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Physician's First Watch for October 1, 2009
David G. Fairchild, MD, MPH, Editor-in-Chief

Benefits of Treating Mild Gestational Diabetes

Maternal Smoking During Pregnancy Linked to Psychotic Symptoms in Children Years Later

Featured in Journal Watch: Inpatient Surgery and In-Hospital Mortality

Benefits of Treating Mild Gestational Diabetes

Treating mild gestational diabetes, although ineffective in lowering perinatal mortality, confers other benefits to both baby and mother, according to a New England Journal of Medicine study.

Nearly a thousand women with mild gestational diabetes underwent randomization to active treatment (counseling, dietary therapy, and insulin if necessary) or to usual care. "Mild" gestational diabetes was defined as a fasting glucose under 95 mg/dL and abnormal results on an oral glucose-tolerance test.

Babies in both treatment and control groups showed roughly the same levels of perinatal mortality and severe complications, such as hyperbilirubinemia and hypoglycemia. However, those in the treatment group were less likely to be large-for-gestational-age or present with shoulder dystocia, and their mothers were less likely to deliver by cesarean section or to have pre-eclampsia or gestational hypertension.

In Journal Watch Women's Health, Dr. Ann Davis writes that "these results provide compelling evidence in favor of treating women who have mild [gestational diabetes]."

NEJM article (Free abstract; full text requires subscription)

NEJM editorial (Subscription required)

Journal Watch Women's Health summary (Free)

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Maternal Smoking During Pregnancy Linked to Psychotic Symptoms in Children Years Later

Children whose mothers smoked during pregnancy are at increased risk for psychotic symptoms by age 12, according to a longitudinal study in the British Journal of Psychiatry.

Researchers gathered information on women's use of tobacco, alcohol, and cannabis during pregnancy and then evaluated their offspring for psychotic symptoms 12 years later. Of nearly 6400 children assessed, about 12% had suspected or definite psychotic symptoms.

In adjusted analyses, maternal smoking was associated with increased risk for psychotic symptoms in offspring, with a dose-response effect (odds ratio for trend, 1.2). A link between alcohol use and psychotic symptoms was limited to mothers who consumed more than 21 units a week. Cannabis use was not associated with symptoms.

The authors say their findings are "consistent with accumulating evidence from animal models of adverse effects on brain development from in utero nicotine exposure."

British Journal of Psychiatry article (Free)

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Featured in Journal Watch: Inpatient Surgery and In-Hospital Mortality

Hospitals with low and high perioperative death rates have surprisingly similar rates of perioperative complications, which suggests that "failure to rescue" is the primary determinant of in-hospital mortality.

Journal Watch Hospital Medicine summary (Your Journal Watch subscription required)

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Physician Editors contributing to this issue were: Susan Sadoughi, MD, Lorenzo Di Francesco, MD, FACP, and Danielle Bowen Scheurer, MD, MSc.

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