Diana Mahoney

Celiac disease-associated serum antibodies and the expression of the human leukocyte antigen complex (HLA) DQ2 genotype can identify individuals with diarrhea-dominant irritable bowel syndrome (IBS-D) who are likely to respond to a gluten-free diet, investigators reported in an article appearing in the July issue of Clinical Gastroenterology and Hepatology.

Although the presence of villous atrophy in the small intestine together with gluten sensitivity are the typical diagnostic criteria for classical celiac disease in patients with diarrhea, gluten sensitivity may also cause abdominal symptoms in the absence of villous atrophy, wrote Dr. Ulrich Wahnschaffe of Ernst-Moritz-Arndt Universität, Greifswald (Germany) and his colleagues.

In a previous study, the investigators found that a subgroup of patients with IBS-D without villous atrophy benefitted from a gluten-free diet; the patients were identified by the expression of HLA-DQ2 (A1*0501/B1*0201) and increased antibodies against gliadin and/or tissue-transglutaminase in duodenal aspirate.

The investigators in the current study sought to determine whether these serum antibodies, in association with HLA-DQ2 expression, are markers for gluten sensitivity. They measured HLA-DQ2 expression and celiac disease-associated IgA and IgG serum antibodies against gliadin and tissue-transglutaminase in 145 patients with IBS-D, 74 celiac patients (30 untreated and 44 treated), 57 patients with active inflammatory bowel disease (IBD) who were used as the disease control group, and 62 healthy controls.

Each patient underwent abdominal ultrasound, upper and lower endoscopy, distal duodenal biopsies, and blood and stool tests.

Of the IBS-D patients, 41 participated in a nonrandomized evaluation of a gluten-free diet for 6 months. Follow-up antibody levels, stool frequency, and gastrointestinal symptom scores were collected for these patients.

Expression of HLA-DQ2 was observed in all of the patients with untreated celiac disease, 93% of those with treated celiac disease, and 39% of the IBS-D patients. “HLA-DQ2 expression was significantly more frequent in IBS-D patients, compared [with IBD] patients and controls,” the authors wrote.

IgA antibodies against gliadin and/or tissue-transglutaminase were observed in 93% of the untreated celiac disease group, 7% of those with treated celiac disease, 2% of those with IBS-D, and no patients with IBD, confirming the significance of these IgA antibodies as a marker for active celiac disease.

In contrast, “increased serum IgG against gliadin and/or tissue transglutaminase were present not only in most patients with untreated [celiac disease], but also in the majority of patients with treated celiac disease and may therefore represent markers for gluten sensitivity,” the authors wrote.

About one-third of the IBS-D patients were positive for this marker, and the proportion of patients with the marker was significantly higher in IBS-D than in IBD patients.

In the extended gluten-free diet study, those IBS-D patients who were HLA-DQ2 positive had significant improvement in diarrhea in response to the diet. In addition, “a symptom score covering typical gastrointestinal symptoms of IBS, … like abdominal pain or bloating, improved to normal values in most patients expressing HLA-DQ2 or with celiac disease-associated serum IgG antibodies after gluten-free diet,” they wrote, noting that this association supports the presence of gluten sensitivity in a subgroup of approximately 17% of IBS-D patients.

The investigators determined that expression of HLA-DQ2 in combination with serum IgG against gliadin and/or tissue-transglutaminase was a predictor of response to a gluten-free diet in IBS-D patients.

“Sensitivity to predict the response to gluten-free diet was higher for HLA-Dq2 expression, whereas specificity was higher for celiac disease-associated IgG; both parameters combined yielded positive and negative predictive values of 56% and 88%, respectively,” they wrote.

These values, although not ideal, are acceptable, because the gluten-free diet is a nontoxic, relatively inexpensive treatment option, they added.

“Our findings, which require confirmation by randomized studies, suggest that screening for HLA-DQ2 and/or celiac disease-associated IgG [in patients with IBS-D] could identify an additional larger subgroup of patients without villous atrophy or celiac disease-associated IgA who will benefit from gluten-free diet,” the authors concluded.

Celiac disease-associated serum antibodies and the expression of the human leukocyte antigen complex (HLA) DQ2 genotype can identify individuals with diarrhea-dominant irritable bowel syndrome (IBS-D) who are likely to respond to a gluten-free diet, investigators reported in an article appearing in the July issue of Clinical Gastroenterology and Hepatology.

Although the presence of villous atrophy in the small intestine together with gluten sensitivity are the typical diagnostic criteria for classical celiac disease in patients with diarrhea, gluten sensitivity may also cause abdominal symptoms in the absence of villous atrophy, wrote Dr. Ulrich Wahnschaffe of Ernst-Moritz-Arndt Universität, Greifswald (Germany) and his colleagues.

In a previous study, the investigators found that a subgroup of patients with IBS-D without villous atrophy benefitted from a gluten-free diet; the patients were identified by the expression of HLA-DQ2 (A1*0501/B1*0201) and increased antibodies against gliadin and/or tissue-transglutaminase in duodenal aspirate.

The investigators in the current study sought to determine whether these serum antibodies, in association with HLA-DQ2 expression, are markers for gluten sensitivity. They measured HLA-DQ2 expression and celiac disease-associated IgA and IgG serum antibodies against gliadin and tissue-transglutaminase in 145 patients with IBS-D, 74 celiac patients (30 untreated and 44 treated), 57 patients with active inflammatory bowel disease (IBD) who were used as the disease control group, and 62 healthy controls.

Each patient underwent abdominal ultrasound, upper and lower endoscopy, distal duodenal biopsies, and blood and stool tests.

Of the IBS-D patients, 41 participated in a nonrandomized evaluation of a gluten-free diet for 6 months. Follow-up antibody levels, stool frequency, and gastrointestinal symptom scores were collected for these patients.

Expression of HLA-DQ2 was observed in all of the patients with untreated celiac disease, 93% of those with treated celiac disease, and 39% of the IBS-D patients. “HLA-DQ2 expression was significantly more frequent in IBS-D patients, compared [with IBD] patients and controls,” the authors wrote.

IgA antibodies against gliadin and/or tissue-transglutaminase were observed in 93% of the untreated celiac disease group, 7% of those with treated celiac disease, 2% of those with IBS-D, and no patients with IBD, confirming the significance of these IgA antibodies as a marker for active celiac disease.

In contrast, “increased serum IgG against gliadin and/or tissue transglutaminase were present not only in most patients with untreated [celiac disease], but also in the majority of patients with treated celiac disease and may therefore represent markers for gluten sensitivity,” the authors wrote.

About one-third of the IBS-D patients were positive for this marker, and the proportion of patients with the marker was significantly higher in IBS-D than in IBD patients.

In the extended gluten-free diet study, those IBS-D patients who were HLA-DQ2 positive had significant improvement in diarrhea in response to the diet. In addition, “a symptom score covering typical gastrointestinal symptoms of IBS, … like abdominal pain or bloating, improved to normal values in most patients expressing HLA-DQ2 or with celiac disease-associated serum IgG antibodies after gluten-free diet,” they wrote, noting that this association supports the presence of gluten sensitivity in a subgroup of approximately 17% of IBS-D patients.

The investigators determined that expression of HLA-DQ2 in combination with serum IgG against gliadin and/or tissue-transglutaminase was a predictor of response to a gluten-free diet in IBS-D patients.

“Sensitivity to predict the response to gluten-free diet was higher for HLA-Dq2 expression, whereas specificity was higher for celiac disease-associated IgG; both parameters combined yielded positive and negative predictive values of 56% and 88%, respectively,” they wrote.

These values, although not ideal, are acceptable, because the gluten-free diet is a nontoxic, relatively inexpensive treatment option, they added.

“Our findings, which require confirmation by randomized studies, suggest that screening for HLA-DQ2 and/or celiac disease-associated IgG [in patients with IBS-D] could identify an additional larger subgroup of patients without villous atrophy or celiac disease-associated IgA who will benefit from gluten-free diet,” the authors concluded.

Celiac disease-associated serum antibodies and the expression of the human leukocyte antigen complex (HLA) DQ2 genotype can identify individuals with diarrhea-dominant irritable bowel syndrome (IBS-D) who are likely to respond to a gluten-free diet, investigators reported in an article appearing in the July issue of Clinical Gastroenterology and Hepatology.

Although the presence of villous atrophy in the small intestine together with gluten sensitivity are the typical diagnostic criteria for classical celiac disease in patients with diarrhea, gluten sensitivity may also cause abdominal symptoms in the absence of villous atrophy, wrote Dr. Ulrich Wahnschaffe of Ernst-Moritz-Arndt Universität, Greifswald (Germany) and his colleagues.

In a previous study, the investigators found that a subgroup of patients with IBS-D without villous atrophy benefitted from a gluten-free diet; the patients were identified by the expression of HLA-DQ2 (A1*0501/B1*0201) and increased antibodies against gliadin and/or tissue-transglutaminase in duodenal aspirate.

The investigators in the current study sought to determine whether these serum antibodies, in association with HLA-DQ2 expression, are markers for gluten sensitivity. They measured HLA-DQ2 expression and celiac disease-associated IgA and IgG serum antibodies against gliadin and tissue-transglutaminase in 145 patients with IBS-D, 74 celiac patients (30 untreated and 44 treated), 57 patients with active inflammatory bowel disease (IBD) who were used as the disease control group, and 62 healthy controls.

Each patient underwent abdominal ultrasound, upper and lower endoscopy, distal duodenal biopsies, and blood and stool tests.

Of the IBS-D patients, 41 participated in a nonrandomized evaluation of a gluten-free diet for 6 months. Follow-up antibody levels, stool frequency, and gastrointestinal symptom scores were collected for these patients.

Expression of HLA-DQ2 was observed in all of the patients with untreated celiac disease, 93% of those with treated celiac disease, and 39% of the IBS-D patients. “HLA-DQ2 expression was significantly more frequent in IBS-D patients, compared [with IBD] patients and controls,” the authors wrote.

IgA antibodies against gliadin and/or tissue-transglutaminase were observed in 93% of the untreated celiac disease group, 7% of those with treated celiac disease, 2% of those with IBS-D, and no patients with IBD, confirming the significance of these IgA antibodies as a marker for active celiac disease.

In contrast, “increased serum IgG against gliadin and/or tissue transglutaminase were present not only in most patients with untreated [celiac disease], but also in the majority of patients with treated celiac disease and may therefore represent markers for gluten sensitivity,” the authors wrote.

About one-third of the IBS-D patients were positive for this marker, and the proportion of patients with the marker was significantly higher in IBS-D than in IBD patients.

In the extended gluten-free diet study, those IBS-D patients who were HLA-DQ2 positive had significant improvement in diarrhea in response to the diet. In addition, “a symptom score covering typical gastrointestinal symptoms of IBS, … like abdominal pain or bloating, improved to normal values in most patients expressing HLA-DQ2 or with celiac disease-associated serum IgG antibodies after gluten-free diet,” they wrote, noting that this association supports the presence of gluten sensitivity in a subgroup of approximately 17% of IBS-D patients.

The investigators determined that expression of HLA-DQ2 in combination with serum IgG against gliadin and/or tissue-transglutaminase was a predictor of response to a gluten-free diet in IBS-D patients.

“Sensitivity to predict the response to gluten-free diet was higher for HLA-Dq2 expression, whereas specificity was higher for celiac disease-associated IgG; both parameters combined yielded positive and negative predictive values of 56% and 88%, respectively,” they wrote.

These values, although not ideal, are acceptable, because the gluten-free diet is a nontoxic, relatively inexpensive treatment option, they added.

“Our findings, which require confirmation by randomized studies, suggest that screening for HLA-DQ2 and/or celiac disease-associated IgG [in patients with IBS-D] could identify an additional larger subgroup of patients without villous atrophy or celiac disease-associated IgA who will benefit from gluten-free diet,” the authors concluded.

ATLANTA — Impaired bone mass acquisition associated with certain oral contraceptives may be a hidden problem affecting adolescent girls, Dr. Barbara Cromer said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Preliminary data from a pilot study comparing bone mineral density in adolescent girls using oral contraceptives containing two different levels of estrogen demonstrated an apparent blunting of bone development gains associated with the lower-estrogen pill, said Dr. Cromer of MetroHealth Medical Center in Cleveland.

Of 12 girls aged 12–18 years included in the randomized study, 5 received a combination oral contraceptive with 20 mcg of ethinyl estradiol and 1 mg of norethindrone acetate for 12 months and 7 received one with 35 mcg of ethinyl estradiol and 1 mg norethindrone for the same duration. All the girls underwent BMD testing with dual-energy x-ray absorptiometry at the lumbar spine (L1-L4) and at the femoral neck at baseline at 6 months and 12 months.

At 12 months, the mean percentage of change in bone mass acquisition from baseline in the lower-estrogen group was 1%, compared with 2% in the higher-dose group, Dr. Cromer reported.

A key question is obviously whether the difference is clinically significant, and “it's one that absolutely warrants further investigation,” she said. “If there is clinical significance, we need to think about whether the appropriate dose of ethynyl estradiol for teens may be 35 mcg and whether the trade-off with the risk of VTE—which is relatively small in adolescents—is acceptable.” It also needs to be clarified whether bone mass recovery occurs after cessation of these agents and whether lifestyle factors can override some of the negative bone effects, she said.

ATLANTA — Impaired bone mass acquisition associated with certain oral contraceptives may be a hidden problem affecting adolescent girls, Dr. Barbara Cromer said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Preliminary data from a pilot study comparing bone mineral density in adolescent girls using oral contraceptives containing two different levels of estrogen demonstrated an apparent blunting of bone development gains associated with the lower-estrogen pill, said Dr. Cromer of MetroHealth Medical Center in Cleveland.

Of 12 girls aged 12–18 years included in the randomized study, 5 received a combination oral contraceptive with 20 mcg of ethinyl estradiol and 1 mg of norethindrone acetate for 12 months and 7 received one with 35 mcg of ethinyl estradiol and 1 mg norethindrone for the same duration. All the girls underwent BMD testing with dual-energy x-ray absorptiometry at the lumbar spine (L1-L4) and at the femoral neck at baseline at 6 months and 12 months.

At 12 months, the mean percentage of change in bone mass acquisition from baseline in the lower-estrogen group was 1%, compared with 2% in the higher-dose group, Dr. Cromer reported.

A key question is obviously whether the difference is clinically significant, and “it's one that absolutely warrants further investigation,” she said. “If there is clinical significance, we need to think about whether the appropriate dose of ethynyl estradiol for teens may be 35 mcg and whether the trade-off with the risk of VTE—which is relatively small in adolescents—is acceptable.” It also needs to be clarified whether bone mass recovery occurs after cessation of these agents and whether lifestyle factors can override some of the negative bone effects, she said.

ATLANTA — Impaired bone mass acquisition associated with certain oral contraceptives may be a hidden problem affecting adolescent girls, Dr. Barbara Cromer said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Preliminary data from a pilot study comparing bone mineral density in adolescent girls using oral contraceptives containing two different levels of estrogen demonstrated an apparent blunting of bone development gains associated with the lower-estrogen pill, said Dr. Cromer of MetroHealth Medical Center in Cleveland.

Of 12 girls aged 12–18 years included in the randomized study, 5 received a combination oral contraceptive with 20 mcg of ethinyl estradiol and 1 mg of norethindrone acetate for 12 months and 7 received one with 35 mcg of ethinyl estradiol and 1 mg norethindrone for the same duration. All the girls underwent BMD testing with dual-energy x-ray absorptiometry at the lumbar spine (L1-L4) and at the femoral neck at baseline at 6 months and 12 months.

At 12 months, the mean percentage of change in bone mass acquisition from baseline in the lower-estrogen group was 1%, compared with 2% in the higher-dose group, Dr. Cromer reported.

A key question is obviously whether the difference is clinically significant, and “it's one that absolutely warrants further investigation,” she said. “If there is clinical significance, we need to think about whether the appropriate dose of ethynyl estradiol for teens may be 35 mcg and whether the trade-off with the risk of VTE—which is relatively small in adolescents—is acceptable.” It also needs to be clarified whether bone mass recovery occurs after cessation of these agents and whether lifestyle factors can override some of the negative bone effects, she said.

BOSTON–Chronic daily headache was not associated with obesity but was significantly associated with depression in a study of more than 300 neurology patients in Brazil.

The lack of an association between obesity and headache in the Brazilian sample contradicts findings from a recent population-based study in the United States showing that obese individuals in the community were at significantly increased risk for developing chronic daily headache, Dr. Luiz Queiroz said at the annual meeting of the American Academy of Neurology.

Dr. Queiroz of the Universidade Federal de Santa Catarina in Florianópolis, Brazil, and colleagues interviewed 336 patients at two neurology clinics from May to November 2005 regardless of whether or not their main complaint was for headache-related symptoms. The interview covered questions about sociodemographic data, the Beck Depression Inventory (BDI), and headache characteristics.

The prevalence of depression in the full sample, indicated by a score of 21 or higher on the BDI scale, was 31%, and the prevalence of obesity was 17%, Dr. Queiroz reported in a poster presentation. Depression and obesity were not significantly associated, but both obesity and depression were significantly more prevalent among women than men, Dr. Queiroz said.

Of the 336 patients (237 women), 291 reported experiencing headaches within the past 12 months, and 73% of those with headache met the International Headache Society criteria for either migraine or probable migraine, and 46% met the criteria for chronic daily headache (15 or more headaches in the previous month).

Women were twice as likely as men to have chronic daily headache (CDH). Age also had an effect, with people aged 30–59 years being twice as likely to have CDH as those 60–84 years of age. People 13–29 years of age were slightly less likely than those 30–59 years old to have CDH. Participants with Beck Depression Inventory scores of 21 or higher were twice as likely to have CDH as those scoring below 21.

Assessment of body mass index (BMI) of patients with chronic daily headache failed to show any correlation between BMI of 30 or higher and chronic daily headache. Among patients with CDH, no statistically significant association was found between headache and obesity.

BOSTON–Chronic daily headache was not associated with obesity but was significantly associated with depression in a study of more than 300 neurology patients in Brazil.

The lack of an association between obesity and headache in the Brazilian sample contradicts findings from a recent population-based study in the United States showing that obese individuals in the community were at significantly increased risk for developing chronic daily headache, Dr. Luiz Queiroz said at the annual meeting of the American Academy of Neurology.

Dr. Queiroz of the Universidade Federal de Santa Catarina in Florianópolis, Brazil, and colleagues interviewed 336 patients at two neurology clinics from May to November 2005 regardless of whether or not their main complaint was for headache-related symptoms. The interview covered questions about sociodemographic data, the Beck Depression Inventory (BDI), and headache characteristics.

The prevalence of depression in the full sample, indicated by a score of 21 or higher on the BDI scale, was 31%, and the prevalence of obesity was 17%, Dr. Queiroz reported in a poster presentation. Depression and obesity were not significantly associated, but both obesity and depression were significantly more prevalent among women than men, Dr. Queiroz said.

Of the 336 patients (237 women), 291 reported experiencing headaches within the past 12 months, and 73% of those with headache met the International Headache Society criteria for either migraine or probable migraine, and 46% met the criteria for chronic daily headache (15 or more headaches in the previous month).

Women were twice as likely as men to have chronic daily headache (CDH). Age also had an effect, with people aged 30–59 years being twice as likely to have CDH as those 60–84 years of age. People 13–29 years of age were slightly less likely than those 30–59 years old to have CDH. Participants with Beck Depression Inventory scores of 21 or higher were twice as likely to have CDH as those scoring below 21.

Assessment of body mass index (BMI) of patients with chronic daily headache failed to show any correlation between BMI of 30 or higher and chronic daily headache. Among patients with CDH, no statistically significant association was found between headache and obesity.

BOSTON–Chronic daily headache was not associated with obesity but was significantly associated with depression in a study of more than 300 neurology patients in Brazil.

The lack of an association between obesity and headache in the Brazilian sample contradicts findings from a recent population-based study in the United States showing that obese individuals in the community were at significantly increased risk for developing chronic daily headache, Dr. Luiz Queiroz said at the annual meeting of the American Academy of Neurology.

Dr. Queiroz of the Universidade Federal de Santa Catarina in Florianópolis, Brazil, and colleagues interviewed 336 patients at two neurology clinics from May to November 2005 regardless of whether or not their main complaint was for headache-related symptoms. The interview covered questions about sociodemographic data, the Beck Depression Inventory (BDI), and headache characteristics.

The prevalence of depression in the full sample, indicated by a score of 21 or higher on the BDI scale, was 31%, and the prevalence of obesity was 17%, Dr. Queiroz reported in a poster presentation. Depression and obesity were not significantly associated, but both obesity and depression were significantly more prevalent among women than men, Dr. Queiroz said.

Of the 336 patients (237 women), 291 reported experiencing headaches within the past 12 months, and 73% of those with headache met the International Headache Society criteria for either migraine or probable migraine, and 46% met the criteria for chronic daily headache (15 or more headaches in the previous month).

Women were twice as likely as men to have chronic daily headache (CDH). Age also had an effect, with people aged 30–59 years being twice as likely to have CDH as those 60–84 years of age. People 13–29 years of age were slightly less likely than those 30–59 years old to have CDH. Participants with Beck Depression Inventory scores of 21 or higher were twice as likely to have CDH as those scoring below 21.

Assessment of body mass index (BMI) of patients with chronic daily headache failed to show any correlation between BMI of 30 or higher and chronic daily headache. Among patients with CDH, no statistically significant association was found between headache and obesity.

BOSTON – Working memory training can significantly improve symptoms in adolescents receiving medical treatment for attention-deficit/hyperactivity disorder, Dr. Bradley S. Gibson said in a poster presentation at a meeting of the Society for Research in Child Development.

In the first U.S. investigation of the Cogmed Working Memory Training system–a computer-based training program developed at the Karolinska Institute in Stockholm–Dr. Gibson and his colleagues administered the program to 12 adolescents aged 12–14 years who had been previously diagnosed with ADHD. The investigators observed significant decreases in inattention and significant improvements in both the working memory and other executive functions.

The findings validate those reported in 2005 by Cogmed developer Dr. Torkel Klingberg and colleagues (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:177–86) showing that the intensive training on a battery of verbal and visual-spatial working memory tasks significantly improved symptoms in a sample of Swedish children (aged 7–12 years) diagnosed with ADHD, compared with a placebo group, said Dr. Gibson of the University of Notre Dame (Ind.).

In the current study, the Cogmed program was administered to the students in the computer laboratory of their Midwestern middle school. All of the students received stimulant medication before and during the study. Each student completed 25 1-hour training sessions comprising 11 verbal and visual-spatial working memory exercises over the course of 6 weeks, Dr. Gibson said.

Before and after the intervention, the students were assessed using standardized tests of verbal and spatial working memory and of abstract, nonverbal reasoning. Additionally, parents and teachers completed Vanderbilt ADHD Diagnostic Rating Scale checklists.

“The results indicated significant improvement compared to baseline in all three of the cognitive measures,” Dr. Gibson reported. Additionally, “there were significant decreases in inattentive and hyperactive/impulsive symptoms as rated by parents, and a significant decrease in inattentive symptoms as rated by teachers,” he wrote.

Dr. Gibson pointed to changes in fluid intelligence–the ability to solve problems or adapt to new situations in real time–as a possible mechanism of action. “Working memory improves fluid intelligence, and fluid intelligence appears to reduce ADHD symptoms,” he noted.

In addition to validating the earlier Swedish study, the current findings, while limited by the study's small size and lack of a placebo control arm, extend the earlier work by “showing that working memory training can enhance some individuals more than others, and more importantly, by showing that individual differences in working memory enhancement are critical for predicting how much the symptoms of ADHD can be improved,” Dr. Gibson wrote.

BOSTON – Working memory training can significantly improve symptoms in adolescents receiving medical treatment for attention-deficit/hyperactivity disorder, Dr. Bradley S. Gibson said in a poster presentation at a meeting of the Society for Research in Child Development.

In the first U.S. investigation of the Cogmed Working Memory Training system–a computer-based training program developed at the Karolinska Institute in Stockholm–Dr. Gibson and his colleagues administered the program to 12 adolescents aged 12–14 years who had been previously diagnosed with ADHD. The investigators observed significant decreases in inattention and significant improvements in both the working memory and other executive functions.

The findings validate those reported in 2005 by Cogmed developer Dr. Torkel Klingberg and colleagues (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:177–86) showing that the intensive training on a battery of verbal and visual-spatial working memory tasks significantly improved symptoms in a sample of Swedish children (aged 7–12 years) diagnosed with ADHD, compared with a placebo group, said Dr. Gibson of the University of Notre Dame (Ind.).

In the current study, the Cogmed program was administered to the students in the computer laboratory of their Midwestern middle school. All of the students received stimulant medication before and during the study. Each student completed 25 1-hour training sessions comprising 11 verbal and visual-spatial working memory exercises over the course of 6 weeks, Dr. Gibson said.

Before and after the intervention, the students were assessed using standardized tests of verbal and spatial working memory and of abstract, nonverbal reasoning. Additionally, parents and teachers completed Vanderbilt ADHD Diagnostic Rating Scale checklists.

“The results indicated significant improvement compared to baseline in all three of the cognitive measures,” Dr. Gibson reported. Additionally, “there were significant decreases in inattentive and hyperactive/impulsive symptoms as rated by parents, and a significant decrease in inattentive symptoms as rated by teachers,” he wrote.

Dr. Gibson pointed to changes in fluid intelligence–the ability to solve problems or adapt to new situations in real time–as a possible mechanism of action. “Working memory improves fluid intelligence, and fluid intelligence appears to reduce ADHD symptoms,” he noted.

In addition to validating the earlier Swedish study, the current findings, while limited by the study's small size and lack of a placebo control arm, extend the earlier work by “showing that working memory training can enhance some individuals more than others, and more importantly, by showing that individual differences in working memory enhancement are critical for predicting how much the symptoms of ADHD can be improved,” Dr. Gibson wrote.

BOSTON – Working memory training can significantly improve symptoms in adolescents receiving medical treatment for attention-deficit/hyperactivity disorder, Dr. Bradley S. Gibson said in a poster presentation at a meeting of the Society for Research in Child Development.

In the first U.S. investigation of the Cogmed Working Memory Training system–a computer-based training program developed at the Karolinska Institute in Stockholm–Dr. Gibson and his colleagues administered the program to 12 adolescents aged 12–14 years who had been previously diagnosed with ADHD. The investigators observed significant decreases in inattention and significant improvements in both the working memory and other executive functions.

The findings validate those reported in 2005 by Cogmed developer Dr. Torkel Klingberg and colleagues (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:177–86) showing that the intensive training on a battery of verbal and visual-spatial working memory tasks significantly improved symptoms in a sample of Swedish children (aged 7–12 years) diagnosed with ADHD, compared with a placebo group, said Dr. Gibson of the University of Notre Dame (Ind.).

In the current study, the Cogmed program was administered to the students in the computer laboratory of their Midwestern middle school. All of the students received stimulant medication before and during the study. Each student completed 25 1-hour training sessions comprising 11 verbal and visual-spatial working memory exercises over the course of 6 weeks, Dr. Gibson said.

Before and after the intervention, the students were assessed using standardized tests of verbal and spatial working memory and of abstract, nonverbal reasoning. Additionally, parents and teachers completed Vanderbilt ADHD Diagnostic Rating Scale checklists.

“The results indicated significant improvement compared to baseline in all three of the cognitive measures,” Dr. Gibson reported. Additionally, “there were significant decreases in inattentive and hyperactive/impulsive symptoms as rated by parents, and a significant decrease in inattentive symptoms as rated by teachers,” he wrote.

Dr. Gibson pointed to changes in fluid intelligence–the ability to solve problems or adapt to new situations in real time–as a possible mechanism of action. “Working memory improves fluid intelligence, and fluid intelligence appears to reduce ADHD symptoms,” he noted.

In addition to validating the earlier Swedish study, the current findings, while limited by the study's small size and lack of a placebo control arm, extend the earlier work by “showing that working memory training can enhance some individuals more than others, and more importantly, by showing that individual differences in working memory enhancement are critical for predicting how much the symptoms of ADHD can be improved,” Dr. Gibson wrote.

BOSTON – A diagnosis of maternal depression any time between 1 year before and 9 years after giving birth is a risk factor for attention-deficit/hyperactivity disorder in school-age children, according to a study presented at a meeting of the Society for Research in Child Development.

In addition, the likelihood of an attention-deficit/hyperactivity disorder (ADHD) diagnosis in children is directly related to the chronicity of depression in the mother, said Anne Guevremont, M.Ed., a research fellow at the Manitoba Centre for Health Policy at the University of Manitoba, Winnipeg

While previous studies have linked maternal depression to ADHD in children, none have specifically investigated whether and to what degree the timing of maternal depression has an impact on the relationship, Ms. Guevremont said.

Through computerized health care utilization files from the Manitoba health department, Ms. Guevremont and senior researcher Marni Brownell, Ph.D., reviewed data on a cohort of 12,323 children born between April 1993 and March 1994 whose mothers were living in Manitoba the year before the child's birth and for whom follow-up information was available until the child was 7–9 years old.

The investigators ascertained the presence of maternal depression by hospital or physician claims for this diagnosis and categorized the depression into one of five groups according to the child's age at the time of the mother's diagnosis: within 1 year before birth, within 1 year after birth, between 1 and 3 years old, 4–6 years old, and 7–9 years old.

Approximately 36% of the mothers in the study had a diagnosis of depression during at least one time period, Ms. Guevremont reported in a poster presentation. Among the children, approximately 5% had a physician diagnosis of ADHD when they were 7–9 years old, she said.

With respect to chronicity, the investigators considered each time period in which a mother had a diagnosis of depression and counted the total number of years that the mother had the diagnosis outside of that time period, according to Ms. Guevremont. “Approximately 16% of the mothers had a depression diagnosis in 1 year only, while 8% of the mothers received a depression diagnosis in 2 years and 12% in 3 or more years,” she said.

In analyses of the effect of the timing and chronicity of maternal depression on child ADHD, children with depressed mothers were approximately 1.5–2 times more likely to have an ADHD diagnosis than children of nondepressed mothers, said Ms. Guevremont, noting that the odds ratio was highest, at 2.18, for mothers diagnosed with depression in the year before the child's birth. This finding “confirms the need to look for maternal depression at every stage of motherhood, including the prenatal period,” she said. “The prenatal period is an excellent time to screen for depression.”

In addition, the chronicity of depression was significant in each model, and the odds of a child being diagnosed with ADHD were higher for each additional year a mother was diagnosed with depression, regardless of the timing of the diagnosis, said Ms. Guevremont.

The interaction between chronicity and timing was significant among children whose mothers were diagnosed in the year before birth, in the year after birth, or when the child was between 1 and 3. Children whose mothers were diagnosed during these periods and who had longer durations of depression were most vulnerable to an ADHD diagnosis, the results showed.

“Clearly, the number of years with a depression diagnosis is particularly important, and should be taken into consideration by clinicians caring for both mothers and their children,” Ms. Guevremont said. “The earlier depressed mothers are recognized and treated, the better for the health of both the mother and her children. Intervention at multiple time periods is possible and needed.” For example, in addition to prenatal screening, “another opportunity for screening is when mothers seek physicians for the children's behavior problems,” she said.

The study is limited by the potential for underreporting of both maternal depression and child ADHD, Ms. Guevremont noted.

“Some physicians may not know a mother is depressed and therefore would not diagnose the condition if symptoms are not reported. Similarly, some children's behavior problems may not be reported to a physician,” she stated. In addition, the study did not look at the effect of treatment methods for maternal depression on child ADHD diagnoses.

Among the study's strengths are its large sample size, availability of physician records of depression and ADHD diagnoses, and breadth of data enabling the study of maternal depression across a child's life span, “which [had] not been examined in previous studies,” Ms. Guevremont said.

BOSTON – A diagnosis of maternal depression any time between 1 year before and 9 years after giving birth is a risk factor for attention-deficit/hyperactivity disorder in school-age children, according to a study presented at a meeting of the Society for Research in Child Development.

In addition, the likelihood of an attention-deficit/hyperactivity disorder (ADHD) diagnosis in children is directly related to the chronicity of depression in the mother, said Anne Guevremont, M.Ed., a research fellow at the Manitoba Centre for Health Policy at the University of Manitoba, Winnipeg

While previous studies have linked maternal depression to ADHD in children, none have specifically investigated whether and to what degree the timing of maternal depression has an impact on the relationship, Ms. Guevremont said.

Through computerized health care utilization files from the Manitoba health department, Ms. Guevremont and senior researcher Marni Brownell, Ph.D., reviewed data on a cohort of 12,323 children born between April 1993 and March 1994 whose mothers were living in Manitoba the year before the child's birth and for whom follow-up information was available until the child was 7–9 years old.

The investigators ascertained the presence of maternal depression by hospital or physician claims for this diagnosis and categorized the depression into one of five groups according to the child's age at the time of the mother's diagnosis: within 1 year before birth, within 1 year after birth, between 1 and 3 years old, 4–6 years old, and 7–9 years old.

Approximately 36% of the mothers in the study had a diagnosis of depression during at least one time period, Ms. Guevremont reported in a poster presentation. Among the children, approximately 5% had a physician diagnosis of ADHD when they were 7–9 years old, she said.

With respect to chronicity, the investigators considered each time period in which a mother had a diagnosis of depression and counted the total number of years that the mother had the diagnosis outside of that time period, according to Ms. Guevremont. “Approximately 16% of the mothers had a depression diagnosis in 1 year only, while 8% of the mothers received a depression diagnosis in 2 years and 12% in 3 or more years,” she said.

In analyses of the effect of the timing and chronicity of maternal depression on child ADHD, children with depressed mothers were approximately 1.5–2 times more likely to have an ADHD diagnosis than children of nondepressed mothers, said Ms. Guevremont, noting that the odds ratio was highest, at 2.18, for mothers diagnosed with depression in the year before the child's birth. This finding “confirms the need to look for maternal depression at every stage of motherhood, including the prenatal period,” she said. “The prenatal period is an excellent time to screen for depression.”

In addition, the chronicity of depression was significant in each model, and the odds of a child being diagnosed with ADHD were higher for each additional year a mother was diagnosed with depression, regardless of the timing of the diagnosis, said Ms. Guevremont.

The interaction between chronicity and timing was significant among children whose mothers were diagnosed in the year before birth, in the year after birth, or when the child was between 1 and 3. Children whose mothers were diagnosed during these periods and who had longer durations of depression were most vulnerable to an ADHD diagnosis, the results showed.

“Clearly, the number of years with a depression diagnosis is particularly important, and should be taken into consideration by clinicians caring for both mothers and their children,” Ms. Guevremont said. “The earlier depressed mothers are recognized and treated, the better for the health of both the mother and her children. Intervention at multiple time periods is possible and needed.” For example, in addition to prenatal screening, “another opportunity for screening is when mothers seek physicians for the children's behavior problems,” she said.

The study is limited by the potential for underreporting of both maternal depression and child ADHD, Ms. Guevremont noted.

“Some physicians may not know a mother is depressed and therefore would not diagnose the condition if symptoms are not reported. Similarly, some children's behavior problems may not be reported to a physician,” she stated. In addition, the study did not look at the effect of treatment methods for maternal depression on child ADHD diagnoses.

Among the study's strengths are its large sample size, availability of physician records of depression and ADHD diagnoses, and breadth of data enabling the study of maternal depression across a child's life span, “which [had] not been examined in previous studies,” Ms. Guevremont said.

BOSTON – A diagnosis of maternal depression any time between 1 year before and 9 years after giving birth is a risk factor for attention-deficit/hyperactivity disorder in school-age children, according to a study presented at a meeting of the Society for Research in Child Development.

In addition, the likelihood of an attention-deficit/hyperactivity disorder (ADHD) diagnosis in children is directly related to the chronicity of depression in the mother, said Anne Guevremont, M.Ed., a research fellow at the Manitoba Centre for Health Policy at the University of Manitoba, Winnipeg

While previous studies have linked maternal depression to ADHD in children, none have specifically investigated whether and to what degree the timing of maternal depression has an impact on the relationship, Ms. Guevremont said.

Through computerized health care utilization files from the Manitoba health department, Ms. Guevremont and senior researcher Marni Brownell, Ph.D., reviewed data on a cohort of 12,323 children born between April 1993 and March 1994 whose mothers were living in Manitoba the year before the child's birth and for whom follow-up information was available until the child was 7–9 years old.

The investigators ascertained the presence of maternal depression by hospital or physician claims for this diagnosis and categorized the depression into one of five groups according to the child's age at the time of the mother's diagnosis: within 1 year before birth, within 1 year after birth, between 1 and 3 years old, 4–6 years old, and 7–9 years old.

Approximately 36% of the mothers in the study had a diagnosis of depression during at least one time period, Ms. Guevremont reported in a poster presentation. Among the children, approximately 5% had a physician diagnosis of ADHD when they were 7–9 years old, she said.

With respect to chronicity, the investigators considered each time period in which a mother had a diagnosis of depression and counted the total number of years that the mother had the diagnosis outside of that time period, according to Ms. Guevremont. “Approximately 16% of the mothers had a depression diagnosis in 1 year only, while 8% of the mothers received a depression diagnosis in 2 years and 12% in 3 or more years,” she said.

In analyses of the effect of the timing and chronicity of maternal depression on child ADHD, children with depressed mothers were approximately 1.5–2 times more likely to have an ADHD diagnosis than children of nondepressed mothers, said Ms. Guevremont, noting that the odds ratio was highest, at 2.18, for mothers diagnosed with depression in the year before the child's birth. This finding “confirms the need to look for maternal depression at every stage of motherhood, including the prenatal period,” she said. “The prenatal period is an excellent time to screen for depression.”

In addition, the chronicity of depression was significant in each model, and the odds of a child being diagnosed with ADHD were higher for each additional year a mother was diagnosed with depression, regardless of the timing of the diagnosis, said Ms. Guevremont.

The interaction between chronicity and timing was significant among children whose mothers were diagnosed in the year before birth, in the year after birth, or when the child was between 1 and 3. Children whose mothers were diagnosed during these periods and who had longer durations of depression were most vulnerable to an ADHD diagnosis, the results showed.

“Clearly, the number of years with a depression diagnosis is particularly important, and should be taken into consideration by clinicians caring for both mothers and their children,” Ms. Guevremont said. “The earlier depressed mothers are recognized and treated, the better for the health of both the mother and her children. Intervention at multiple time periods is possible and needed.” For example, in addition to prenatal screening, “another opportunity for screening is when mothers seek physicians for the children's behavior problems,” she said.

The study is limited by the potential for underreporting of both maternal depression and child ADHD, Ms. Guevremont noted.

“Some physicians may not know a mother is depressed and therefore would not diagnose the condition if symptoms are not reported. Similarly, some children's behavior problems may not be reported to a physician,” she stated. In addition, the study did not look at the effect of treatment methods for maternal depression on child ADHD diagnoses.

Among the study's strengths are its large sample size, availability of physician records of depression and ADHD diagnoses, and breadth of data enabling the study of maternal depression across a child's life span, “which [had] not been examined in previous studies,” Ms. Guevremont said.

ATLANTA — Impaired bone mass acquisition associated with certain oral contraceptives may be a hidden public health problem affecting adolescent girls, Dr. Barbara Cromer said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Preliminary data from a pilot study comparing bone mineral density in adolescent girls using oral contraceptives containing two different levels of estrogen demonstrated an apparent blunting of bone development gains associated with the lower-estrogen pill, said Dr. Cromer of MetroHealth Medical Center in Cleveland.

The adverse skeletal effects of hormonal contraceptives have come under scrutiny in recent years, particularly as studies have linked the use of depot medroxyprogesterone acetate (DMPA) to bone mineral density (BMD) loss in adolescents, Dr. Cromer said. The relationship between oral contraceptives and BMD is less clear, however. “While some studies in premenopausal women suggest positive or no effects on bone mass associated with oral contraceptives, there is conflicting evidence about whether ultralow-dose oral contraceptives [containing 20 mcg ethinyl estradiol] interfere with the large increases in bone mineral density normally observed in adolescence,” Dr. Cromer said. On the other hand, low-dose oral contraceptives—those containing 30–40 mcg of ethinyl estradiol—seem to offer some bone protection in young adult women, she said.

Because an estimated 25%–40% of a woman's peak bone mass is acquired during the teen years, optimizing bone development during this period is considered the most important factor in the primary prevention of osteoporosis.

To determine whether and to what degree ultralow-dose oral contraceptives—which are thought to decrease the associated risk of venous thromboembolic events (VTE) in adult women relative to combined oral contraceptives with more estrogen—Dr. Cromer and colleagues undertook a single-blind randomized clinical trail in adolescent girls comparing the skeletal effects associated with oral contraceptives containing 20 mcg and 35 mcg of ethinyl estradiol.

Of 12 girls aged 12–18 years included in the study, 5 received a combination oral contraceptive with 20 mcg of ethinyl estradiol and 1 mg of norethindrone acetate for 12 months and 7 received one with 35 mcg of ethinyl estradiol and 1 mg norethindrone for the same duration. The mean age of subjects in the 20-mcg group was 15.2 years, compared with 15.6 years for the 35-mcg group. Half of the lower-dose estrogen group was African American, compared with 62% of the higher-dose group, said Dr. Cromer.

All of the girls underwent BMD testing with dual-energy x-ray absorptiometry at the lumbar spine (L1-L4) and at the femoral neck at baseline, at 6 months, and 12 months. The main outcome measure was percent of change in BMD.

At 12 months, the mean percentage of change in bone mass acquisition from baseline in the lower-estrogen group was 1%, compared with 2% in the higher-dose group, Dr. Cromer reported.

Although the study was not powered to detect statistical significance, the observed differences in bone development raise important questions, said Dr. Cromer. “The first question is obviously whether the difference is clinically significant, and it's one that absolutely warrants further investigation,” she said. “If there is clinical significance, we need to think about whether the appropriate dose of ethynyl estradiol for teens may be 35 mcg and whether the trade-off with the risk of VTE—which is relatively small in adolescents—is acceptable.” Additional questions include whether and to what degree bone mass recovery occurs after cessation of these agents and whether lifestyle factors, including nutrition and physical activity, can override some of the negative bone effects, she said

ATLANTA — Impaired bone mass acquisition associated with certain oral contraceptives may be a hidden public health problem affecting adolescent girls, Dr. Barbara Cromer said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Preliminary data from a pilot study comparing bone mineral density in adolescent girls using oral contraceptives containing two different levels of estrogen demonstrated an apparent blunting of bone development gains associated with the lower-estrogen pill, said Dr. Cromer of MetroHealth Medical Center in Cleveland.

The adverse skeletal effects of hormonal contraceptives have come under scrutiny in recent years, particularly as studies have linked the use of depot medroxyprogesterone acetate (DMPA) to bone mineral density (BMD) loss in adolescents, Dr. Cromer said. The relationship between oral contraceptives and BMD is less clear, however. “While some studies in premenopausal women suggest positive or no effects on bone mass associated with oral contraceptives, there is conflicting evidence about whether ultralow-dose oral contraceptives [containing 20 mcg ethinyl estradiol] interfere with the large increases in bone mineral density normally observed in adolescence,” Dr. Cromer said. On the other hand, low-dose oral contraceptives—those containing 30–40 mcg of ethinyl estradiol—seem to offer some bone protection in young adult women, she said.

Because an estimated 25%–40% of a woman's peak bone mass is acquired during the teen years, optimizing bone development during this period is considered the most important factor in the primary prevention of osteoporosis.

To determine whether and to what degree ultralow-dose oral contraceptives—which are thought to decrease the associated risk of venous thromboembolic events (VTE) in adult women relative to combined oral contraceptives with more estrogen—Dr. Cromer and colleagues undertook a single-blind randomized clinical trail in adolescent girls comparing the skeletal effects associated with oral contraceptives containing 20 mcg and 35 mcg of ethinyl estradiol.

Of 12 girls aged 12–18 years included in the study, 5 received a combination oral contraceptive with 20 mcg of ethinyl estradiol and 1 mg of norethindrone acetate for 12 months and 7 received one with 35 mcg of ethinyl estradiol and 1 mg norethindrone for the same duration. The mean age of subjects in the 20-mcg group was 15.2 years, compared with 15.6 years for the 35-mcg group. Half of the lower-dose estrogen group was African American, compared with 62% of the higher-dose group, said Dr. Cromer.

All of the girls underwent BMD testing with dual-energy x-ray absorptiometry at the lumbar spine (L1-L4) and at the femoral neck at baseline, at 6 months, and 12 months. The main outcome measure was percent of change in BMD.

At 12 months, the mean percentage of change in bone mass acquisition from baseline in the lower-estrogen group was 1%, compared with 2% in the higher-dose group, Dr. Cromer reported.

Although the study was not powered to detect statistical significance, the observed differences in bone development raise important questions, said Dr. Cromer. “The first question is obviously whether the difference is clinically significant, and it's one that absolutely warrants further investigation,” she said. “If there is clinical significance, we need to think about whether the appropriate dose of ethynyl estradiol for teens may be 35 mcg and whether the trade-off with the risk of VTE—which is relatively small in adolescents—is acceptable.” Additional questions include whether and to what degree bone mass recovery occurs after cessation of these agents and whether lifestyle factors, including nutrition and physical activity, can override some of the negative bone effects, she said

ATLANTA — Impaired bone mass acquisition associated with certain oral contraceptives may be a hidden public health problem affecting adolescent girls, Dr. Barbara Cromer said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Preliminary data from a pilot study comparing bone mineral density in adolescent girls using oral contraceptives containing two different levels of estrogen demonstrated an apparent blunting of bone development gains associated with the lower-estrogen pill, said Dr. Cromer of MetroHealth Medical Center in Cleveland.

The adverse skeletal effects of hormonal contraceptives have come under scrutiny in recent years, particularly as studies have linked the use of depot medroxyprogesterone acetate (DMPA) to bone mineral density (BMD) loss in adolescents, Dr. Cromer said. The relationship between oral contraceptives and BMD is less clear, however. “While some studies in premenopausal women suggest positive or no effects on bone mass associated with oral contraceptives, there is conflicting evidence about whether ultralow-dose oral contraceptives [containing 20 mcg ethinyl estradiol] interfere with the large increases in bone mineral density normally observed in adolescence,” Dr. Cromer said. On the other hand, low-dose oral contraceptives—those containing 30–40 mcg of ethinyl estradiol—seem to offer some bone protection in young adult women, she said.

Because an estimated 25%–40% of a woman's peak bone mass is acquired during the teen years, optimizing bone development during this period is considered the most important factor in the primary prevention of osteoporosis.

To determine whether and to what degree ultralow-dose oral contraceptives—which are thought to decrease the associated risk of venous thromboembolic events (VTE) in adult women relative to combined oral contraceptives with more estrogen—Dr. Cromer and colleagues undertook a single-blind randomized clinical trail in adolescent girls comparing the skeletal effects associated with oral contraceptives containing 20 mcg and 35 mcg of ethinyl estradiol.

Of 12 girls aged 12–18 years included in the study, 5 received a combination oral contraceptive with 20 mcg of ethinyl estradiol and 1 mg of norethindrone acetate for 12 months and 7 received one with 35 mcg of ethinyl estradiol and 1 mg norethindrone for the same duration. The mean age of subjects in the 20-mcg group was 15.2 years, compared with 15.6 years for the 35-mcg group. Half of the lower-dose estrogen group was African American, compared with 62% of the higher-dose group, said Dr. Cromer.

All of the girls underwent BMD testing with dual-energy x-ray absorptiometry at the lumbar spine (L1-L4) and at the femoral neck at baseline, at 6 months, and 12 months. The main outcome measure was percent of change in BMD.

At 12 months, the mean percentage of change in bone mass acquisition from baseline in the lower-estrogen group was 1%, compared with 2% in the higher-dose group, Dr. Cromer reported.

Although the study was not powered to detect statistical significance, the observed differences in bone development raise important questions, said Dr. Cromer. “The first question is obviously whether the difference is clinically significant, and it's one that absolutely warrants further investigation,” she said. “If there is clinical significance, we need to think about whether the appropriate dose of ethynyl estradiol for teens may be 35 mcg and whether the trade-off with the risk of VTE—which is relatively small in adolescents—is acceptable.” Additional questions include whether and to what degree bone mass recovery occurs after cessation of these agents and whether lifestyle factors, including nutrition and physical activity, can override some of the negative bone effects, she said

ATLANTA — Religious practices and beliefs play an important role in the sexual behavior of adolescent girls, Melanie Gold, D.O., said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

In a study of 572 adolescent girls and young adults aged 13–21 years, those who scored high on a religiosity index were less likely to have ever had sex than were their peers who scored low on the index, said Dr. Gold of the Children's Hospital of Pittsburgh. Additionally, “sexually active participants with low religiosity had sex more frequently in the past month and had more lifetime partners” than did those with medium or high religiosity scores, she said.

“Previous studies have found that high religiosity in adolescent girls is associated with delaying initial sexual activity and fewer sexual partners. Yet other studies have also linked high religiosity with decreased use of condoms and hormonal contraception in this population, leading to conflicting opinions about whether religiosity is a protective or a risk factor for unintended pregnancy, sexually transmitted diseases [STDs], and sexual risk-taking behavior,” Dr. Gold said. Because of this, the current study was designed to examine religiosity as both a protective and a risk factor for these outcomes.

Toward this end, the investigators developed a religiosity index based on four items: religious affiliation, frequency of attendance at religious services, the impact of religion on beliefs about sex, and the impact of religion on beliefs about contraception. They used multiple regression analysis to examine the relationship between the index scores and sexual, reproductive, contraceptive, and STD history in a cohort of predominantly minority adolescent girls recruited from an urban, hospital-based adolescent care clinic, Dr. Gold said. Scores on the religiosity index ranged from 4 to 17, with scores of 4–7 considered low religiosity; 8–11, medium religiosity; and 12–17, high religiosity. With respect to participant characteristics, 59% of the population was black and 32% was white and the mean age was 17.4 years, Dr. Gold said. Additionally, 68% of the young women reported being sexually active with a mean age at first intercourse of 15 years, and among the sexually active cohort, 17% had ever been pregnant and 25% had ever had an STD, she said.

In terms of religion, 74% of the study population had a religious affiliation, 33% attended religious services weekly or more, 22% never attended services, and 19% went once or twice a year, said Dr. Gold. Most (32%) of those reporting a religious affiliation identified themselves as Baptists, followed by Roman Catholics (16%), and other Christian denominations, she said. Of the full study population, 19% said that their religious beliefs had a high impact on decisions about sex and 25% said their beliefs substantially affected their decisions about contraceptive use.

Based on the religiosity index scores, 20% of the participants met the criteria for high religiosity, while 40% each met the criteria for medium and low religiosity, Dr. Gold noted.

According to the logistic regression model, participants with high religiosity had a significantly lower odds ratio for ever having had sex. “The adjusted model demonstrated that individuals in the high-religiosity group were 78% less likely to have ever had sex compared with those in the low religiosity group,” said Dr. Gold. Among those who had ever had sex, she noted, “those with high religiosity had a significantly lower odds ratio of having had frequent sex [more than six times in the past month], and those with medium religiosity showed a nonsignificant trend in the same direction.”

In addition, those with high religiosity also had a significantly lower odds ratio for having had at least four lifetime partners, and those with medium religiosity again showed a nonsignificant trend in the same direction, she said.

Regarding history of pregnancy or sexually transmitted disease, “among the participants who had ever had sex, those with medium religiosity had significantly lower odds ratios for ever being pregnant and for ever having a sexually transmitted disease,” said Dr. Gold.

Nonsignificant trends in the same direction were observed among those with high religiosity, she said.

No associations were seen between level of religiosity and age at first coitus, history of pregnancy or sexually transmitted diseases, contraceptive method used at last sex, or future sexual and contraceptive plans, Dr. Gold noted.

“Based on our findings, religiosity appears to be a protective factor, both in terms of delaying first sex in adolescent girls, as has been shown in other studies, but also with respect to sexual risk-taking behaviors among girls who are already sexually active,” Dr. Gold said. “It's important to point out, however, that not all of the relationships were statistically significant,” she said. “Also, the findings are limited by a number of factors, including the overrepresentation of Baptists relative to the general population and the fact that the participants knew they were enrolling in a study looking at the relationship between religious beliefs and practices and sexual behaviors, which could have led to selection bias.”

Despite these limitations, the findings do suggest that clinicians who provide reproductive health care to adolescents “should routinely ask their patients about religiosity—particularly the frequency of attendance at religious services and whether and to what degree religious beliefs affect decisions about sex and contraception—since it does play into sexual risk behaviors,” Dr. Gold said.

ATLANTA — Religious practices and beliefs play an important role in the sexual behavior of adolescent girls, Melanie Gold, D.O., said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

In a study of 572 adolescent girls and young adults aged 13–21 years, those who scored high on a religiosity index were less likely to have ever had sex than were their peers who scored low on the index, said Dr. Gold of the Children's Hospital of Pittsburgh. Additionally, “sexually active participants with low religiosity had sex more frequently in the past month and had more lifetime partners” than did those with medium or high religiosity scores, she said.

“Previous studies have found that high religiosity in adolescent girls is associated with delaying initial sexual activity and fewer sexual partners. Yet other studies have also linked high religiosity with decreased use of condoms and hormonal contraception in this population, leading to conflicting opinions about whether religiosity is a protective or a risk factor for unintended pregnancy, sexually transmitted diseases [STDs], and sexual risk-taking behavior,” Dr. Gold said. Because of this, the current study was designed to examine religiosity as both a protective and a risk factor for these outcomes.

Toward this end, the investigators developed a religiosity index based on four items: religious affiliation, frequency of attendance at religious services, the impact of religion on beliefs about sex, and the impact of religion on beliefs about contraception. They used multiple regression analysis to examine the relationship between the index scores and sexual, reproductive, contraceptive, and STD history in a cohort of predominantly minority adolescent girls recruited from an urban, hospital-based adolescent care clinic, Dr. Gold said. Scores on the religiosity index ranged from 4 to 17, with scores of 4–7 considered low religiosity; 8–11, medium religiosity; and 12–17, high religiosity. With respect to participant characteristics, 59% of the population was black and 32% was white and the mean age was 17.4 years, Dr. Gold said. Additionally, 68% of the young women reported being sexually active with a mean age at first intercourse of 15 years, and among the sexually active cohort, 17% had ever been pregnant and 25% had ever had an STD, she said.

In terms of religion, 74% of the study population had a religious affiliation, 33% attended religious services weekly or more, 22% never attended services, and 19% went once or twice a year, said Dr. Gold. Most (32%) of those reporting a religious affiliation identified themselves as Baptists, followed by Roman Catholics (16%), and other Christian denominations, she said. Of the full study population, 19% said that their religious beliefs had a high impact on decisions about sex and 25% said their beliefs substantially affected their decisions about contraceptive use.

Based on the religiosity index scores, 20% of the participants met the criteria for high religiosity, while 40% each met the criteria for medium and low religiosity, Dr. Gold noted.

According to the logistic regression model, participants with high religiosity had a significantly lower odds ratio for ever having had sex. “The adjusted model demonstrated that individuals in the high-religiosity group were 78% less likely to have ever had sex compared with those in the low religiosity group,” said Dr. Gold. Among those who had ever had sex, she noted, “those with high religiosity had a significantly lower odds ratio of having had frequent sex [more than six times in the past month], and those with medium religiosity showed a nonsignificant trend in the same direction.”

In addition, those with high religiosity also had a significantly lower odds ratio for having had at least four lifetime partners, and those with medium religiosity again showed a nonsignificant trend in the same direction, she said.

Regarding history of pregnancy or sexually transmitted disease, “among the participants who had ever had sex, those with medium religiosity had significantly lower odds ratios for ever being pregnant and for ever having a sexually transmitted disease,” said Dr. Gold.

Nonsignificant trends in the same direction were observed among those with high religiosity, she said.

No associations were seen between level of religiosity and age at first coitus, history of pregnancy or sexually transmitted diseases, contraceptive method used at last sex, or future sexual and contraceptive plans, Dr. Gold noted.

“Based on our findings, religiosity appears to be a protective factor, both in terms of delaying first sex in adolescent girls, as has been shown in other studies, but also with respect to sexual risk-taking behaviors among girls who are already sexually active,” Dr. Gold said. “It's important to point out, however, that not all of the relationships were statistically significant,” she said. “Also, the findings are limited by a number of factors, including the overrepresentation of Baptists relative to the general population and the fact that the participants knew they were enrolling in a study looking at the relationship between religious beliefs and practices and sexual behaviors, which could have led to selection bias.”

Despite these limitations, the findings do suggest that clinicians who provide reproductive health care to adolescents “should routinely ask their patients about religiosity—particularly the frequency of attendance at religious services and whether and to what degree religious beliefs affect decisions about sex and contraception—since it does play into sexual risk behaviors,” Dr. Gold said.

ATLANTA — Religious practices and beliefs play an important role in the sexual behavior of adolescent girls, Melanie Gold, D.O., said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

In a study of 572 adolescent girls and young adults aged 13–21 years, those who scored high on a religiosity index were less likely to have ever had sex than were their peers who scored low on the index, said Dr. Gold of the Children's Hospital of Pittsburgh. Additionally, “sexually active participants with low religiosity had sex more frequently in the past month and had more lifetime partners” than did those with medium or high religiosity scores, she said.

“Previous studies have found that high religiosity in adolescent girls is associated with delaying initial sexual activity and fewer sexual partners. Yet other studies have also linked high religiosity with decreased use of condoms and hormonal contraception in this population, leading to conflicting opinions about whether religiosity is a protective or a risk factor for unintended pregnancy, sexually transmitted diseases [STDs], and sexual risk-taking behavior,” Dr. Gold said. Because of this, the current study was designed to examine religiosity as both a protective and a risk factor for these outcomes.

Toward this end, the investigators developed a religiosity index based on four items: religious affiliation, frequency of attendance at religious services, the impact of religion on beliefs about sex, and the impact of religion on beliefs about contraception. They used multiple regression analysis to examine the relationship between the index scores and sexual, reproductive, contraceptive, and STD history in a cohort of predominantly minority adolescent girls recruited from an urban, hospital-based adolescent care clinic, Dr. Gold said. Scores on the religiosity index ranged from 4 to 17, with scores of 4–7 considered low religiosity; 8–11, medium religiosity; and 12–17, high religiosity. With respect to participant characteristics, 59% of the population was black and 32% was white and the mean age was 17.4 years, Dr. Gold said. Additionally, 68% of the young women reported being sexually active with a mean age at first intercourse of 15 years, and among the sexually active cohort, 17% had ever been pregnant and 25% had ever had an STD, she said.

In terms of religion, 74% of the study population had a religious affiliation, 33% attended religious services weekly or more, 22% never attended services, and 19% went once or twice a year, said Dr. Gold. Most (32%) of those reporting a religious affiliation identified themselves as Baptists, followed by Roman Catholics (16%), and other Christian denominations, she said. Of the full study population, 19% said that their religious beliefs had a high impact on decisions about sex and 25% said their beliefs substantially affected their decisions about contraceptive use.

Based on the religiosity index scores, 20% of the participants met the criteria for high religiosity, while 40% each met the criteria for medium and low religiosity, Dr. Gold noted.

According to the logistic regression model, participants with high religiosity had a significantly lower odds ratio for ever having had sex. “The adjusted model demonstrated that individuals in the high-religiosity group were 78% less likely to have ever had sex compared with those in the low religiosity group,” said Dr. Gold. Among those who had ever had sex, she noted, “those with high religiosity had a significantly lower odds ratio of having had frequent sex [more than six times in the past month], and those with medium religiosity showed a nonsignificant trend in the same direction.”

In addition, those with high religiosity also had a significantly lower odds ratio for having had at least four lifetime partners, and those with medium religiosity again showed a nonsignificant trend in the same direction, she said.

Regarding history of pregnancy or sexually transmitted disease, “among the participants who had ever had sex, those with medium religiosity had significantly lower odds ratios for ever being pregnant and for ever having a sexually transmitted disease,” said Dr. Gold.

Nonsignificant trends in the same direction were observed among those with high religiosity, she said.

No associations were seen between level of religiosity and age at first coitus, history of pregnancy or sexually transmitted diseases, contraceptive method used at last sex, or future sexual and contraceptive plans, Dr. Gold noted.

“Based on our findings, religiosity appears to be a protective factor, both in terms of delaying first sex in adolescent girls, as has been shown in other studies, but also with respect to sexual risk-taking behaviors among girls who are already sexually active,” Dr. Gold said. “It's important to point out, however, that not all of the relationships were statistically significant,” she said. “Also, the findings are limited by a number of factors, including the overrepresentation of Baptists relative to the general population and the fact that the participants knew they were enrolling in a study looking at the relationship between religious beliefs and practices and sexual behaviors, which could have led to selection bias.”

Despite these limitations, the findings do suggest that clinicians who provide reproductive health care to adolescents “should routinely ask their patients about religiosity—particularly the frequency of attendance at religious services and whether and to what degree religious beliefs affect decisions about sex and contraception—since it does play into sexual risk behaviors,” Dr. Gold said.

BOSTON — Maternal cortisol levels during pregnancy are highly correlated with newborn cortisol levels in the first days of life, a study has shown. Additionally, both prenatal anxiety and postpartum depression independently predict newborn cortisol levels, according to Raquel Costa, a doctoral candidate at the University of Minho in Braga, Portugal.

These findings from a prospective investigation of 56 mother-child pairs support the hypothesis that a woman's emotional state both during pregnancy and after childbirth can have a significant effect on newborn physiology, Ms. Costa said in a poster presentation at a meeting of the Society for Research in Child Development.

All of the women in the current study were enrolled during their third trimester of pregnancy, and none had multiple gestations. Upon enrollment through 48 hours after childbirth, each woman provided 24 urine samples to measure cortisol levels, as well as blood samples to measure oxytocin levels. For assessment of depression and anxiety at both time points, each woman completed the 10-item Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). Newborn cortisol levels were measured via urine sample within 2 days of birth.

Approximately 30% of the mothers screened positive for depression during pregnancy, and 17% screened positive after childbirth, Ms. Costa said. With respect to anxiety, positive screens were observed in 29% of the women prior to giving birth and 20% after childbirth, she said.

Measurement of maternal cortisol showed that approximately 53% of the women had levels higher than the normative range of 20–90 mcg/24 hours during pregnancy, and 17% had levels higher than the normative range after childbirth, Ms. Costa reported.

Regarding oxytocin measurements, prior to childbirth 52% of the women had levels higher than the group's mean. Following childbirth, 45% of the mothers had oxytocin levels higher than the group's postpartum mean.

In a t test for independent samples to analyze differences in newborns' cortisol levels according to mothers' depressive mood, anxiety, oxytocin, and cortisol levels before and after childbirth, “there were no significant differences in newborn cortisol levels according to mother's psychopathology or hormone levels,” Ms. Costa stated.

However, linear regression analysis on the neonatal cortisol levels with the maternal depressive mood, anxiety, oxytocin, and cortisol levels both during pregnancy and post partum “suggested that maternal anxiety during pregnancy and depression after childbirth were predictive of neonatal cortisol levels,” said Ms. Costa. Neither maternal cortisol nor oxytocin levels were predictive of newborn cortisol levels in the regression analyses, she noted.

Together with the results of earlier studies linking elevated prenatal cortisol levels in mothers to short gestation and low birth weight in newborns, and those associating prenatal stress with behavioral problems and motor/cognitive deficits in newborns, the findings of the current study highlight the importance of assessing maternal emotional status and stress hormone levels during pregnancy, and implementing early intervention strategies when warranted, Ms. Costa said.

BOSTON — Maternal cortisol levels during pregnancy are highly correlated with newborn cortisol levels in the first days of life, a study has shown. Additionally, both prenatal anxiety and postpartum depression independently predict newborn cortisol levels, according to Raquel Costa, a doctoral candidate at the University of Minho in Braga, Portugal.

These findings from a prospective investigation of 56 mother-child pairs support the hypothesis that a woman's emotional state both during pregnancy and after childbirth can have a significant effect on newborn physiology, Ms. Costa said in a poster presentation at a meeting of the Society for Research in Child Development.

All of the women in the current study were enrolled during their third trimester of pregnancy, and none had multiple gestations. Upon enrollment through 48 hours after childbirth, each woman provided 24 urine samples to measure cortisol levels, as well as blood samples to measure oxytocin levels. For assessment of depression and anxiety at both time points, each woman completed the 10-item Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). Newborn cortisol levels were measured via urine sample within 2 days of birth.

Approximately 30% of the mothers screened positive for depression during pregnancy, and 17% screened positive after childbirth, Ms. Costa said. With respect to anxiety, positive screens were observed in 29% of the women prior to giving birth and 20% after childbirth, she said.

Measurement of maternal cortisol showed that approximately 53% of the women had levels higher than the normative range of 20–90 mcg/24 hours during pregnancy, and 17% had levels higher than the normative range after childbirth, Ms. Costa reported.

Regarding oxytocin measurements, prior to childbirth 52% of the women had levels higher than the group's mean. Following childbirth, 45% of the mothers had oxytocin levels higher than the group's postpartum mean.

In a t test for independent samples to analyze differences in newborns' cortisol levels according to mothers' depressive mood, anxiety, oxytocin, and cortisol levels before and after childbirth, “there were no significant differences in newborn cortisol levels according to mother's psychopathology or hormone levels,” Ms. Costa stated.

However, linear regression analysis on the neonatal cortisol levels with the maternal depressive mood, anxiety, oxytocin, and cortisol levels both during pregnancy and post partum “suggested that maternal anxiety during pregnancy and depression after childbirth were predictive of neonatal cortisol levels,” said Ms. Costa. Neither maternal cortisol nor oxytocin levels were predictive of newborn cortisol levels in the regression analyses, she noted.

Together with the results of earlier studies linking elevated prenatal cortisol levels in mothers to short gestation and low birth weight in newborns, and those associating prenatal stress with behavioral problems and motor/cognitive deficits in newborns, the findings of the current study highlight the importance of assessing maternal emotional status and stress hormone levels during pregnancy, and implementing early intervention strategies when warranted, Ms. Costa said.

BOSTON — Maternal cortisol levels during pregnancy are highly correlated with newborn cortisol levels in the first days of life, a study has shown. Additionally, both prenatal anxiety and postpartum depression independently predict newborn cortisol levels, according to Raquel Costa, a doctoral candidate at the University of Minho in Braga, Portugal.

These findings from a prospective investigation of 56 mother-child pairs support the hypothesis that a woman's emotional state both during pregnancy and after childbirth can have a significant effect on newborn physiology, Ms. Costa said in a poster presentation at a meeting of the Society for Research in Child Development.

All of the women in the current study were enrolled during their third trimester of pregnancy, and none had multiple gestations. Upon enrollment through 48 hours after childbirth, each woman provided 24 urine samples to measure cortisol levels, as well as blood samples to measure oxytocin levels. For assessment of depression and anxiety at both time points, each woman completed the 10-item Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). Newborn cortisol levels were measured via urine sample within 2 days of birth.

Approximately 30% of the mothers screened positive for depression during pregnancy, and 17% screened positive after childbirth, Ms. Costa said. With respect to anxiety, positive screens were observed in 29% of the women prior to giving birth and 20% after childbirth, she said.

Measurement of maternal cortisol showed that approximately 53% of the women had levels higher than the normative range of 20–90 mcg/24 hours during pregnancy, and 17% had levels higher than the normative range after childbirth, Ms. Costa reported.

Regarding oxytocin measurements, prior to childbirth 52% of the women had levels higher than the group's mean. Following childbirth, 45% of the mothers had oxytocin levels higher than the group's postpartum mean.

In a t test for independent samples to analyze differences in newborns' cortisol levels according to mothers' depressive mood, anxiety, oxytocin, and cortisol levels before and after childbirth, “there were no significant differences in newborn cortisol levels according to mother's psychopathology or hormone levels,” Ms. Costa stated.

However, linear regression analysis on the neonatal cortisol levels with the maternal depressive mood, anxiety, oxytocin, and cortisol levels both during pregnancy and post partum “suggested that maternal anxiety during pregnancy and depression after childbirth were predictive of neonatal cortisol levels,” said Ms. Costa. Neither maternal cortisol nor oxytocin levels were predictive of newborn cortisol levels in the regression analyses, she noted.

Together with the results of earlier studies linking elevated prenatal cortisol levels in mothers to short gestation and low birth weight in newborns, and those associating prenatal stress with behavioral problems and motor/cognitive deficits in newborns, the findings of the current study highlight the importance of assessing maternal emotional status and stress hormone levels during pregnancy, and implementing early intervention strategies when warranted, Ms. Costa said.

ATLANTA — Advanced provision of emergency contraceptive pills did not significantly decrease the rapid repeat pregnancy rate in a racially and ethnically diverse group of adolescents enrolled in a Colorado study “because many of the young women failed to use them,” Jeanelle Sheeder reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

To better understand why emergency contraceptive pills (ECPs) have not had the anticipated impact on teen pregnancy, Ms. Sheeder and colleagues in the department of pediatrics at the University of Colorado Health Sciences Center in Denver assessed the sexual and contraceptive behavior of 382 predominantly primiparous 14- to 21-year-old women in that institution's adolescent maternity program. At the time of enrollment, all of the young women expressed a desire not to get pregnant again for at least 2 years. Each participant received either a prescription for or a packet of ECPs, with no limit on refills.

At each clinic visit, conducted at 6- to 8-week intervals through the sixth postpartum month, the study participants completed a questionnaire that asked about their interval sexual and contraceptive behavior, Ms. Sheeder said.

Controlling for age, race/ethnicity, education level, reason for not using contraception before conception, future family plans, and postpartum month, the investigators also analyzed the use of ECPs in relation to unprotected intercourse.

During the course of the study, 44% of the young mothers had episodes of unprotected intercourse, said Ms. Sheeder, noting that “of these women, 15% reported one episode of unprotected intercourse, 24% had two to four episodes, and 5% had more than four episodes.”

While more than half (54%) of the women reporting unprotected intercourse used ECPs, only 28% used them appropriately, Ms. Sheeder noted. “They were underutilized by 65% of the women and 7% engaged in augmented use,” she said.

A total of 19 pregnancies occurred during the study period. “Teens who experienced unwanted pregnancies did not engage in more unprotected intercourse or ECP underuse than those who did not,” Ms. Sheeder noted.

Of the 19 pregnancies, 9 were in young women who reported using some contraceptive method during the study period but their contraceptive use was inconsistent or incorrect. The remaining 10 pregnancies were not attributable to unrecognized contraceptive or ECP failure.

The findings suggest a high prevalence of unprotected intercourse during the first 6 postpartum months among teen mothers who say they don't want a rapid repeat pregnancy, said Ms. Sheeder. “Additionally, it appears that the reason ECPs have not significantly decreased the repeat teen pregnancy rate is because most teen mothers underutilize ECPs even when they have them on hand,” she said.

ATLANTA — Advanced provision of emergency contraceptive pills did not significantly decrease the rapid repeat pregnancy rate in a racially and ethnically diverse group of adolescents enrolled in a Colorado study “because many of the young women failed to use them,” Jeanelle Sheeder reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

To better understand why emergency contraceptive pills (ECPs) have not had the anticipated impact on teen pregnancy, Ms. Sheeder and colleagues in the department of pediatrics at the University of Colorado Health Sciences Center in Denver assessed the sexual and contraceptive behavior of 382 predominantly primiparous 14- to 21-year-old women in that institution's adolescent maternity program. At the time of enrollment, all of the young women expressed a desire not to get pregnant again for at least 2 years. Each participant received either a prescription for or a packet of ECPs, with no limit on refills.

At each clinic visit, conducted at 6- to 8-week intervals through the sixth postpartum month, the study participants completed a questionnaire that asked about their interval sexual and contraceptive behavior, Ms. Sheeder said.

Controlling for age, race/ethnicity, education level, reason for not using contraception before conception, future family plans, and postpartum month, the investigators also analyzed the use of ECPs in relation to unprotected intercourse.

During the course of the study, 44% of the young mothers had episodes of unprotected intercourse, said Ms. Sheeder, noting that “of these women, 15% reported one episode of unprotected intercourse, 24% had two to four episodes, and 5% had more than four episodes.”

While more than half (54%) of the women reporting unprotected intercourse used ECPs, only 28% used them appropriately, Ms. Sheeder noted. “They were underutilized by 65% of the women and 7% engaged in augmented use,” she said.

A total of 19 pregnancies occurred during the study period. “Teens who experienced unwanted pregnancies did not engage in more unprotected intercourse or ECP underuse than those who did not,” Ms. Sheeder noted.

Of the 19 pregnancies, 9 were in young women who reported using some contraceptive method during the study period but their contraceptive use was inconsistent or incorrect. The remaining 10 pregnancies were not attributable to unrecognized contraceptive or ECP failure.

The findings suggest a high prevalence of unprotected intercourse during the first 6 postpartum months among teen mothers who say they don't want a rapid repeat pregnancy, said Ms. Sheeder. “Additionally, it appears that the reason ECPs have not significantly decreased the repeat teen pregnancy rate is because most teen mothers underutilize ECPs even when they have them on hand,” she said.

ATLANTA — Advanced provision of emergency contraceptive pills did not significantly decrease the rapid repeat pregnancy rate in a racially and ethnically diverse group of adolescents enrolled in a Colorado study “because many of the young women failed to use them,” Jeanelle Sheeder reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

To better understand why emergency contraceptive pills (ECPs) have not had the anticipated impact on teen pregnancy, Ms. Sheeder and colleagues in the department of pediatrics at the University of Colorado Health Sciences Center in Denver assessed the sexual and contraceptive behavior of 382 predominantly primiparous 14- to 21-year-old women in that institution's adolescent maternity program. At the time of enrollment, all of the young women expressed a desire not to get pregnant again for at least 2 years. Each participant received either a prescription for or a packet of ECPs, with no limit on refills.

At each clinic visit, conducted at 6- to 8-week intervals through the sixth postpartum month, the study participants completed a questionnaire that asked about their interval sexual and contraceptive behavior, Ms. Sheeder said.

Controlling for age, race/ethnicity, education level, reason for not using contraception before conception, future family plans, and postpartum month, the investigators also analyzed the use of ECPs in relation to unprotected intercourse.

During the course of the study, 44% of the young mothers had episodes of unprotected intercourse, said Ms. Sheeder, noting that “of these women, 15% reported one episode of unprotected intercourse, 24% had two to four episodes, and 5% had more than four episodes.”

While more than half (54%) of the women reporting unprotected intercourse used ECPs, only 28% used them appropriately, Ms. Sheeder noted. “They were underutilized by 65% of the women and 7% engaged in augmented use,” she said.

A total of 19 pregnancies occurred during the study period. “Teens who experienced unwanted pregnancies did not engage in more unprotected intercourse or ECP underuse than those who did not,” Ms. Sheeder noted.

Of the 19 pregnancies, 9 were in young women who reported using some contraceptive method during the study period but their contraceptive use was inconsistent or incorrect. The remaining 10 pregnancies were not attributable to unrecognized contraceptive or ECP failure.

The findings suggest a high prevalence of unprotected intercourse during the first 6 postpartum months among teen mothers who say they don't want a rapid repeat pregnancy, said Ms. Sheeder. “Additionally, it appears that the reason ECPs have not significantly decreased the repeat teen pregnancy rate is because most teen mothers underutilize ECPs even when they have them on hand,” she said.

A projected shortage of the quadrivalent measles-mumps-rubella-varicella vaccine means that children who require immunization for these diseases will need to get two shots instead of the single combination vaccine until supplies of the latter are replenished, according to the Centers for Disease Control and Prevention.

The quadrivalent vaccine (ProQuad) shortage is expected to begin in July, although actual timing will depend on market demand, and last at least through the end of 2007 (MMWR 2007 May 11;56:453).

Attributing the shortfall to lower-than-expected amounts of varicella zoster virus (VZV) in its recent batch of bulk vaccine, manufacturer Merck & Co. notified the CDC earlier this year of its intent to use its available supply of VZV in the production of its varicella-only vaccine (Varivax) and its zoster vaccine (Zostavax) and to temporarily halt the production of ProQuad.

In anticipation of the shortage, Merck is requesting that physicians begin transitioning from the quadrivalent vaccine to the measles-mumps-rubella vaccine (MMR-II) and the varicella vaccine. The company expects to have adequate supplies of both of the latter vaccines to fully implement the recommended immunization schedules, according to the notice.

“This will allow for continued use of varicella vaccine for all age groups, including the routine two-dose schedule for children aged 12–15 months and 4–6 years, catch-up vaccination with the second dose for children or adolescents who received only 1 dose, and vaccination with two doses for other children, adolescents, and adults without evidence of immunity,” the notice said. The company expects to have an adequate supply of zoster vaccine for routine vaccination of adults over age 60.

A projected shortage of the quadrivalent measles-mumps-rubella-varicella vaccine means that children who require immunization for these diseases will need to get two shots instead of the single combination vaccine until supplies of the latter are replenished, according to the Centers for Disease Control and Prevention.

The quadrivalent vaccine (ProQuad) shortage is expected to begin in July, although actual timing will depend on market demand, and last at least through the end of 2007 (MMWR 2007 May 11;56:453).

Attributing the shortfall to lower-than-expected amounts of varicella zoster virus (VZV) in its recent batch of bulk vaccine, manufacturer Merck & Co. notified the CDC earlier this year of its intent to use its available supply of VZV in the production of its varicella-only vaccine (Varivax) and its zoster vaccine (Zostavax) and to temporarily halt the production of ProQuad.

In anticipation of the shortage, Merck is requesting that physicians begin transitioning from the quadrivalent vaccine to the measles-mumps-rubella vaccine (MMR-II) and the varicella vaccine. The company expects to have adequate supplies of both of the latter vaccines to fully implement the recommended immunization schedules, according to the notice.

“This will allow for continued use of varicella vaccine for all age groups, including the routine two-dose schedule for children aged 12–15 months and 4–6 years, catch-up vaccination with the second dose for children or adolescents who received only 1 dose, and vaccination with two doses for other children, adolescents, and adults without evidence of immunity,” the notice said. The company expects to have an adequate supply of zoster vaccine for routine vaccination of adults over age 60.

A projected shortage of the quadrivalent measles-mumps-rubella-varicella vaccine means that children who require immunization for these diseases will need to get two shots instead of the single combination vaccine until supplies of the latter are replenished, according to the Centers for Disease Control and Prevention.

The quadrivalent vaccine (ProQuad) shortage is expected to begin in July, although actual timing will depend on market demand, and last at least through the end of 2007 (MMWR 2007 May 11;56:453).

Attributing the shortfall to lower-than-expected amounts of varicella zoster virus (VZV) in its recent batch of bulk vaccine, manufacturer Merck & Co. notified the CDC earlier this year of its intent to use its available supply of VZV in the production of its varicella-only vaccine (Varivax) and its zoster vaccine (Zostavax) and to temporarily halt the production of ProQuad.

In anticipation of the shortage, Merck is requesting that physicians begin transitioning from the quadrivalent vaccine to the measles-mumps-rubella vaccine (MMR-II) and the varicella vaccine. The company expects to have adequate supplies of both of the latter vaccines to fully implement the recommended immunization schedules, according to the notice.

“This will allow for continued use of varicella vaccine for all age groups, including the routine two-dose schedule for children aged 12–15 months and 4–6 years, catch-up vaccination with the second dose for children or adolescents who received only 1 dose, and vaccination with two doses for other children, adolescents, and adults without evidence of immunity,” the notice said. The company expects to have an adequate supply of zoster vaccine for routine vaccination of adults over age 60.