From Medscape Medical News
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
April 17, 2009 — Novel risk factors for sudden infant death syndrome (SIDS) include sleeping outside the parental home, in the living room, or prone on a sheepskin, according to the results of a population-based, case-control study reported in the April issue of Pediatrics.
"A number of case-control studies in the late 1980s and early 1990s identified prone sleeping as a major risk factor for SIDS," write Mechtild M. Vennemann, MD, PD, MPH, from the University of Münster in Münster, Germany, and colleagues from the German Sudden Infant Death Syndrome Study Group.
"Following advice to put infants only on their back for sleeping, the rates in all developed countries for SIDS have decreased dramatically."
The purpose of this study, which took place from 1998 to 2001 in Germany, was to identify risk factors for SIDS in the sleep environment for a population in which few infants sleep prone because of widespread education campaigns.
During the study period, there were 333 SIDS cases and 998 matched controls. Only 4.1% of the infants were placed in a prone position to sleep, but the risk for SIDS was increased in those infants. The risk was very high in those infants who were unaccustomed to sleeping prone or who were turned to prone.
Factors associated with an increased risk for SIDS were bed sharing, particularly for infants younger than 13 weeks; use of duvets; sleeping prone on a sheepskin; sleeping in the house of a friend or a relative vs sleeping in the parental home; and sleeping in the living room vs in the parental bedroom.
Pacifier use during the last sleep was associated with a significantly decreased risk for SIDS.
Limitations of this study include small numbers of cases in groups with some of the novel risk factors.
Pediatrics. 2009;123:1162-1170.
Clinical Context
SIDS is the leading cause of death in infants younger than 1 year in developed countries. Sleeping in a prone position has been identified as a significant risk, leading to the Back to Sleep campaign, which resulted in a reduction in SIDS mortality rates in many countries. Since that campaign was initiated, other risk factors such as sleep environment have not been fully examined.
This is a population-based case-control study conducted in a part of Germany with more than 50% of its live births to determine risk factors associated with SIDS during a 3-year period (1998-2001).
Thursday, December 31, 2009
Wednesday, December 30, 2009
Clinical Risk Factors May Predict Depression During Pregnancy
From Medscape Medical News
Laurie Barclay, MD
December 30, 2009 — Clinical risk factors that may be easily identified during routine obstetric examination may help predict depression during pregnancy, according to the results of a review of 57 studies reported in the January 2010 issue of the American Journal of Obstetrics & Gynecology.
"Prenatal care providers are uniquely suited to address antepartum depression," write Christie A. Lancaster, MD, MS, from the University of Michigan in Ann Arbor, and colleagues. "First of all, providers have already captured their target population, because most women will use obstetric services at some point during their pregnancies. Providers also have multiple opportunities to assess, treat, and follow-up with patients, as obstetric visits are recurring during a several-month span."
Based on an English-language search of the literature from 1980 through 2008, the reviewers aimed to examine risk factors for antepartum depressive symptoms that could be detected in routine obstetric care. Selection criteria were studies evaluating the association between antepartum depressive symptoms and 1 or more risk factors. Two masked, independent reviewers assessed the overall trend of evidence for each potential risk factor.
There were 57 studies identified that met selection criteria.
Factors associated with a greater likelihood of antepartum depressive symptoms in bivariate analyses were maternal anxiety, life stress, history of depression, lack of social support, unintended pregnancy, Medicaid insurance, domestic violence, lower income, lower education, smoking, single status, and poor relationship quality.
In multivariate analyses, factors that continued to show a significant association with depressive symptoms were life stress, lack of social support, and domestic violence.
"Our results demonstrate several correlates that are consistently related to an increased risk of depressive symptoms during pregnancy," the review authors write.
"Our results are important for practicing clinicians because they identify risk factors that can be assessed during routine obstetric care," they add.
"For current practice, providers should especially consider the likelihood of depressive symptoms in women with these risk factors, such as report of domestic violence or a lack of social support during pregnancy."
Limitations of the studies reviewed include significant heterogeneity among studies; lack of diagnostic assessments for depression; use of different cutoff points on screening tools; limited sample size; and observational, cross-sectional design in most studies. Limitations of the data analysis include possible publication bias, review of only studies published in English, and subjective assessment of quality.
"Future work should address how well our current obstetric screening forms capture these constructs and how we can use risk factor identification to improve screening efficiency and accuracy and to enhance our clinical assessments during pregnancy," the study authors conclude.
"For example, future research studies could evaluate the likelihood of major depressive disorder in women with positive depression screens that do or do not have these additional risk factors."
The Robert Wood Johnson Clinical Scholars Program supported this study.
Am J Obstet Gynecol. 2010;202:5-14.
Laurie Barclay, MD
December 30, 2009 — Clinical risk factors that may be easily identified during routine obstetric examination may help predict depression during pregnancy, according to the results of a review of 57 studies reported in the January 2010 issue of the American Journal of Obstetrics & Gynecology.
"Prenatal care providers are uniquely suited to address antepartum depression," write Christie A. Lancaster, MD, MS, from the University of Michigan in Ann Arbor, and colleagues. "First of all, providers have already captured their target population, because most women will use obstetric services at some point during their pregnancies. Providers also have multiple opportunities to assess, treat, and follow-up with patients, as obstetric visits are recurring during a several-month span."
Based on an English-language search of the literature from 1980 through 2008, the reviewers aimed to examine risk factors for antepartum depressive symptoms that could be detected in routine obstetric care. Selection criteria were studies evaluating the association between antepartum depressive symptoms and 1 or more risk factors. Two masked, independent reviewers assessed the overall trend of evidence for each potential risk factor.
There were 57 studies identified that met selection criteria.
Factors associated with a greater likelihood of antepartum depressive symptoms in bivariate analyses were maternal anxiety, life stress, history of depression, lack of social support, unintended pregnancy, Medicaid insurance, domestic violence, lower income, lower education, smoking, single status, and poor relationship quality.
In multivariate analyses, factors that continued to show a significant association with depressive symptoms were life stress, lack of social support, and domestic violence.
"Our results demonstrate several correlates that are consistently related to an increased risk of depressive symptoms during pregnancy," the review authors write.
"Our results are important for practicing clinicians because they identify risk factors that can be assessed during routine obstetric care," they add.
"For current practice, providers should especially consider the likelihood of depressive symptoms in women with these risk factors, such as report of domestic violence or a lack of social support during pregnancy."
Limitations of the studies reviewed include significant heterogeneity among studies; lack of diagnostic assessments for depression; use of different cutoff points on screening tools; limited sample size; and observational, cross-sectional design in most studies. Limitations of the data analysis include possible publication bias, review of only studies published in English, and subjective assessment of quality.
"Future work should address how well our current obstetric screening forms capture these constructs and how we can use risk factor identification to improve screening efficiency and accuracy and to enhance our clinical assessments during pregnancy," the study authors conclude.
"For example, future research studies could evaluate the likelihood of major depressive disorder in women with positive depression screens that do or do not have these additional risk factors."
The Robert Wood Johnson Clinical Scholars Program supported this study.
Am J Obstet Gynecol. 2010;202:5-14.
Saturday, December 26, 2009
Antiviral Medications in Pregnancy
From Centers for Disease Control and Prevention (CDC): Expert Commentary
CDC Commentary: 2009 H1N1
Sonja A. Rasmussen, MD
http://www.medscape.com/viewarticle/711570
CDC Commentary: 2009 H1N1
Sonja A. Rasmussen, MD
http://www.medscape.com/viewarticle/711570
Friday, December 18, 2009
Breast-Feeding May Protect the Mother From Metabolic Syndrome CME
From MedscapeCME Clinical Briefs
News Author: Laurie Barclay, MD
CME Author: Charles P. Vega, MD
December 17, 2009 — Breast-feeding may protect the nursing mother from the metabolic syndrome, according to the results of a prospective, observational cohort study reported in the December 3 Online First issue of Diabetes.
"The Metabolic Syndrome is a clustering of risk factors related to obesity and metabolism that strongly predicts future diabetes and possibly, coronary heart disease during midlife and early death for women," lead author Erica Gunderson, PhD, from Kaiser Permanente's Division of Research in Oakland, California, said in a news release. "Because the Metabolic Syndrome affects about 18 to 37 percent of U.S. women between ages 20-59, the childbearing years may be a vulnerable period for its development. Postpartum screening of risk factors for diabetes and heart disease may offer an important opportunity for primary prevention."
The multicenter, population-based, US cohort used for this study consisted of 1399 nulliparous women (39% black, aged 18 - 30 years) enrolled in the ongoing Coronary Artery Risk Development in Young Adults Study. Participants were free of the metabolic syndrome at baseline from 1985 to 1986 and before subsequent pregnancies. At 7, 10, 15, and/or 20 years after baseline, participants were re-examined, and National Cholesterol Education Program criteria were used to identify incident cases of metabolic syndrome.
Of 704 parous women, 84 had gestational diabetes and 620 did not. During 9993 person-years, there were 120 incident cases of metabolic syndrome, yielding an overall crude incidence rate of 12.0 per 1000 person-years (10.8 for nongestational diabetes and 22.1 for gestational diabetes). Increasing duration of lactation was associated with lower crude incidence rates of metabolic syndrome from 0 to 1 month through 9 months or more of breast-feeding (P < .001).
"The findings indicate that breastfeeding a child may have lasting favorable effects on a woman's risk factors for later developing diabetes or heart disease," Dr. Gunderson said.
Risk reductions associated with longer duration of lactation were greater among women with gestational diabetes (fully adjusted relative hazards range, 0.14 - 0.56; P = .03) vs those without gestational diabetes (fully adjusted relative hazards range, 0.44 - 0.61; P = .03).
Limitations of this study include observational design and possible residual confounding.
"Longer duration of lactation was associated with lower incidence of the metabolic syndrome years post-weaning among women with a history of GDM [gestational diabetes mellitus] and without GDM controlling for preconception measurements, BMI [body mass index], socio-demographic and lifestyle traits," the study authors conclude. "Further investigation is needed to elucidate the mechanisms through which lactation may influence women's cardiometabolic risk profiles, and whether lifestyle modifications, including lactation duration, may affect development of coronary heart disease and type 2 diabetes, particularly among high-risk groups such as women with a history of GDM."
The National Institutes of Health (the National Heart, Lung, and Blood Institute; the National Institute of Diabetes, Digestive and Kidney Diseases) and the American Diabetes Association supported this study. The study authors have disclosed no relevant financial relationships.
Diabetes. Published online December 3, 2009. Abstract
News Author: Laurie Barclay, MD
CME Author: Charles P. Vega, MD
December 17, 2009 — Breast-feeding may protect the nursing mother from the metabolic syndrome, according to the results of a prospective, observational cohort study reported in the December 3 Online First issue of Diabetes.
"The Metabolic Syndrome is a clustering of risk factors related to obesity and metabolism that strongly predicts future diabetes and possibly, coronary heart disease during midlife and early death for women," lead author Erica Gunderson, PhD, from Kaiser Permanente's Division of Research in Oakland, California, said in a news release. "Because the Metabolic Syndrome affects about 18 to 37 percent of U.S. women between ages 20-59, the childbearing years may be a vulnerable period for its development. Postpartum screening of risk factors for diabetes and heart disease may offer an important opportunity for primary prevention."
The multicenter, population-based, US cohort used for this study consisted of 1399 nulliparous women (39% black, aged 18 - 30 years) enrolled in the ongoing Coronary Artery Risk Development in Young Adults Study. Participants were free of the metabolic syndrome at baseline from 1985 to 1986 and before subsequent pregnancies. At 7, 10, 15, and/or 20 years after baseline, participants were re-examined, and National Cholesterol Education Program criteria were used to identify incident cases of metabolic syndrome.
Of 704 parous women, 84 had gestational diabetes and 620 did not. During 9993 person-years, there were 120 incident cases of metabolic syndrome, yielding an overall crude incidence rate of 12.0 per 1000 person-years (10.8 for nongestational diabetes and 22.1 for gestational diabetes). Increasing duration of lactation was associated with lower crude incidence rates of metabolic syndrome from 0 to 1 month through 9 months or more of breast-feeding (P < .001).
"The findings indicate that breastfeeding a child may have lasting favorable effects on a woman's risk factors for later developing diabetes or heart disease," Dr. Gunderson said.
Risk reductions associated with longer duration of lactation were greater among women with gestational diabetes (fully adjusted relative hazards range, 0.14 - 0.56; P = .03) vs those without gestational diabetes (fully adjusted relative hazards range, 0.44 - 0.61; P = .03).
Limitations of this study include observational design and possible residual confounding.
"Longer duration of lactation was associated with lower incidence of the metabolic syndrome years post-weaning among women with a history of GDM [gestational diabetes mellitus] and without GDM controlling for preconception measurements, BMI [body mass index], socio-demographic and lifestyle traits," the study authors conclude. "Further investigation is needed to elucidate the mechanisms through which lactation may influence women's cardiometabolic risk profiles, and whether lifestyle modifications, including lactation duration, may affect development of coronary heart disease and type 2 diabetes, particularly among high-risk groups such as women with a history of GDM."
The National Institutes of Health (the National Heart, Lung, and Blood Institute; the National Institute of Diabetes, Digestive and Kidney Diseases) and the American Diabetes Association supported this study. The study authors have disclosed no relevant financial relationships.
Diabetes. Published online December 3, 2009. Abstract
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