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foundation and the only global developer of evidence-based clinical practice guidelines in kidney disease. “It’s unfortunate there wasn’t an attempt to harmonize these recommendations, because it’s not responsible for one body to put out recommendations after another did, without discussing any differences,” Levey said. “This leaves clinicians in the middle saying, ‘What am I supposed to believe?’”
Pregnancy After Bariatric Surgery Associated With Risks to Offspring Jill Jin, MD, MPH
W
ith the worldwide prevalence of obesity on the increase, more individuals are opting for bariatric surgery as a solution, including an increasing number of women of childbearing age. Given the known negative effects of obesity on both fertility and pregnancy outcomes, bariatric surgery in obese women hoping to have children has generally not been discouraged by physicians. Now, however, new research suggests that pregnancies in women with previous bariatric surgery may have worse perinatal outcomes than previously thought. In a new study, researchers at the Karolinska Institute in Sweden looked at outcomes of pregnancies among 2534 women who had undergone previous bariatric surgery (gastric bypass, gastric banding, or vertical banded gastroplasty) and more than 12 000 from women without a history of bariatric surgery, all of whom gave birth between 1992 and 2009 (Roos N et al. BMJ. 2013;347:f6460. doi:10.1136/bmj.f6460). To account for other factors that could influence pregnancy outcome, the women without a history of bariatric surgery were matched to the bariatric surgery group in a 5:1 ratio based on age, parity, body mass index (BMI) at first prenatal visit, smoking status, educational level, and year of delivery. The main outcome measures were preterm birth (less than 37 weeks’ gestation) and birth weight for gestational age. The researchers found that women who had undergone previous bariatric
2388
surgery had a statistically significant higher rate of preterm birth than those who had not: 9.7% vs 6.1%. They were also significantly more likely to deliver a small-for-gestational-age infant (a sign of fetal growth restriction) compared with those who did not have the surgery (5.2% vs 3.0%). These increased risks were seen with all 3 types of bariatric surgery, and the risks were still present more than 5 years after surgery. There was no difference in rates of stillbirth or neonatal death, although both of these outcomes were sufficiently rare that a difference may not have been detected based on the study size. Women who had undergone bariatric surgery were less likely than those in the control group to deliver an infant that was large for gestational age (4.2% vs 7.3%). Such infants are at increased risk of impaired glucose tolerance and childhood obesity. The researchers commented that poorer nutrient absorption in women who have had bariatric surgery may result in micronutrient deficiencies that negatively affect both fetal and placental growth but noted that their study did not investigate this possibility. They suggested that it may be beneficial for pregnant women with a history of bariatric surgery to be regarded as a high-risk group and to receive prenatal counseling on the increased risks of preterm birth and fetal growth restriction.
.
news@JAMA FROM JAMA’S DAILY NEWS SITE
Genes, Ethnicity, and Health Risks Researchers from 5 institutions will explore whether subtle variations in the genetic makeup of ethnically diverse populations account for their differences in various health risks. The National Institutes of Health is funding the work through the Population Architecture Using Genomics and Epidemiology program of the National Human Genome Research Institute. The investigators will use large epidemiological studies and data sets that include whites, blacks, Hispanics, Native Americans, Native Hawaiians, and Japanese Americans. Because population-related biological pathways often contribute to disease, examining many traits and diseases together gives a more thorough picture of the role of genetic variation. http://jama.md/17dYlu6 Children at Risk for Pertussis An increasing number of children aged 3 to 36 months are undervaccinated, putting them at increased risk of developing pertussis. In a recent study, researchers found 72 confirmed cases of pertussis among children born between 2004 and 2008 who received care through 1 of 8 managed care organizations. Children who were undervaccinated were much more likely than fully vaccinated children to become ill with pertussis. Children undervaccinated for 3 or 4 doses of vaccine were about 18 times and about 28 times more likely, respectively, to be diagnosed with pertussis than age-appropriately vaccinated children. http://jama.md/1ex8ZQk “Sausage Making” in Clinical Research Clinicaltrials.gov, the database created to increase transparency in clinical research, is shining an unflattering light on how data are compiled and published. No one anticipated the role of clinicaltrials.gov “as a window into the sausage factory,” said Deborah Zarin, MD, director of clinicaltrials.gov, which is run by the US National Library of Medicine. Reviews of the database have shown reporting errors, typos in journals, or intentional distortion of results to present more favorable findings in published studies. http://jama.md/17Wa4ds
For more on these stories and other medical news, visit http://newsatjama.jama.com.
JAMA December 11, 2013 Volume 310, Number 22
Copyright 2013 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a Karolinska Institutet University Library User on 05/25/2015
jama.com
cosmin4000/iStock.com
avoiding drug toxicity, and you need to do the basic metabolic panel when a patient comes in sick so you know his or her kidney function to adjust a medication dose appropriately,” said Levey. Another issue for Levey is that the ACP guidelines conflict with the recently released guidelines on the treatment of hypertension in patients with chronic kidney disease from Kidney Disease: Improving Global Outcomes (KDIGO), a Belgian
foundation and the only global developer of evidence-based clinical practice guidelines in kidney disease. “It’s unfortunate there wasn’t an attempt to harmonize these recommendations, because it’s not responsible for one body to put out recommendations after another did, without discussing any differences,” Levey said. “This leaves clinicians in the middle saying, ‘What am I supposed to believe?’”
Pregnancy After Bariatric Surgery Associated With Risks to Offspring Jill Jin, MD, MPH
W
ith the worldwide prevalence of obesity on the increase, more individuals are opting for bariatric surgery as a solution, including an increasing number of women of childbearing age. Given the known negative effects of obesity on both fertility and pregnancy outcomes, bariatric surgery in obese women hoping to have children has generally not been discouraged by physicians. Now, however, new research suggests that pregnancies in women with previous bariatric surgery may have worse perinatal outcomes than previously thought. In a new study, researchers at the Karolinska Institute in Sweden looked at outcomes of pregnancies among 2534 women who had undergone previous bariatric surgery (gastric bypass, gastric banding, or vertical banded gastroplasty) and more than 12 000 from women without a history of bariatric surgery, all of whom gave birth between 1992 and 2009 (Roos N et al. BMJ. 2013;347:f6460. doi:10.1136/bmj.f6460). To account for other factors that could influence pregnancy outcome, the women without a history of bariatric surgery were matched to the bariatric surgery group in a 5:1 ratio based on age, parity, body mass index (BMI) at first prenatal visit, smoking status, educational level, and year of delivery. The main outcome measures were preterm birth (less than 37 weeks’ gestation) and birth weight for gestational age. The researchers found that women who had undergone previous bariatric
2388
surgery had a statistically significant higher rate of preterm birth than those who had not: 9.7% vs 6.1%. They were also significantly more likely to deliver a small-for-gestational-age infant (a sign of fetal growth restriction) compared with those who did not have the surgery (5.2% vs 3.0%). These increased risks were seen with all 3 types of bariatric surgery, and the risks were still present more than 5 years after surgery. There was no difference in rates of stillbirth or neonatal death, although both of these outcomes were sufficiently rare that a difference may not have been detected based on the study size. Women who had undergone bariatric surgery were less likely than those in the control group to deliver an infant that was large for gestational age (4.2% vs 7.3%). Such infants are at increased risk of impaired glucose tolerance and childhood obesity. The researchers commented that poorer nutrient absorption in women who have had bariatric surgery may result in micronutrient deficiencies that negatively affect both fetal and placental growth but noted that their study did not investigate this possibility. They suggested that it may be beneficial for pregnant women with a history of bariatric surgery to be regarded as a high-risk group and to receive prenatal counseling on the increased risks of preterm birth and fetal growth restriction.
.
news@JAMA FROM JAMA’S DAILY NEWS SITE
Genes, Ethnicity, and Health Risks Researchers from 5 institutions will explore whether subtle variations in the genetic makeup of ethnically diverse populations account for their differences in various health risks. The National Institutes of Health is funding the work through the Population Architecture Using Genomics and Epidemiology program of the National Human Genome Research Institute. The investigators will use large epidemiological studies and data sets that include whites, blacks, Hispanics, Native Americans, Native Hawaiians, and Japanese Americans. Because population-related biological pathways often contribute to disease, examining many traits and diseases together gives a more thorough picture of the role of genetic variation. http://jama.md/17dYlu6 Children at Risk for Pertussis An increasing number of children aged 3 to 36 months are undervaccinated, putting them at increased risk of developing pertussis. In a recent study, researchers found 72 confirmed cases of pertussis among children born between 2004 and 2008 who received care through 1 of 8 managed care organizations. Children who were undervaccinated were much more likely than fully vaccinated children to become ill with pertussis. Children undervaccinated for 3 or 4 doses of vaccine were about 18 times and about 28 times more likely, respectively, to be diagnosed with pertussis than age-appropriately vaccinated children. http://jama.md/1ex8ZQk “Sausage Making” in Clinical Research Clinicaltrials.gov, the database created to increase transparency in clinical research, is shining an unflattering light on how data are compiled and published. No one anticipated the role of clinicaltrials.gov “as a window into the sausage factory,” said Deborah Zarin, MD, director of clinicaltrials.gov, which is run by the US National Library of Medicine. Reviews of the database have shown reporting errors, typos in journals, or intentional distortion of results to present more favorable findings in published studies. http://jama.md/17Wa4ds
For more on these stories and other medical news, visit http://newsatjama.jama.com.
JAMA December 11, 2013 Volume 310, Number 22
Copyright 2013 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a Karolinska Institutet University Library User on 05/25/2015
jama.com
cosmin4000/iStock.com
avoiding drug toxicity, and you need to do the basic metabolic panel when a patient comes in sick so you know his or her kidney function to adjust a medication dose appropriately,” said Levey. Another issue for Levey is that the ACP guidelines conflict with the recently released guidelines on the treatment of hypertension in patients with chronic kidney disease from Kidney Disease: Improving Global Outcomes (KDIGO), a Belgian
