Age of menarche in Jordanian girls

Acknowledgment. We are grateful to Dr. M. A 36-year-old caucasian woman, multigravida Ammari in collecting the data. case had begun to use barbexaclone 300 mg/day and oxcarbazepine 600 mg/day, for 2 years before the Received 10th June 2003. Accepted for publication in final form 13th September 2003. pregnancy, due to epilepsy and continued to use both drugs until the end of week 10 of her From the Department of Medicine, Jordan University of Science and pregnancy. When she became aware of pregnancy, Technology, Irbid, Jordan. Address correspondence and reprint requests to Dr. Fawaz Ammari, Department of Medicine, Jordan she decided to quit taking barbexaclone with our University of Science and Technology, PO Box 3030, Irbid 22110, recommendation, as there was no data regarding this Jordan. Tel/Fax. +962 (2) 7095010. E-mail: dr_fammari@hotIntroduction drug regarding human or animal pregnancy. Oxcarbazepine 1200 mg/day was continued until the References end of pregnancy. She did not use folic acid before or during the pregnancy. No clinical worsening in 1. Saar E, Shalev C, Dalal I, Sod-Moriah UA. Age at epilepsy was observed after withdrawal of menarche: The influence of environmental condition. Int J barbexaclone. She had a history of one therapeutic Biometeorol 1988; 32: 33-35. 2. Manniche E. Age at menarche: Nicolai Edvard Ravn’s data abortion due to carbamazepine use and one on 3385 women in mid-19th century Denmark. Ann Hum spontaneous abortion. All obstetrical and Biol 1983; 10: 79-82. ultrasonographical findings of the present pregnancy 3. Attallah NL, Matta WM, El-Mankonshi M. Age at menarche of schoolgirls in Khartoum. Ann Hum Biol were found normal. Due to maternal serum 1983; 10: 185-188. alpha-fetoprotein was low (0.36 MoM; Multiples of 4. Kak G, Auxiliadora de Sonata Cruz C, Median) in the sixteenth week, the case underwent Velazquez-Melendez G. Secular trend in age at menarche amniocentesis. No chromosomal abnormality was for women born between 1920-1979 in Rio de Janeiro, Brazil. Ann Hum Biol 2000; 27: 423-428. found by amniocentesis in the eighteenth week. The 5. Floris G, Murgia E, Sancia GM, Sanna E. Age at menarche patient elected to have sectio delivery at 37 weeks in Sardinia (Italy). Ann Hum Biol 1987; 14: 285-286. of gestation and had a female infant (3.2 kg, 49 cm) ------with APGAR scores of 9 and 10, by an uncomplicated delivery. The case continued to use Barbexaclone use in pregnancy oxcarbazepine during the breast feeding period. The baby was followed for 2 years, and no major congenital abnormalities or minor malformations Fusun Yaris, MD, PhD, Mine Kadioglu, MD, were observed based on physical examinations. Her Murat Kesim, MD, Cunay Ulku, MD, Ersin Yaris, MD, PhD, Nuri I. Kalyoncu, MD physical, motor and mental development at 24 months of age was completely normal. Pregnancy in epileptic women is known to be associated with a rug exposure in pregnancy is a complex problem higher risk of congenital malformations than D for obstetricians. Epilepsy is the most common non-epileptic pregnant women. The offspring of serious chronic neurological condition with a women with epilepsy are at increased risk for prevalence of 4-10/1000, and most of epileptic congenital malformation, but the impact of the patients, including women of childbearing years various contributing factors remains unresolved.1,2 (25% of total epileptic populations), require Bokhari et al4 reported strong association between treatment with anti-epileptic drugs. Due to potential the presence of coned epiphyses in feet and hands, teratogenic side effects of the antiepileptic drugs, but could not be considered a distinctive feature of risks and benefits of the drugs must be assessed for teratogenicity of phenytoin and phenobarbital. The both the mother and fetus.1,2 Barbiturates and frequency of epileptic seizure may be altered by pregnancy and seizures may cause complications in phenytoin are particularly associated with pregnancy. Hypoxic conditions caused by epileptic congenital heart malformations, facial clefts and 1,3 seizures may affect the fetus in a serious or negative some other malformations. Barbexaclone is a way.1,2 All these issues must be considered in the levopropylhexedryn salt of barbiturate, and no treatment of epileptic pregnant women. The available data are present in the literature about incidence of malformations due to the use of pregnant women, who used barbexaclone alone or oxcarbazepine was found 8% and 5% in the drug in combination with any other drug. We are group and control groups in mice, and this reporting on a patient who used barbexaclone for 2 difference was not statistically significant.5 years before pregnancy and during the first 10 Carbamazepine, phenytoin and valproic acid have weeks of the pregnancy. A physician, was unaware been shown to be associated with teratogenicity, but of the pregnancy, and prescribed the drug. a lower risk was observed with oxcarbazepine

www.smj.org.sa Saudi Med J 2004; Vol. 25 (2) 245 Barbexaclone use in pregnancy compared to the other agents.1,5 As the first choice No evidence of persistent drug, oxcarbazepine can be used as monotherapy at helicobacter pylori infection in the lowest effective dose in the treatment of peripheral blood of patients with epileptic syndrome.1 Careful planning and management of any pregnancy in women with coronary heart disease epilepsy is essential to increase the likelihood of a healthy outcome for both mother and infant.1,2 In our case, pregnancy had not been planned; antiepileptic Abdulaziz S. Al-Khattaf, MSc, PhD. . drugs were used during the first 10 weeks of the R pregnancy. After consultation among physicians ecently, it was proposed that coronary heart within our departments, we recommended that she disease (CHD) may be associated with chronic stop taking barbexaclone due to lack of data in the helicobacter pylori infection.1 The data, however, literature regarding its effects on pregnant women. are conflicting since there are reports denying the In the light of the previous studies, we link between the 2 conditions.2 Similarly, there have recommended oxcarbazepine as a monotherapy that been several claims of strong and significant could be taken throughout the remainder of her correlation between chronic H. pylori infection and pregnancy. Oxcarbazepine seems to be safer than various vascular risk factors such as fibrinogen other available agents. Diet before conception and concentration and white cell count.3 The presence of during organogenesis should contain adequate high concentration of immunoglobulin G antibodies amounts of folic acid. This is valid also for pregnant to H. pylori has been associated with chronic gastric women using antiepileptic drugs, but our patient did infection.4 Association of chronic H. pylori infection not elect to use folic acid upon our recommendation. with CHD was established on the bases of the In the literature, this is the first case of an evidence that antibodies against H. pylori were observation of barbexaclone exposure in a pregnant detected in sera of 76.6% of patients with CHD.3 woman. We did not find any congenital anomaly in Since antibodies against H. pylori are also present in the baby. This single case is not enough to define the sera of other wise normal healthy individuals the drug as "safe in pregnancy," but we wish to and the significance of these antibodies in sera of share this information with the other physicians. patients with CHD and their association with CHD remains doubtful.5 In order to investigate the Received 28th July 2003. Accepted for publication in final form 20th October 2003. association between persistent H. pylori infection and CHD this study was performed to detect the From the Department of Family Medicine (Yaris), Department of presence of H. pylori DNA in the peripheral blood Pharmacology (Kadioglu, Kesim, Ulku, Yaris, Kalyoncu), School of Medicine, Karadeniz Technical University, Trabzon, Turkey. Address of patients with CHD by polymerase chain reaction correspondence and reprint requests to Dr. Murat Kesim, Department (PCR). of Pharmacology, School of Medicine, Karadeniz Technical University, TR-61187, Tabzon, Turkey. Tel. +90 (462) 3775306. Fax. +90 (462) Sera from 20 male patients, with mean age of 54 3775498. E-mail: [email protected] ± 5, diagnosed as having CHD according to the World Health Organization criteria of non-fatal References myocardial infraction, and 12 healthy blood donors with mean age of 56 ± 5 with no history of any 1. Morrow JI, Craig JJ. Anti-epileptic drugs in pregnancy: current safety and other issues. Expert Opin Pharmacother significant illness in the past were tested. Ten ml of 2003; 4: 445-456. blood was collected by venipuncture in sterile tube, 2. Barrett C, Richens A. Epilepsy and pregnancy: Report of an and was allowed to clot at 40C for 2-4 hours. Serum Epilepsy Research Foundation Workshop. Epilepsy Res was separated from whole blood by centrifugation at 2003; 52: 147-148. 1200 x g for 20 minutes at room temperature, and 3. Lindhout D, Omtzigt JG. Pregnancy and the risk of stored at –200C until used. Table 1 illustrates the teratogenicity. Epilepsia 1992; 33 Suppl 4: S41-48. 4. Bokhari A, Connolly S, Coull BA, Harvey EA, Holmes LB, structural design of primers and capture probe used Bokhari A. Effects on toes from prenatal exposure to in this study. The selection of primers and capture anticonvulsants. Teratology 2002; 66: 122-126. (Erratum probe was based on the sequence ure C, and had in: Teratology 2002; 66: 348-349). been used in a previously published study.6 5. Bennett GD, Amore BM, Finnell RH, Wlodarczyk B, Serum sample was lysed using lysis buffer with Kalhorn TF, Skiles GL et al. Teratogenicity of Proteinase K and was precipitated in ethanol, which carbamazepine-10, 11-epoxide and oxcarbazepine in the SWV mouse. Pharmacol Exp Ther 1996; 279: 1237-1242. was followed by vacuum drying. In the first round

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