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(1) PREGNANCY COMPLICATIONS STILL HIGH FOR WOMEN WITH DIABETES
(2) GOVERNMENT SCHEME TO IMPROVE HEALTH AND WELL-BEING OF DEPRIVED FAMILIES CALLED INTO QUESTION
(3) PROPOSED CHANGES
TO OBESITY GUIDELINES MAY HARM CHILDREN IN THE US
(1) PREGNANCY COMPLICATIONS STILL HIGH FOR WOMEN WITH DIABETES
Online First
(Perinatal mortality and congenital anomalies in babies of women with
type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population
based study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38856.692986.AE
The risk of death and major birth defects are still high in babies born to women with diabetes, despite an international strategy to raise standards of diabetes care, say researchers in a study published on bmj.com today.
They also warn that these problems will get worse as the number of young women diagnosed with type 1 and type 2 diabetes continues to rise.
Researchers analysed deaths shortly after birth (perinatal mortality) and congenital anomalies in babies born to women with type 1 or type 2 diabetes who delivered between 1 March 2002 and 28 February 2003 in England, Wales, and Northern Ireland.
Of 2,359 women with diabetes, 1,707 had type 1 diabetes and 652 had type 2 diabetes. Women with type 2 diabetes were more likely to come from an ethnic minority group and from a deprived area.
Perinatal mortality was similar in babies of women with type 1 (31.7 per 1000 births) and type 2 diabetes (32.3 per 1000 births), and was nearly four times higher than that in the general maternity population.
The rate of major congenital anomaly (mainly heart and nervous system defects) was 46 per 1000 births in women with diabetes (48 per 1000 births for type 1 diabetes and 43 per 1000 for type 2 diabetes), more than double than that in the general maternity population.
Because of this increased risk, the authors say that women with diabetes should take a higher than usual dose (5 mg) of folic acid from before conception up to week 12 of pregnancy. They also suggest that pregnant women with diabetes should be routinely screening for heart defects.
In the past, type 2 diabetes has been viewed as a less serious condition than type 1 diabetes and may have been subject to less vigilant care, add the authors. However, in view of these findings, and the increasing prevalence of type 2 diabetes in young adults, raised awareness of the increased risk of adverse pregnancy outcomes in this group of women is needed.
This study is substantially larger than any previous ones in this field, but more work is needed to find out how women with either type of diabetes can best be enabled to improve the outcomes of their pregnancy, they conclude.
Contacts:
Mary Macintosh, Medical Director,
Confidential Enquiry into Maternal and Child Health, London, UK
Email: mary.macintosh@hpa.org.uk
or
Kate Fleming, Senior Data Analyst,
Confidential Enquiry into Maternal and Child Health, London, UK
(2) GOVERNMENT SCHEME TO IMPROVE HEALTH AND WELL-BEING OF DEPRIVED FAMILIES CALLED INTO QUESTION
Online First
(Effects of Sure Start local programmes on children and families:
early findings from a quasi-experimental, cross sectional study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38853.451748.2F
The Government’s Sure Start programme, set up in 1999 to improve the health and development of socially deprived families with young children, shows some benefit for most poor families but may also be adversely affecting the worst off to some extent, says a paper in this week’s BMJ.
The programme targets individual families with children under four in designated deprived areas. It provides outreach or home visiting, advice about family health and development, support for people with special needs, and support for good quality play, learning, and childcare experiences.
Researchers looked at families in 150 Sure Start communities, comparing them with families in 50 areas of similar deprivation. To measure the success of the programme, they looked at how many of the community services the families used and how useful they found them, the home learning environment, and the degree of supportive or negative parenting.
The study also looked at reported behavioural problems, and children’s development (verbal, spatial and number skills).
The researchers found that children from the relatively less well off families but not worst off - those of non-teenage mothers - showed some benefit from the Sure Start programme. But children from more deprived families - teenage mothers, lone parents, workless households - were adversely affected.
They also found that Sure Start programmes led by health agencies were the most effective.
The authors warn that the results should be treated with caution at this early stage of Sure Start's implementation, and the scheme needs further evaluation. They point out that more families benefited than were negatively affected by the initiative. But since the programme resulted in some adverse effects for the most deprived - the socio-economic group involved in a disproportionately high level of society's problems - Sure Start's negative though limited effects could have considerable consequences.
Contact
Professor Jay Belsky, Institute
for the Study of Children, Families and Social Issues, Birkbeck University
of London, UK
Email: j.belsky@bbk.ac.uk
or
Professor Edward Melhish
(3) PROPOSED CHANGES TO OBESITY GUIDELINES MAY HARM CHILDREN IN THE US
(Expanding definitions of
obesity may harm children)
http://bmj.com/cgi/content/full/332/7555/1412
(Obesity task force linked
to WHO takes "millions" from drug firms)
http://bmj.com/cgi/content/full/332/7555/1412
New guidelines on obesity in the US may end up harming children, says an article in this week's BMJ. And an accompanying article goes on to question the financial links between the organisation promoting these proposals and the pharmaceutical industry. If implemented, the proposals would see many more children classified as overweight or obese - and thus eligible for treatment with obesity drugs.
The article outlines how an influential expert committee of the American Medical Association has "tentatively decided" to reclassify obesity definitions. This will result in healthy children being categorized as medically overweight or obese, says the author, and mean that approximately a quarter of toddlers and two fifths of children aged 6-11 in America will be classed as having the disease.
Author of the articles is Ray Moynihan, who has previously written about drug companies promoting an increasing reliance on medications to the public. His report reveals that the US proposals have been greeted with alarm by some senior public health academics who have written to the committee. Dr Jenny O'Dea from the University of Sydney, for instance, warned that labelling children as overweight or obese can lead to stigmatisation, eating problems, and avoidance of exercise.
Mr Moynihan points out that one of the prime movers behind the proposed changes being considered by the expert committee is Dr William Dietz, a senior member of the International Obesity Task Force. In the second article Mr Moynihan reveals how the high profile and highly influential Task Force, which has close ties to the World Health Organisation, was set up in the mid-1990s with the help of grants from three drug companies and continues to benefit from drug company sponsorship.
Now merged with another international obesity forum, the Task Force gets two thirds of its funding from pharmaceutical giants Roche and Abbott. Roche makes the anti-obesity drug Xenical (orlistat), and Abbott makes the appetite suppressant Reductil (sibutramine hydrochloride). Over recent years, the article states, drug company sponsorship is likely to have amounted to "millions".
The Task Force has responded to Mr Moynihan's questions about its funding, saying that it has made no secret of the grants it has received from drug companies and emphasising that an internal ethical scrutiny system ensures independence from sponsors.
Contact Ray Moynihan
Email: ray.moynihan@newcastle.edu.au
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