Countryman\'s standard, and 2000 interphase was observed in each subject of CVMN frequency. 1,014,000 interphase cells were scored. There was no correlation between CVMN frequency and maternal age. The difference of the correlation coefficient between CVMN frequency and pregnancy was not statistically significant. 105 women had aborted before, 9 had had spontaneous abortion, and 113 had neither. There were no statistical differences between these women and no correlation with CVMN frequency. The gestation ranged from 32 days to 79 days; again, no correlation was found. The mean frequency of CVMN was significantly higher in those with smoking husbands than in nonsmokers and nondrinkers. The CVMN frequency of women with drinking husbands was also high but without statistical significance. The group with husbands who both smoked and drank had the highest CVMN frequency, but this did not differ significantly from controls. The mutagens and carcinogens of cigarettes linger in the smoke. In addition to effect on the function and MN frequency in the sperm of smokers, the ova and embryo of passive smokers may be affected as damage in the DNA and spindle apparatus of chorionic villi increases the frequency of MN.

This study examined the association between exposure to occupational hazards and pregnancy outcomes using data from a case-control study conducted in 29 hospitals in Shanghai, China. The sample included 1,875 perinatal deaths and newborns with birth defects and the same number of controls. Information on mother\'s exposure to occupational radiation, chemicals, noise, and pesticides was investigated. Logistic regression analysis controlling for potential confounders showed that exposure to radiation before/during pregnancy was associated with antepartum fetal death, birth defects, small-for-gestational-age (SGA), and threatened abortion. Exposure to chemicals before/during pregnancy was associated with antepartum fetal death, early neonatal death, birth defects, preterm birth, and threatened abortion. Women exposed to pesticides during pregnancy had an increased risk of SGA and threatened abortion. Exposure to occupational noise during pregnancy increased the risk of antepartum fetal death. Furthermore, higher than expected numbers of congenital anomalies in the central nervous system (CNS) were identified among women exposed to chemicals before pregnancy and to pesticides during the first trimester of pregnancy. No significant association was found between occupational exposure and intrapartum fetal death. Although recall bias may be possible in our study, the findings encourage further research.
Epidemiologist analyzed October 1986-September 1987 data on 1875 perinatal deaths and newborns with defects and the same number of controls from 29 hospitals in Shanghai, China, to determine the association between occupational exposure to radiation, chemicals, pesticides, and noise and congenital abnormalities, perinatal death, small for gestational age (SGA), preterm birth, and threatened abortion. They found much higher than expected numbers of central nervous system birth defects and significantly lower than expected numbers of other birth defects among women exposed to chemicals (p .1 and p .05, respectively). They uncovered higher than expected numbers of urogenital system birth defects and other birth defects among women exposed to occupational noise during the 1st trimester of pregnancy (p .01 and p .05, respectively). There were very much higher than expected numbers of central nervous system effects among women exposed to pesticides during the 1st trimester of pregnancy (p .01). None of the hazards was associated with intrapartum fetal death. Exposure to radiation before and during pregnancy was positively related with antepartum fetal death (odds ratio [OR] = 1.7 and 2.4 respectively), birth defects (OR = 1.9 both before and during), SGA (OR = 2.7 and 2.2, respectively), and threatened abortion (OR = 2.1 and 3.2). Chemical exposure before and during pregnancy had an increased risk for antepartum fetal death (OR = 2.9 and 3.5, respectively), early neonatal mortality (OR = 1.7 and 2.2, respectively), birth defects (OR = 1.7 and 3.5, respectively), preterm birth (OR = 1.2 and 1.4, respectively), and threatened abortion (OR = 1.5 and 1.3, respectively). Pesticide exposure during pregnancy was associated with SGA (PR + 2.9) and threatened abortion (OR = 3.9). Noise exposure during pregnancy was related with antepartum fetal death (OR = 1.9). Even though recall bias may have been a factor in this study, these results did suggest additional research.