Obstetrics

WASHINGTON – Only 20% of women of childbearing age taking antiepileptic drugs also received a folate prescription, a small study revealed – but a brief intervention helped boost the rate above 60%.

Folic acid supplementation is de rigueur for women of childbearing age – and especially important in very early pregnancy. The need appears even greater in women who take antiepileptic drugs, many of which increase the risk of birth defects.

Despite current recommendations for folic acid supplementation in all women, prescription by neurologists seems low, according to Dr. Brian D. Moseley of the University of Cincinnati.

“We wanted to look at the rates of the prescription of folic acid to women on antiepileptic drugs who were seen in our general neurology clinic,” Dr. Moseley explained.

In an interview at the annual meeting of the American Academy of Neurology, Dr. Moseley discussed the study’s findings, how a brief intervention with the clinic’s physicians increased folic acid prescription rates, and which folic acid dosages may be optimal.

[email protected]

WASHINGTON – Only 20% of women of childbearing age taking antiepileptic drugs also received a folate prescription, a small study revealed – but a brief intervention helped boost the rate above 60%.

Folic acid supplementation is de rigueur for women of childbearing age – and especially important in very early pregnancy. The need appears even greater in women who take antiepileptic drugs, many of which increase the risk of birth defects.

Despite current recommendations for folic acid supplementation in all women, prescription by neurologists seems low, according to Dr. Brian D. Moseley of the University of Cincinnati.

“We wanted to look at the rates of the prescription of folic acid to women on antiepileptic drugs who were seen in our general neurology clinic,” Dr. Moseley explained.

In an interview at the annual meeting of the American Academy of Neurology, Dr. Moseley discussed the study’s findings, how a brief intervention with the clinic’s physicians increased folic acid prescription rates, and which folic acid dosages may be optimal.

[email protected]

WASHINGTON – Only 20% of women of childbearing age taking antiepileptic drugs also received a folate prescription, a small study revealed – but a brief intervention helped boost the rate above 60%.

Folic acid supplementation is de rigueur for women of childbearing age – and especially important in very early pregnancy. The need appears even greater in women who take antiepileptic drugs, many of which increase the risk of birth defects.

Despite current recommendations for folic acid supplementation in all women, prescription by neurologists seems low, according to Dr. Brian D. Moseley of the University of Cincinnati.

“We wanted to look at the rates of the prescription of folic acid to women on antiepileptic drugs who were seen in our general neurology clinic,” Dr. Moseley explained.

In an interview at the annual meeting of the American Academy of Neurology, Dr. Moseley discussed the study’s findings, how a brief intervention with the clinic’s physicians increased folic acid prescription rates, and which folic acid dosages may be optimal.

[email protected]

Hepatitis B vertical infections are rare, but they are more likely if any of several risk factors are present, according to the results of a study led by Dr. Sarah Schillie.

Dr. Schillie of the division of viral hepatitis at the Centers for Disease Control and Prevention, Atlanta, and her associates analyzed prospectively collected data from 2007 to 2013 on 17,951 infant-mother pairs (including 15,938 mothers) in five U.S.-funded Perinatal Hepatitis B Prevention Programs in Florida, Michigan, Minnesota, New York, and most of Texas. The mothers had a median age of 30 years, and all tested positive for hepatitis B surface antigen (HBsAg).

CDC/Dr. Erskine Palmer

Most infants born to mothers with active hepatitis B virus (HBV) received the vaccine plus immune globulin, but 1.1% acquired the infection perinatally (Pediatrics 2014 April 20 [doi:10.1542/peds.2014-3213]).

Newborns were more likely to acquire an infection if their mother was younger, was of Asian or Pacific Islander race, tested positive for hepatitis B antigens, tested negative for antibodies to hepatitis B antigens, or had a viral load of at least 2,000 IU/mL.

Further, 6.7% of infants with fewer than three doses of the vaccine developed an HBV infection, compared with 1.1% of infants who received at least three doses. Developing an infection was not linked to gestational age, birth weight, or timing of the vaccine or immune globulin (within or after 12 hours of birth).

“The identification of women with a higher risk of perinatal hepatitis B transmission in the context of optimal postexposure prophylaxis suggests that interventions such as maternal antiviral therapy might further decrease or eliminate perinatal hepatitis B infections,” Dr. Schillie and her associates reported.

Among 11,479 infants with information on HBV vaccine timing, 96.4% received the vaccine within 12 hours of birth; 95.5% of 11,633 newborns with timing data received hepatitis B immune globulin. Among 11,335 newborns with information available, 94.9% received both. HBsAg results were available for 51.5% of the total group (9,252 infants): 99.5% of these received at least three doses of the vaccine, and 1.1% (100 infants) acquired HBV perinatal infections.

The research was funded by the CDC and the U.S. Department of Energy. The authors reported no disclosures.

Hepatitis B vertical infections are rare, but they are more likely if any of several risk factors are present, according to the results of a study led by Dr. Sarah Schillie.

Dr. Schillie of the division of viral hepatitis at the Centers for Disease Control and Prevention, Atlanta, and her associates analyzed prospectively collected data from 2007 to 2013 on 17,951 infant-mother pairs (including 15,938 mothers) in five U.S.-funded Perinatal Hepatitis B Prevention Programs in Florida, Michigan, Minnesota, New York, and most of Texas. The mothers had a median age of 30 years, and all tested positive for hepatitis B surface antigen (HBsAg).

CDC/Dr. Erskine Palmer

Most infants born to mothers with active hepatitis B virus (HBV) received the vaccine plus immune globulin, but 1.1% acquired the infection perinatally (Pediatrics 2014 April 20 [doi:10.1542/peds.2014-3213]).

Newborns were more likely to acquire an infection if their mother was younger, was of Asian or Pacific Islander race, tested positive for hepatitis B antigens, tested negative for antibodies to hepatitis B antigens, or had a viral load of at least 2,000 IU/mL.

Further, 6.7% of infants with fewer than three doses of the vaccine developed an HBV infection, compared with 1.1% of infants who received at least three doses. Developing an infection was not linked to gestational age, birth weight, or timing of the vaccine or immune globulin (within or after 12 hours of birth).

“The identification of women with a higher risk of perinatal hepatitis B transmission in the context of optimal postexposure prophylaxis suggests that interventions such as maternal antiviral therapy might further decrease or eliminate perinatal hepatitis B infections,” Dr. Schillie and her associates reported.

Among 11,479 infants with information on HBV vaccine timing, 96.4% received the vaccine within 12 hours of birth; 95.5% of 11,633 newborns with timing data received hepatitis B immune globulin. Among 11,335 newborns with information available, 94.9% received both. HBsAg results were available for 51.5% of the total group (9,252 infants): 99.5% of these received at least three doses of the vaccine, and 1.1% (100 infants) acquired HBV perinatal infections.

The research was funded by the CDC and the U.S. Department of Energy. The authors reported no disclosures.

Hepatitis B vertical infections are rare, but they are more likely if any of several risk factors are present, according to the results of a study led by Dr. Sarah Schillie.

Dr. Schillie of the division of viral hepatitis at the Centers for Disease Control and Prevention, Atlanta, and her associates analyzed prospectively collected data from 2007 to 2013 on 17,951 infant-mother pairs (including 15,938 mothers) in five U.S.-funded Perinatal Hepatitis B Prevention Programs in Florida, Michigan, Minnesota, New York, and most of Texas. The mothers had a median age of 30 years, and all tested positive for hepatitis B surface antigen (HBsAg).

CDC/Dr. Erskine Palmer

Most infants born to mothers with active hepatitis B virus (HBV) received the vaccine plus immune globulin, but 1.1% acquired the infection perinatally (Pediatrics 2014 April 20 [doi:10.1542/peds.2014-3213]).

Newborns were more likely to acquire an infection if their mother was younger, was of Asian or Pacific Islander race, tested positive for hepatitis B antigens, tested negative for antibodies to hepatitis B antigens, or had a viral load of at least 2,000 IU/mL.

Further, 6.7% of infants with fewer than three doses of the vaccine developed an HBV infection, compared with 1.1% of infants who received at least three doses. Developing an infection was not linked to gestational age, birth weight, or timing of the vaccine or immune globulin (within or after 12 hours of birth).

“The identification of women with a higher risk of perinatal hepatitis B transmission in the context of optimal postexposure prophylaxis suggests that interventions such as maternal antiviral therapy might further decrease or eliminate perinatal hepatitis B infections,” Dr. Schillie and her associates reported.

Among 11,479 infants with information on HBV vaccine timing, 96.4% received the vaccine within 12 hours of birth; 95.5% of 11,633 newborns with timing data received hepatitis B immune globulin. Among 11,335 newborns with information available, 94.9% received both. HBsAg results were available for 51.5% of the total group (9,252 infants): 99.5% of these received at least three doses of the vaccine, and 1.1% (100 infants) acquired HBV perinatal infections.

The research was funded by the CDC and the U.S. Department of Energy. The authors reported no disclosures.

HOUSTON– New-onset eczema during pregnancy is a common phenomenon with several newly identified risk factors.

This disease entity deserves a proper name: gestational eczema, Dr. Wilfried J.J. Karmaus asserted at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In contrast, the likelihood of new-onset asthma arising during pregnancy isn’t significantly more common than in an affected woman’s male partner during the same time frame.

“There was no large difference in wheezing between the women and men. Therefore, we cannot propose the term ‘gestational asthma,’” said Dr. Karmaus, professor of epidemiology at the University of Memphis. “Investigations into how to prevent eczema and asthma in pregnancy are really important, because eczema and asthma in pregnancy can increase the risk of these diseases in the offspring. This is a totally undeveloped field.”

He presented new findings from the Isle of Wight study, a prospective study in which a cohort of women has been followed from birth through pregnancy across three generations.

Eczema and asthma are common atopic diseases, and they are particularly common during pregnancy. Indeed, eczema is the most common skin disease seen in pregnancy, accounting for 35%-50% of all dermatoses in previous studies by other investigators. In those studies, only 20%-40% of women with eczema during pregnancy had a prepregnancy history of the disease.

In the Isle of Wight cohort, women were evaluated for asthma and eczema symptoms at ages 1, 2, 4, 10, and 18 years and again during pregnancy at gestational weeks 20 and 28. A total of 26 of 116 women developed eczema during pregnancy, with eight of them (31%) experiencing the skin disease for the first time in their lives. In contrast, only six of their male partners had eczema during the pregnancy time frame, and just one of them had new-onset eczema.

A history of maternal eczema in the preceding generation was associated with a 52% increased relative risk of having eczema by age 18 and a 3.1-fold increased likelihood of eczema during pregnancy. Also, methylation of the filaggrin gene at the cytosine-phosphate-guanine site cg13447818 when assessed at age 18 was associated with a significantly increased likelihood of eczema in a subject’s mother as well as increased risk of gestational eczema 1-7 years later, Dr. Karmaus continued.

Eighteen percent of women in the Isle of Wight cohort had asthma during pregnancy, as did a similar proportion of their male partners. Twenty-seven percent of women with asthma during pregnancy had no previous history of the respiratory disease, a rate which was again comparable in their male partners with asthma.

DNA methylation of the IL1RL1 gene at cg17738684 was significantly associated with asthma heritability across three generations in the Isle of Wight study. The IL1RL1 gene at cg17738684 is a candidate gene for asthma that encodes for interleukin-33. This finding raises the possibility that addressing this DNA methylation could prove fruitful as a transgenerational asthma prevention strategy.

The Isle of Wight birth cohort study is funded by the National Institutes of Health, Asthma UK, and the Isle of Wight Trust. Dr. Karmaus reported having no financial conflicts of interest.

[email protected]

HOUSTON– New-onset eczema during pregnancy is a common phenomenon with several newly identified risk factors.

This disease entity deserves a proper name: gestational eczema, Dr. Wilfried J.J. Karmaus asserted at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In contrast, the likelihood of new-onset asthma arising during pregnancy isn’t significantly more common than in an affected woman’s male partner during the same time frame.

“There was no large difference in wheezing between the women and men. Therefore, we cannot propose the term ‘gestational asthma,’” said Dr. Karmaus, professor of epidemiology at the University of Memphis. “Investigations into how to prevent eczema and asthma in pregnancy are really important, because eczema and asthma in pregnancy can increase the risk of these diseases in the offspring. This is a totally undeveloped field.”

He presented new findings from the Isle of Wight study, a prospective study in which a cohort of women has been followed from birth through pregnancy across three generations.

Eczema and asthma are common atopic diseases, and they are particularly common during pregnancy. Indeed, eczema is the most common skin disease seen in pregnancy, accounting for 35%-50% of all dermatoses in previous studies by other investigators. In those studies, only 20%-40% of women with eczema during pregnancy had a prepregnancy history of the disease.

In the Isle of Wight cohort, women were evaluated for asthma and eczema symptoms at ages 1, 2, 4, 10, and 18 years and again during pregnancy at gestational weeks 20 and 28. A total of 26 of 116 women developed eczema during pregnancy, with eight of them (31%) experiencing the skin disease for the first time in their lives. In contrast, only six of their male partners had eczema during the pregnancy time frame, and just one of them had new-onset eczema.

A history of maternal eczema in the preceding generation was associated with a 52% increased relative risk of having eczema by age 18 and a 3.1-fold increased likelihood of eczema during pregnancy. Also, methylation of the filaggrin gene at the cytosine-phosphate-guanine site cg13447818 when assessed at age 18 was associated with a significantly increased likelihood of eczema in a subject’s mother as well as increased risk of gestational eczema 1-7 years later, Dr. Karmaus continued.

Eighteen percent of women in the Isle of Wight cohort had asthma during pregnancy, as did a similar proportion of their male partners. Twenty-seven percent of women with asthma during pregnancy had no previous history of the respiratory disease, a rate which was again comparable in their male partners with asthma.

DNA methylation of the IL1RL1 gene at cg17738684 was significantly associated with asthma heritability across three generations in the Isle of Wight study. The IL1RL1 gene at cg17738684 is a candidate gene for asthma that encodes for interleukin-33. This finding raises the possibility that addressing this DNA methylation could prove fruitful as a transgenerational asthma prevention strategy.

The Isle of Wight birth cohort study is funded by the National Institutes of Health, Asthma UK, and the Isle of Wight Trust. Dr. Karmaus reported having no financial conflicts of interest.

[email protected]

HOUSTON– New-onset eczema during pregnancy is a common phenomenon with several newly identified risk factors.

This disease entity deserves a proper name: gestational eczema, Dr. Wilfried J.J. Karmaus asserted at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In contrast, the likelihood of new-onset asthma arising during pregnancy isn’t significantly more common than in an affected woman’s male partner during the same time frame.

“There was no large difference in wheezing between the women and men. Therefore, we cannot propose the term ‘gestational asthma,’” said Dr. Karmaus, professor of epidemiology at the University of Memphis. “Investigations into how to prevent eczema and asthma in pregnancy are really important, because eczema and asthma in pregnancy can increase the risk of these diseases in the offspring. This is a totally undeveloped field.”

He presented new findings from the Isle of Wight study, a prospective study in which a cohort of women has been followed from birth through pregnancy across three generations.

Eczema and asthma are common atopic diseases, and they are particularly common during pregnancy. Indeed, eczema is the most common skin disease seen in pregnancy, accounting for 35%-50% of all dermatoses in previous studies by other investigators. In those studies, only 20%-40% of women with eczema during pregnancy had a prepregnancy history of the disease.

In the Isle of Wight cohort, women were evaluated for asthma and eczema symptoms at ages 1, 2, 4, 10, and 18 years and again during pregnancy at gestational weeks 20 and 28. A total of 26 of 116 women developed eczema during pregnancy, with eight of them (31%) experiencing the skin disease for the first time in their lives. In contrast, only six of their male partners had eczema during the pregnancy time frame, and just one of them had new-onset eczema.

A history of maternal eczema in the preceding generation was associated with a 52% increased relative risk of having eczema by age 18 and a 3.1-fold increased likelihood of eczema during pregnancy. Also, methylation of the filaggrin gene at the cytosine-phosphate-guanine site cg13447818 when assessed at age 18 was associated with a significantly increased likelihood of eczema in a subject’s mother as well as increased risk of gestational eczema 1-7 years later, Dr. Karmaus continued.

Eighteen percent of women in the Isle of Wight cohort had asthma during pregnancy, as did a similar proportion of their male partners. Twenty-seven percent of women with asthma during pregnancy had no previous history of the respiratory disease, a rate which was again comparable in their male partners with asthma.

DNA methylation of the IL1RL1 gene at cg17738684 was significantly associated with asthma heritability across three generations in the Isle of Wight study. The IL1RL1 gene at cg17738684 is a candidate gene for asthma that encodes for interleukin-33. This finding raises the possibility that addressing this DNA methylation could prove fruitful as a transgenerational asthma prevention strategy.

The Isle of Wight birth cohort study is funded by the National Institutes of Health, Asthma UK, and the Isle of Wight Trust. Dr. Karmaus reported having no financial conflicts of interest.

[email protected]

In 2011, nearly 30% of women who gave birth to single infants had an interval of less than 18 months between the conception of their most recent pregnancy and the birth of their previous child, potentially putting them at risk for pregnancy complications.

The findings, released April 16, come from a new report from researchers at the Centers for Disease Control and Prevention, who analyzed birth certificate data covering 1,723,084 women who had singleton births in 2011. In addition to women with short birth intervals, the report found that nearly 21% of women had birth intervals of 60 months or longer, which is also associated with a higher risk for adverse health outcomes, the researchers wrote (National Vital Statistics Report 2015;64:1-10).

About half of women had an interval of 18-59 months between the birth of one child and the conception of the next child, the researchers found.

Age and race had an impact on the birth interval, according to the birth certificate data. The median interpregnancy interval increased along with the age of the mother. For instance, the median interpregnancy interval was 11-14 months for women under age 20 years, but it was 39-76 months for women aged 40 years and older. Non-Hispanic white women had the shortest median interpregnancy interval at 26 months. This is compared with 30 months for non-Hispanic black women and 34 months for Hispanic women.

The birth certificate data used in the study, from 36 states and the District of Columbia, is not nationally representative and may not be generalizable across the United States, but the researchers pointed out that the percentages of women with short and long pregnancy intervals were similar to pregnancy data from the 2006-2010 National Survey on Family Growth.

The researchers called for further studies to assess whether pregnancy intervals are “independently associated with adverse maternal and infant health outcomes or whether these relationships are due to other confounding factors” such as maternal age, socioeconomic status, and pregnancy health behaviors.

Find the full study here.

In 2011, nearly 30% of women who gave birth to single infants had an interval of less than 18 months between the conception of their most recent pregnancy and the birth of their previous child, potentially putting them at risk for pregnancy complications.

The findings, released April 16, come from a new report from researchers at the Centers for Disease Control and Prevention, who analyzed birth certificate data covering 1,723,084 women who had singleton births in 2011. In addition to women with short birth intervals, the report found that nearly 21% of women had birth intervals of 60 months or longer, which is also associated with a higher risk for adverse health outcomes, the researchers wrote (National Vital Statistics Report 2015;64:1-10).

About half of women had an interval of 18-59 months between the birth of one child and the conception of the next child, the researchers found.

Age and race had an impact on the birth interval, according to the birth certificate data. The median interpregnancy interval increased along with the age of the mother. For instance, the median interpregnancy interval was 11-14 months for women under age 20 years, but it was 39-76 months for women aged 40 years and older. Non-Hispanic white women had the shortest median interpregnancy interval at 26 months. This is compared with 30 months for non-Hispanic black women and 34 months for Hispanic women.

The birth certificate data used in the study, from 36 states and the District of Columbia, is not nationally representative and may not be generalizable across the United States, but the researchers pointed out that the percentages of women with short and long pregnancy intervals were similar to pregnancy data from the 2006-2010 National Survey on Family Growth.

The researchers called for further studies to assess whether pregnancy intervals are “independently associated with adverse maternal and infant health outcomes or whether these relationships are due to other confounding factors” such as maternal age, socioeconomic status, and pregnancy health behaviors.

Find the full study here.

In 2011, nearly 30% of women who gave birth to single infants had an interval of less than 18 months between the conception of their most recent pregnancy and the birth of their previous child, potentially putting them at risk for pregnancy complications.

The findings, released April 16, come from a new report from researchers at the Centers for Disease Control and Prevention, who analyzed birth certificate data covering 1,723,084 women who had singleton births in 2011. In addition to women with short birth intervals, the report found that nearly 21% of women had birth intervals of 60 months or longer, which is also associated with a higher risk for adverse health outcomes, the researchers wrote (National Vital Statistics Report 2015;64:1-10).

About half of women had an interval of 18-59 months between the birth of one child and the conception of the next child, the researchers found.

Age and race had an impact on the birth interval, according to the birth certificate data. The median interpregnancy interval increased along with the age of the mother. For instance, the median interpregnancy interval was 11-14 months for women under age 20 years, but it was 39-76 months for women aged 40 years and older. Non-Hispanic white women had the shortest median interpregnancy interval at 26 months. This is compared with 30 months for non-Hispanic black women and 34 months for Hispanic women.

The birth certificate data used in the study, from 36 states and the District of Columbia, is not nationally representative and may not be generalizable across the United States, but the researchers pointed out that the percentages of women with short and long pregnancy intervals were similar to pregnancy data from the 2006-2010 National Survey on Family Growth.

The researchers called for further studies to assess whether pregnancy intervals are “independently associated with adverse maternal and infant health outcomes or whether these relationships are due to other confounding factors” such as maternal age, socioeconomic status, and pregnancy health behaviors.

Find the full study here.

Metformin and glyburide are both as effective as insulin in the management of gestational diabetes, a meta-analysis of randomized clinical trials has found, though their risk profiles differ.

The investigators looked at 18 trials comparing the two oral agents with insulin, and in some cases with each other, in about 2,800 women with gestational diabetes.

The study showed significant differences among the oral drugs and insulin in maternal fasting blood glucose or glycosylated hemoglobin levels, suggesting that all are effective in controlling GDM, according to Dr. Yun-fa Jiang of Hebei Medical University in Shijiazhuang, China, and associates (J. Clin. Endocrinol. Metab. [doi:10.1210/jc.2014-4403]).

However, compared with insulin, metformin was associated with lower maternal weight gain (weighted mean difference: –1.49 kg; 95% confidence interval, –2.26 to 0.31), and shorter gestational age (WMD, –0.16 kg/week; 95% CI, –0.30 to –0.03). Glyburide was associated with higher neonatal birth weight (130.68 g; 95% CI, 55.98 to 205.38), neonatal hypoglycemia (odds ratio, 2.64; 95% CI, 1.59 to 4.38), and increased incidence of macrosomia (OR, 3.09; 95% CI, 1.59 to 6.04) compared with insulin. In a network meta-analysis, metformin was seen associated with significantly less maternal weight gain, compared with glyburide (WMD, –1.34; 95% CI, –3.05 to 0.38; P = .009).

The differences might be attributable to different mechanisms of action in the two oral drugs, according to the investigators, who noted that this was the first network meta-analysis comparing efficacy and safety of oral antidiabetics in management of gestational diabetes. “There exists some apprehension regarding the use of oral antidiabetic drugs during pregnancy,” they wrote. “While no long-term harms to the exposed offspring from either of these drugs have been demonstrated, no long-term studies have been performed with appropriate controls, either in humans or animal models.”

Dr. Jiang and colleagues noted among the weaknesses of their study the relatively few trials included, and that blinding was not possible in trials that compared oral agents with insulin therapy.

The study was funded by China’s National Science Foundation and none of its authors declared conflicts of interest.

Metformin and glyburide are both as effective as insulin in the management of gestational diabetes, a meta-analysis of randomized clinical trials has found, though their risk profiles differ.

The investigators looked at 18 trials comparing the two oral agents with insulin, and in some cases with each other, in about 2,800 women with gestational diabetes.

The study showed significant differences among the oral drugs and insulin in maternal fasting blood glucose or glycosylated hemoglobin levels, suggesting that all are effective in controlling GDM, according to Dr. Yun-fa Jiang of Hebei Medical University in Shijiazhuang, China, and associates (J. Clin. Endocrinol. Metab. [doi:10.1210/jc.2014-4403]).

However, compared with insulin, metformin was associated with lower maternal weight gain (weighted mean difference: –1.49 kg; 95% confidence interval, –2.26 to 0.31), and shorter gestational age (WMD, –0.16 kg/week; 95% CI, –0.30 to –0.03). Glyburide was associated with higher neonatal birth weight (130.68 g; 95% CI, 55.98 to 205.38), neonatal hypoglycemia (odds ratio, 2.64; 95% CI, 1.59 to 4.38), and increased incidence of macrosomia (OR, 3.09; 95% CI, 1.59 to 6.04) compared with insulin. In a network meta-analysis, metformin was seen associated with significantly less maternal weight gain, compared with glyburide (WMD, –1.34; 95% CI, –3.05 to 0.38; P = .009).

The differences might be attributable to different mechanisms of action in the two oral drugs, according to the investigators, who noted that this was the first network meta-analysis comparing efficacy and safety of oral antidiabetics in management of gestational diabetes. “There exists some apprehension regarding the use of oral antidiabetic drugs during pregnancy,” they wrote. “While no long-term harms to the exposed offspring from either of these drugs have been demonstrated, no long-term studies have been performed with appropriate controls, either in humans or animal models.”

Dr. Jiang and colleagues noted among the weaknesses of their study the relatively few trials included, and that blinding was not possible in trials that compared oral agents with insulin therapy.

The study was funded by China’s National Science Foundation and none of its authors declared conflicts of interest.

Metformin and glyburide are both as effective as insulin in the management of gestational diabetes, a meta-analysis of randomized clinical trials has found, though their risk profiles differ.

The investigators looked at 18 trials comparing the two oral agents with insulin, and in some cases with each other, in about 2,800 women with gestational diabetes.

The study showed significant differences among the oral drugs and insulin in maternal fasting blood glucose or glycosylated hemoglobin levels, suggesting that all are effective in controlling GDM, according to Dr. Yun-fa Jiang of Hebei Medical University in Shijiazhuang, China, and associates (J. Clin. Endocrinol. Metab. [doi:10.1210/jc.2014-4403]).

However, compared with insulin, metformin was associated with lower maternal weight gain (weighted mean difference: –1.49 kg; 95% confidence interval, –2.26 to 0.31), and shorter gestational age (WMD, –0.16 kg/week; 95% CI, –0.30 to –0.03). Glyburide was associated with higher neonatal birth weight (130.68 g; 95% CI, 55.98 to 205.38), neonatal hypoglycemia (odds ratio, 2.64; 95% CI, 1.59 to 4.38), and increased incidence of macrosomia (OR, 3.09; 95% CI, 1.59 to 6.04) compared with insulin. In a network meta-analysis, metformin was seen associated with significantly less maternal weight gain, compared with glyburide (WMD, –1.34; 95% CI, –3.05 to 0.38; P = .009).

The differences might be attributable to different mechanisms of action in the two oral drugs, according to the investigators, who noted that this was the first network meta-analysis comparing efficacy and safety of oral antidiabetics in management of gestational diabetes. “There exists some apprehension regarding the use of oral antidiabetic drugs during pregnancy,” they wrote. “While no long-term harms to the exposed offspring from either of these drugs have been demonstrated, no long-term studies have been performed with appropriate controls, either in humans or animal models.”

Dr. Jiang and colleagues noted among the weaknesses of their study the relatively few trials included, and that blinding was not possible in trials that compared oral agents with insulin therapy.

The study was funded by China’s National Science Foundation and none of its authors declared conflicts of interest.

The number of neonatal and maternal hospitalizations in children less than 18 years old fell from 2000 to 2012, with maternal hospital stays in teenagers dropping significantly, according to a report from the Agency for Healthcare Research and Quality.

From 2000 to 2006, the number of neonatal hospitalizations increased by about 250,000, rising from slightly more than 4 million to just under 4.3 million. From 2006 to 2012, the number dropped significantly, dipping below the 2000 level to about 3.9 million. Overall, neonatal hospitalizations fell by about 140,000 from 2000 to 2012, or 3.3%, the AHRQ reported.

Maternal hospital stays for teenage girls dropped significantly from 2000 to 2012, despite a small rise from 2003 to 2006. There were just over 196,000 maternal hospitalizations in 2000, but by 2012, the number fell to less than 105,000, a decrease of about 47%. More than half of the decrease occurred in the last 3 years measured, with maternal hospitalizations falling by 50,000 from 2009 to 2012.

There were 5.85 million total hospitalizations in 2012 of children under 18 years. Of these, about two-thirds were neonatal related, while maternal hospitalizations accounted for less than 2% of the total, according to the AHRQ.

The AHRQ report used data collected by the Healthcare Cost and Utilization Project Kids’ Inpatient Database.

[email protected]

The number of neonatal and maternal hospitalizations in children less than 18 years old fell from 2000 to 2012, with maternal hospital stays in teenagers dropping significantly, according to a report from the Agency for Healthcare Research and Quality.

From 2000 to 2006, the number of neonatal hospitalizations increased by about 250,000, rising from slightly more than 4 million to just under 4.3 million. From 2006 to 2012, the number dropped significantly, dipping below the 2000 level to about 3.9 million. Overall, neonatal hospitalizations fell by about 140,000 from 2000 to 2012, or 3.3%, the AHRQ reported.

Maternal hospital stays for teenage girls dropped significantly from 2000 to 2012, despite a small rise from 2003 to 2006. There were just over 196,000 maternal hospitalizations in 2000, but by 2012, the number fell to less than 105,000, a decrease of about 47%. More than half of the decrease occurred in the last 3 years measured, with maternal hospitalizations falling by 50,000 from 2009 to 2012.

There were 5.85 million total hospitalizations in 2012 of children under 18 years. Of these, about two-thirds were neonatal related, while maternal hospitalizations accounted for less than 2% of the total, according to the AHRQ.

The AHRQ report used data collected by the Healthcare Cost and Utilization Project Kids’ Inpatient Database.

[email protected]

The number of neonatal and maternal hospitalizations in children less than 18 years old fell from 2000 to 2012, with maternal hospital stays in teenagers dropping significantly, according to a report from the Agency for Healthcare Research and Quality.

From 2000 to 2006, the number of neonatal hospitalizations increased by about 250,000, rising from slightly more than 4 million to just under 4.3 million. From 2006 to 2012, the number dropped significantly, dipping below the 2000 level to about 3.9 million. Overall, neonatal hospitalizations fell by about 140,000 from 2000 to 2012, or 3.3%, the AHRQ reported.

Maternal hospital stays for teenage girls dropped significantly from 2000 to 2012, despite a small rise from 2003 to 2006. There were just over 196,000 maternal hospitalizations in 2000, but by 2012, the number fell to less than 105,000, a decrease of about 47%. More than half of the decrease occurred in the last 3 years measured, with maternal hospitalizations falling by 50,000 from 2009 to 2012.

There were 5.85 million total hospitalizations in 2012 of children under 18 years. Of these, about two-thirds were neonatal related, while maternal hospitalizations accounted for less than 2% of the total, according to the AHRQ.

The AHRQ report used data collected by the Healthcare Cost and Utilization Project Kids’ Inpatient Database.

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Infants born to women taking prescription opioids were more likely to have neonatal abstinence syndrome (NAS) if their mothers smoked tobacco or took selective serotonin reuptake inhibitors (SSRIs), according to a recent study. Cumulative opioid exposure and opioid type (maintenance and long-acting) also increased the risk of NAS.

“The American Academy of Pediatrics recommends that all opioid-exposed infants be observed in the hospital for 4 to 7 days after birth. However, our data suggest there was a wide variability in an infant’s risk of drug withdrawal based on opioid type, dose, SSRI use, and number of cigarettes smoked per day by the mother,” reported Dr. Stephen W. Patrick of Vanderbilt University, Nashville, Tenn. “Future studies should evaluate new care models for opioid-exposed infants at different risk levels of developing NAS,” wrote Dr. Patrick and his associates [Pediatrics 2015 April 13 [doi: 10.1542/peds.2014-3299]).

Dr. Patrick’s team analyzed prescription data and vital statistics of 112,029 pregnant women and their newborns who were enrolled in the Tennessee Medicaid program between 2009 and 2011. Of these, 28% of the women filled at least one prescription for opioids; these included 96.2% taking short-acting medications, 2.7% receiving maintenance treatment for substance use disorders and 0.6% taking long-acting medications.

Among women taking prescription opioids, 5.3% had depression, 4.3% had an anxiety disorder, 41.8% smoked, 4.3% had been prescribed SSRIs within 30 days before birth, 8.3% had headache or migraine, and 23.7% had musculoskeletal disease, compared to 2.7%, 1.6% and 25.8%, 1.9%, 2.0% and 5.8%, respectively, for mothers not taking opioids.

Nearly a third of women on maintenance therapy (29.3%) had infants with NAS while 14.7% of mothers taking long-acting opioids and 1.4% of women taking short-acting preparations had newborns with NAS. Newborns were twice as likely to develop NAS if their mothers took SSRIs (odds ratio, 2.08), and their risk of NAS increased in a dose-response fashion with the number of daily cigarettes their mothers smoked.

NAS rates nearly doubled during the course of the study, landing at 10.7 per 1,000 births in the final year. Among the 1,086 newborns diagnosed with NAS, 21.2% had low birth weight, 16.7% were preterm, 28.7% had respiratory diagnoses, 13.1% had feeding difficulties, 7.2% had sepsis, and 3.7% had seizures. Among those exposed to opioids who did not develop NAS, 11.8% had low birth weight, 11.6% were preterm, 10.1% had respiratory diagnoses, 2.6% had feeding difficulties, 2.3% had sepsis and 0.4% had seizures. Among unexposed newborns, 9.9% had low birth weight, 11% were preterm, 8.8% had respiratory diagnoses, 2.3% had feeding difficulties, 1.9% had sepsis, and 0.3% had seizures.

“Public health efforts should focus on limiting inappropriate [opioid pain relievers] and tobacco use in pregnancy,” the authors wrote. “Prescribing opioids in pregnancy should be done with caution because it can lead to significant complications for the neonate.”

The research was funded by the Tennessee Department of Health and the National Institutes of Health. The authors reported no disclosures.

Infants born to women taking prescription opioids were more likely to have neonatal abstinence syndrome (NAS) if their mothers smoked tobacco or took selective serotonin reuptake inhibitors (SSRIs), according to a recent study. Cumulative opioid exposure and opioid type (maintenance and long-acting) also increased the risk of NAS.

“The American Academy of Pediatrics recommends that all opioid-exposed infants be observed in the hospital for 4 to 7 days after birth. However, our data suggest there was a wide variability in an infant’s risk of drug withdrawal based on opioid type, dose, SSRI use, and number of cigarettes smoked per day by the mother,” reported Dr. Stephen W. Patrick of Vanderbilt University, Nashville, Tenn. “Future studies should evaluate new care models for opioid-exposed infants at different risk levels of developing NAS,” wrote Dr. Patrick and his associates [Pediatrics 2015 April 13 [doi: 10.1542/peds.2014-3299]).

Dr. Patrick’s team analyzed prescription data and vital statistics of 112,029 pregnant women and their newborns who were enrolled in the Tennessee Medicaid program between 2009 and 2011. Of these, 28% of the women filled at least one prescription for opioids; these included 96.2% taking short-acting medications, 2.7% receiving maintenance treatment for substance use disorders and 0.6% taking long-acting medications.

Among women taking prescription opioids, 5.3% had depression, 4.3% had an anxiety disorder, 41.8% smoked, 4.3% had been prescribed SSRIs within 30 days before birth, 8.3% had headache or migraine, and 23.7% had musculoskeletal disease, compared to 2.7%, 1.6% and 25.8%, 1.9%, 2.0% and 5.8%, respectively, for mothers not taking opioids.

Nearly a third of women on maintenance therapy (29.3%) had infants with NAS while 14.7% of mothers taking long-acting opioids and 1.4% of women taking short-acting preparations had newborns with NAS. Newborns were twice as likely to develop NAS if their mothers took SSRIs (odds ratio, 2.08), and their risk of NAS increased in a dose-response fashion with the number of daily cigarettes their mothers smoked.

NAS rates nearly doubled during the course of the study, landing at 10.7 per 1,000 births in the final year. Among the 1,086 newborns diagnosed with NAS, 21.2% had low birth weight, 16.7% were preterm, 28.7% had respiratory diagnoses, 13.1% had feeding difficulties, 7.2% had sepsis, and 3.7% had seizures. Among those exposed to opioids who did not develop NAS, 11.8% had low birth weight, 11.6% were preterm, 10.1% had respiratory diagnoses, 2.6% had feeding difficulties, 2.3% had sepsis and 0.4% had seizures. Among unexposed newborns, 9.9% had low birth weight, 11% were preterm, 8.8% had respiratory diagnoses, 2.3% had feeding difficulties, 1.9% had sepsis, and 0.3% had seizures.

“Public health efforts should focus on limiting inappropriate [opioid pain relievers] and tobacco use in pregnancy,” the authors wrote. “Prescribing opioids in pregnancy should be done with caution because it can lead to significant complications for the neonate.”

The research was funded by the Tennessee Department of Health and the National Institutes of Health. The authors reported no disclosures.

Infants born to women taking prescription opioids were more likely to have neonatal abstinence syndrome (NAS) if their mothers smoked tobacco or took selective serotonin reuptake inhibitors (SSRIs), according to a recent study. Cumulative opioid exposure and opioid type (maintenance and long-acting) also increased the risk of NAS.

“The American Academy of Pediatrics recommends that all opioid-exposed infants be observed in the hospital for 4 to 7 days after birth. However, our data suggest there was a wide variability in an infant’s risk of drug withdrawal based on opioid type, dose, SSRI use, and number of cigarettes smoked per day by the mother,” reported Dr. Stephen W. Patrick of Vanderbilt University, Nashville, Tenn. “Future studies should evaluate new care models for opioid-exposed infants at different risk levels of developing NAS,” wrote Dr. Patrick and his associates [Pediatrics 2015 April 13 [doi: 10.1542/peds.2014-3299]).

Dr. Patrick’s team analyzed prescription data and vital statistics of 112,029 pregnant women and their newborns who were enrolled in the Tennessee Medicaid program between 2009 and 2011. Of these, 28% of the women filled at least one prescription for opioids; these included 96.2% taking short-acting medications, 2.7% receiving maintenance treatment for substance use disorders and 0.6% taking long-acting medications.

Among women taking prescription opioids, 5.3% had depression, 4.3% had an anxiety disorder, 41.8% smoked, 4.3% had been prescribed SSRIs within 30 days before birth, 8.3% had headache or migraine, and 23.7% had musculoskeletal disease, compared to 2.7%, 1.6% and 25.8%, 1.9%, 2.0% and 5.8%, respectively, for mothers not taking opioids.

Nearly a third of women on maintenance therapy (29.3%) had infants with NAS while 14.7% of mothers taking long-acting opioids and 1.4% of women taking short-acting preparations had newborns with NAS. Newborns were twice as likely to develop NAS if their mothers took SSRIs (odds ratio, 2.08), and their risk of NAS increased in a dose-response fashion with the number of daily cigarettes their mothers smoked.

NAS rates nearly doubled during the course of the study, landing at 10.7 per 1,000 births in the final year. Among the 1,086 newborns diagnosed with NAS, 21.2% had low birth weight, 16.7% were preterm, 28.7% had respiratory diagnoses, 13.1% had feeding difficulties, 7.2% had sepsis, and 3.7% had seizures. Among those exposed to opioids who did not develop NAS, 11.8% had low birth weight, 11.6% were preterm, 10.1% had respiratory diagnoses, 2.6% had feeding difficulties, 2.3% had sepsis and 0.4% had seizures. Among unexposed newborns, 9.9% had low birth weight, 11% were preterm, 8.8% had respiratory diagnoses, 2.3% had feeding difficulties, 1.9% had sepsis, and 0.3% had seizures.

“Public health efforts should focus on limiting inappropriate [opioid pain relievers] and tobacco use in pregnancy,” the authors wrote. “Prescribing opioids in pregnancy should be done with caution because it can lead to significant complications for the neonate.”

The research was funded by the Tennessee Department of Health and the National Institutes of Health. The authors reported no disclosures.

Infants exposed to drugs prenatally had alterations in their brains’ functional organization, a new study shows.

A total of 88 such infants were born to mothers who had used either cocaine or other drugs, such as nicotine, alcohol, marijuana, and antidepressants, during pregnancy. Resting-state functional magnetic resonance imaging (rsfMRI) brain scans found that all 88 infants had connectivity disruptions within the amygdala-frontal, insula-frontal, and insula-sensorimotor circuits, reported investigators at the University of North Carolina at Chapel Hill and the University of Utah, Salt Lake City.

In the infants with prenatal cocaine exposure, an additional alteration was found but within the amygdala-prefrontal network. Disruption of this circuit might explain why arousal dysregulation is seen in infants with prenatal exposure to cocaine, the investigators said in a statement from UNC Health Care.

“Overall, this study revealed that rsfMRI in infants may play a pivotal role in the search for objective biomarkers for the identification of risks and guidance of early intervention to improve later behavioral outcomes,” said the statement.

Find the full study in the Journal of Neuroscience (doi:10.1523/JNEUROSCI.4333-14.2015).

Infants exposed to drugs prenatally had alterations in their brains’ functional organization, a new study shows.

A total of 88 such infants were born to mothers who had used either cocaine or other drugs, such as nicotine, alcohol, marijuana, and antidepressants, during pregnancy. Resting-state functional magnetic resonance imaging (rsfMRI) brain scans found that all 88 infants had connectivity disruptions within the amygdala-frontal, insula-frontal, and insula-sensorimotor circuits, reported investigators at the University of North Carolina at Chapel Hill and the University of Utah, Salt Lake City.

In the infants with prenatal cocaine exposure, an additional alteration was found but within the amygdala-prefrontal network. Disruption of this circuit might explain why arousal dysregulation is seen in infants with prenatal exposure to cocaine, the investigators said in a statement from UNC Health Care.

“Overall, this study revealed that rsfMRI in infants may play a pivotal role in the search for objective biomarkers for the identification of risks and guidance of early intervention to improve later behavioral outcomes,” said the statement.

Find the full study in the Journal of Neuroscience (doi:10.1523/JNEUROSCI.4333-14.2015).

Infants exposed to drugs prenatally had alterations in their brains’ functional organization, a new study shows.

A total of 88 such infants were born to mothers who had used either cocaine or other drugs, such as nicotine, alcohol, marijuana, and antidepressants, during pregnancy. Resting-state functional magnetic resonance imaging (rsfMRI) brain scans found that all 88 infants had connectivity disruptions within the amygdala-frontal, insula-frontal, and insula-sensorimotor circuits, reported investigators at the University of North Carolina at Chapel Hill and the University of Utah, Salt Lake City.

In the infants with prenatal cocaine exposure, an additional alteration was found but within the amygdala-prefrontal network. Disruption of this circuit might explain why arousal dysregulation is seen in infants with prenatal exposure to cocaine, the investigators said in a statement from UNC Health Care.

“Overall, this study revealed that rsfMRI in infants may play a pivotal role in the search for objective biomarkers for the identification of risks and guidance of early intervention to improve later behavioral outcomes,” said the statement.

Find the full study in the Journal of Neuroscience (doi:10.1523/JNEUROSCI.4333-14.2015).