Preconception care of diabetes; glycemic control prevents congenital anomalies

Article Abstract:

Birth defects develop in approximately 2 percent of all pregnancies, but affect between 4 percent and 12 percent of infants whose mothers have overt diabetes. Previous studies have found that the frequency of birth defects declined as the mother's diabetes was more closely monitored during pregnancy. This study began intervention before pregnancy and continued close management throughout to see if the relatively high rate of defects could be lowered among these infants. Eighty-four diabetic women began preconception training and treatment; at the same time, 110 women who were already 6 to 32 weeks pregnant, registered for the program. All the women were told of the possible complications, taught to monitor their glucose levels and adjust their insulin dose, and were given an individualized eating and exercise regimen. There was only one major defect among infants born to mothers in the preconception group (1.2 percent), but there were 12 major defects among the postconception infants (10.9 percent), even though the glycemic (blood sugar) level was rapidly controlled after the mothers entered the program. This study confirms results of previous studies, which suggest that controlling the glycemic level before and during pregnancy reduces the frequency of birth defects among infants of diabetic mothers to an incidence comparable to that in the nondiabetic population. Animal studies have found that other serum factors are implicated as a cause of birth defects in the infants of diabetic mothers and that the vulnerable period for the fetus is between 19 and 24 days after conception (which is the earliest pregnancy can be detected). Education and management of diabetes should begin before conception to prevent birth defects; treatment should aim for near normalization of blood sugar levels. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Research, Complications and side effects, Diabetes in pregnancy, Gestational diabetes

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Preconception care: risk reduction and health promotion in preparation for pregnancy

Article Abstract:

The state of a woman's health before she becomes pregnant has important effects on the outcome of the pregnancy, and reduction of reproductive risks through 'preconception care' is a health care priority, endorsed by the US Public Health Service Expert Panel on the Content of Prenatal Care. Preconception care includes risk assessment and health promotion. Risks may include individual or social conditions that could lead to problems during pregnancy, or they may be health or psychological problems. Health promotion is conducted through counseling patients regarding available services and the importance of prenatal care, and through providing advice about family planning and ongoing medical care. Interventions can be specific medical treatments, referral to other practitioners, immunization, or the provision of services as needed. Problems such as drug or alcohol abuse, obesity, or anorexia nervosa (an eating disorder associated with extreme weight loss) can be identified. If needed, genetic counseling should begin before a couple attempts to conceive. Preconception care can be delivered by family planning clinics, prepregnancy clinics, or as part of regular primary care. Obstacles to this approach include the difficulty of attracting high-risk women to such programs; the lack of coordination among services that already exist; the lack of treatment for many high-risk behaviors, such as poor nutrition or substance abuse; and inadequate funding for risk assessment and health promotion. Presently, comprehensive preconception services cannot be provided in most communities for these reasons. It is also not known whether starting certain treatments before pregnancy, as opposed to in early pregnancy, confers any significant advantage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Pregnancy, Complications of, Pregnancy complications, Maternal health services

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Routine antimicrobial treatment of acute otitis media: is it necessary?

Article Abstract:

Physicians should consider withholding antibiotic treatment for otitis media unless the infection worsens during the first three days. Otitis media is a middle ear infection and it accounts for the most antibiotic prescriptions among young children. However, there is little evidence that antibiotics are effective in this condition and inappropriate antibiotic use has been linked to drug-resistant bacteria. In 1990, the Netherlands instituted a policy of giving children painkillers for the first three days and antibiotics only if their condition worsened. Since then, Dutch children have fared as well as children who receive antibiotics.

Health aspects, Antibiotics, Drug therapy, Otitis media

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