Press releases Monday 2 August to Saturday 7 August 2010

Please remember to credit the BMJas source when publicising an article and to tell your readers that they can read its full text on the journal's website (http://www.bmj.com).

(1) Women don’t need to delay getting pregnant after miscarriage
(2) Eliminating diabetes and depression, and boosting education, most likely to ward off dementia

(1) Women don’t need to delay getting pregnant after miscarriage
(Research: Effect of interpregnancy interval on outcomes of pregnancy after miscarriage: retrospective analysis of hospital episode statistics in Scotland)
(Editorial: Miscarriage and time to next pregnancy)

Women who conceive within six months of an initial miscarriage have the best chance of having a healthy pregnancy with the lowest complication rates, finds a paper published on bmj.com today.

Lead author, Sohinee Bhattacharya from University of Aberdeen, says that current World Health Organisation (WHO) guidelines recommending that women who experience a miscarriage should wait at least six months before getting pregnant again may need to be reviewed.

Women who experience a miscarriage are not only at an increased risk of a second miscarriage, says the study, but also of complications in a subsequent pregnancy. Around one in five pregnancies ends in miscarriage before 24 weeks.

But the length of time couples should wait before trying again to get pregnant are not consistent, say the authors, with some doctors saying there is no justification for asking women to wait and other bodies, such as the WHO, recommending a wait of at least six months. This study was based on women delivering in Scotland and while the findings are valid for this population, the original WHO guidelines may still be applicable to women in developing countries.

Delaying getting pregnant is particularly problematic in the western world, they add, because “women over 35 are more likely to experience difficulties in conceiving and women aged 40 years have a 30% chance of miscarriage which rises to 50% in those aged 45 years or more … any delay in attempting conception could further decrease their chance of a healthy baby.”

The researchers reviewed the data of over 30,000 women who attended Scottish hospitals between 1981 and 2000. The participants all had a miscarriage in their first pregnancy and subsequently had another pregnancy.

The results show that women who conceived again within six months were less likely to have another miscarriage, termination of pregnancy or ectopic pregnancy compared to women who got pregnant between six and 12 months after their initial miscarriage.

The women who conceived within six months were also less likely to experience a caesarean section, deliver prematurely or have low birth weight babies. This association wasn't explained by social and personal factors or by other problems in pregnancy including smoking.

The authors conclude: “our research shows that it is unnecessary for women to delay conception after a miscarriage”. They add that when there are reasons to delay, for example if there are signs of infection, women should be advised about what to do to protect their health.

An accompanying editorial supports the view that women who conceive earlier may have better outcomes and fewer complications and calls for further research into this important area.

Contacts:
Research: Sohinee Bhattacharya, Lecturer Obstetric Epidemiology, University of Aberdeen, Dugald Baird Centre for Research on Women’s Health, Aberdeen Maternity Hospital, Aberdeen, Scotland, UK
Email: sohinee.bhattacharya@abdn.ac.uk

Editorial: Julia Shelley, Associate Professor, School of Health and Social Development, Deakin University, Melbourne, Australia
Email: julia.shelley@deakin.edu.au

(2) Eliminating diabetes and depression, and boosting education, most likely to ward off dementia
(Research: Designing prevention programmes to reduce incidence of dementia: prospective cohort study of modifiable risk factors)
(Research: Survival of people with clinical diagnosis of dementia in primary care: cohort study)
(Editorial: Survival after diagnosis of dementia in primary care)

Eliminating diabetes and depression, as well as increasing education and fruit and vegetable consumption, are likely to have the biggest impact on reducing levels of dementia in the coming years, should no effective treatment be found, concludes a study published on bmj.com today.

These findings suggest priorities for future public health interventions.

While the exact cause of dementia is still unknown, several modifiable risk factors have already been identified. These include vascular risk factors (heart disease, stroke, high blood pressure, obesity, diabetes, and high cholesterol), a history of depression, diet, alcohol consumption, and education level.

Based on this knowledge, a team of researchers based in France and the UK estimated which of these risk factors might be most effective in reducing the future burden of dementia, should no effective treatment be found.

Their analysis involved 1,433 healthy people aged over 65 years living in the south of France and recruited between 1999 and 2001. Participants underwent cognitive testing at the start of the study and again at two, four and seven years. A reading test (the Neale score) was also used as an indicator of lifetime intelligence.

Medical history and information on measures such as height, weight, education level, monthly income, mobility, dietary habits, alcohol consumption, and tobacco use was obtained. An individual’s genetic risk of dementia was also measured: although it's not a factor that can be changed it served as a useful benchmark for dementia risk.

Results showed that eliminating depression and diabetes and increasing fruit and vegetable consumption were estimated to lead to an overall 21% reduction in new cases of dementia, with depression making the greatest contribution (just over 10%). However, the researchers point out that the direct (causal) relationship between depression and dementia remains unclear.

Increasing education would also lead to an estimated 18% reduction in new cases of dementia across the general population over the next seven years. By contrast, eliminating the principal known genetic risk factor from the general population would lead only to a 7% reduction in the number of new cases over the next seven years.

Given these findings, the authors suggest that public health initiatives should focus on encouraging literacy at all ages irrespective of ability, prompt treatment of depressive symptoms, and early screening for glucose intolerance and insulin resistance (early stages in the development of diabetes).

While these calculations can only provide a crude estimate of impact on incidence, they do make a significant statement about public health priorities in disease prevention in the face of current knowledge, conclude the authors. Further studies including younger adults are clearly needed to test the impact of intervention measures.

A second study, also published on bmj.com today, finds that death rates are more than three times higher in people with dementia than in those without dementia in the first year after diagnosis. The study also says that earlier and better detection of dementia in primary care is needed. An accompanying editorial suggests that key areas to focus on include better education and training in primary care, developing more integrated systems of care, and ensuring that policy makers and commissioners plan services that reflect the effects of dementia on primary care and other services.

Contacts:
Research: Karen Ritchie, INSERM, La Colombiere Hospital, Montpellier, France
Email: karen.ritchie@inserm.fr

Second study: Greta Rait, Senior Clinical Scientist, Medical Research Council General Practice Research Framework, London, UK
Email: gr@gprf.mrc.ac.uk

Editorial: Elizabeth England, NIHR Academic Research Fellow, University of Birmingham, UK
Email: e.j.england@bham.ac.uk

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