Pregnancy in Type 1 Diabetes: Glucose Control Can Reduce Fetal Overgrowth

MedicalResearch.com Interview with:

Rachel McGrath BSc (Hons), PhD Senior Research Fellow - Department of Endocrinology, RNSH Clinical Senior Lecturer - Northern Clinical School University of Sydney

Dr. Rachel McGrath

Rachel McGrath BSc (Hons), PhD
Senior Research Fellow – Department of Endocrinology, RNSH
Clinical Senior Lecturer – Northern Clinical School
University of Sydney 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Women with type 1 diabetes are significantly more likely to experience complications during pregnancy and to have infants with high birth weights. This can result in adverse outcomes at the time of delivery for both mother and baby, and can also predispose infants to obesity and chronic disease in later life.

The relationship between maternal blood glucose levels and foetal growth in type 1 diabetes in pregnancy has not been completely elucidated. Thus, we examined the association between maternal glycaemic control and foetal growth by examining serial ultrasound measurements and also by determining the relationship between HbA1c (a measure of circulating glucose exposure over a three month time period) and infant birth weight.

We found that maternal glucose levels were directly related to foetal abdominal circumference in the late second and third trimesters and also to birth weight. We also confirmed the results of previous studies to show that the optimal HbA1c during pregnancy to reduce the likelihood of large-for-gestational-age neonates is < 6%.  Continue reading

Relationship Status Helps Determine Contraception Choice

MedicalResearch.com Interview with:
“Birth control pills” by lookcatalog is licensed under CC BY 2.0Marie Harvey, DrPH MPH
Lisa P. Oakley, PhD MPH
College of Public Health and Human Sciences
Oregon State University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Because decisions about contraceptives are often made by young adults in the context of their relationships and specific partners, the characteristics of that relationship and feelings about that partner will likely influence how those decisions are made. Many studies have previously investigated individual factors that affect contraceptive choice and when examining partner influences have used questions that were not specific to a particular partner. Intuition, however, suggests that feelings for a specific partner would likely influence one’s perception of risk for disease acquisition, and thereby, their contraceptive choice. So, it was important to us to look at the influences of each specific partner and how the unique dynamics of each partnership influence contraceptive use.

In this study, we investigated how relationship qualities and dynamics (such as commitment and sexual decision-making) impact contraceptive choice above and beyond individual factors. We also used partner-specific questions.

We found that both individual and partner-specific relationship qualities and dynamics predicted contraceptive use, but these factors varied by contraceptive method. For example, young adults who reported greater exclusivity with a specific partner and more relationship commitment were less likely to use only condoms with that partner. Additionally, individuals who felt they played a strong role in making sexual decisions in their relationship were also more likely to only use condoms. Continue reading

How Much Genetic Information From Prenatal Testing Do Pregnant Women Want?

“Pregnancy 1” by operalynn is licensed under CC BY 2.0MedicalResearch.com Interview with:
Professor Jane Halliday, PhD
Group Leader, Public Health Genetics
Genetics
Murdoch Childrens Research Institute
The Royal Children’s Hospital
Parkville, Victoria  AUS 

MedicalResearch.com: What is the background for this study?

Response: The aim of the study was to examine the choice that pregnant women make about the amount of genetic information they want from their pregnancy. Women who underwent prenatal testing via chorionic villus sampling (CVS) or amniocentesis were recruited from across seven sites in Victoria.

Provision of this choice is not routinely offered but we thought it was important to look at this issue carefully, in a real-time setting, because, over the last five years, advances in technology have transformed how genetic abnormalities can be detected during a pregnancy.  Rather than examining genetic material (chromosomes) down the microscope, it is now possible to use a technique called ‘microarray’ which can do the analysis with 100 times greater depth than can be achieved using a microscope. The plus side is that the microarray technique can detect a far greater number of potentially important genetic differences; but a down side is that it can also detect many changes for which the impact on the health of the baby is unknown or uncertain.

Examples of genetic differences that carry certainty are major chromosome abnormalities such as the trisomies e.g. Down Syndrome, and deletions associated with severe intellectual disability in 100% of cases, e.g. 1p.36 deletion. Uncertain findings are the various small deletions and duplications that are known to only have an adverse outcome in 10-20% of people with them.

All participants were provided with a decision aid which described in detail the choice available in regards to the genetic information. The options were ‘targeted’, where only the information that would affect health of the baby was provided, or ‘extended’, where all information, even the uncertain aspects, was provided. Participants were asked to read the decision aid, complete a ten minute survey along with indicating their choice of genetic information.

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Teenage Daughters More Likely To Have Abortion If Their Mother Had One

MedicalResearch.com Interview with:
“Don't forget the teens” by Jon Seidman is licensed under CC BY 2.0Ning Liu PhD Student

Senior Research Analyst at ICES
Institute of Health Policy, Management and Evaluation
Institute for Clinical Evaluative Sciences
University of Toronto

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous studies suggested intergenerational tendencies between a mother and her daughter in fertility patterns, such as when they give birth to a child for the first time, or the total number of children they have during their lifetime.

We explored whether there is also an intergenerational tendency for induced abortion practices between a mother and her teen daughter.

To do so, we used anonymized records of 431,623 daughters and their mothers, and found that a teenage daughter was twice as likely to have an induced abortion if her mother had had an induced abortion.  Continue reading

Study Evaluates Effects of Probiotics During Pregnancy

MedicalResearch.com Interview with:
“My nightly probiotics to help me :) barely holding back PostOp issues! Very GRATEFUL for them!” by Ashley Steel is licensed under CC BY 2.0Mahsa Nordqvist MD
Department of Obstetrics and Gynecology
Sahlgrenska University Hospital
Gothenburg, Sweden 

MedicalResearch.com: What is the background for this study?

Response: We have shown in earlier observational studies that there is an association between probiotic intake and lower risk of preterm delivery and preeclampsia. Since pregnancy is a time of rapid change and different exposures can have different effect depending on the time of exposure, we wanted to find out if there is any special time point of consumption that might be of greater importance when it comes to these associations.

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PCOS: Hyperandrogenism Associated With Changes in Gut Microbiome

MedicalResearch.com Interview with:

Varykina Thackray, Ph.D. Associate Professor of Reproductive Medicine University of California, San Diego

Dr. Thackray

Varykina Thackray, Ph.D.
Associate Professor of Reproductive Medicine
University of California, San Diego

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous studies have shown that changes in the composition of intestinal microbes (gut microbiome) are associated with metabolic diseases. Since many women with polycystic ovary syndrome (PCOS) have metabolic dysregulation that increases the risk of developing type 2 diabetes and cardiovascular disease, we wondered whether PCOS was associated with changes in the gut microbiome and if these changes were linked to any clinical features of PCOS.

We collaborated with Beata Banaszewska and her colleagues at the Poznan University of Medical Sciences in Poznan, Poland to obtain clinical data and fecal samples from 163 premenopausal women recruited for the study. In collaboration with Scott Kelley at San Diego State University, we used 16S ribosomal RNA gene sequencing and bioinformatics analyses to show that the diversity of the gut microbiome was reduced in Polish women with PCOS compared to healthy women and women with polycystic ovaries but no other symptoms of PCOS.

The study confirmed findings reported in two other recent studies with smaller cohorts of Caucasian and Han Chinese women. Since many factors could affect the gut microbiome in women with PCOS, regression analysis was used to identify clinical hallmarks that correlated with changes in the gut microbiome. In contrast to body mass index or insulin resistance, hyperandrogenism was associated with changes in the gut microbiome in this cohort of women, suggesting that elevated testosterone may be an important factor in shaping the gut microbiome in women.

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Medicaid Expansion Linked To Decreased Infant Mortality, Especially Among African Americans

MedicalResearch.com Interview with:

Chintan Bhatt  MBBS, MPH    (HE/HIM/HIS) Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University Miami Fl 

Dr. Bhatt

Chintan Bhatt  MBBS, MPH    (HE/HIM/HIS)
Department of Health Promotion & Disease Prevention,
Robert Stempel College of Public Health and Social Work,
Florida International University
Miami Fl 

MedicalResearch.com: What is the background for this study?

Response: Women and children are disproportionately affected by the uncertainty around medical health insurance rising in the United States. The Patient Protection and Affordable Care Act was implemented on Jan 1st, 2014, since then the uninsured rate decreased considerably, especially in women aged 18 to 64 years. ACA revised and expanded Medicaid eligibility. Under the law, all U.S. citizens and legal residents with income up to 133% of the poverty line, including adults without dependent children, would qualify for coverage in any state that participated in the Medicaid program. Because of the large proportion of maternal, infant, and child health care and preventive services funded by Medicaid. The purpose of our study was to examine the potential effect of Medicaid expansion on infant mortality rates by comparing infant mortality rate trends in states and Washington D.C. by Medicaid expansion acceptance or decline.

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Doxylamine-Pyridoxine May Not Be Effective For Nausea and Vomiting of Pregnancy

MedicalResearch.com Interview with:

Navindra Persaud MD, MSc, BA, BSc Department of Family and Community Medicine and  Li Ka Shing Knowledge Institute St Michael’s Hospital Toronto, Ontario, Canada

Dr. Persaud

Navindra Persaud MD, MSc, BA, BSc
Department of Family and Community Medicine and
Li Ka Shing Knowledge Institute
St Michael’s Hospital
Toronto, Ontario, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: I used to prescribe doxylamine-pyridoxine for nausea and vomiting during pregnancy. I was taught to prescribe it. The medication was recommended as the first line medication for nausea and vomiting during pregnancy. When I looked carefully at the clinical practice guidelines that recommended this medication, they did not cite supporting studies. So I tried to find the basis for the recommendations. It was surprisingly difficult to obtain information about this commonly prescribed drug.

The medication seems to be ineffective based on the results of this trial.

I was also surprised that important information about the trial was hidden until now. Although some results were published in 2010, the earlier reports did not mention the fact that a difference of 3 points on the 13-point symptom scale was prespecified as the minimal important difference (or the smallest difference that a patient would deem as important).

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Benefits of Gastric Bypass in Diabetes Control Significant But Diminish Over Time

MedicalResearch.com Interview with:

Charles Billington MD Chief, Section of Endocrinology and Metabolism Minneapolis VA Health Care System Professor of Medicine, University of Minnesota 

Dr. Billington

Charles Billington MD
Chief, Section of Endocrinology and Metabolism
Minneapolis VA Health Care System
Professor of Medicine, University of Minnesota 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: We wanted to know if adding gastric bypass to intense lifestyle and medical therapy would improve overall diabetes treatment as represented by the triple endpoint of blood sugar, blood pressure and cholesterol control. We found that adding gastric bypass did provide significant benefit at five years after surgery, but that the size of the benefit declined substantially from the first to the fifth year. We also found that gastric bypass did provide significantly better blood sugar control throughout the five years, but the rate of diabetes remission at five years was low. There were many more adverse events in the gastric bypass group. 

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Program Improves Sleep For Mothers Hospitalized For Delivery

MedicalResearch.com Interview with:
“Now I’m having contractions.” by Remus Pereni is licensed under CC BY 2.0Kathryn A. Lee, RN, CBSM, PhD
Department of Family Health Care Nursing
University of California at San Francisco
San Francisco, California 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Sleep deprivation can adversely affect health and wellbeing in any patient population.

In pregnancy, adverse outcomes may include preterm birth, longer labor, cesarean birth, and depression.

We found that women with high-risk pregnancies were sleep deprived even prior to hospitalization. Our sample averaged 29 weeks gestation, and half reported getting only between 5 and 6.5 hours of sleep at home before hospital admission. Our sleep hygiene intervention strategies gave them more control over the environment in their hospital room, and they self-reported significantly better sleep than controls. Interestingly, both groups increased their sleep time to almost 7 hours at night, on average, in the hospital before they were discharged home.

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