On the relationship between maternal conditions during pregnancy and congenital malformations.

Th theory has, therefore, been advanced that mongolism is to some extent a result of of foetal environment due to this state. Advanced age of the mother has also been shown to be a factor in other congenital malformations, such as anencephaly, spina bifida, and congeital hydrocephaly (Malpas, 1937; Penrose, 1946a). In one series of 570 families with children showing various congenital abnormalities, Murphy (1936) rported that the mean maternal age at the time of birth of the first malformed child was 28-4 years, the corresponding age at the birth of the first normal child being 23 years. Some authors have noticed that certain abnormalities appear more often in the first-born than in subsequent pregnances. Still (1927), for instanc, orted the well-known fact that a large proportion of children with pyloric stenosis are first-born, and suggsted that the same is probably true for some other abnormaities. Prinogeniture also is shown to be of possible etiological sig with regard to anencephaly, spina biida, and congenital hydrocephaly (Malpas, 1937; Penrose, 1946a). On the otih hand,some malformations tend to occur more often in later born children than in earlier sibings Certain forms of mental defic , most notably imngolian idiocy, seem to come into this categoy (Penrose, 1934). Malpas (1937) reported in a study of 294 children with various congenital malformations born at the Iiverpool Matenity Hospital that 70 per cent. of the children with cleft palate and harelip were born to multiparae in contrast to an average of multparae in the whole hospital population of 54 per cent. In a similar study of 582 malformed children in whom hydrocephaly and spina bifida wer reprsented in nearly one-half of the cases, Murphy and Mazer (1935) concludedthat congenital abnormalties occurred more frequently in later than in earlier prencs