Notes: Abstract This investigation analyzed social and demographic characteristics of women having an unwanted or mistimed pregnancy (unintended pregnancies at the current time) in South America. A sample of 5135 women having had a normal non-malformed live-born infant were interviewed immediately postpartum at 18 hospitals participating in the Latin American Collaborative Study of Congenital Malformations (Spanish acronym: ECLAMC). Half (2568/5135 = 50%) reported that their pregnancies had been unintended, and, of those, 59.3% (1522/2568 = 59.3%) declared that they were trying to avoid conception. The latter group (n = 1522) was the main sample for this study. Patients were asked about their knowledge of when during the menstrual cycle conception is most likely to occur, their biomedical and social characteristics, the type of contraceptive methods used, their opinion of reasons for contraceptive failure, and their reasons for not using contraceptive methods. Women with unintended pregnancies who had not attempted to avoid conception were younger, often primigravid, less educated, and less knowledgeable concerning when during the cycle pregnancy is most likely to occur. Thus, reproductive health policies should be aimed at this target group.

Notes: Abstract Conceptions involving aging gametes are of relevance to natural family planning (NFP) because women using NFP to avoid pregnancy abstain from intercourse during the fertile time of the cycle. To help verify the safety of pregnancies occurring among NFP practitioners, our group has, since 1986, conducted a large cohort study involving six experienced NFP centers. Timing of conception was determined from NFP charts, in which women recorded days on which intercourse occurred. The number of days from the most probable conception intercourse to probable day of ovulation was first determined, and used as an estimate of the time gametes remained in the genital tract before fertilization. Several studies have already been completed, cohort as well as case-control in nature. 1. Spontaneous abortions. Three hundred and sixty-one conceptions occurred during the optimal time (day -1 or 0 relative to ovulation), and of these 33 resulted in spontaneous abortion (9.1%). Five hundred and seven conceptions occurred at non-optimal times during the cycle, and of these 55 resulted in spontaneous abortions (10.9%). These differences were not statistically significant (relative risk 1.19, 95% CI, 0.79-1.80) [1]. 2. Anomalies. Among 780 singleton births in 868 cohort pregnancies, 24 infants had major anomalies (3.1%) as of the present analysis [2]. This frequency is comparable to the general population. To further assess anomalies we employed a case-control approach. All consecutive births (live and stillborn) weighing 500 g or more taking place in 18 participating South American hospitals were examined for minor and major congential anomalies. Mothers of malformed and control infants did not differ with respect to the reported frequency of NFP use, which overall was 6.3% of the 10 642 mothers interviewed (5277 having a malformed infant; 5371 controls). Of 262 discordant pairs, there were 28 or 10.69% mothers within the Down syndrome case group vs. 16/262 or 6.11% among matched controls [3,4]. The odds ratio was 1.84; 95% CI, 0.99-3.96; however, even this non-significant difference narrowed substantially when adjusted for maternal age (OR, 1.78; 95% CI, 0.84-3.75); parity (OR, 1.68; 95% CI, 0.87-3.24); maternal educational level (OR, 1.71; 95% CI, 0.86-3.44); or all three together (OR, 1.74; 95% CI, 0.83-3.64). Conclusions. Our findings should be reassuring to natural family planning users. The overall rate of spontaneous abortion was not increased in NFP users who became pregnant, nor to date was the rate of anomalies. Any contribution to Down syndrome or abortion due to aging gametes would have to be small.

Notes: Abstract Users of natural family planning (NFP) practice periodic abstinence,leading many to reason that such couples should show increased anomalies inoffspring as a result of fertilization involving aging gametes. In an effortto complement our NFP cohort study, we currently conducted a case-controlstudy in the same region (South America) in which the largest number ofcases have been recruited for our cohort NFP study. During 1992-94, 5324case-control pairs of mothers were interviewed during the immediatepostpartum period in 18 maternity hospitals participating in theLatin-American Collaborative Study of Congenital Malformations: ECLAMC(Spanish acronym for Latin-American Collaborative Study of CongenitalMalformations). Natural family planning (NFP) usage was recorded in6% of mothers in the ECLAMC sample studied (n = 10 648). Overall, nosignificant differences in frequency of NFP usage were observed betweenmalformed cases (349/5324 = 6.6%) and normal controls (303/5324 =5.7%) (χ2 = 3.3; df = 1; p 〉 0.05). No significant differencesin sex ratios were observed between children of NFP user and non-usermothers. Of special interest is the lack of association between NFP and Downsyndrome, the sentinel phenotype for the hypothesis of delayed fertilization(aging gametes).