Saturday 22 February 2003
No 7386 Volume 326
Please remember to credit the BMJ as source when publicising
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(1) TOO
MUCH COFFEE DURING PREGNANCY
RISKS STILLBIRTH
(2) HIGHER
RISKS FOR WOMEN WITH DIABETES
USING HRT
(3) LINK
FOUND BETWEEN SPONTANEOUS
ABORTION AND
HEART DISEASE
(4) DOCTORS
MAY OMIT INFORMATION WHEN
COPYING LETTERS
TO PATIENTS
(1) TOO MUCH COFFEE
DURING PREGNANCY
RISKS STILLBIRTH
(Maternal consumption of coffee during
pregnancy and
stillbirth and infant death in first
year of life: prospective
study)
http://bmj.com/cgi/content/full/326/7386/420
Pregnant women who drink eight or more
cups of coffee
a day run more than twice the risk of
stillbirth compared
with women who do not drink coffee, finds
a study in this
week's BMJ.
Researchers in Denmark identified 18,478
pregnant
women booking for delivery at Aarhus University
Hospital
during 1989-96. The women completed two
questionnaires, providing information
such as medical
history, smoking habits, alcohol and coffee
consumption.
The risk of stillbirth increased with the
number of cups of
coffee a day during pregnancy. Compared
with women
who did not drink any coffee, women who
drank four to
seven cups a day had an 80% increased
risk of stillbirth,
and women who drank eight or more cups
a day a 300%
increased risk. There was no association
between coffee
consumption and death in the first year
of life.
Women with a high intake of coffee are
more likely to be
smokers and to have a high intake of alcohol,
say the
authors. Adjusting for these factors reduced
the risk
slightly, but the link remained significant.
Contact:
Kirsten Wisborg, Specialist Registrar,
Perinatal
Epidemiological Research Unit, Department
of Obstetrics
and Gynaecology, Aarhus University Hospital,
Denmark
Email: kiwi{at}perinatal.dk
(2) HIGHER RISKS
FOR WOMEN WITH DIABETES
USING HRT
(Relation between hormone replacement
therapy and
ischaemic heart disease in women:
prospective
observational study)
http://bmj.com/cgi/content/full/326/7386/426
Women with diabetes who use hormone replacement
therapy are at an increased risk of death
from all causes
and heart disease, finds a study in this
week's BMJ.
Using data from a group of Danish nurses,
researchers
examined the association between hormone
replacement
therapy and ischaemic heart disease, heart
attack, and
total number of deaths among 13,084 postmenopausal
women.
They found that hormone replacement therapy
did not
protect women against heart disease or
heart attack, but
there was a significantly increased risk
of death from all
causes and ischaemic heart disease among
women with
diabetes.
This effect was not influenced by other
risk factors for
heart disease, such as smoking, alcohol
consumption, and
body mass index, say the authors.
Reasons for the harmful effect of hormone
replacement
therapy among women with diabetes are
inconclusive, but
could be explained by an influence on
blood sugar control,
they conclude.
Contact:
Ellen Løkkegaard, Research Fellow,
Department of
Obstetrics and Gynaecology, Hvidovre University
Hospital, Hvidovre, Denmark
Email: loekkegaard{at}dadlnet.dk
(3) LINK FOUND
BETWEEN SPONTANEOUS
ABORTION AND HEART DISEASE
(Spontaneous loss of early pregnancy
and risk of
ischaemic heart disease in later
life: retrospective cohort
study)
http://bmj.com/cgi/content/full/326/7386/423
For the first time, a specific link has
been found between
spontaneous abortion and risk of heart
disease in later life,
according to researchers in this week's
BMJ.
The team analysed national data on births
in Scotland
during 1981-5 and deaths or hospital admissions
due to
ischaemic heart disease (IHD) during 1981-99.
They found that women with a history of
spontaneous loss
of early pregnancy were at increased risk
of IHD. By
contrast, there was no association between
therapeutic
abortion and subsequent risk of IHD.
To our knowledge, this is the first study
to show a specific
association between spontaneous abortion
and maternal
risk of IHD, say the authors.
However, further studies are required to
corroborate
these findings and confirm that the association
is
independent of smoking and other factors,
such as
maternal disease (for example, diabetes
and polycystic
ovarian syndrome), they conclude.
Contact:
Professor Gordon Smith, Department of Obstetrics
and
Gynaecology, The Rosie Hospital, Cambridge,
UK
Email: gcss2{at}cam.ac.uk
(4) DOCTORS MAY
OMIT INFORMATION WHEN
COPYING LETTERS TO PATIENTS
(Letter: Copying letters to patients)
http://bmj.com/cgi/content/full/326/7386/449
From April 2004, patients will receive
copies of all
correspondence between clinicians working
in the NHS as
a matter of course. However, some doctors
are worried
about distressing patients by what they
write and
consequently tend to omit information,
say researchers in
this week's BMJ.
Their study involved 76 new patients who
attended two
psychiatry clinics from January to July
2002 and eight
psychiatrists who worked in these clinics
during this time.
After the assessment, patients were sent
a copy of the
psychiatrist's letter to the general practitioner
and asked to
complete a short questionnaire on their
evaluation of the
letter. Psychiatrists were asked whether
anything of
importance had been omitted from the letter,
if so, why
and how the omitted information would
be communicated
to general practitioners.
Fifty six of the 76 letters (74%) were
sent to the patient in
an unaltered form. In three cases the
psychiatrists thought
it inappropriate for the patient to receive
a copy of the
letter, citing concerns over patients'
distress. In 17 cases,
clinicians made omissions, mainly of parts
of the history.
Reasons cited for omission were fear of
distressing the
patient (14 instances), concern about
people other than the
patient having access to information (four
instances), and
protection of information supplied by
third parties (two
instances). General practitioners were
informed of the
omitted information, either by letter
or in person. Most
patients (33 out of 40) wished to continue
receiving copies
of correspondence.
Although patients appreciate receiving
copies of letters,
some training and reassurance about this
practice may be
needed for doctors before implementation,
conclude the
authors.
Contact:
Graham Murray, Research Associate, Department
of
Psychiatry, University of Cambridge, Addenbrooke's
Hospital, Cambridge, UK
Email: gm285{at}cam.ac.uk
FOR ACCREDITED JOURNALISTS
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London WC1H 9JR
(contact: pressoffice{at}bma.org.uk)
and from:
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Association for the
Advancement of Science
(http://www.eurekalert.org)
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