{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T10:47:49Z","timestamp":1780051669571,"version":"3.53.1"},"reference-count":52,"publisher":"BMJ","issue":"6350","license":[{"start":{"date-parts":[[1982,10,30]],"date-time":"1982-10-30T00:00:00Z","timestamp":404784000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br Med J (Clin Res Ed)"],"published-print":{"date-parts":[[1982,10,30]]},"abstract":"<jats:p>Forty-six diabetics treated with twice-daily insulin were seen every two weeks for six months in an intensive education programme aided by regular home urine glucose testing. Control was improved with a decrease in 24-hour urinary glucose excretion (median 138 mmol\/24 h (24.8 g\/24 h) falling to 70 mmol\/24 h (12.6 g\/24 h); p less than 0.002), glycosylated haemoglobin concentration (mean 11.4 +\/- SD 2.3% falling to 10.4 +\/- 1.5%; p less than 0.001), and Diastix score (median 3.0 falling to 1.3; p less than 0.001). There was no reported increase in hypoglycaemia. Thirty-eight of the diabetics proceeded to a nine-month randomised cross-over study of the effect on blood glucose control of monitoring urinary glucose or blood glucose measured visually or by a reflectance meter using appropriate reagent strips. No further improvement in control was observed after home blood glucose monitoring. Nevertheless, 29 out of 37 patients preferred blood to urine glucose monitoring. During both the education and cross-over studies there was evidence of an initial improvement in control followed by deterioration. This was independent of the monitoring method used in the cross-over period and may have been due to waning enthusiasm. Despite patient enthusiasm and other reports to the contrary, home blood glucose monitoring offered no improvement in control over intensive attention and conventional urine glucose monitoring.<\/jats:p>","DOI":"10.1136\/bmj.285.6350.1233","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T11:00:59Z","timestamp":1238670059000},"page":"1233-1240","source":"Crossref","is-referenced-by-count":103,"title":["Intensive attention improves glycaemic control in insulin-dependent diabetes without further advantage from home blood glucose monitoring: results of a controlled trial."],"prefix":"10.1136","volume":"285","author":[{"given":"R","family":"Worth","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P D","family":"Home","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D G","family":"Johnston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Anderson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Ashworth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J M","family":"Burrin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Appleton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Binder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K G","family":"Alberti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1982,10,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"146","DOI":"10.2337\/diab.5.2.146","article-title":"Teaching the diabetic patient","volume":"5","author":"Beaser, S.M.","year":"1956","unstructured":"Beaser SM. Teaching the diabetic patient. Diabetes 1956;5:146-9.","journal-title":"Diabetes"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"51","DOI":"10.2337\/diab.20.1.51","article-title":"Comparative study of diabetes knowledge among juvenile diabetics and their parents","volume":"20","author":"Collier, B.N.; Etzwiler, D.D.","year":"1971","unstructured":"Collier BN, Etzwiler DD. Comparative study of diabetes knowledge among juvenile diabetics and their parents. Diabetes 1971;20:51-7.","journal-title":"Diabetes"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"35","DOI":"10.2337\/diacare.2.1.35","article-title":"Teaching the person with diabetes: experience with a follow-up session","volume":"2","author":"Whitehouse, F.W.; Whitehouse, I.J.; Smith, J.; Hohl, R.D.","year":"1979","unstructured":"Whitehouse FW, Whitehouse IJ, Smith J, Hohl RD. Teaching the person with diabetes: experience with a follow-up session. 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Diabetes Care 1980;3:127-33.","journal-title":"Diabetes Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"967","DOI":"10.2337\/diab.21.9.967","article-title":"Evaluation of programmed education among juvenile diabetics and their families","volume":"21","author":"Etzwiler, D.D.; Robb, JR","year":"1972","unstructured":"Etzwiler DD, Robb JR. Evaluation of programmed education among juvenile diabetics and their families. Diabetes 1972;21:967-71.","journal-title":"Diabetes"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"474","DOI":"10.2337\/diab.23.5.474","article-title":"Evaluation of some commonly used semi-quantitative methods for urinary glucose and ketone determination","volume":"23","author":"James, R.C.; Chase, G.R.","year":"1974","unstructured":"James RC, Chase GR. Evaluation of some commonly used semi-quantitative methods for urinary glucose and ketone determination. Diabetes 1974;23:474-9.","journal-title":"Diabetes"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1001\/jama.1972.03210030020004","article-title":"Urine glucose analyses during continuous blood glucose monitoring","volume":"222","author":"Service, F.J.; Molnar, G.D.; Taylor, W.F.","year":"1972","unstructured":"Service FJ, Molnar GD, Taylor WF. Urine glucose analyses during continuous blood glucose monitoring. JAMA 1972;222:294-8.","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/BF00421230","article-title":"Relation of diabetic control to the development of microvascular complications","volume":"15","author":"Tchobroutsky, G.","year":"1978","unstructured":"Tchobroutsky G. Relation of diabetic control to the development of microvascular complications. Diabetologia 1978;15:143-52.","journal-title":"Diabetologia"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"168","DOI":"10.2337\/diacare.1.3.168","article-title":"Diabetes mellitus and its degenerative complications: a prospective study of 4400 patients observed between 1947 and 1973","volume":"1","author":"Pirart, J.","year":"1978","unstructured":"Pirart J. Diabetes mellitus and its degenerative complications: a prospective study of 4400 patients observed between 1947 and 1973. Diabetes Care 1978;1:168-88, 252-63.","journal-title":"Diabetes Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1056\/NEJM197604292941811","article-title":"\"Control\" and diabetes","volume":"294","author":"Cahill, G.F.; Etzwiler, D.D.; Freinkel, N.","year":"1976","unstructured":"Cahill GF, Etzwiler DD, Freinkel N. \"Control\" and diabetes. 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Basle: Ciba-Geigy, 1970:712.","edition":"7th ed","journal-title":"Basle: Ciba-Geigy"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"396","DOI":"10.2337\/diacare.4.3.396","article-title":"A comparison of accuracy and estimated costs of methods for home blood glucose monitoring","volume":"4","author":"Shapiro, B.; Savage, P.J.; Lomatch, D.","year":"1981","unstructured":"Shapiro B, Savage PJ, Lomatch D, et al. A comparison of accuracy and estimated costs of methods for home blood glucose monitoring. Diabetes Care 1981;4:396-403.","journal-title":"Diabetes Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"404","DOI":"10.2337\/diacare.4.3.404","article-title":"Comparison of methods for blood glucose monitoring","volume":"4","author":"Reeves, M.L.; Forhan, S.E.; Skyler, J.S.; Peterson, C.M.","year":"1981","unstructured":"Reeves ML, Forhan SE, Skyler JS, Peterson CM. Comparison of methods for blood glucose monitoring. 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Diabetes Care 1981;4:417-9.","journal-title":"Diabetes Care"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"311","DOI":"10.2337\/diacare.4.2.311","article-title":"Algorithms for adjustments of insulin dosage by patients who monitor blood glucose","volume":"4","author":"Skyler, J.S.; Skyler, D.L.; Seigler, D.E.; O'Sullivan, M.J.","year":"1981","unstructured":"Skyler JS, Skyler DL, Seigler DE, O'Sullivan MJ. Algorithms for adjustments of insulin dosage by patients who monitor blood glucose. Diabetes Care 1981;4:311-8.","journal-title":"Diabetes Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/0014-5793(76)80969-6","article-title":"In vitro synthesis of hemoglobin Al","volume":"71","author":"Fluckiger, R.; Winterhalter, K.H.","year":"1976","unstructured":"Fluckiger R, Winterhalter KH. In vitro synthesis of hemoglobin Al,. FEBS Lett 1976;71:356-60.","journal-title":"FEBS Lett"},{"key":"ref_27","first-page":"393","article-title":"Haemoglobin Al,, a reliable index of diabetic control","volume":"13","author":"Fluckiger, R.; Berger, W.; Winterhalter, K.H.","year":"1977","unstructured":"Fluckiger R, Berger W, Winterhalter KH. Haemoglobin Al,, a reliable index of diabetic control. Diabetologia 1977;13:393.","journal-title":"Diabetologia"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1515\/bchm2.1976.357.1.751","article-title":"Production of antisera to synthetic benzy'oxycarbonyl-C-peptide of human pro-insulin","volume":"357","author":"Faber, O.K.; Markussen, J.; Naithani, V.K.; Binder, C.","year":"1976","unstructured":"Faber OK, Markussen J, Naithani VK, Binder C. Production of antisera to synthetic benzy'oxycarbonyl-C-peptide of human pro-insulin. HoppeSeylers Z Physiol Chem 1976;357:751-7.","journal-title":"HoppeSeylers Z Physiol Chem"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/BF01222971","article-title":"Methods of assessing diabetic control","volume":"17","author":"Molnar, G.D.; Marien, G.J.; Hunter, A.N.; Harley, C.H.","year":"1979","unstructured":"Molnar GD, Marien GJ, Hunter AN, Harley CH. Methods of assessing diabetic control. Diabetologia 1979;17:5-16.","journal-title":"Diabetologia"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1111\/j.0954-6820.1965.tb01810.x","article-title":"The M-value, an index of blood sugar control in diabetes","volume":"177","year":"1965","unstructured":"Schlichtkrull J, Munck 0, Jersild M. The M-value, an index of blood sugar control in diabetes. Acta Med Scand 1965;177:95-102.","journal-title":"Acta Med Scand"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"644","DOI":"10.2337\/diab.19.9.644","article-title":"Mean amplitude of glycemic excursions, a measure of diabetic instability","volume":"19","author":"Service, F.J.; Molnar, G.D.; Rosevear, J.W.; Ackerman, E.; Gatewood, L.C.; Taylor, W.F.","year":"1970","unstructured":"Service FJ, Molnar GD, Rosevear JW, Ackerman E, Gatewood LC, Taylor WF. Mean amplitude of glycemic excursions, a measure of diabetic instability. Diabetes 1970;19:644-55.","journal-title":"Diabetes"},{"key":"ref_32","first-page":"734","article-title":"Haemoglobin Al: an indicator of the metabolic control of diabetic patients","author":"Gonen, B.; Rochman, H.; Horwitz, D.L.; Rubenstein, A.H.; Tanega, S.P.","year":"1977","unstructured":"Gonen B, Rochman H, Horwitz DL, Rubenstein AH, Tanega SP. Haemoglobin Al: an indicator of the metabolic control of diabetic patients. L ancet 1977;ii:734-6.","journal-title":"L ancet"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1210\/jcem-44-5-859","article-title":"Glycosylated hemoglobins and long-term blood glucose control in diabetes mellitus","volume":"44","author":"Gabbay, K.H.; Hasty, K.; Breslow, J.L.; Ellison, R.C.; Bunn, H.F.; Gallop, P.M.","year":"1977","unstructured":"Gabbay KH, Hasty K, Breslow JL, Ellison RC, Bunn HF, Gallop PM. Glycosylated hemoglobins and long-term blood glucose control in diabetes mellitus. Jf Clin Endocrinol Metab 1977;44:859-64.","journal-title":"Jf Clin Endocrinol Metab"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1056\/NEJM197608192950804","article-title":"Correlation of glucose regulation and hemoglobin Al, in diabetes mellitus","volume":"295","year":"1976","unstructured":"Correlation of glucose regulation and hemoglobin Al, in diabetes mellitus. N Engl j Med 1976;295:417-20.","journal-title":"N Engl j Med"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1007\/BF00421859","article-title":"Rapid changes in chromatographically determined haemoglobin Al,, induced by short-term changes in glucose concentration","volume":"19","author":"PAa, Svendsen; JS, Christiansen; U, Soegard; BS, Weldinder; J, Nerup","year":"1980","unstructured":"Svendsen PAa, Christiansen JS, Soegard U, Weldinder BS, Nerup J. Rapid changes in chromatographically determined haemoglobin Al,, induced by short-term changes in glucose concentration. Diabetologia 1980;19:130-6.","journal-title":"Diabetologia"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/0002-9343(81)90770-1","article-title":"The clinical utility of glycosylated hemoglobin","volume":"70","author":"Jovanovic, L.; Peterson, C.M.","year":"1981","unstructured":"Jovanovic L, Peterson CM. The clinical utility of glycosylated hemoglobin. AmJ Med 1981;70:331-8.","journal-title":"AmJ Med"},{"key":"ref_37","first-page":"221","article-title":"Hyperlipidemia in diabetes","volume":"4","author":"Shafrir, E.","year":"1975","unstructured":"Shafrir E. Hyperlipidemia in diabetes. In: Sussman KE, Metz RJS, eds. Diabetes mellitus. Vol 4. New York: American Diabetes Association, 1975:221-8."},{"key":"ref_38","first-page":"179","article-title":"Complications of diabetes","author":"Jarrett, R.J.","year":"1975","unstructured":"Jarrett RJ, Keen H, eds. Diabetes and atherosclerosis. In: Complications of diabetes. London: Edward Arnold, 1975:179-203."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/BF01106970","article-title":"Dietary fats, the diurnal blood lipids and ketones in juvenile diabetes","volume":"2","author":"Sterky, G.C.G.; Persson, B.E.H.; Larsson, Y.A.A.","year":"1966","unstructured":"Sterky GCG, Persson BEH, Larsson YAA. Dietary fats, the diurnal blood lipids and ketones in juvenile diabetes. Diabetologia 1966;2:14-9.","journal-title":"Diabetologia"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"672","DOI":"10.2337\/diab.24.7.672","article-title":"Plasma lipid levels in diabetic children. Effect of diet restricted in cholesterol and saturated fats","volume":"24","author":"Kaufman, R.L.; Assal, J.P.; Soeldner, J.S.","year":"1975","unstructured":"Kaufman RL, Assal JP, Soeldner JS, et al. Plasma lipid levels in diabetic children. Effect of diet restricted in cholesterol and saturated fats. Diabetes 1975;24:672-9.","journal-title":"Diabetes"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/0026-0495(78)90169-5","article-title":"Diabetic regulation and its relationship to microangiopathy","volume":"27","author":"Raskin, P.","year":"1978","unstructured":"Raskin P. Diabetic regulation and its relationship to microangiopathy. Metabolism 1978;27:235-52.","journal-title":"Metabolism"},{"key":"ref_42","first-page":"1122","article-title":"Management of the pregnant diabetic: home or hospital with or without glucose meters ?","volume":"i:","author":"Stubbs, S.M.; Pyke, D.A.; Brudenell, J.M.; Watkins, P.J.; Stubbs, W.A.; Alberti, K.G.M.M.","year":"1980","unstructured":"Stubbs SM, Pyke DA, Brudenell JM, Watkins PJ, Stubbs WA, Alberti KGMM. Management of the pregnant diabetic: home or hospital with or without glucose meters ? Lancet 1980;i:1122-4.","journal-title":"Lancet"},{"key":"ref_43","first-page":"187","article-title":"Home blood glucose monitoring: revolution, revelation or rip-off?","volume":"ii:","author":"Anonymous","year":"1980","unstructured":"Anonymous. Home blood glucose monitoring: revolution, revelation or rip-off? Lancet 1980;ii: 187-8.","journal-title":"Lancet"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"140","DOI":"10.2337\/diacare.3.1.140","article-title":"Virtually continuous euglycemia for 5 years in a labile juvenile-onset diabetic patient under non-invasive closed loop control","volume":"3","author":"Bernstein, R.K.","year":"1980","unstructured":"Bernstein RK. Virtually continuous euglycemia for 5 years in a labile juvenile-onset diabetic patient under non-invasive closed loop control. Diabetes Care 1980;3:140-3.","journal-title":"Diabetes Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"155","DOI":"10.2337\/diacare.3.1.155","article-title":"Feasibility of blood glucose self-monitoring in unstable insulin-dependent diabetes","volume":"3","author":"Barbosa, J.; Menth, L.; Schumacher, G.; Johnson, S.; Najarian, J.","year":"1980","unstructured":"Barbosa J, Menth L, Schumacher G, Johnson S, Najarian J. Feasibility of blood glucose self-monitoring in unstable insulin-dependent diabetes. Diabetes Care 1980;3:155-9.","journal-title":"Diabetes Care"},{"key":"ref_46","first-page":"326","article-title":"Glycaemic control with intensified conventional therapy","volume":"21","author":"Seigler, D.E.; Reeves, M.; Ryan, E.; Goldberg, R.B.; Skyler, J.S.","year":"1981","unstructured":"Seigler DE, Reeves M, Ryan E, Goldberg RB, Skyler JS. Glycaemic control with intensified conventional therapy. Diabetologia 1981;21:326-7.","journal-title":"Diabetologia"},{"key":"ref_47","first-page":"25564","article-title":"Comparison between continuous subcutaneous insulin infusion and multiple injections of insulin","volume":"31","author":"Schiffrin, A.; Belmonte, M.M.","year":"1982","unstructured":"Schiffrin A, Belmonte MM. Comparison between continuous subcutaneous insulin infusion and multiple injections of insulin. Diabetes 1982;31:25564.","journal-title":"Diabetes"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1007\/BF00281300","article-title":"Seasonal variation in fasting plasma glucose levels in man","volume":"22","author":"Suarez, L.; Barrett-Connor, E.","year":"1982","unstructured":"Suarez L, Barrett-Connor E. Seasonal variation in fasting plasma glucose levels in man. Diabetologia 1982;22:250-3.","journal-title":"Diabetologia"},{"key":"ref_49","article-title":"Accepted","year":"1982","unstructured":"(Accepted 6 August 1982)"},{"key":"ref_50","article-title":"Case report An unmarried 32-year-old multigravida presented to the antenatal clinic on","volume-title":"Her last menstrual period had been on 3 July 1980 and the expected date of delivery was 10 April. She was a somewhat unreliable historian but a letter of referral dated September 1980 summarised her medical history. She had had four previous full-term normal deliveries, all the babies weighing over 3700 g, and had been a heroin addict for several years. In 1979 she had developed septicaemia and subacute bacterial endocarditis, which had damaged the mitral valve. During two months as an inpatient she had been weaned off drugs of addiction. She had been in Germany since September 1980 and as she had felt well had not sought antenatal care. Two weeks earlier she had noted decreased fetal movements and had returned to England for delivery","year":"1981","unstructured":"Case report An unmarried 32-year-old multigravida presented to the antenatal clinic on 8 April 1981. Her last menstrual period had been on 3 July 1980 and the expected date of delivery was 10 April. She was a somewhat unreliable historian but a letter of referral dated September 1980 summarised her medical history. She had had four previous full-term normal deliveries, all the babies weighing over 3700 g, and had been a heroin addict for several years. In 1979 she had developed septicaemia and subacute bacterial endocarditis, which had damaged the mitral valve. During two months as an inpatient she had been weaned off drugs of addiction. She had been in Germany since September 1980 and as she had felt well had not sought antenatal care. Two weeks earlier she had noted decreased fetal movements and had returned to England for delivery."},{"key":"ref_51","article-title":"Routine investigations were begun to determine the nature of the infection, but syphilis was diagnosed when treponemes were seen in the refrigerated ascitic fluid examined two days after birth. Serological tests for syphilis were positive on both the mother's blood and cord blood. Both mother and baby were treated with penicillin with good results, though the infant was seriously ill with thrombocytopenic purpura, haemolytic anaemia, and disseminated intravascular coagulation and was jaundiced for several weeks. She was discharged on 2 July and taken into care. She did not have any skin lesions apart from the petechial rash, nor were there the expected radiological bony changes of congenital syphilis. The mother had been treated for early syphilis and gonorrhoea in February 1980, but a new infection had probably been acquired in December 1980, when she would have been about 24 weeks pregnant","unstructured":"Routine investigations were begun to determine the nature of the infection, but syphilis was diagnosed when treponemes were seen in the refrigerated ascitic fluid examined two days after birth. Serological tests for syphilis were positive on both the mother's blood and cord blood. Both mother and baby were treated with penicillin with good results, though the infant was seriously ill with thrombocytopenic purpura, haemolytic anaemia, and disseminated intravascular coagulation and was jaundiced for several weeks. She was discharged on 2 July and taken into care. She did not have any skin lesions apart from the petechial rash, nor were there the expected radiological bony changes of congenital syphilis. The mother had been treated for early syphilis and gonorrhoea in February 1980, but a new infection had probably been acquired in December 1980, when she would have been about 24 weeks pregnant."},{"key":"ref_52","article-title":"Congenital syphilis is now uncommon in Britain, only 19 cases having been reported in 1979 and eight in 1980.1 This is probably largely due to antenatal screening, though penicillin has made a contribution. Treponemes cross the placenta even in the first trimester, but the fetus does not seem to react to this process until after the fourth month.2 Intrauterine death may result or a child may be born with or soon develop signs of syphilis. Intrauterine growth retardation may precede the intrauterine death, and without fetal monitoring, prompt intervention, and skilled paediatric intensive care this baby would probably have died. We have been unable to find a report of congenital syphilis presenting with diminished movements or fetal distress detected by monitoring before labour","unstructured":"Congenital syphilis is now uncommon in Britain, only 19 cases having been reported in 1979 and eight in 1980.1 This is probably largely due to antenatal screening, though penicillin has made a contribution. Treponemes cross the placenta even in the first trimester, but the fetus does not seem to react to this process until after the fourth month.2 Intrauterine death may result or a child may be born with or soon develop signs of syphilis. Intrauterine growth retardation may precede the intrauterine death, and without fetal monitoring, prompt intervention, and skilled paediatric intensive care this baby would probably have died. We have been unable to find a report of congenital syphilis presenting with diminished movements or fetal distress detected by monitoring before labour."}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.285.6350.1233","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.285.6350.1233","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T19:05:57Z","timestamp":1765307157000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.285.6350.1233"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1982,10,30]]},"references-count":52,"journal-issue":{"issue":"6350","published-online":{"date-parts":[[1982,10,30]]},"published-print":{"date-parts":[[1982,10,30]]}},"alternative-id":["10.1136\/bmj.285.6350.1233"],"URL":"https:\/\/doi.org\/10.1136\/bmj.285.6350.1233","relation":{},"ISSN":["0007-1447","1468-5833"],"issn-type":[{"value":"0007-1447","type":"print"},{"value":"1468-5833","type":"electronic"}],"subject":[],"published":{"date-parts":[[1982,10,30]]}}}