Authors

  1. Worth, Tammy

Abstract

Poor glucose control may increase risk.

 

Article Content

The link between diabetes and birth defects is not completely understood, but good control of glucose levels appears to play a large role in prevention.

 

Researchers from the Centers for Disease Control and Prevention examined nearly 18,000 records from the National Birth Defects Prevention Study (4,895 control subjects, and 13,030 cases of children with birth defects) in an attempt to understand the impact of maternal diabetes on a wide range of birth defects. Their study found that diabetic women with good glucose control have the same chance of having children with birth defects as the general population. But as a woman's glucose levels climb, so does her risk of having a child with birth defects.

 

Pregestational diabetes. Women who gave birth to children with any birth defect were three times more likely to have pregestational diabetes, and those who had babies with multiple defects were more than nine times more likely to have pregestational diabetes.

 

Gestational diabetes. Although women who had children with birth defects were about 1.5 times more likely to have gestational diabetes, weight may play a large role in that outcome. According to the study authors, the associations of defects to gestational diabetes "were weaker and generally limited to offspring of women with a prepregnancy" body mass index of 25 kg/m2 or higher. The authors think it likely that many of these women had undiagnosed pregestational diabetes.

 

According to coauthor Adolfo Correa, the study results are "a call to action [horizontal ellipsis] to improve access to preconception care for women with pregestational diabetes, especially those who are obese or overweight."

 

Tammy Worth

 

NewsCAPS

Extensively drug-resistant tuberculosis was cured in 60% of 48 Peruvian outpatients, according to a report in the August 7 issue of the New England Journal of Medicine. None of the 48 patients had HIV, and all received personalized regimens-typically, high doses of five drugs that researchers judged to be most appropriate. Most regimens lasted more than two years. Adherence was high because of daily supervision by health care workers, who also managed any adverse effects. In addition, more than two-thirds of the 603 patients with less serious multidrug-resistant tuberculosis were cured.

 

Topical lidocaine relieves the pain of mammography, a study published in the September issue of Radiology found. Comparing the use of 4% lidocaine gel (Topicaine) with oral acetaminophen or ibuprofen about 60 minutes before a mammogram, researchers found that women who applied the gel reported significantly less discomfort; the oral medications brought no pain relief. And the gel did not impair the quality of the image. Because lidocaine gel is water-based, women can apply about one ounce at home an hour before their appointment, then remove it just before the procedure with a wet washcloth or paper towels.

 

A ketogenic diet reduced or eliminated seizures among children with epilepsy as a result of focal malformation of cortical development, reported the journal Pediatrics in August. A total of 47 children (average age, 47 months) who were candidates for epilepsy surgery were first treated with the classic ketogenic diet: high in fat, with adequate protein, and low in carbohydrates. Those who showed progress at a three-month evaluation remained on the diet for two years. At the three-month evaluation, the seizure frequency in 29 (62%) of the children had decreased by more than half-including 21 (45%) who were seizure free. Of those, 16 remained seizure free after two years on the diet, and nine completed the diet and stayed seizure free over nearly four years of follow-up.

 

Inhaling mannitol improves lung function in patients with cystic fibrosis, the journal Chest reported in June. The 39 subjects received two weeks' treatment with twice-daily fine-particle active mannitol or placebo; after a two-week washout, the study arms were reversed. Forced expiratory volume in one second increased by an average of 7% in those receiving mannitol, a sugar alcohol that draws water into the airways to help clear the thick mucus produced in cystic fibrosis.

 
 

Correa A, et al. Am J Obstet Gynecol 2008;199(3): 237.e1-237.e9.