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Archive - 09 - 2009

Treating Pregnant Women for Mild Gestational Diabetes Reduces Serious Birthing Problems

Posted by dlife on Wed, Sep 30, 09, 05:09 PM 0 Comment

September 30, 2009 (Newswise) - Treating pregnant women for mild gestational diabetes resulted in fewer cesarean sections and other serious birthing problems associated with larger than average babies, according to a study conducted in part at the University of North Carolina at Chapel Hill.'This study is important because it clearly indicates the value to mothers and their newborns of screening for and treatment of diabetes-like conditions provoked by pregnancy, said John M. Thorp, M.D., McAllister distinguished professor of obstetrics and gynecology at the UNC School of Medicine and a co-author of the study.Our work resolves a 40-year controversy in women's health and should be immediately helpful to both pregnant women and the clinicians caring for them.The study is published in the Oct. 1 issue of the New England Journal of Medicine. The lead author and principal investigator is Mark B. Landon, M.D. of Ohio State University. It was conducted at 14 sites that are part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network.About 4 percent of all pregnant women in the U.S. develop gestational diabetes, resulting in about 135,000 cases each year, Thorp said. Because these women have high blood sugar levels, their babies receive more blood glucose than they need, and the extra energy is stored as fat. These babies tend to be larger and fatter than average at birth and thus are more likely to be affected by problems associated with larger babies, such as the need for cesarean delivery, damage to their shoulders during birth and a greater risk of becoming obese as children and developing type 2 diabetes as adults.There has been a longstanding controversy among physicians on the question of whether treating pregnant women with gestational diabetes for their high blood sugar levels would provide worthwhile benefits. Several professional organizations advocate screening, but the 2008 guidelines of the U.S. Preventive Services Task Force concluded there is insufficient evidence to support screening for and treatment of gestational diabetes.Against this background, the MFMU Network launched a clinical trial to determine if treating mothers for mild gestational diabetes would reduce infant deaths and birth-related complications. A total of 958 women between 24 and 31 weeks of pregnancy were randomized, with 485 receiving treatment (including dietary changes, self blood glucose monitoring and insulin if necessary) and 473 in the untreated group.There were no infant deaths in the study and no significant differences between the two groups in terms of babies born with problems such as hypoglycemia, hyperbilirubinemia, neonatal hyperinsulinemia and birth trauma.However, there were significantly fewer babies in the treatment group to experience unusually large size (7.1 percent vs. 14.5 percent), high birth weight (5.9 percent vs. 14.3 percent), shoulder damage during birth (1.5 percent vs. 4.0 percent) or to require cesarean delivery (26.9 percent vs. 33.8 percent).In addition, Thorp said, Its especially intriguing that mothers in the treatment arm gained less weight during pregnancy, experienced fewer preterm births and had fewer cases of preeclampsia than mothers in the untreated group. Preeclampsia is a syndrome marked by a sudden increase in the blood pressure of a pregnant woman after the 20th week of pregnancy, which can be fatal or lead to long-term health problems for mother and baby.The study concludes that these findings confirm a benefit to the identification and treatment of women with mild carbohydrate intolerance during pregnancy.

Less Than 50 Percent of Men and Women with Depression See a Doctor for Treatment

Posted by dlife on Wed, Sep 30, 09, 11:42 AM 0 Comment

September 30, 2009 (EurekAlert) - Less than half of men and women in Ontario who may be suffering from depression see a doctor to treat their potentially debilitating condition, according to a new women's health study by researchers at St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES). What's more, many hospitalized for severe depression fail to see a doctor for follow-up care within 30 days of being discharged, and many head to hospital emergency departments for care. The findings suggest the need for a comprehensive care model involving a multidisciplinary team of health-care professionals, including family doctors and mental health specialists, to help women and men and better manage depression and improve their quality of life."As a leading cause of disease-related disability among women and men, depression puts a tremendous emotional and financial burden on people, their families and our health-care system," says Dr. Arlene Bierman, a physician at St. Michael's Hospital and principal investigator of the study Project for an Ontario Women's Health Evidence-Based Report (POWER). "Many Ontarians with depression are not treated for their condition and those who are often receive less than desired care. While there is a lot that is known about how to improve depression, we need to apply this to our work with patients if we want to improve the diagnosis and management of depression. "This involves better co-ordination among primary care and mental health-care professionals in both community and hospital settings," added Dr. Bierman, a researcher at ICES.Nearly half a million Ontarians, aged 15 and older, suffer from depression. Worldwide, an estimated 154 million people are afflicted by the condition, which is responsible for lost productivity, increased disability claims and greater use of health-care services.Key findings of the POWER study released today include:

  • Less than 50% of men and women with depression visited a doctor for care for their condition
  • 33% of men and women discharged from hospital for severe depression did not see a doctor for a follow-up visit within 30 days
  • 17% visited a hospital emergency room within 30 days of discharge from hospital while about 8% were readmitted to hospital
  • Many older adults started on antidepressant medication did not receive the recommended number of follow-up visits to manage their condition.
  • The lack of co-ordinated care for patients suggests the need for a collaborative care-model involving a team of health-care professionals, including mental health professionals and primary care providers."Research shows that patients cared for using a collaborative model are more likely to see improvement in symptoms, are able to better manage their depression and avoid multiple visits for emergency care," said Dr. Elizabeth Lin, lead author of the chapter and a research scientist at the Centre for Addiction and Mental Health (CAMH). A study by CAMH released earlier this year also found collaborative care to be a less costly and more effective way of providing mental health treatments for people on short-term disability leave for a psychiatric disorder.

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