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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)
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)
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)
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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