User login
Katie Lennon is editor of MDedge's Family Practice News and Internal Medicine News. She has also served as editor of CHEST Physician; a staff writer for Financial Times publications; and a reporter for the Princeton Packet, Ocean County Observer, and South Bend Tribune. She is a graduate of the University of Notre Dame, South Bend, Ind. Follow her on Twitter @KatieWLennon.
USPSTF silent on iron supplementation in pregnancy
The U.S. Preventive Services Task Force announced, in a recommendation on Sept. 7, that it is unsure whether pregnant women who are asymptomatic for iron deficiency anemia should be screened for this condition or take iron supplements.
The recommendation is an update to the 2006 USPSTF recommendation, which also expressed uncertainty on whether iron supplementation is beneficial to pregnant women.
“Both the 2006 and the current recommendation statements found insufficient evidence to determine the balance of the benefits and harms of iron supplementation during pregnancy,” Dr. Albert L. Siu wrote on behalf of members of the USPSTF.
The 2006 recommendation differed from the current one in that it had advocated for routine screening for iron deficiency anemia in pregnant women.
“In its review of the evidence to update the 2006 recommendation, the USPSTF found no good- or fair-quality studies on the benefits or harms of screening that would be applicable to the current U.S. population of pregnant women,” according to the task force recommendation statement published in the Annals of Internal Medicine.
The USPSTF based the updated recommendation on a systematic evidence review, which focused on whether pregnant women and adolescents’ use of oral iron supplementation or treatment was associated with changes in iron status and improvement in maternal and infant health outcomes. It reviewed “studies conducted in settings similar to the United States in rates of malnutrition, hemoparasite burden, and general socioeconomic status.”
The USPSTF’s review included 12 “good- or fair-quality randomized controlled trials,” which evaluated the effects of iron supplementation on various maternal hematologic indexes, including hemoglobin level, serum ferritin level, anemia, iron deficiency, and iron deficiency anemia.
Eight of the studies reported maternal hemoglobin levels at term or delivery, with six of the studies having reported a significantly higher mean hemoglobin level in the supplemented groups than in the control groups (122-139 g/L vs. 115-128 g/L, respectively). Seven studies reported serum ferritin levels at term or delivery, with five of these having reported a significantly higher ferritin level in the supplemented groups, compared with the control groups (12.0-30.0 mcg/L vs. 6.2-24.9 mcg/L, respectively).
“Although adequate evidence shows that [iron] supplementation increases hemoglobin and ferritin levels, the evidence is unclear on whether this increase leads to an improvement in maternal and fetal outcomes. In most of these studies, the supplemented groups had higher mean hemoglobin levels than the nonsupplemented groups; however, both groups reported values within normal limits,” the USPSTF wrote.
Research on the harmful effects of iron supplementation in pregnant women better addressed the USPSTF’s questions; 10 of the trials showed that the harms of iron supplementation during pregnancy were “small to none,” with most of the harms reported having been nausea, constipation, and diarrhea.
While the USPSTF found adequate evidence about the lack of harm from iron supplementation, it failed to find adequate evidence on the benefits of supplementation.
“Reported benefits of supplementation were limited to intermediate outcomes (maternal hematologic indexes), and evidence on the benefits of supplementation on maternal and infant health outcomes was inadequate because of inconsistent results and underpowered studies,” the USPSTF wrote.
The group found less research on the outcomes of screening for iron deficiency anemia in asymptomatic pregnant women and adolescents. “No good- or fair quality studies were found that evaluated the benefits or harms of screening in this population,” according to the recommendation.
The USPSTF concluded that the “current evidence is insufficient to assess the balance of benefits and harms of screening for iron deficiency anemia in pregnant women … [and] of routine iron supplementation for pregnant women to prevent adverse maternal health and birth outcomes.”
Read the full recommendation in Annals of Internal Medicine (doi: 10.7326/M15-1707).
The U.S. Preventive Services Task Force announced, in a recommendation on Sept. 7, that it is unsure whether pregnant women who are asymptomatic for iron deficiency anemia should be screened for this condition or take iron supplements.
The recommendation is an update to the 2006 USPSTF recommendation, which also expressed uncertainty on whether iron supplementation is beneficial to pregnant women.
“Both the 2006 and the current recommendation statements found insufficient evidence to determine the balance of the benefits and harms of iron supplementation during pregnancy,” Dr. Albert L. Siu wrote on behalf of members of the USPSTF.
The 2006 recommendation differed from the current one in that it had advocated for routine screening for iron deficiency anemia in pregnant women.
“In its review of the evidence to update the 2006 recommendation, the USPSTF found no good- or fair-quality studies on the benefits or harms of screening that would be applicable to the current U.S. population of pregnant women,” according to the task force recommendation statement published in the Annals of Internal Medicine.
The USPSTF based the updated recommendation on a systematic evidence review, which focused on whether pregnant women and adolescents’ use of oral iron supplementation or treatment was associated with changes in iron status and improvement in maternal and infant health outcomes. It reviewed “studies conducted in settings similar to the United States in rates of malnutrition, hemoparasite burden, and general socioeconomic status.”
The USPSTF’s review included 12 “good- or fair-quality randomized controlled trials,” which evaluated the effects of iron supplementation on various maternal hematologic indexes, including hemoglobin level, serum ferritin level, anemia, iron deficiency, and iron deficiency anemia.
Eight of the studies reported maternal hemoglobin levels at term or delivery, with six of the studies having reported a significantly higher mean hemoglobin level in the supplemented groups than in the control groups (122-139 g/L vs. 115-128 g/L, respectively). Seven studies reported serum ferritin levels at term or delivery, with five of these having reported a significantly higher ferritin level in the supplemented groups, compared with the control groups (12.0-30.0 mcg/L vs. 6.2-24.9 mcg/L, respectively).
“Although adequate evidence shows that [iron] supplementation increases hemoglobin and ferritin levels, the evidence is unclear on whether this increase leads to an improvement in maternal and fetal outcomes. In most of these studies, the supplemented groups had higher mean hemoglobin levels than the nonsupplemented groups; however, both groups reported values within normal limits,” the USPSTF wrote.
Research on the harmful effects of iron supplementation in pregnant women better addressed the USPSTF’s questions; 10 of the trials showed that the harms of iron supplementation during pregnancy were “small to none,” with most of the harms reported having been nausea, constipation, and diarrhea.
While the USPSTF found adequate evidence about the lack of harm from iron supplementation, it failed to find adequate evidence on the benefits of supplementation.
“Reported benefits of supplementation were limited to intermediate outcomes (maternal hematologic indexes), and evidence on the benefits of supplementation on maternal and infant health outcomes was inadequate because of inconsistent results and underpowered studies,” the USPSTF wrote.
The group found less research on the outcomes of screening for iron deficiency anemia in asymptomatic pregnant women and adolescents. “No good- or fair quality studies were found that evaluated the benefits or harms of screening in this population,” according to the recommendation.
The USPSTF concluded that the “current evidence is insufficient to assess the balance of benefits and harms of screening for iron deficiency anemia in pregnant women … [and] of routine iron supplementation for pregnant women to prevent adverse maternal health and birth outcomes.”
Read the full recommendation in Annals of Internal Medicine (doi: 10.7326/M15-1707).
The U.S. Preventive Services Task Force announced, in a recommendation on Sept. 7, that it is unsure whether pregnant women who are asymptomatic for iron deficiency anemia should be screened for this condition or take iron supplements.
The recommendation is an update to the 2006 USPSTF recommendation, which also expressed uncertainty on whether iron supplementation is beneficial to pregnant women.
“Both the 2006 and the current recommendation statements found insufficient evidence to determine the balance of the benefits and harms of iron supplementation during pregnancy,” Dr. Albert L. Siu wrote on behalf of members of the USPSTF.
The 2006 recommendation differed from the current one in that it had advocated for routine screening for iron deficiency anemia in pregnant women.
“In its review of the evidence to update the 2006 recommendation, the USPSTF found no good- or fair-quality studies on the benefits or harms of screening that would be applicable to the current U.S. population of pregnant women,” according to the task force recommendation statement published in the Annals of Internal Medicine.
The USPSTF based the updated recommendation on a systematic evidence review, which focused on whether pregnant women and adolescents’ use of oral iron supplementation or treatment was associated with changes in iron status and improvement in maternal and infant health outcomes. It reviewed “studies conducted in settings similar to the United States in rates of malnutrition, hemoparasite burden, and general socioeconomic status.”
The USPSTF’s review included 12 “good- or fair-quality randomized controlled trials,” which evaluated the effects of iron supplementation on various maternal hematologic indexes, including hemoglobin level, serum ferritin level, anemia, iron deficiency, and iron deficiency anemia.
Eight of the studies reported maternal hemoglobin levels at term or delivery, with six of the studies having reported a significantly higher mean hemoglobin level in the supplemented groups than in the control groups (122-139 g/L vs. 115-128 g/L, respectively). Seven studies reported serum ferritin levels at term or delivery, with five of these having reported a significantly higher ferritin level in the supplemented groups, compared with the control groups (12.0-30.0 mcg/L vs. 6.2-24.9 mcg/L, respectively).
“Although adequate evidence shows that [iron] supplementation increases hemoglobin and ferritin levels, the evidence is unclear on whether this increase leads to an improvement in maternal and fetal outcomes. In most of these studies, the supplemented groups had higher mean hemoglobin levels than the nonsupplemented groups; however, both groups reported values within normal limits,” the USPSTF wrote.
Research on the harmful effects of iron supplementation in pregnant women better addressed the USPSTF’s questions; 10 of the trials showed that the harms of iron supplementation during pregnancy were “small to none,” with most of the harms reported having been nausea, constipation, and diarrhea.
While the USPSTF found adequate evidence about the lack of harm from iron supplementation, it failed to find adequate evidence on the benefits of supplementation.
“Reported benefits of supplementation were limited to intermediate outcomes (maternal hematologic indexes), and evidence on the benefits of supplementation on maternal and infant health outcomes was inadequate because of inconsistent results and underpowered studies,” the USPSTF wrote.
The group found less research on the outcomes of screening for iron deficiency anemia in asymptomatic pregnant women and adolescents. “No good- or fair quality studies were found that evaluated the benefits or harms of screening in this population,” according to the recommendation.
The USPSTF concluded that the “current evidence is insufficient to assess the balance of benefits and harms of screening for iron deficiency anemia in pregnant women … [and] of routine iron supplementation for pregnant women to prevent adverse maternal health and birth outcomes.”
Read the full recommendation in Annals of Internal Medicine (doi: 10.7326/M15-1707).
FROM ANNALS OF INTERNAL MEDICINE
Study: Bipolar mothers’ interaction with infants weaker than unipolar mothers’
Maternal-infant interaction was worse when mothers had bipolar depression, compared with when mothers had unipolar depression or no depression, according to a study.
The study’s participants included 40 women with bipolar disorder, 50 women with a unipolar major depressive disorder, and 40 women without a major mood disorder. Researchers observed and videotaped the mothers interacting with their babies, when the mothers were 12 months post partum. Four research assistants separately assessed the interactions of each mother-baby pair, using the following four observational instruments: the Ainsworth Maternal Sensitivity Scale (AMSS), the Maternal Behavior Q-Sort (MBQS), the Dyadic Mini Code (DMC), and the Child-Caregiver Mutual Regulation Scale (CCMR). The research assistants were unaware of each mother’s depression and treatment statuses.
Women with bipolar disorder had lower scores related to maternal-infant interaction on the AMSS, DMC, and MBQS, compared with women without depression or with unipolar depression. Measures of maternal sensitivity (AMSS, MBQS) and maternal-infant synchrony (DMC) also were lower in the women with bipolar depression.
“Although there was a trend for measures of both maternal sensitivity (especially the AMSS) and maternal-infant synchrony to be lower in women with bipolar depression, the differences were not significant,” reported M. Cynthia Logsdon, Ph.D., of the University of Louisville (Ky.), and her colleagues.
Studies on maternal-infant interaction at earlier postpartum periods are needed, according to the researchers.
Read the full study here: (Appl Nurs Res. 2015;28:381-3. doi:10.1016/j.apnr.2015.01.012).
Maternal-infant interaction was worse when mothers had bipolar depression, compared with when mothers had unipolar depression or no depression, according to a study.
The study’s participants included 40 women with bipolar disorder, 50 women with a unipolar major depressive disorder, and 40 women without a major mood disorder. Researchers observed and videotaped the mothers interacting with their babies, when the mothers were 12 months post partum. Four research assistants separately assessed the interactions of each mother-baby pair, using the following four observational instruments: the Ainsworth Maternal Sensitivity Scale (AMSS), the Maternal Behavior Q-Sort (MBQS), the Dyadic Mini Code (DMC), and the Child-Caregiver Mutual Regulation Scale (CCMR). The research assistants were unaware of each mother’s depression and treatment statuses.
Women with bipolar disorder had lower scores related to maternal-infant interaction on the AMSS, DMC, and MBQS, compared with women without depression or with unipolar depression. Measures of maternal sensitivity (AMSS, MBQS) and maternal-infant synchrony (DMC) also were lower in the women with bipolar depression.
“Although there was a trend for measures of both maternal sensitivity (especially the AMSS) and maternal-infant synchrony to be lower in women with bipolar depression, the differences were not significant,” reported M. Cynthia Logsdon, Ph.D., of the University of Louisville (Ky.), and her colleagues.
Studies on maternal-infant interaction at earlier postpartum periods are needed, according to the researchers.
Read the full study here: (Appl Nurs Res. 2015;28:381-3. doi:10.1016/j.apnr.2015.01.012).
Maternal-infant interaction was worse when mothers had bipolar depression, compared with when mothers had unipolar depression or no depression, according to a study.
The study’s participants included 40 women with bipolar disorder, 50 women with a unipolar major depressive disorder, and 40 women without a major mood disorder. Researchers observed and videotaped the mothers interacting with their babies, when the mothers were 12 months post partum. Four research assistants separately assessed the interactions of each mother-baby pair, using the following four observational instruments: the Ainsworth Maternal Sensitivity Scale (AMSS), the Maternal Behavior Q-Sort (MBQS), the Dyadic Mini Code (DMC), and the Child-Caregiver Mutual Regulation Scale (CCMR). The research assistants were unaware of each mother’s depression and treatment statuses.
Women with bipolar disorder had lower scores related to maternal-infant interaction on the AMSS, DMC, and MBQS, compared with women without depression or with unipolar depression. Measures of maternal sensitivity (AMSS, MBQS) and maternal-infant synchrony (DMC) also were lower in the women with bipolar depression.
“Although there was a trend for measures of both maternal sensitivity (especially the AMSS) and maternal-infant synchrony to be lower in women with bipolar depression, the differences were not significant,” reported M. Cynthia Logsdon, Ph.D., of the University of Louisville (Ky.), and her colleagues.
Studies on maternal-infant interaction at earlier postpartum periods are needed, according to the researchers.
Read the full study here: (Appl Nurs Res. 2015;28:381-3. doi:10.1016/j.apnr.2015.01.012).
FROM APPLIED NURSING RESEARCH
Genetically lowered vitamin D levels linked to MS risk
Genetically reduced vitamin D levels were “strongly associated” with increased risk of multiple sclerosis (MS) in a study of European populations.
The researchers used patients’ levels of 25-hydroxyvitamin D (25OHD) to determine genetically reduced vitamin D levels. They conducted a Mendelian randomization study “to describe the effect of genetically lowered 25OHD on the odds of MS in the International Multiple Sclerosis Genetics Consortium study,” which comprised 14,498 MS patients and 24,091 healthy controls.
“Each genetically determined one-standard-deviation decrease in log-transformed 25OHD level conferred a twofold increase in the odds of MS (95% confidence interval; 1.7-2.5; P = 7.7 X 10-12; I2 = 63%, 95% CI: 0-88%),” according to Dr. J. Brent Richards of McGill University, Montreal, and his colleagues. This provided “strong evidence” that vitamin D played “a causal role” in the patients’ susceptibility to MS.
“Whether vitamin D sufficiency can delay, or prevent, MS onset merits further investigation in long-term randomized controlled trials,” the researchers wrote.
Read the full study in PLOS Medicine (doi:10.1371/journal.pmed.1001866).
Genetically reduced vitamin D levels were “strongly associated” with increased risk of multiple sclerosis (MS) in a study of European populations.
The researchers used patients’ levels of 25-hydroxyvitamin D (25OHD) to determine genetically reduced vitamin D levels. They conducted a Mendelian randomization study “to describe the effect of genetically lowered 25OHD on the odds of MS in the International Multiple Sclerosis Genetics Consortium study,” which comprised 14,498 MS patients and 24,091 healthy controls.
“Each genetically determined one-standard-deviation decrease in log-transformed 25OHD level conferred a twofold increase in the odds of MS (95% confidence interval; 1.7-2.5; P = 7.7 X 10-12; I2 = 63%, 95% CI: 0-88%),” according to Dr. J. Brent Richards of McGill University, Montreal, and his colleagues. This provided “strong evidence” that vitamin D played “a causal role” in the patients’ susceptibility to MS.
“Whether vitamin D sufficiency can delay, or prevent, MS onset merits further investigation in long-term randomized controlled trials,” the researchers wrote.
Read the full study in PLOS Medicine (doi:10.1371/journal.pmed.1001866).
Genetically reduced vitamin D levels were “strongly associated” with increased risk of multiple sclerosis (MS) in a study of European populations.
The researchers used patients’ levels of 25-hydroxyvitamin D (25OHD) to determine genetically reduced vitamin D levels. They conducted a Mendelian randomization study “to describe the effect of genetically lowered 25OHD on the odds of MS in the International Multiple Sclerosis Genetics Consortium study,” which comprised 14,498 MS patients and 24,091 healthy controls.
“Each genetically determined one-standard-deviation decrease in log-transformed 25OHD level conferred a twofold increase in the odds of MS (95% confidence interval; 1.7-2.5; P = 7.7 X 10-12; I2 = 63%, 95% CI: 0-88%),” according to Dr. J. Brent Richards of McGill University, Montreal, and his colleagues. This provided “strong evidence” that vitamin D played “a causal role” in the patients’ susceptibility to MS.
“Whether vitamin D sufficiency can delay, or prevent, MS onset merits further investigation in long-term randomized controlled trials,” the researchers wrote.
Read the full study in PLOS Medicine (doi:10.1371/journal.pmed.1001866).
FROM PLOS MEDICINE