Lactation increases energy expenditure, promotes post-partum weight loss and improves glucose tolerance and lipid metabolism. It may also have long-term beneficial effects on glucose metabolism. Now data from the US Women’s Health Initiative study have linked prolonged breastfeeding with lower postmenopausal cardiovascular risk.
Data were analysed from 139,681 postmenopausal women (median age, 63 years) who had had at least one live birth. A lifetime history of >12 months of lactation was associated with significant reductions of 12% in hypertension, 20% in diabetes, 19% in hyperlipidaemia and 9% in cardiovascular disease (CVD). There was no reduction in the prevalence of obesity. Over an average of 8 years of follow-up, there was a significant 28% reduction in incidence of CVD among women who had had a single live birth and breastfed for 7–12 months compared with similar women who did not breastfeed.
Prolonged breastfeeding may protect against later CVD.
Schwarz EB, et al. Duration of lactation and risk factors for maternal cardiovascular disease. Obstet Gynecol 2009;113:974–982.
http://www.mims.com/Page.aspx?menuid=RecentHL&RecentHeaderID=353
Friday, October 30, 2009
Postnatal Depression
Health visitor delivered psychotherapy for post-natal depression
Depression affects about 13% of women in the year after delivery. Now a UK trial in general practice has shown benefit from interventions by health visitors.
A total of 2,749 women were enrolled antenatally at 101 general practices and randomized
(2:1) to intervention or control groups. In the intervention group, specially trained health visitors identified symptoms of depression using the Edinburgh post-natal depression scale (EPDS) and clinical assessment, and provided therapy (either cognitive behavioural therapy or person-centred therapy) in sessions lasting for an hour, each week for 8 weeks. The control group had usual care. At 6 weeks after delivery, 595 women had an EPDS score of at least 12. Of 418 of these women reassessed at 6 months, 93/271 (34%) in the intervention group and 67/147 (46%) in the control group had a score of at least 12, a significant 38% reduction in prevalence in the intervention group. In the total cohort, the prevalence of a score of at least 12 at 6 months was 12.4% (intervention) versus 16.7% (control), a significant 33% difference. The benefit was maintained at 12 months. There was no difference in outcome with cognitive behavioural or person-centred therapy.
Therapy provided by trained health visitors was successful.
Morrell CJ, et al. Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: pragmatic cluster randomised trial in primary care. BMJ 2009;338:276– 280; Dennis C-L. Preventing and treating postnatal depression. Ibid:246– 247 (editorial).
http://www.mims.com/Page.aspx?menuid=RecentHL&RecentHeaderID=352
Depression affects about 13% of women in the year after delivery. Now a UK trial in general practice has shown benefit from interventions by health visitors.
A total of 2,749 women were enrolled antenatally at 101 general practices and randomized
(2:1) to intervention or control groups. In the intervention group, specially trained health visitors identified symptoms of depression using the Edinburgh post-natal depression scale (EPDS) and clinical assessment, and provided therapy (either cognitive behavioural therapy or person-centred therapy) in sessions lasting for an hour, each week for 8 weeks. The control group had usual care. At 6 weeks after delivery, 595 women had an EPDS score of at least 12. Of 418 of these women reassessed at 6 months, 93/271 (34%) in the intervention group and 67/147 (46%) in the control group had a score of at least 12, a significant 38% reduction in prevalence in the intervention group. In the total cohort, the prevalence of a score of at least 12 at 6 months was 12.4% (intervention) versus 16.7% (control), a significant 33% difference. The benefit was maintained at 12 months. There was no difference in outcome with cognitive behavioural or person-centred therapy.
Therapy provided by trained health visitors was successful.
Morrell CJ, et al. Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: pragmatic cluster randomised trial in primary care. BMJ 2009;338:276– 280; Dennis C-L. Preventing and treating postnatal depression. Ibid:246– 247 (editorial).
http://www.mims.com/Page.aspx?menuid=RecentHL&RecentHeaderID=352
Eating during labour
It is common practice to discourage food intake during labour. Now a study in London, England, has suggested that a light diet does no harm.
The study included 2,426 nondiabetic nulliparae in labour at term with a singleton, cephalic-presenting fetus and at least 5 cm cervical dilatation. Randomization was to light (low fat, low residue) diet or water only. The rate of normal vaginal delivery was 44% in each group. Duration of labour was similar in the two groups (597 minutes with food, 612 minutes with water only). There were no significant differences in rates of instrumental or Caesarean delivery, maternal vomiting, or use of epidural analgesia or oxytocin. There were no cases of aspiration. Apgar scores and rates of admission to neonatal intensive care were similar.
Allowing women to eat in labour caused no harm.
O’Sullivan G, et al. Effect of food intake during labour on obstetric outcome: randomised controlled trial. BMJ 2009;338:880; Downe S. Eating a light diet during labour. Ibid: 842–843 (editorial).
MIMS Online http://www.mims.com/Page.aspx?menuid=RecentHL&RecentHeaderID=354
The study included 2,426 nondiabetic nulliparae in labour at term with a singleton, cephalic-presenting fetus and at least 5 cm cervical dilatation. Randomization was to light (low fat, low residue) diet or water only. The rate of normal vaginal delivery was 44% in each group. Duration of labour was similar in the two groups (597 minutes with food, 612 minutes with water only). There were no significant differences in rates of instrumental or Caesarean delivery, maternal vomiting, or use of epidural analgesia or oxytocin. There were no cases of aspiration. Apgar scores and rates of admission to neonatal intensive care were similar.
Allowing women to eat in labour caused no harm.
O’Sullivan G, et al. Effect of food intake during labour on obstetric outcome: randomised controlled trial. BMJ 2009;338:880; Downe S. Eating a light diet during labour. Ibid: 842–843 (editorial).
MIMS Online http://www.mims.com/Page.aspx?menuid=RecentHL&RecentHeaderID=354
Thursday, October 29, 2009
Stages of Pregnancy in Pictures
view pictures of fetus in utero
http://www.emedicinehealth.com/slideshow_stages_of_pregnancy_pictures/article_em.htm
http://www.emedicinehealth.com/slideshow_stages_of_pregnancy_pictures/article_em.htm
Wednesday, October 28, 2009
Breastfeeding Recommended for Low-Income Mothers
From Medscape Medical News
Crina Frincu-Mallos, PhD
October 28, 2009 (Washington, DC) — Despite the recommendation from the World Health Organization that all women exclusively breastfeed for the first 6 months for optimal infant growth and development, data from 198 primiparous women in Tennessee show that even women intending to nurse give up after the first 2 months. The findings were reported here at the American Academy of Pediatrics 2009 National Conference and Exhibition.
More than half of low-income first-time mothers start breastfeeding, but only 13% continue up to 6 months, partly because of the availability of free infant formula provided by the Special Supplemental Nutrition Program for Women, Infants, and Children, known as the WIC program, researchers told meeting attendees.
Mother's Milk Is Best . . . and Free
"We did our research in first-time mothers in the South, which has the lowest rates of breastfeeding," said Stephanie M. Reich, PhD, assistant professor in the Department of Education at University of California at Irvine.
"We found that if they were getting free formula from their pediatrician, they were more than twice as likely to quit breastfeeding," Dr. Reich said in an interview with Medscape Pediatrics.
The 198 women in the study were interviewed at home during the third trimester of their pregnancy. Of these, 168 women were interviewed after they gave birth, and again at 2, 4, 6, 9, 12, and 18 months postpartum. Study participants were African American (n = 125), white (n = 62), Hispanic (n = 16), and Asian (n = 2). Most women in study were single mothers (n = 154). Pregnancy was planned in only 40 cases (20%).
In terms of education, 58 first-time mothers were high-school graduates, 57 attended college, 52 attended high school, 21 had associate and/or bachelors degrees, and 10 were in graduate school. In terms of annual income, 31 first-time mothers had incomes higher than $26,000, 29 had incomes lower than $8000, and the rest fell within this range.
Good Intentions but Negative Impact of Free Infant Formula
"Giving new mothers formula gives them the idea that formula, in some way, might be preferable to breast milk, which it is not," noted Paula Brinkley, MD, a pediatrician in private practice in Berkeley, California, who was attending the meeting. "In order to maximize breastfeeding, it's preferable not to make formula too easy to obtain," Dr. Brinkley, who was not involved with the study, told Medscape Pediatrics in an interview.
"Keep formula companies from giving free formula to hospitals, which they often do, suggested Dr. Brinkley, "and, as a pediatrician, don't give formula to mothers, don't offer it as a perk, unless it's necessary," she advised.
There are other factors that contribute to a new mother's decision to stop breastfeeding, yet all mothers "were more likely to give it up if they were given free formula," explained Dr. Reich. "If you are frustrated with breastfeeding, it's 1 more step to have to go and buy formula and decide, but if you can open a cabinet and do that, it's easier. Formula is expensive, but if you get it for free, you don't have the cost barrier that a lot of other women face," she said.
Breastfeeding Decision Is Influenced by Parents, Physicians
Most women in the study (71%) planned to breastfeed their infants and even more (99%) knew about the health benefits of mother's milk. Those not intending to breastfeed felt it would be a hassle and were more likely to be receiving WIC, said Dr. Reich.
The study results indicate that the obstetrician's influence regarding a new mother's decision to breastfeed is relatively high, compared with the pediatrician's influence (23% vs 9%). However, "family members were very influential in their decision to breastfeed," noted Dr. Reich, "so if their parents were against breastfeeding (46%), they didn't at all, but if their parents were supportive, they were more likely to try it."
Interestingly, looking at postnatal practices, the results show that of the first-time mothers who said during the initial interview that they intend to breastfeed, 89% actually did. However, of those who intended to use free formula, none breastfed.
Dr. Reich added that "a lot of them did not intend to breastfeed for very long, only planned to breastfeed for 1 month, which doesn't give as many of the benefits, but gives all the discomforts — the discouragement, the soreness, . . . the rest of it, but they don't have enough education about breastfeeding to know that it's easier downstream."
"Women who know more about breastfeeding," she remarked, "know more about the benefits of breastfeeding, the protective factor, and do continue breastfeeding."
"This is part of a larger study in which we are trying to educate women by providing educational information through baby books, so as women read to their children, they learn more about child development and intervention," explained Dr. Reich. "We are studying these infants for the first 18 months of their lives and [by now] we know that books work, we know that moms know more after reading them. Then we look at whether that changes any of their behaviors, if it increases their interaction with their babies, and do they provide nutritional benefits."
"We started with breastfeeding," Dr. Reich said, "but we look at other feeding practices, safety in their home, the quality of their interactions, [and] language and cognitive development in the babies."
Knowing the benefits of breast milk is not sufficient for inducing low-income first-time mothers to breastfeed their babies for at least 6 months. Understanding the reasons for never starting or discontinuing early and the role that family and doctors play in this decision could help with implementing breastfeeding practices, concluded Dr. Reich.
Dr. Reich and Dr. Brinkley have disclosed no relevant financial relationships.
American Academy of Pediatrics (AAP) 2009 National Conference and Exhibition: Abstract 7890. Presented October 18, 2009.
Crina Frincu-Mallos, PhD
October 28, 2009 (Washington, DC) — Despite the recommendation from the World Health Organization that all women exclusively breastfeed for the first 6 months for optimal infant growth and development, data from 198 primiparous women in Tennessee show that even women intending to nurse give up after the first 2 months. The findings were reported here at the American Academy of Pediatrics 2009 National Conference and Exhibition.
More than half of low-income first-time mothers start breastfeeding, but only 13% continue up to 6 months, partly because of the availability of free infant formula provided by the Special Supplemental Nutrition Program for Women, Infants, and Children, known as the WIC program, researchers told meeting attendees.
Mother's Milk Is Best . . . and Free
"We did our research in first-time mothers in the South, which has the lowest rates of breastfeeding," said Stephanie M. Reich, PhD, assistant professor in the Department of Education at University of California at Irvine.
"We found that if they were getting free formula from their pediatrician, they were more than twice as likely to quit breastfeeding," Dr. Reich said in an interview with Medscape Pediatrics.
The 198 women in the study were interviewed at home during the third trimester of their pregnancy. Of these, 168 women were interviewed after they gave birth, and again at 2, 4, 6, 9, 12, and 18 months postpartum. Study participants were African American (n = 125), white (n = 62), Hispanic (n = 16), and Asian (n = 2). Most women in study were single mothers (n = 154). Pregnancy was planned in only 40 cases (20%).
In terms of education, 58 first-time mothers were high-school graduates, 57 attended college, 52 attended high school, 21 had associate and/or bachelors degrees, and 10 were in graduate school. In terms of annual income, 31 first-time mothers had incomes higher than $26,000, 29 had incomes lower than $8000, and the rest fell within this range.
Good Intentions but Negative Impact of Free Infant Formula
"Giving new mothers formula gives them the idea that formula, in some way, might be preferable to breast milk, which it is not," noted Paula Brinkley, MD, a pediatrician in private practice in Berkeley, California, who was attending the meeting. "In order to maximize breastfeeding, it's preferable not to make formula too easy to obtain," Dr. Brinkley, who was not involved with the study, told Medscape Pediatrics in an interview.
"Keep formula companies from giving free formula to hospitals, which they often do, suggested Dr. Brinkley, "and, as a pediatrician, don't give formula to mothers, don't offer it as a perk, unless it's necessary," she advised.
There are other factors that contribute to a new mother's decision to stop breastfeeding, yet all mothers "were more likely to give it up if they were given free formula," explained Dr. Reich. "If you are frustrated with breastfeeding, it's 1 more step to have to go and buy formula and decide, but if you can open a cabinet and do that, it's easier. Formula is expensive, but if you get it for free, you don't have the cost barrier that a lot of other women face," she said.
Breastfeeding Decision Is Influenced by Parents, Physicians
Most women in the study (71%) planned to breastfeed their infants and even more (99%) knew about the health benefits of mother's milk. Those not intending to breastfeed felt it would be a hassle and were more likely to be receiving WIC, said Dr. Reich.
The study results indicate that the obstetrician's influence regarding a new mother's decision to breastfeed is relatively high, compared with the pediatrician's influence (23% vs 9%). However, "family members were very influential in their decision to breastfeed," noted Dr. Reich, "so if their parents were against breastfeeding (46%), they didn't at all, but if their parents were supportive, they were more likely to try it."
Interestingly, looking at postnatal practices, the results show that of the first-time mothers who said during the initial interview that they intend to breastfeed, 89% actually did. However, of those who intended to use free formula, none breastfed.
Dr. Reich added that "a lot of them did not intend to breastfeed for very long, only planned to breastfeed for 1 month, which doesn't give as many of the benefits, but gives all the discomforts — the discouragement, the soreness, . . . the rest of it, but they don't have enough education about breastfeeding to know that it's easier downstream."
"Women who know more about breastfeeding," she remarked, "know more about the benefits of breastfeeding, the protective factor, and do continue breastfeeding."
"This is part of a larger study in which we are trying to educate women by providing educational information through baby books, so as women read to their children, they learn more about child development and intervention," explained Dr. Reich. "We are studying these infants for the first 18 months of their lives and [by now] we know that books work, we know that moms know more after reading them. Then we look at whether that changes any of their behaviors, if it increases their interaction with their babies, and do they provide nutritional benefits."
"We started with breastfeeding," Dr. Reich said, "but we look at other feeding practices, safety in their home, the quality of their interactions, [and] language and cognitive development in the babies."
Knowing the benefits of breast milk is not sufficient for inducing low-income first-time mothers to breastfeed their babies for at least 6 months. Understanding the reasons for never starting or discontinuing early and the role that family and doctors play in this decision could help with implementing breastfeeding practices, concluded Dr. Reich.
Dr. Reich and Dr. Brinkley have disclosed no relevant financial relationships.
American Academy of Pediatrics (AAP) 2009 National Conference and Exhibition: Abstract 7890. Presented October 18, 2009.
Tuesday, October 27, 2009
Pregnant? Stop Smoking or Risk having a Psychotic Teen
From Medscape Medical News CME
Maternal Smoking in Pregnancy Linked to Increased Risk for Psychotic Symptoms in Adolescents
Deborah Brauser & Laurie Barclay,
October 16, 2009 — The maternal use of tobacco while pregnant is associated with an increased risk for psychotic symptoms such as hallucinations and delusions in their children, with evidence of a dose-response effect, according to results from a large cohort study published in the October issue of the British Journal of Psychiatry.
"These findings indicate that the risk factors for development of non-clinical psychotic experiences may operate during early development," write Stanley Zammit, PhD, clinical senior lecturer in psychiatric epidemiology in the Department of Psychological Medicine at Cardiff University in Wales and the University of Bristol in the United Kingdom, and colleagues.
"This is the only study to really try and tease out to what extent this association is causal rather than being confounded or explained by other factors," Dr. Zammit told Medscape Psychiatry.
"There could still be confounding, of course, but this makes us a bit more confident that the association may be due to the effects of nicotine on the developing brain in the uterus," he added.
Smoking While Pregnant Common in the United Kingdom
"In the [United Kingdom], 15-20% of women continue to smoke throughout their pregnancy, and although cannabis use is less common, some alcohol intake during pregnancy is reported by most women," write the study authors.
They note that past studies have shown an association between maternal smoking and, to a lesser extent, maternal cannabis and alcohol use and adverse long-term effects on their offspring, including reduced cognitive ability and increased incidence of both attention-deficit/hyperactivity disorder and conduct disorder during childhood and adolescence.
However, the authors report that there have been very few epidemiological studies showing causal inference between maternal substance abuse and childhood psychopathology.
"Our aim [in this study] was to investigate, in a longitudinal design, whether maternal tobacco, cannabis, or alcohol use during pregnancy were independently associated with risk of the offspring developing psychotic symptoms during early adolescence," write the study authors.
"I'm interested in the effects of substance use on mental health outcomes," explained Dr. Zammit. "In animals, there is good evidence that nicotine in utero can disrupt the normal development/function of the fetal brain, so it seems very plausible that this could happen in humans and have subtle effects that are not noticeable early on in life but are only expressed later during development."
The investigators examined data from the Avon Longitudinal Study of Parents and Children, including 14,062 adolescents born between April 1991 and December 1992.
Dr. Zammit and his team focused their evaluation on a cohort of 6356 adolescents, all 12 years of age, who participated in a semistructured interview for psychosis-like symptoms (PLIKS). This interview included 12 core questions, which covered hallucinations, delusions, and experiences of thought interference during the past 6 months.
Data on parental substance use were obtained from self-report postal questionnaires completed by the mother at 8, 18, and 32 weeks of pregnancy and at 2, 21, 33, and 47 months after giving birth, and from the father at 18 weeks of pregnancy and at 2, 8, and 21 months after birth.
Of these mothers, 1219 (19.3%) smoked tobacco, 4372 (70.0%) drank alcohol, and 157 (2.5%) used cannabis at least once during pregnancy.
Maternal Tobacco Use Increased Risk for PLIKS
At the end of this cohort study, a total of 734 of the children (11.6%) were rated as having suspected or definite PLIKS, and 300 of these children (4.7%) had definite symptoms.
The investigators found that maternal tobacco use during pregnancy was strongly associated with an increased risk for suspected or definite PLIKS in their offspring (adjusted odds ratio [OR], 1.20; 95% confidence interval [CI], 1.05 – 1.37; P = .007). This risk further increased based on frequency of tobacco use.
In addition, "the offspring of mothers who used tobacco only in their third trimester had a greater risk of developing any suspected or definite PLIKS than offspring whose mothers smoked only in the first trimester (OR, 2.1; 95% CI, 0.96-4.59; P = 0.063)," report the authors.
After adjusting for confounders and maternal smoking during pregnancy, paternal smoking during pregnancy, maternal smoking postpregnancy, or maternal cannabis use were not associated with any suspected or definite PLIKS.
Although maternal alcohol use did show a nonlinear association with psychotic symptoms, this effect was found almost exclusively in the offspring of the 25 women who drank more than 21 units weekly.
Future Studies Needed
"Maternal smoking during pregnancy was associated with an increased risk of psychotic symptoms in the children, with evidence of a dose-response effect whereby risk of PLIKS was highest in the offspring of mothers who smoked most heavily," write the study authors.
"If our results are non-biased and truly reflect a causal relationship, we can estimate that about 20% of adolescents in this cohort would not have developed psychotic symptoms if their mothers had not smoked," they add.
Study limitations included missing data resulting from attrition and wave nonresponse, as well as possible underreporting of substance use (including cannabis, which is illegal in the United Kingdom).
"Hopefully this will encourage more research into the effects of tobacco on brain development in utero, and increase understanding of how any disruptions of brain development can impact risk of psychosis," Dr. Zammit concluded.
This study was supported by the Wellcome Trust Grant, with additional funding to Dr. Zammit through a Clinician Scientist Award from the National Assembly for Wales. The other study authors have disclosed no relevant financial relationships.
Br J Psychiatry. 2009;195:294–300. Abstract
Additonal Resource
More information on tobacco use and pregnancy is available on the Centers for Disease Control and Prevention's Web site.
Maternal Smoking in Pregnancy Linked to Increased Risk for Psychotic Symptoms in Adolescents
Deborah Brauser & Laurie Barclay,
October 16, 2009 — The maternal use of tobacco while pregnant is associated with an increased risk for psychotic symptoms such as hallucinations and delusions in their children, with evidence of a dose-response effect, according to results from a large cohort study published in the October issue of the British Journal of Psychiatry.
"These findings indicate that the risk factors for development of non-clinical psychotic experiences may operate during early development," write Stanley Zammit, PhD, clinical senior lecturer in psychiatric epidemiology in the Department of Psychological Medicine at Cardiff University in Wales and the University of Bristol in the United Kingdom, and colleagues.
"This is the only study to really try and tease out to what extent this association is causal rather than being confounded or explained by other factors," Dr. Zammit told Medscape Psychiatry.
"There could still be confounding, of course, but this makes us a bit more confident that the association may be due to the effects of nicotine on the developing brain in the uterus," he added.
Smoking While Pregnant Common in the United Kingdom
"In the [United Kingdom], 15-20% of women continue to smoke throughout their pregnancy, and although cannabis use is less common, some alcohol intake during pregnancy is reported by most women," write the study authors.
They note that past studies have shown an association between maternal smoking and, to a lesser extent, maternal cannabis and alcohol use and adverse long-term effects on their offspring, including reduced cognitive ability and increased incidence of both attention-deficit/hyperactivity disorder and conduct disorder during childhood and adolescence.
However, the authors report that there have been very few epidemiological studies showing causal inference between maternal substance abuse and childhood psychopathology.
"Our aim [in this study] was to investigate, in a longitudinal design, whether maternal tobacco, cannabis, or alcohol use during pregnancy were independently associated with risk of the offspring developing psychotic symptoms during early adolescence," write the study authors.
"I'm interested in the effects of substance use on mental health outcomes," explained Dr. Zammit. "In animals, there is good evidence that nicotine in utero can disrupt the normal development/function of the fetal brain, so it seems very plausible that this could happen in humans and have subtle effects that are not noticeable early on in life but are only expressed later during development."
The investigators examined data from the Avon Longitudinal Study of Parents and Children, including 14,062 adolescents born between April 1991 and December 1992.
Dr. Zammit and his team focused their evaluation on a cohort of 6356 adolescents, all 12 years of age, who participated in a semistructured interview for psychosis-like symptoms (PLIKS). This interview included 12 core questions, which covered hallucinations, delusions, and experiences of thought interference during the past 6 months.
Data on parental substance use were obtained from self-report postal questionnaires completed by the mother at 8, 18, and 32 weeks of pregnancy and at 2, 21, 33, and 47 months after giving birth, and from the father at 18 weeks of pregnancy and at 2, 8, and 21 months after birth.
Of these mothers, 1219 (19.3%) smoked tobacco, 4372 (70.0%) drank alcohol, and 157 (2.5%) used cannabis at least once during pregnancy.
Maternal Tobacco Use Increased Risk for PLIKS
At the end of this cohort study, a total of 734 of the children (11.6%) were rated as having suspected or definite PLIKS, and 300 of these children (4.7%) had definite symptoms.
The investigators found that maternal tobacco use during pregnancy was strongly associated with an increased risk for suspected or definite PLIKS in their offspring (adjusted odds ratio [OR], 1.20; 95% confidence interval [CI], 1.05 – 1.37; P = .007). This risk further increased based on frequency of tobacco use.
In addition, "the offspring of mothers who used tobacco only in their third trimester had a greater risk of developing any suspected or definite PLIKS than offspring whose mothers smoked only in the first trimester (OR, 2.1; 95% CI, 0.96-4.59; P = 0.063)," report the authors.
After adjusting for confounders and maternal smoking during pregnancy, paternal smoking during pregnancy, maternal smoking postpregnancy, or maternal cannabis use were not associated with any suspected or definite PLIKS.
Although maternal alcohol use did show a nonlinear association with psychotic symptoms, this effect was found almost exclusively in the offspring of the 25 women who drank more than 21 units weekly.
Future Studies Needed
"Maternal smoking during pregnancy was associated with an increased risk of psychotic symptoms in the children, with evidence of a dose-response effect whereby risk of PLIKS was highest in the offspring of mothers who smoked most heavily," write the study authors.
"If our results are non-biased and truly reflect a causal relationship, we can estimate that about 20% of adolescents in this cohort would not have developed psychotic symptoms if their mothers had not smoked," they add.
Study limitations included missing data resulting from attrition and wave nonresponse, as well as possible underreporting of substance use (including cannabis, which is illegal in the United Kingdom).
"Hopefully this will encourage more research into the effects of tobacco on brain development in utero, and increase understanding of how any disruptions of brain development can impact risk of psychosis," Dr. Zammit concluded.
This study was supported by the Wellcome Trust Grant, with additional funding to Dr. Zammit through a Clinician Scientist Award from the National Assembly for Wales. The other study authors have disclosed no relevant financial relationships.
Br J Psychiatry. 2009;195:294–300. Abstract
Additonal Resource
More information on tobacco use and pregnancy is available on the Centers for Disease Control and Prevention's Web site.
Monday, October 26, 2009
New-Onset Breast Tenderness During Hormone Therapy Linked to Increased Breast Cancer Risk
From Medscape Medical News CME
Laurie Barclay, MD
Charles P. Vega, MD
October 21, 2009 — New-onset breast tenderness during conjugated equine estrogens plus medroxyprogesterone acetate (CEE+MPA) hormonal therapy is linked to increased breast cancer risk, according to an analysis of data from a randomized controlled trial reported in the October 12 issue of the Archives of Internal Medicine.
"To our knowledge, no prior published studies have addressed whether there is an association between CEE+MPA–induced new-onset breast tenderness and breast cancer risk," lead author Carolyn J. Crandall, MD, MS, from the David Geffen School of Medicine at University of Southern California, Los Angeles, said in a news release.
In the Women's Health Initiative (WHI) Estrogen Plus Progestin Trial, postmenopausal women with an intact uterus were randomly assigned to receive daily CEE+MPA (0.625/2.5 mg; n = 8506) or placebo (n = 8102). Mammography and clinical breast examination were performed at baseline and once yearly, and self-reported breast tenderness was evaluated at baseline and at 12 months. During follow-up (mean duration, 5.6 years), medical record review allowed confirmation of invasive breast cancer incidence.
Among 14,538 women who did not report breast tenderness at baseline, new-onset breast tenderness after 12 months occurred in 36.1% of those randomly assigned to CEE+MPA vs 11.8% of those in the placebo group (P < .001). Among women receiving CEE+MPA, those with new-onset breast tenderness had significantly higher breast cancer risk vs those without self-reported tenderness (hazard ratio, 1.48; 95% confidence interval, 1.08 - 2.03; P = .02).
"Is it because the hormone therapy is causing breast-tissue cells to multiply more rapidly, which causes breast tenderness and at the same time indicates increased cancer risk?" Dr. Crandall said. "We need to figure out what makes certain women more susceptible to developing breast tenderness during hormone therapy than other women."
Breast cancer risk was not significantly associated with new-onset breast tenderness in the placebo group (P = .97).
Limitations of this study include annual vs more frequent assessment of breast tenderness, relatively high rates of discontinuation of combination therapy and of crossover from placebo to active therapy, and lack of generalizability to other types of hormonal therapy.
"New-onset breast tenderness during conjugated equine estrogens plus medroxyprogesterone therapy was associated with increased breast cancer risk," the study authors write. "The sensitivity and specificity of the association between breast tenderness and breast cancer were similar in magnitude to those of the Gail model."
The National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services supported the WHI. Dr. Crandall's work was supported by the National Institute on Aging, National Institutes of Health, and the Tarlow-Eisner-Moss Research Endowment of the Iris Cantor–UCLA Women's Health Center. Wyeth-Ayerst Research Laboratories supplied the active study drug and placebo. One of the study authors (Dr. Chlebowski) has disclosed various financial relationships with Astra-Zeneca, Eli Lilly & Co, Novartis International AG, Wyeth Pharmaceuticals, and Pfizer Inc.
Arch Intern Med. 2009;169:1684-1691.
Additional Resources
More information on breast cancer and hormone therapy is available on the Women's Health Inititaive's Web site and also on the National Cancer Institute's Web site.
Clinical Context
Women with increased breast density on mammography results have a higher risk for breast cancer, and a previous study suggests that breast symptoms in women during menopause may predict the degree of breast density. In another study by Crandall and colleagues, which was published in the August 14-28 issue of the Archives of Internal Medicine, middle-aged and older women with new-onset breast discomfort had a significant 3.9% increase in total breast density vs women who did not have discomfort. Although participants in this research were enrolled in a trial of postmenopausal hormone therapy, the positive relationship between breast density and breast discomfort was present whether they were receiving active treatment or placebo.
Postmenopausal hormone therapy can increase breast density, and breast discomfort as a marker may be useful to identify women with a higher risk for breast cancer. The current study examines the relationship between breast discomfort and breast cancer using data from the WHI.
Laurie Barclay, MD
Charles P. Vega, MD
October 21, 2009 — New-onset breast tenderness during conjugated equine estrogens plus medroxyprogesterone acetate (CEE+MPA) hormonal therapy is linked to increased breast cancer risk, according to an analysis of data from a randomized controlled trial reported in the October 12 issue of the Archives of Internal Medicine.
"To our knowledge, no prior published studies have addressed whether there is an association between CEE+MPA–induced new-onset breast tenderness and breast cancer risk," lead author Carolyn J. Crandall, MD, MS, from the David Geffen School of Medicine at University of Southern California, Los Angeles, said in a news release.
In the Women's Health Initiative (WHI) Estrogen Plus Progestin Trial, postmenopausal women with an intact uterus were randomly assigned to receive daily CEE+MPA (0.625/2.5 mg; n = 8506) or placebo (n = 8102). Mammography and clinical breast examination were performed at baseline and once yearly, and self-reported breast tenderness was evaluated at baseline and at 12 months. During follow-up (mean duration, 5.6 years), medical record review allowed confirmation of invasive breast cancer incidence.
Among 14,538 women who did not report breast tenderness at baseline, new-onset breast tenderness after 12 months occurred in 36.1% of those randomly assigned to CEE+MPA vs 11.8% of those in the placebo group (P < .001). Among women receiving CEE+MPA, those with new-onset breast tenderness had significantly higher breast cancer risk vs those without self-reported tenderness (hazard ratio, 1.48; 95% confidence interval, 1.08 - 2.03; P = .02).
"Is it because the hormone therapy is causing breast-tissue cells to multiply more rapidly, which causes breast tenderness and at the same time indicates increased cancer risk?" Dr. Crandall said. "We need to figure out what makes certain women more susceptible to developing breast tenderness during hormone therapy than other women."
Breast cancer risk was not significantly associated with new-onset breast tenderness in the placebo group (P = .97).
Limitations of this study include annual vs more frequent assessment of breast tenderness, relatively high rates of discontinuation of combination therapy and of crossover from placebo to active therapy, and lack of generalizability to other types of hormonal therapy.
"New-onset breast tenderness during conjugated equine estrogens plus medroxyprogesterone therapy was associated with increased breast cancer risk," the study authors write. "The sensitivity and specificity of the association between breast tenderness and breast cancer were similar in magnitude to those of the Gail model."
The National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services supported the WHI. Dr. Crandall's work was supported by the National Institute on Aging, National Institutes of Health, and the Tarlow-Eisner-Moss Research Endowment of the Iris Cantor–UCLA Women's Health Center. Wyeth-Ayerst Research Laboratories supplied the active study drug and placebo. One of the study authors (Dr. Chlebowski) has disclosed various financial relationships with Astra-Zeneca, Eli Lilly & Co, Novartis International AG, Wyeth Pharmaceuticals, and Pfizer Inc.
Arch Intern Med. 2009;169:1684-1691.
Additional Resources
More information on breast cancer and hormone therapy is available on the Women's Health Inititaive's Web site and also on the National Cancer Institute's Web site.
Clinical Context
Women with increased breast density on mammography results have a higher risk for breast cancer, and a previous study suggests that breast symptoms in women during menopause may predict the degree of breast density. In another study by Crandall and colleagues, which was published in the August 14-28 issue of the Archives of Internal Medicine, middle-aged and older women with new-onset breast discomfort had a significant 3.9% increase in total breast density vs women who did not have discomfort. Although participants in this research were enrolled in a trial of postmenopausal hormone therapy, the positive relationship between breast density and breast discomfort was present whether they were receiving active treatment or placebo.
Postmenopausal hormone therapy can increase breast density, and breast discomfort as a marker may be useful to identify women with a higher risk for breast cancer. The current study examines the relationship between breast discomfort and breast cancer using data from the WHI.
Wednesday, October 7, 2009
Rate of Postpartum Diabetes Screening May Be Low
From Medscape Medical News
Laurie Barclay, MD Charles P. Vega, MD
Diabetes Care. Published online September 9, 2009. Abstract
Clinical Context
Gestational diabetes is associated with an increased risk for the subsequent development of type 2 diabetes, and a previous systematic review by Kim and colleagues explored this relationship. Their findings, which were published in the October 2002 issue of Diabetes Care, suggested that the lifetime incidence of type 2 diabetes among women with a history of gestational diabetes could be more than 70%. The risk for incident diabetes is highest in the first 5 years after delivery and plateaus by 10 years. An elevated fasting glucose level was the most important factor in predicting the risk for incident diabetes.
Nonetheless, many women at risk for incident diabetes do not receive testing for hyperglycemia in the postpartum period. The current study examines the prevalence of such testing and compares oral glucose tolerance testing vs fasting glucose testing in diagnosing hyperglycemia.
Study Highlights
The study design was a retrospective cohort review of cases from 1 hospital in Canada. The researchers focused on women with a history of gestational diabetes or impaired glucose tolerance during pregnancy.
Gestational diabetes was diagnosed after a 50-g oral glucose tolerance test result of 10.3 mmol/L or more at 1 hour, or after an abnormal 2-hour glucose tolerance test result after an equivocal 1-hour result. Impaired glucose tolerance was defined as a fasting plasma glucose level of 5.3 mmol/L or more, a 1-hour result of 10.6 mmol/L or more, or a 2-hour result of 8.9 mmol/L or more after a 75-g oral glucose tolerance test.
Women with a history of hyperglycemia before pregnancy were excluded from study analysis.
Researchers examined the prevalence of screening for diabetes postpartum and compared oral glucose tolerance testing vs fasting plasma glucose testing in diagnosing hyperglycemia.
Diabetes was defined as a fasting plasma glucose level of 7 mmol/L or more, or a 2-hour glucose level of at least 11.1 mmol/L after a 75-g oral glucose tolerance test. Impaired glucose tolerance was defined as a 2-hour glucose level of 7.8 to 11.1 mmol/L after a 75-g oral glucose tolerance test. Impaired fasting glucose was defined as a glucose level between 6.1 and 6.9 mmol/L.
909 women underwent analysis. The mean age of subjects was 31.7 years, and two thirds of the cohort had a family history of diabetes. A total of 61% of women had used insulin during pregnancy.
Only 438 (48.2%) of women underwent postpartum testing, of whom 21 completed only a fasting plasma glucose test.
Women with a higher parity and who did not use insulin were less likely to receive postpartum glucose testing.
14 women were diagnosed with type 2 diabetes at the postpartum visit, whereas 15 had impaired fasting glucose, 57 had impaired glucose tolerance, and 3 had both impaired glucose tolerance and impaired fasting glucose.
Results of the fasting plasma glucose test and oral glucose tolerance test were abnormal in 5.7% and 21.3% of women, respectively. Fasting glucose testing alone would have missed 72% of women with an abnormal glucose result.
Non-Caucasian ethnicity, previous gestational diabetes, and higher pregnancy oral glucose tolerance testing values were all predictors of a higher risk for an abnormal postpartum glucose testing result.
Clinical Implications
A previous systematic review found that the lifetime incidence of type 2 diabetes among women with a history of gestational diabetes may exceed 70%.
The rate of new cases of diabetes was highest in the first 5 years after delivery. Although a high fasting glucose test result during pregnancy was found to be an important predictor of the risk for type 2 diabetes, race alone was not.
Less than half of women with abnormal glucose testing results during pregnancy received postpartum glucose screening in the current study. Oral glucose tolerance testing was more sensitive than fasting plasma glucose testing in diagnosing postpartum glucose abnormalities.
Laurie Barclay, MD Charles P. Vega, MD
Diabetes Care. Published online September 9, 2009. Abstract
Clinical Context
Gestational diabetes is associated with an increased risk for the subsequent development of type 2 diabetes, and a previous systematic review by Kim and colleagues explored this relationship. Their findings, which were published in the October 2002 issue of Diabetes Care, suggested that the lifetime incidence of type 2 diabetes among women with a history of gestational diabetes could be more than 70%. The risk for incident diabetes is highest in the first 5 years after delivery and plateaus by 10 years. An elevated fasting glucose level was the most important factor in predicting the risk for incident diabetes.
Nonetheless, many women at risk for incident diabetes do not receive testing for hyperglycemia in the postpartum period. The current study examines the prevalence of such testing and compares oral glucose tolerance testing vs fasting glucose testing in diagnosing hyperglycemia.
Study Highlights
The study design was a retrospective cohort review of cases from 1 hospital in Canada. The researchers focused on women with a history of gestational diabetes or impaired glucose tolerance during pregnancy.
Gestational diabetes was diagnosed after a 50-g oral glucose tolerance test result of 10.3 mmol/L or more at 1 hour, or after an abnormal 2-hour glucose tolerance test result after an equivocal 1-hour result. Impaired glucose tolerance was defined as a fasting plasma glucose level of 5.3 mmol/L or more, a 1-hour result of 10.6 mmol/L or more, or a 2-hour result of 8.9 mmol/L or more after a 75-g oral glucose tolerance test.
Women with a history of hyperglycemia before pregnancy were excluded from study analysis.
Researchers examined the prevalence of screening for diabetes postpartum and compared oral glucose tolerance testing vs fasting plasma glucose testing in diagnosing hyperglycemia.
Diabetes was defined as a fasting plasma glucose level of 7 mmol/L or more, or a 2-hour glucose level of at least 11.1 mmol/L after a 75-g oral glucose tolerance test. Impaired glucose tolerance was defined as a 2-hour glucose level of 7.8 to 11.1 mmol/L after a 75-g oral glucose tolerance test. Impaired fasting glucose was defined as a glucose level between 6.1 and 6.9 mmol/L.
909 women underwent analysis. The mean age of subjects was 31.7 years, and two thirds of the cohort had a family history of diabetes. A total of 61% of women had used insulin during pregnancy.
Only 438 (48.2%) of women underwent postpartum testing, of whom 21 completed only a fasting plasma glucose test.
Women with a higher parity and who did not use insulin were less likely to receive postpartum glucose testing.
14 women were diagnosed with type 2 diabetes at the postpartum visit, whereas 15 had impaired fasting glucose, 57 had impaired glucose tolerance, and 3 had both impaired glucose tolerance and impaired fasting glucose.
Results of the fasting plasma glucose test and oral glucose tolerance test were abnormal in 5.7% and 21.3% of women, respectively. Fasting glucose testing alone would have missed 72% of women with an abnormal glucose result.
Non-Caucasian ethnicity, previous gestational diabetes, and higher pregnancy oral glucose tolerance testing values were all predictors of a higher risk for an abnormal postpartum glucose testing result.
Clinical Implications
A previous systematic review found that the lifetime incidence of type 2 diabetes among women with a history of gestational diabetes may exceed 70%.
The rate of new cases of diabetes was highest in the first 5 years after delivery. Although a high fasting glucose test result during pregnancy was found to be an important predictor of the risk for type 2 diabetes, race alone was not.
Less than half of women with abnormal glucose testing results during pregnancy received postpartum glucose screening in the current study. Oral glucose tolerance testing was more sensitive than fasting plasma glucose testing in diagnosing postpartum glucose abnormalities.
Friday, October 2, 2009
Regular Exercise During Pregnancy May Lower Risk for Excessive Birth Weight
From Medscape Medical News CME
Laurie Barclay, Désirée Lie,
Obstet Gynecol. 2009;114:770-776.
Clinical Context
Macrosomia, defined as birth weight of 4000 or 4500 g regardless of birth length, has increased in frequency in the past decades and is associated with increased perinatal and neonatal morbidity and mortality rates. Although exercise has been shown to be beneficial in pregnancy, the frequency and intensity of exercise decrease as pregnancy progresses.
This is a prospective cohort study of pregnant women in Norway to examine the association between self-reported exercise before and during pregnancy and the risk for excessive newborn birth weight.
Study Highlights
The data were derived from the Norwegian Mother and Child Cohort Study, a nationwide cohort linked to the Medical Birth Registry of Norway.
Included were women from 50 of 52 maternity units in Norway who received a routine ultrasound examination at 17 weeks, delivered at 37 weeks of gestation or later, and who completed 3 questionnaires during pregnancy, 2 at 17 weeks, and 1 at 30 weeks of gestation.
Excluded were women with multiple pregnancies or with unknown birth dates of their infants.
1 questionnaire administered at 17 weeks asked about lifestyle, including exercise before and during pregnancy, and the other was a food frequency questionnaire.
The third questionnaire administered at 30 weeks focused on maternal outcomes during pregnancy and followed up on some items from the first questionnaire.
For all exercises, women were asked about type and frequency of exercise, with degree of frequency from "never" to "three or more times a week."
For prepregnancy exercise, women were asked at week 17 for their frequency and type of exercise 3 months before the current pregnancy.
Primary outcome was excessive birth weight, defined as equal or above the 90th percentile (4170 g for nulliparous women and 4362 g for multiparous women).
There were 16,064 nulliparous and 20,805 multiparous women.
Mean energy intake was 9600 kcal daily, mean total gestational weight gain was 9300 g, and two thirds of women had a normal prepregnancy body mass index.
At week 17, a total of 10% were smokers.
Mean birth weight was 3683 g, and 10.9% of infants had excessive birth weight.
A greater number of infants with excessive birth weight were born to multiparous vs nulliparous women.
Nulliparous and multiparous women did not differ in age, smoking, height, diabetes, or education, but nulliparous women were younger, had lower energy intake, and gained more weight.
The highest proportion of overweight women, nonexercisers, and excessive newborn weight was found in the multiparous group.
Regular exercise performed 3 months before the current pregnancy did not decrease the risk for high newborn birth weight in nulliparous or multiparous women.
Nulliparous women who reported exercising 3 times or more weekly in week 17 were less likely to have a newborn with excessive birth weight (P for trend = .008); this was not affected by adjustment for diabetes and preeclampsia.
Nulliparous women who reported exercising 1 to 2 times weekly in week 30 were also at lower risk of having a newborn with excessive birth weight.
Walking (aOR, 0.86) and running (aOR, 0.63) in nulliparous women in week 17 and walking in week 30 (aOR, 0.84) were negatively associated with excessive newborn weight.
Multiparous women who participated in dancing in week 17 were less likely to deliver an infant with excessive weight (aOR, 0.75).
Low-impact aerobics (aOR, 0.68) and dancing (aOR, 0.69) at week 30 were associated with a lower risk for excessive newborn birth weight in multiparous women.
However, weight training in fitness centers in week 17 and swimming in week 30 in multiparous women were associated with a higher risk for excessive birth weight.
The authors concluded that exercise during pregnancy, but not before pregnancy, was associated with a lower risk for excessive newborn birth weight; they suggested that this benefit may be the result of the effect of exercise on glucose tolerance.
Clinical Implications
Self-reported exercise before pregnancy is not associated with a lower risk for excessive newborn birth weight in nulliparous or multiparous women.
Self-reported exercise during pregnancy is associated with a lower risk for excessive newborn birth weight in nulliparous and multiparous women.
Laurie Barclay, Désirée Lie,
Obstet Gynecol. 2009;114:770-776.
Clinical Context
Macrosomia, defined as birth weight of 4000 or 4500 g regardless of birth length, has increased in frequency in the past decades and is associated with increased perinatal and neonatal morbidity and mortality rates. Although exercise has been shown to be beneficial in pregnancy, the frequency and intensity of exercise decrease as pregnancy progresses.
This is a prospective cohort study of pregnant women in Norway to examine the association between self-reported exercise before and during pregnancy and the risk for excessive newborn birth weight.
Study Highlights
The data were derived from the Norwegian Mother and Child Cohort Study, a nationwide cohort linked to the Medical Birth Registry of Norway.
Included were women from 50 of 52 maternity units in Norway who received a routine ultrasound examination at 17 weeks, delivered at 37 weeks of gestation or later, and who completed 3 questionnaires during pregnancy, 2 at 17 weeks, and 1 at 30 weeks of gestation.
Excluded were women with multiple pregnancies or with unknown birth dates of their infants.
1 questionnaire administered at 17 weeks asked about lifestyle, including exercise before and during pregnancy, and the other was a food frequency questionnaire.
The third questionnaire administered at 30 weeks focused on maternal outcomes during pregnancy and followed up on some items from the first questionnaire.
For all exercises, women were asked about type and frequency of exercise, with degree of frequency from "never" to "three or more times a week."
For prepregnancy exercise, women were asked at week 17 for their frequency and type of exercise 3 months before the current pregnancy.
Primary outcome was excessive birth weight, defined as equal or above the 90th percentile (4170 g for nulliparous women and 4362 g for multiparous women).
There were 16,064 nulliparous and 20,805 multiparous women.
Mean energy intake was 9600 kcal daily, mean total gestational weight gain was 9300 g, and two thirds of women had a normal prepregnancy body mass index.
At week 17, a total of 10% were smokers.
Mean birth weight was 3683 g, and 10.9% of infants had excessive birth weight.
A greater number of infants with excessive birth weight were born to multiparous vs nulliparous women.
Nulliparous and multiparous women did not differ in age, smoking, height, diabetes, or education, but nulliparous women were younger, had lower energy intake, and gained more weight.
The highest proportion of overweight women, nonexercisers, and excessive newborn weight was found in the multiparous group.
Regular exercise performed 3 months before the current pregnancy did not decrease the risk for high newborn birth weight in nulliparous or multiparous women.
Nulliparous women who reported exercising 3 times or more weekly in week 17 were less likely to have a newborn with excessive birth weight (P for trend = .008); this was not affected by adjustment for diabetes and preeclampsia.
Nulliparous women who reported exercising 1 to 2 times weekly in week 30 were also at lower risk of having a newborn with excessive birth weight.
Walking (aOR, 0.86) and running (aOR, 0.63) in nulliparous women in week 17 and walking in week 30 (aOR, 0.84) were negatively associated with excessive newborn weight.
Multiparous women who participated in dancing in week 17 were less likely to deliver an infant with excessive weight (aOR, 0.75).
Low-impact aerobics (aOR, 0.68) and dancing (aOR, 0.69) at week 30 were associated with a lower risk for excessive newborn birth weight in multiparous women.
However, weight training in fitness centers in week 17 and swimming in week 30 in multiparous women were associated with a higher risk for excessive birth weight.
The authors concluded that exercise during pregnancy, but not before pregnancy, was associated with a lower risk for excessive newborn birth weight; they suggested that this benefit may be the result of the effect of exercise on glucose tolerance.
Clinical Implications
Self-reported exercise before pregnancy is not associated with a lower risk for excessive newborn birth weight in nulliparous or multiparous women.
Self-reported exercise during pregnancy is associated with a lower risk for excessive newborn birth weight in nulliparous and multiparous women.
Maternal Obesity, Overweight Linked to Congenital Heart Defects
From Medscape Medical News
Laurie Barclay, MD
October 2, 2009 — Maternal obesity and overweight before pregnancy are linked to congenital heart defects (CHDs) in the offspring, according to the results of a large case-control study reported in the October issue of the American Journal of Obstetrics & Gynecology.
"Congenital heart defects are the most common types of birth defect, and among all birth defects, they are a leading cause of illness, death, and medical expenditures," Dr. Edwin Trevathan, director of the US Centers for Disease Control and Prevention's (CDC) National Center on Birth Defects and Developmental Disabilities, said in a news release. "Women who are obese and who are planning a pregnancy could benefit by working with their physicians to achieve a healthy weight before pregnancy."
The goal of this analysis from the National Birth Defects Prevention Study (NBDPS) was to evaluate associations between prepregnancy body mass index (BMI) and CHDs in the offspring. Case infants with CHDs (n = 6440) were compared vs 5673 liveborn control infants without birth defects enrolled in the NBDPS from 1997 to 2004.
For all CHDs combined, adjusted odds ratios were 1.16 for overweight status (95% confidence interval [CI], 1.05 - 1.29), 1.15 for moderate obesity (95% CI, 1.00 -1.32), and 1.31 for severe obesity (95% CI, 1.11 - 1.56). Phenotypes of CHD associated with maternal BMI of at least 25.0 kg/m2 were conotruncal defects (tetralogy of Fallot), total anomalous pulmonary venous return, hypoplastic left heart syndrome, right ventricular outflow tract (RVOT) defects (pulmonary valve stenosis), and septal defects (secundum atrial septal defect).
The study authors concluded that these findings supported those from previous research and also highlighted new associations between obesity and conotruncal defects and RVOT defects.
"These results support previous studies, as well as provide additional evidence, that there is an association between a woman being overweight or obese before pregnancy and certain types of heart defects," said lead author Suzanne M. Gilboa, PhD, epidemiologist at CDC's National Center on Birth Defects and Developmental Disabilities. "This provides another reason for women to maintain a healthy weight. In addition to the impact on a woman's own health and the known pregnancy complications associated with maternal obesity, the baby's health could be at risk."
Limitations of this study include BMI calculated from self-reported weight and height, some missing data for prepregnancy BMI, 70% response rate in the NBDPS, and inability to determine any causal relationship between maternal body weight and CHDs. In addition, study centers in Massachusetts and New Jersey did not ascertain case infants among pregnancy terminations, and New York began ascertaining pregnancy terminations only in the year 2000.
The NBDPS is funded by the CDC. The views expressed in the journal article are those of the study authors and do not necessarily represent the official position of the CDC.
Am J Obstet Gynecol. Published online October 1, 2009.
Laurie Barclay, MD
October 2, 2009 — Maternal obesity and overweight before pregnancy are linked to congenital heart defects (CHDs) in the offspring, according to the results of a large case-control study reported in the October issue of the American Journal of Obstetrics & Gynecology.
"Congenital heart defects are the most common types of birth defect, and among all birth defects, they are a leading cause of illness, death, and medical expenditures," Dr. Edwin Trevathan, director of the US Centers for Disease Control and Prevention's (CDC) National Center on Birth Defects and Developmental Disabilities, said in a news release. "Women who are obese and who are planning a pregnancy could benefit by working with their physicians to achieve a healthy weight before pregnancy."
The goal of this analysis from the National Birth Defects Prevention Study (NBDPS) was to evaluate associations between prepregnancy body mass index (BMI) and CHDs in the offspring. Case infants with CHDs (n = 6440) were compared vs 5673 liveborn control infants without birth defects enrolled in the NBDPS from 1997 to 2004.
For all CHDs combined, adjusted odds ratios were 1.16 for overweight status (95% confidence interval [CI], 1.05 - 1.29), 1.15 for moderate obesity (95% CI, 1.00 -1.32), and 1.31 for severe obesity (95% CI, 1.11 - 1.56). Phenotypes of CHD associated with maternal BMI of at least 25.0 kg/m2 were conotruncal defects (tetralogy of Fallot), total anomalous pulmonary venous return, hypoplastic left heart syndrome, right ventricular outflow tract (RVOT) defects (pulmonary valve stenosis), and septal defects (secundum atrial septal defect).
The study authors concluded that these findings supported those from previous research and also highlighted new associations between obesity and conotruncal defects and RVOT defects.
"These results support previous studies, as well as provide additional evidence, that there is an association between a woman being overweight or obese before pregnancy and certain types of heart defects," said lead author Suzanne M. Gilboa, PhD, epidemiologist at CDC's National Center on Birth Defects and Developmental Disabilities. "This provides another reason for women to maintain a healthy weight. In addition to the impact on a woman's own health and the known pregnancy complications associated with maternal obesity, the baby's health could be at risk."
Limitations of this study include BMI calculated from self-reported weight and height, some missing data for prepregnancy BMI, 70% response rate in the NBDPS, and inability to determine any causal relationship between maternal body weight and CHDs. In addition, study centers in Massachusetts and New Jersey did not ascertain case infants among pregnancy terminations, and New York began ascertaining pregnancy terminations only in the year 2000.
The NBDPS is funded by the CDC. The views expressed in the journal article are those of the study authors and do not necessarily represent the official position of the CDC.
Am J Obstet Gynecol. Published online October 1, 2009.
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