Journal of the American Medical Association

Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. .

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Valproate is used for the treatment of epilepsy and other neuropsychological disorders and may be the only treatment option for women of childbearing potential. However, prenatal exposure to valproate may increase the risk of autism.

OBJECTIVE: To determine whether prenatal exposure to valproate is associated with an increased risk of autism in offspring.
DESIGN, SETTING AND
PARTICIPANTS: Population-based study of all children born alive in Denmark from 1996 to 2006. National registers were used to identify children exposed to valproate during pregnancy and diagnosed with autism spectrum disorders (childhood autism [autistic disorder], Asperger syndrome, atypical autism, and other or unspecified pervasive developmental disorders). We analyzed the risks associated with all autism spectrum disorders as well as childhood autism. Data were analyzed by Cox regression adjusting for potential confounders (maternal age at conception, paternal age at conception, parental psychiatric history, gestational age, birth weight, sex, congenital malformations, and parity). Children were followed up from birth until the day of autism spectrum disorder diagnosis, death, emigration, or December 31, 2010, whichever came first. MAIN OUTCOMES AND MEASURES: Absolute risk (cumulative incidence) and the hazard ratio (HR) of autism spectrum disorder and childhood autism in children after exposure to valproate in pregnancy.
RESULTS: Of 655,615 children born from 1996 through 2006, 5437 were identified with autism spectrum disorder, including 2067 with childhood autism. The mean age of the children at end of follow-up was 8.84 years (range, 4-14; median, 8.85). The estimated absolute risk after 14 years of follow-up was 1.53% (95% CI, 1.47%-1.58%) for autism spectrum disorder and 0.48% (95% CI, 0.46%-0.51%) for childhood autism. Overall, the 508 children exposed to valproate had an absolute risk of 4.42% (95% CI, 2.59%-7.46%) for autism spectrum disorder (adjusted HR, 2.9 [95% CI, 1.7-4.9]) and an absolute risk of 2.50% (95% CI, 1.30%-4.81%) for childhood autism (adjusted HR, 5.2 [95% CI, 2.7-10.0]). When restricting the cohort to the 6584 children born to women with epilepsy, the absolute risk of autism spectrum disorder among 432 children exposed to valproate was 4.15% (95% CI, 2.20%-7.81%) (adjusted HR, 1.7 [95% CI, 0.9-3.2]), and the absolute risk of childhood autism was 2.95% (95% CI, 1.42%-6.11%) (adjusted HR, 2.9 [95% CI, 1.4-6.0]) vs 2.44% (95% CI, 1.88%-3.16%) for autism spectrum disorder and 1.02% (95% CI, 0.70%-1.49%) for childhood autism among 6152 children not exposed to valproate. CONCLUSIONS AND RELEVANCE: Maternal use of valproate during pregnancy was associated with a significantly increased risk of autism spectrum disorder and childhood autism in the offspring, even after adjusting for maternal epilepsy. For women of childbearing potential who use antiepileptic medications, these findings must be balanced against the treatment benefits for women who require valproate for epilepsy control.

Source: JAMA

 

 



 

Source: Nature

 

Quitting smoking ‘cuts heart risk despite weight gain’.

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Stopping smoking cuts the risk of heart disease even if it leads to significant weight gain, a US study says.

Researchers writing in the Journal of the American Medical Association say the prospect of weight gain makes some smokers reluctant to stop.

But they say quitting has a “positive effect on cardiovascular risk“.

The health gains from giving up were most marked in people who did not have diabetes, but people with the condition were still said to have benefited.

 “Start Quote

If you’re keen to quit smoking but worried about putting on weight, using smoking cessation aids such as inhalators, gum, or lozenges may help you resist the temptation to reach for comfort food in the place of a cigarette”

Doireann Maddock of the British Heart Association

Obesity is a risk factor in heart disease, leading past research to examine whether weight gain might cancel out some of the benefits of quitting smoking.

Studies suggest people who stop smoking gain on average 6-13lb (2.7-5.9kg) over the first six months.

The JAMA research looked at the smoking habits and heart health of more than 3,000 people between 1981 and 2011.

Former smokers who had stayed away from tobacco for more than four years had a 54% lower risk of heart and artery disease than smokers.

Recent quitters who had stopped smoking for up to four years experienced almost the same benefit with a 53% lower relative risk.

This was despite recent quitters typically gaining 5-10lb over a period of four years, and long-term quitters 1-2lb.

Dr James Meigs, one of the authors of the study at Harvard Medical School, said: “We can now say without question that stopping smoking has a very positive effect on cardiovascular risk for patients with and without diabetes, even if they experience moderate weight gain.”

Doireann Maddock, senior cardiac nurse at the British Heart Foundation said weight gain should not deter smokers from quitting.

“If you’re keen to quit smoking but worried about putting on weight, using smoking cessation aids such as inhalators, gum, or lozenges may help you resist the temptation to reach for comfort food in the place of a cigarette.”

Source:BBC

 

 

‘Weight is healthy’ study criticised.

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What is a healthy weight?

 

A study which suggests being overweight can lead to a longer life has caused controversy among obesity experts.

One labelled the findings a “pile of rubbish” while another said it was a “horrific message” to put out.

The research, in the Journal of the American Medical Association, suggested the overweight were less likely to die prematurely than people with a “healthy” weight.

Being underweight or severely obese did cut life expectancy.

The researchers at the US National Centre for Health Statistics looked at 97 studies involving nearly 2.9 million people to compare death rates with Body Mass Index (BMI) – a way of measuring obesity using a person’s weight and height.

A healthy BMI is considered to be above 18.5 and below 25. However, overweight people (with a BMI between 25 and 30) were 6% less likely to die early than those considered to have a healthy weight, the study reports.

Have you ever seen a 100-year-old human being who is overweight? The answer is you probably haven’t.”

Prof John Wass Royal College of Physicians

Mildly obese people (BMI between 30 and 35) were no more likely to die prematurely than people with a healthy BMI.

The study said being “overweight was associated with significantly lower all-cause mortality”.

Possible explanations included overweight people getting medical treatment, such as to control blood pressure, more quickly or the extra weight helping people survive being severely ill in hospital.

However, the researchers point out they looked only at deaths and not years spent free of ill-health.

Unconvinced

On Tuesday, the Royal College of Physicians called for the UK to rethink the way it tackles obesity.

Prof John Wass, vice-president of the college, said: “Have you ever seen a 100-year-old human being who is overweight? The answer is you probably haven’t.”

He said the largest people will have died years before and pointed to health problems and higher levels of Type 2 diabetes.

“Huge pieces of evidence go against this, countless other studies point in the other direction.”

Other experts criticised the research methods.

“Some portion of those thin people are actually sick, and sick people tend to die sooner,” according to Donald Berry, from the University of Texas

Dr Walter Willett, from the Harvard School of Public Health said: “This is an even greater pile of rubbish” than a study conducted by the same group in 2005.

Tam Fry, from the National Obesity Forum in the UK, said: “It’s a horrific message to put out at this particular time.

“We shouldn’t take it for granted that we can cancel the gym, that we can eat ourselves to death with black forest gateaux.”

Source:BBC

SSRI Use During Pregnancy Doesn’t Increase Mortality Risk in Offspring.

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Use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy is not associated with stillbirth or infant mortality, according to a JAMA study.

Using national registries in five Nordic countries, researchers identified women who filled a prescription for an SSRI from 3 months before they became pregnant through birth. Of 1.6 million births from 1996 to 2007, 1.8% of mothers had filled an SSRI prescription during pregnancy.

There were increased rates of stillbirth and postneonatal mortality among children whose mothers used SSRIs, but the authors say this could be explained by the severity of maternal psychiatric disease and maternal characteristics, such as smoking. After adjusting for these factors, SSRI use was not associated with an increased mortality risk.

Source: JAMA

Multivitamin Use Does Not Reduce Cardiovascular Risk in Men.

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Taking a daily multivitamin does not reduce the risk for major cardiovascular events in men, according to a JAMA study.

As part of the Physicians’ Health Study II, nearly 15,000 men aged 50 and older were randomized to a daily multivitamin or placebo. After a median follow-up of 11 years, the rate of the primary composite outcome — myocardial infarction, stroke, or cardiovascular mortality — did not differ between the two groups. There were slightly fewer MI deaths among multivitamin users, but the authors speculate that this may have been due to chance. The effect did not differ between men with and without baseline cardiovascular disease.

An editorialist writes that multiple trials “clearly confirm that CVD cannot be prevented or treated with vitamins.” She concludes: “The message needs to remain simple and focused: CVD is largely preventable, and this can be achieved by eating healthy foods, exercising regularly, avoiding tobacco products, and, for those with high risk factor levels or previous CVD events, taking proven, safe, and effective medications.”

Source: JAMA

Patients with Rheumatoid Arthritis Face ‘Moderately’ Increased Thrombosis Risk .

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Rheumatoid arthritis is associated with increased risk for venous thromboembolism, according to a JAMA study.

Using Swedish national registries, researchers identified roughly 38,000 patients with prevalent RA, 8000 patients with incident RA, and 210,000 age- and sex-matched individuals from the general population (comparison cohort).

During follow-up, patients with prevalent RA were twice as likely as the general population to have a first hospitalization for VTE (5.9 vs. 2.8 events per 1000 person-years). Similarly, incident RA was associated with a higher risk for VTE hospitalization (4.5 vs. 2.8 per 1000 person-years); this increased risk was observed within a year after RA diagnosis.

The researchers note that in inflammatory diseases like RA, upregulation of procoagulatory factors might increase the risk for thrombotic events. They conclude: “In general, patients with RA should be considered at a moderately elevated risk of VTE.”

Source:JAMA

Perioperative Steroids Do Not Increase Serious Bleeding After Tonsillectomy .

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Children undergoing tonsillectomy who receive perioperative corticosteroid therapy — as recommended by current guidelines to reduce postoperative nausea and vomiting — do not face increased risk for postoperative bleeding, according to a JAMA study.

In response to a study suggesting such steroid use increases hemorrhage after tonsillectomy, researchers randomized some 300 children to perioperative intravenous dexamethasone or placebo. During the 14 days after tonsillectomy, rates of bleeding that required hospitalization or surgical repair (so-called level II or III bleeds) did not differ between the groups.

Level I bleeds — defined as any reported bleeding event, regardless of clinical evidence — were more common with dexamethasone than with placebo (11 vs. 7 events). However, the authors point out that such events tended to be “nondescript and self-limited.” Level II and III bleeds, they say, “are a more reliable indicator for complications.”

Source: JAMA