Study Links Birth Defects To Obesity In Pregnancy

A study by researchers in the UK found that being obese in pregnancy raised the chances of women having babies with birth defects including
spina bifida, cleft lip and palate and other congenital abnormalities such as malformed limbs. The researchers stressed however that despite their
findings, the rates at which these occur are still very small.


The study was the work of Dr Katherine J Stothard and colleagues from Newcastle University, Newcastle upon Tyne, UK, and is published in the
February 11 issue of JAMA, Journal of the American Medical Asssociation.


Congenital abnormalities are a leading cause of stillbirth and infant death, accounting for 1 in 5 deaths among infants in the US, and they contribute to
preterm birth and childhood illnesses, wrote the authors in their background information.


While no national figures available, a recent study suggests that up to one fifth of pregnant women are classed as obese in the UK, and as many as one
in three women over the age of 15 in the US was obese in 2004, they said in a separate press statement.


According to the World Health Organization, you are classed as obese if your Body Mass Index (BMI, the ratio of your weight in kilos to the square of
your height in metres) is over 30. You are classed as overweight if your BMI is over 25.


Co-author Dr Judith Rankin said:


"Women who are thinking about trying for a baby need to check their own weight first and then think about seeking help if they are
overweight."


She said during pregnancy was not the right time to start a weight loss diet; it was more important to eat healthily and sensibly.


The researchers found that women who were obese had more than twice the risk of having a baby with spina bifida, a rare condition that may result in
disability.


For the meta-analytical study they reviewed studies that looked at the risk of birth defects in babies born to obese or overweight mothers.


They found the studies by searching a number of medical databases for studies published between 1966 and 2008 and also looked at reference lists of relevant review
articles.


The researchers only included observational studies where women's early or pre-pregnancy weight or BMI was known or estimated and there was data on congenital
abnormalities. Of 1,944 articles that met their criteria, 39 were systematically reviewed and the results from 18 were pooled for the meta-analysis.


The results showed that:

Compared to mothers of recommended BMI, obese mothers were nearly twice as likely to have a baby with neural tube defects (caused by the
incomplete development of the brain, spinal cord and/or their protective coverings).

For one neural tube defect, spina bifida, the risk was more than doubled.

There was also an increased risk of heart defects (cardiovascular anomaly), cleft lip and palate, malformation of lower bowel (anorectal atresia),
water in the brain (hydrocephaly) and malformed arms and legs (limb reduction anomaly).

The risk of gastroschisis however was significantly reduced (where the fetus develops a hole in the abdomen).

The study concluded that:


"Maternal obesity is associated with an increased risk of a range of structural anomalies, although the absolute increase is likely to be small."


There was also some evidence that being overweight in pregnancy raised the chances of having a baby with neural tube defects, but the researchers said
more studies were needed to confirm this.


Rankin said:


"This is the first time that so many studies have been combined to build a more accurate picture and it shows a link between a mother's weight and
many of these serious conditions in the newborn baby."


"Given that we are seeing an increase in the number of people who are overweight or obese, then we may see an increase in the number of babies born
with abnormalities," she added.


Despite these findings, however, the researchers said that the abnormalities are uncommon:


"Spina bifida only occurs in approximately one in every two thousand births, so the risk, even among obese women, remains very low," they
stressed.


"Maternal Overweight and Obesity and the Risk of Congenital Anomalies: A Systematic Review and Meta-analysis."

Katherine J. Stothard; Peter W. G. Tennant; Ruth Bell; Judith Rankin.

JAMA Vol. 301 No. 6, pp 636-650, February 11, 2009.


Click here for Abstract.


Sources: Journal abstract, JAMA news release, Newcastle University.


: Catharine Paddock, PhD

Regular Family Meals Lower Risk Of Eating Disorders Among Adolescent Girls

An adolescent girl who regularly has family meals is less likely to suffer and go on to suffer from an eating disorder, or consume laxatives, diet pills, or take some extreme measure to control her weight, according to an article in Archives of Pediatrics & Adolescent Medicine (JAMA/Archives).


The incidence of binge eating and self-induced vomiting is generally higher as a youth progresses from adolescence to adulthood, explain the authors. "Disordered eating behaviors are associated with a number of harmful behavioral, physical and psychological consequences, including poorer dietary quality, weight gain and obesity onset, depressive symptoms and the onset of eating disorders. Thus, it is important to identify strategies for the prevention of disordered eating behaviors."


Dianne Neumark-Sztainer, Ph.D., M.P.H., R.D., University of Minnesota, Minneapolis, and team looked at 2,516 adolescent children from 31 Minnesota schools. The children completed two surveys - one in the classroom in 1999, and another one that was mailed to them in 2004. They were asked how frequently they ate with their families, what their BMI (body mass index) was, how connected they felt with their family, and their eating behaviors.


Teenage girls who ate with their families at least five times each week in 1999 were substantially less likely to report using extreme measures, such as using diuretics or making themselves vomit to control their weight in 2004, this was despite such factors as sociodemographics, BMI and family connectedness.


The reasons for the sex difference are unclear, the authors wrote. "Perhaps boys who engage in regular family meals are different in some way that increases their risk for disordered eating behaviors. There is also the possibility that adolescent boys and girls have different experiences at family meals. For example, girls may have more involvement in food preparation and other food-related tasks, which may play a protective role in the development of disordered eating behaviors. Finally, family meals may offer more benefits to adolescent girls, who may be more sensitive to and likely to be influenced by interpersonal and familial relationships than are adolescent boys."


The findings that emanated from this and previous studies should encourage us to find ways of helping families eat meals together, the authors say. "Health care professionals have an important role to play in reinforcing the benefits of family meals, helping families set realistic goals for increasing family meal frequency given schedules of adolescents and their parents, exploring ways to enhance the atmosphere at family meals with adolescents and discussing strategies for creating healthful and easy-to-prepare family meals," they conclude. "Schools and community organizations should also be encouraged to make it easier for families to have shared mealtimes on a regular basis."


"Family Meals and Disordered Eating in Adolescents. Longitudinal Findings From Project EAT"

Dianne Neumark-Sztainer, PhD, MPH, RD; Marla E. Eisenberg, ScD, MPH; Jayne A. Fulkerson, PhD; Mary Story, PhD, RD; Nicole I. Larson, MPH, RD

Arch Pediatr Adolesc Med. 2008;162(1):17-22.

Click here to view abstract online

Hormone Replacement Therapy Decreases Mortality In Younger Postmenopausal Woman According To Study

An article published in the November 2009 issue of The American Journal of Medicine, reports that researchers conducting a meta-analysis of the available data using Bayesian methods concluded that hormone replacement therapy (HRT) almost undoubtedly decreases mortality in younger postmenopausal women. For over sixty years, HRT has been in widespread use to treat menopausal estrogen deficiency. Over the years, numerous observational studies indicated that HRT use by younger postmenopausal women was linked with a significant reduction in total mortality. There was existing substantiation that routine use of HRT increases longevity in postmenopausal women. However, the 2002 publication of an important study, the Women's Health Initiative (WHI), indicated increased risk for certain outcomes in older women, without increasing mortality. This initiated a debate regarding the potential benefits or harms of HRT.



Bayesian analysis uses prior data and updates it with new information, and then makes statistical inferences. The authors joined results from nineteen randomized trials. It included age-specific data from the WHI, with 16,000 younger postmenopausal women (average age of 55 years) monitored for 83,000 patient-years. It showed a mortality relative risk of 0.73. When data from eight observational studies were added to the analysis, the resultant relative risk was 0.72. Using Bayesian analysis to synthesize the available data, the probability of a mortality benefit in this population was 1.0. As a result, this suggests that the probability of the hypothesis that hormone therapy reduces total mortality in younger women is essentially 1.


Shelley R. Salpeter, MD writes "It is clear that these findings need to be interpreted in the light of potential benefits and harms of hormone therapy. The available evidence indicates that hormone therapy in younger postmenopausal women increases the risk of breast cancer and pulmonary embolism and reduces the risk of cardiovascular events, colon cancer, and hip fracture. The cardiovascular benefit is a result of a small absolute increase in stroke and a greater reduction in coronary heart disease events. The total mortality benefit for younger women seen in the randomized trials and observational studies indicates that the reduction in deaths from coronary heart disease, fracture, and colon cancer outweighed the increase in deaths from breast cancer, stroke and pulmonary embolism. In addition to this mortality benefit, hormone therapy in younger women provides an improvement in quality-of-life measures, at least in the first few years of treatment."


"Bayesian Meta-analysis of Hormone Therapy and Mortality in Younger Postmenopausal Women"

Shelley R. Salpeter, MD, Ji Cheng, MSc, Lehana Thabane, PhD, Nicholas S. Buckley, and Edwin E. Salpeter, PhD (Posthumous).

The American Journal of Medicine, Volume 122, Issue 11 (November 2009)

The American Journal of Medicine


Stephanie Brunner (B.A.)

Less Than Half Of U.S. Women At Risk For Chlamydia Receive Screening, CDC Reports

Less than half of the women in the U.S. who are at risk for chlamydia are being screened for the sexually transmitted infection, which is the most common STI in the country, the Centers for Disease Control and Prevention recently reported in its Morbidity and Mortality Weekly Report, Reuters reports. For the report, CDC researcher Karen Hoover and colleagues examined public and private health plan records representing more than 40% of the U.S. population. They found that screening rates increased from 25.3% in 2000 to 43.6% in 2006, then decreased slightly in 2007 to 41.6%. Despite the increase, the researchers said that far too few women are being screened for the disease, which often produces few symptoms and can lead to infertility if untreated. About 1.1 million cases of chlamydia were reported to CDC in 2007, of which more than 50% were in women ages 15 to 25, and it is estimated that more than 2.8 million new cases occur annually, the report said.

CDC recommends annual chlamydia screening for all sexually active women ages 25 and younger, women older than 25 who have had multiple sex partners or a new partner, and all pregnant women. Unless treated with antibiotics, chlamydia can cause pelvic inflammatory disease, infertility, chronic pain and ectopic pregnancy, Reuters reports. The infection affects both women and men, and untreated partners can re-infect each other. Chlamydia can also cause sterility in men in rare cases (Fox, Reuters, 4/16).


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