In this issue of BJOG, Shah and Sharif report an increased risk of adverse perinatal outcomes in women meeting IADPSG, but not "2-step" criteria for GDM (Shah B, et al. BJOG 2019). These women were not considered to have GDM and were not treated for the condition. The authors used a clever study design leveraging population-based data and their findings are consistent with other studies.
{"title":"GDM: more diabetes, more good or more harm?","authors":"R. Silver","doi":"10.1111/1471-0528.15998","DOIUrl":"https://doi.org/10.1111/1471-0528.15998","url":null,"abstract":"In this issue of BJOG, Shah and Sharif report an increased risk of adverse perinatal outcomes in women meeting IADPSG, but not \"2-step\" criteria for GDM (Shah B, et al. BJOG 2019). These women were not considered to have GDM and were not treated for the condition. The authors used a clever study design leveraging population-based data and their findings are consistent with other studies.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83408619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A woman diagnosed with pre-eclampsia between 34 and 37 weeks’ gestation presents a clinical challenge. Prior to 34 weeks, the risks of prematurity are high and conservative management is followed if possible, whereas after 37 weeks the risks of maternal deterioration outweigh the neonatal risks and delivery is usually indicated. To guide clinicians, a trial was undertaken in nearly 50 maternity units in the UK where women presenting with preeclampsia during this critical gestational window were allocated to immediate delivery or conservative therapy, and both maternal and fetal/neonatal outcomes were monitored (Chappell et al. Lancet 2019;394:1181–90). From the total cohort of 900 women, those in the immediate delivery group had fewer severe hypertensive episodes (65%) compared with those treated conservatively (75%), which the authors interpret as being strong evidence suggesting that planned delivery reduces maternal morbidity. Fetal/neonatal negative outcomes, based primarily on the need for neonatal unit admission, were higher in the induction group (42%) compared with the expectant management group (34%). The number of serious adverse events to mother and baby in each group was similar, at approximately 1%. Other considerations were a caesarean section rate above 50% in both groups and higher costs (13%) in the expectant management group, primarily due to inpatient care prior to delivery. It should be noted that these data are from high-income situations where options for the mother and safeguards for the neonate are available. This research reiterates the high-risk nature of the 2–3% of pregnancies that develop pre-eclampsia and that appropriate facilities must be provided for dealing with maternal and neonatal complications. Where these do exist, there is room for shared decision making on the timing of the delivery. Epidemiologically, it can be anticipated that the incidence of pre-eclampsia will increase as it is linked to maternal age and is often superimposed on chronic hypertension. Both of these indices are rising – at least in high-income countries such as the USA, according to a long-term study (Ananth et al. Hypertension 2019; 74:1089–95). Surprisingly, although chronic hypertension rates are increasing by 6% per annum, the authors do not link this rise to elevated trends in body mass index.
{"title":"Insights from outside BJOG","authors":"A. Kent, S. Kirtley","doi":"10.1111/1471-0528.16009","DOIUrl":"https://doi.org/10.1111/1471-0528.16009","url":null,"abstract":"A woman diagnosed with pre-eclampsia between 34 and 37 weeks’ gestation presents a clinical challenge. Prior to 34 weeks, the risks of prematurity are high and conservative management is followed if possible, whereas after 37 weeks the risks of maternal deterioration outweigh the neonatal risks and delivery is usually indicated. To guide clinicians, a trial was undertaken in nearly 50 maternity units in the UK where women presenting with preeclampsia during this critical gestational window were allocated to immediate delivery or conservative therapy, and both maternal and fetal/neonatal outcomes were monitored (Chappell et al. Lancet 2019;394:1181–90). From the total cohort of 900 women, those in the immediate delivery group had fewer severe hypertensive episodes (65%) compared with those treated conservatively (75%), which the authors interpret as being strong evidence suggesting that planned delivery reduces maternal morbidity. Fetal/neonatal negative outcomes, based primarily on the need for neonatal unit admission, were higher in the induction group (42%) compared with the expectant management group (34%). The number of serious adverse events to mother and baby in each group was similar, at approximately 1%. Other considerations were a caesarean section rate above 50% in both groups and higher costs (13%) in the expectant management group, primarily due to inpatient care prior to delivery. It should be noted that these data are from high-income situations where options for the mother and safeguards for the neonate are available. This research reiterates the high-risk nature of the 2–3% of pregnancies that develop pre-eclampsia and that appropriate facilities must be provided for dealing with maternal and neonatal complications. Where these do exist, there is room for shared decision making on the timing of the delivery. Epidemiologically, it can be anticipated that the incidence of pre-eclampsia will increase as it is linked to maternal age and is often superimposed on chronic hypertension. Both of these indices are rising – at least in high-income countries such as the USA, according to a long-term study (Ananth et al. Hypertension 2019; 74:1089–95). Surprisingly, although chronic hypertension rates are increasing by 6% per annum, the authors do not link this rise to elevated trends in body mass index.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85280428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ceptual health issue: societal norms are a cornerstone for children’s development, especially for the many unplanned pregnancies. Why has the JECS not been used to investigate how to better identify those women who have experienced multiple stressors and shocks, including abuse and social exclusion, which are the roots of unhealthy behaviours? Alcohol use in most developed countries (including France, UK, USA) is a public health crisis. Alcohol is a human carcinogen (Class1, InternationalAgency for Research on Cancer) with a doserelated effect beginning at 1–2 drinks/ day. It is also the first avoidable cause of congenital mental retardation and of domestic violence.&
{"title":"Re: Safety of acupuncture during pregnancy: a retrospective cohort study in Korea","authors":"Jialyu Huang, Y. Kuang","doi":"10.1111/1471-0528.16015","DOIUrl":"https://doi.org/10.1111/1471-0528.16015","url":null,"abstract":"ceptual health issue: societal norms are a cornerstone for children’s development, especially for the many unplanned pregnancies. Why has the JECS not been used to investigate how to better identify those women who have experienced multiple stressors and shocks, including abuse and social exclusion, which are the roots of unhealthy behaviours? Alcohol use in most developed countries (including France, UK, USA) is a public health crisis. Alcohol is a human carcinogen (Class1, InternationalAgency for Research on Cancer) with a doserelated effect beginning at 1–2 drinks/ day. It is also the first avoidable cause of congenital mental retardation and of domestic violence.&","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72670469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hye-Yeon Moon, Me-riong Kim, Deok-Sang Hwang, Jun-Bock Jang, Jinho Lee, Joon-Shik Shin, I. Ha, Y. Lee
cohort study of its kind, and the authors concluded that acupuncture may be a safe therapeutic option for relieving discomfort in pregnancy. Although a study like this is much needed and provides essential information, we noticed several problems that should be addressed before any firm conclusion can be drawn. First, the authors reported that the incidences of preterm delivery were 8.45% and 6.93% in the acupuncture and control groups, respectively. Although comparison by chi-square test did not indicate significant differences, it should be noted that the P-value and lower confidence limit approached significance in both crude and adjusted analyses. Considering the retrospective nature of this study, a small number of errors during data collection could dramatically change the results, especially at the statistical margins. It would be advisable for the authors to add the absolute difference between groups with a 95% confidence interval. Second, the authors stated that women who received acupuncture therapy were frequently diagnosed with such ailments as functional dyspepsia, lower back pain and influenza, but the physical status of women in the control group remained unclear. As a result of the potential adverse effects of these disorders on pregnancy outcomes, a direct comparison between these two populations could be affected by the patient characteristics and so fail to fully reflect the effects of the acupuncture treatment itself. Notably, the women in the acupuncture group had significantly more visits to obstetrics and gynaecology specialists, suggesting that the comparable delivery outcomes might be to the result of more frequent monitoring and more prompt treatment than in the control group. We question why the number of visits was not adjusted as a confounder when other baseline features were all included in multivariable regression analysis. Important variables are also missing from the report. We refer to gravidity, parity, and previous history of preterm birth and stillbirth, all of which are very closely associated with the outcomes that the research team chose to analyse and so should have been taken into account for adjustment. Finally, we are interested in what effect acupuncture in pregnant women would have on babies apart from similar risks in abnormal delivery, such as neonatal birthweight and major congenital malformations. Given the benefits of acupuncture on maternal symptoms, a comprehensive safety validation for neonates would further promote the widespread use of this complementary therapy. In summary, although this study is meaningful, the conclusion would be more solid if more accurate, detailed and complete analyses were performed.&
{"title":"Authors' reply re: Safety of acupuncture during pregnancy: a retrospective cohort study in Korea","authors":"Hye-Yeon Moon, Me-riong Kim, Deok-Sang Hwang, Jun-Bock Jang, Jinho Lee, Joon-Shik Shin, I. Ha, Y. Lee","doi":"10.1111/1471-0528.16014","DOIUrl":"https://doi.org/10.1111/1471-0528.16014","url":null,"abstract":"cohort study of its kind, and the authors concluded that acupuncture may be a safe therapeutic option for relieving discomfort in pregnancy. Although a study like this is much needed and provides essential information, we noticed several problems that should be addressed before any firm conclusion can be drawn. First, the authors reported that the incidences of preterm delivery were 8.45% and 6.93% in the acupuncture and control groups, respectively. Although comparison by chi-square test did not indicate significant differences, it should be noted that the P-value and lower confidence limit approached significance in both crude and adjusted analyses. Considering the retrospective nature of this study, a small number of errors during data collection could dramatically change the results, especially at the statistical margins. It would be advisable for the authors to add the absolute difference between groups with a 95% confidence interval. Second, the authors stated that women who received acupuncture therapy were frequently diagnosed with such ailments as functional dyspepsia, lower back pain and influenza, but the physical status of women in the control group remained unclear. As a result of the potential adverse effects of these disorders on pregnancy outcomes, a direct comparison between these two populations could be affected by the patient characteristics and so fail to fully reflect the effects of the acupuncture treatment itself. Notably, the women in the acupuncture group had significantly more visits to obstetrics and gynaecology specialists, suggesting that the comparable delivery outcomes might be to the result of more frequent monitoring and more prompt treatment than in the control group. We question why the number of visits was not adjusted as a confounder when other baseline features were all included in multivariable regression analysis. Important variables are also missing from the report. We refer to gravidity, parity, and previous history of preterm birth and stillbirth, all of which are very closely associated with the outcomes that the research team chose to analyse and so should have been taken into account for adjustment. Finally, we are interested in what effect acupuncture in pregnant women would have on babies apart from similar risks in abnormal delivery, such as neonatal birthweight and major congenital malformations. Given the benefits of acupuncture on maternal symptoms, a comprehensive safety validation for neonates would further promote the widespread use of this complementary therapy. In summary, although this study is meaningful, the conclusion would be more solid if more accurate, detailed and complete analyses were performed.&","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80233124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Bick, Cath Taylor, V. Bhavnani, A. Healey, P. Seed, Sarah Roberts, Magdelena Zasada, A. Avery, V. Craig, Nina Khazaezadah, S. McMullen, Sheila O’Connor, B. Oki, Eugene Oteng Ntim, L. Poston, M. Ussher
To assess feasibility of a future randomised controlled trial (RCT) of clinical and cost‐effectiveness of lifestyle information and commercial weight management groups to support postnatal weight management to 12 months post‐birth.
{"title":"Lifestyle information and commercial weight management groups to support maternal postnatal weight management and positive lifestyle behaviour: the SWAN feasibility randomised controlled trial","authors":"D. Bick, Cath Taylor, V. Bhavnani, A. Healey, P. Seed, Sarah Roberts, Magdelena Zasada, A. Avery, V. Craig, Nina Khazaezadah, S. McMullen, Sheila O’Connor, B. Oki, Eugene Oteng Ntim, L. Poston, M. Ussher","doi":"10.1111/1471-0528.16043","DOIUrl":"https://doi.org/10.1111/1471-0528.16043","url":null,"abstract":"To assess feasibility of a future randomised controlled trial (RCT) of clinical and cost‐effectiveness of lifestyle information and commercial weight management groups to support postnatal weight management to 12 months post‐birth.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77349018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Rousseau, E. Azria, S. Baumann, C. Deneux-Tharaux, M. Senat
To describe spontaneous preterm birth prevention practices self‐reported before and after the dissemination of relevant guidelines, and to identify personal and organisational factors associated with adherence.
描述在相关指南传播前后自我报告的自发性早产预防实践，并确定与依从性相关的个人和组织因素。
{"title":"Do obstetricians apply the national guidelines? A vignette‐based study assessing practices for the prevention of preterm birth","authors":"A. Rousseau, E. Azria, S. Baumann, C. Deneux-Tharaux, M. Senat","doi":"10.1111/1471-0528.16039","DOIUrl":"https://doi.org/10.1111/1471-0528.16039","url":null,"abstract":"To describe spontaneous preterm birth prevention practices self‐reported before and after the dissemination of relevant guidelines, and to identify personal and organisational factors associated with adherence.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80204352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Selvaratnam, Mary-Ann Davey, S. Anil, SJ McDonald, T. Farrell, E. Wallace
To assess the impact of publicly reporting a statewide fetal growth restriction (FGR) performance indicator.
评估公开报告全州胎儿生长受限(FGR)性能指标的影响。
{"title":"Does public reporting of the detection of fetal growth restriction improve clinical outcomes: a retrospective cohort study","authors":"R. Selvaratnam, Mary-Ann Davey, S. Anil, SJ McDonald, T. Farrell, E. Wallace","doi":"10.1111/1471-0528.16038","DOIUrl":"https://doi.org/10.1111/1471-0528.16038","url":null,"abstract":"To assess the impact of publicly reporting a statewide fetal growth restriction (FGR) performance indicator.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77563020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jennifer Drevin, J. Hallqvist, K. Sonnander, A. Rosenblad, Ronnie Pingel, E. Bjelland
To study if childhood emotional, physical and sexual abuse are determinants for having an unplanned pregnancy, if the categories of abuse interact, and if a potential bias due to the selection of the participants (collider stratification bias) could explain the effect of childhood abuse.
{"title":"Childhood abuse and unplanned pregnancies: a cross‐sectional study of women in the Norwegian Mother and Child Cohort Study","authors":"Jennifer Drevin, J. Hallqvist, K. Sonnander, A. Rosenblad, Ronnie Pingel, E. Bjelland","doi":"10.1111/1471-0528.16037","DOIUrl":"https://doi.org/10.1111/1471-0528.16037","url":null,"abstract":"To study if childhood emotional, physical and sexual abuse are determinants for having an unplanned pregnancy, if the categories of abuse interact, and if a potential bias due to the selection of the participants (collider stratification bias) could explain the effect of childhood abuse.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76503989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Frijstein, C. Lok, N. Trommel, M. ten Kate‐Booij, L. Massuger, E. Werkhoven, D. Short, X. Aguiar, R. Fisher, B. Kaur, N. Sarwar, N. Sebire, M. Seckl
Presence of lung metastases in low‐risk gestational trophoblastic neoplasia (GTN) is generally considered not to influence prognosis. However, in a recent study in the Netherlands, GTN patients with lung metastases had a higher recurrence rate and more disease‐specific deaths compared with patients without metastases. The aim of the present study was to validate these findings in a different country.
{"title":"Lung metastases in low‐risk gestational trophoblastic neoplasia: a retrospective cohort study","authors":"M. Frijstein, C. Lok, N. Trommel, M. ten Kate‐Booij, L. Massuger, E. Werkhoven, D. Short, X. Aguiar, R. Fisher, B. Kaur, N. Sarwar, N. Sebire, M. Seckl","doi":"10.1111/1471-0528.16036","DOIUrl":"https://doi.org/10.1111/1471-0528.16036","url":null,"abstract":"Presence of lung metastases in low‐risk gestational trophoblastic neoplasia (GTN) is generally considered not to influence prognosis. However, in a recent study in the Netherlands, GTN patients with lung metastases had a higher recurrence rate and more disease‐specific deaths compared with patients without metastases. The aim of the present study was to validate these findings in a different country.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76053848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The commonest groups of patients with gestational trophoblastic neoplasia (GTN) are those with persistently raised serum hCG following evacuation of uterus and choriocarcinoma. Patients with low risk disease are treated with single agent chemotherapy using methotrexate and folinic acid rescue whereas those with high risk disease are treated with a multi-agent regime with etoposide, methotrexate, actinomycin-D, cyclophosphomide, vincristine (EMA-CO). Methotrexate chemotherapy is usually well tolerated and associated with less toxic adverse effects.
{"title":"Pulmonary metastases increase chemotherapy resistance and recurrence of gestational trophoblastic neoplasia","authors":"P. Chien","doi":"10.1111/1471-0528.16035","DOIUrl":"https://doi.org/10.1111/1471-0528.16035","url":null,"abstract":"The commonest groups of patients with gestational trophoblastic neoplasia (GTN) are those with persistently raised serum hCG following evacuation of uterus and choriocarcinoma. Patients with low risk disease are treated with single agent chemotherapy using methotrexate and folinic acid rescue whereas those with high risk disease are treated with a multi-agent regime with etoposide, methotrexate, actinomycin-D, cyclophosphomide, vincristine (EMA-CO). Methotrexate chemotherapy is usually well tolerated and associated with less toxic adverse effects.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73460668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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