Robin Turner

Gestational impaired glucose tolerance, defined by a single abnormal value at 1 hour during the oral glucose tolerance test, is associated with many of the same adverse outcomes as gestational diabetes mellitus, including postpartum glycemia, insulin resistance, and β-cell dysfunction, according to the results of a recent study.

Investigators evaluated metabolic function and outcomes in a cohort of more than 360 women stratified by glucose tolerance status during pregnancy. The participants underwent an antepartum glucose challenge test (GCT) and a 3-hour oral glucose tolerance test (OGTT), an assessment of obstetric outcome at delivery, and a metabolic characterization by OGTT at 3 months post partum.

The investigators identified five study groups: those with gestational diabetes mellitus (GDM), 1-hour gestational impaired glucose tolerance (GIGT), 2- or 3-hour GIGT, abnormal glucose challenge test (GCT) with normal glucose tolerance (NGT), and normal GCT with NGT (Diabetes Care 2008;31:1275–81). There were no significant differences among the groups with respect to mean age, smoking status, and parity.

The researchers noted the 1-hour GIGT group had adverse outcomes similar to the group with gestational diabetes mellitus, although the GIGT group did not have increased infant birth weight. The “Caesarian section rate was highest in the 1-hour GIGT group; there were no significant differences [among] the four non-GDM groups,” wrote Dr. Ravi Retnakaran of the Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, and his colleagues.

In addition, there were no significant differences among the four non-GDM groups with respect to length of gestation, infant sex, or Apgar scores.

At 3 months post partum, glycemic parameters progressively increased from normal glucose challenge test with normal glucose tolerance to abnormal glucose challenge test with normal glucose tolerance to 2- or 3-hour gestational impaired glucose tolerance to 1-hour GIGT to gestational diabetes mellitus. Insulin sensitivity and β-cell function progressively decreased across the groups in the same manner.

Participants in the normal GCT NGT group underwent the 3-hour oral glucose tolerance test at a median of 32 weeks' gestation, compared with a median of 29 weeks' gestation for the other four groups.

Gestational diabetes mellitus is a metabolically heterogeneous disorder, which could lead to a higher risk of developing type 2 diabetes in the years following pregnancy.

Short term, there is an increased risk of adverse obstetric outcomes related to fetal overgrowth and higher birth weight. Long term, women with a history of GDM have chronic insulin resistance and β-cell dysfunction.

One limitation of the current study is the relatively modest number of participants with GIGT (28), wrote Dr. Retnakaran and his colleagues. Still, they said the issue warrants further investigation, including long-term follow-up to determine the risk of type 2 diabetes and appropriate cost-benefit evaluation of postpartum care strategies.

Dr. Retnakaran also is in the division of endocrinology and metabolism at the University of Toronto.

The study was supported by a grant from the Canadian Institutes of Health Research.

Gestational impaired glucose tolerance, defined by a single abnormal value at 1 hour during the oral glucose tolerance test, is associated with many of the same adverse outcomes as gestational diabetes mellitus, including postpartum glycemia, insulin resistance, and β-cell dysfunction, according to the results of a recent study.

Investigators evaluated metabolic function and outcomes in a cohort of more than 360 women stratified by glucose tolerance status during pregnancy. The participants underwent an antepartum glucose challenge test (GCT) and a 3-hour oral glucose tolerance test (OGTT), an assessment of obstetric outcome at delivery, and a metabolic characterization by OGTT at 3 months post partum.

The investigators identified five study groups: those with gestational diabetes mellitus (GDM), 1-hour gestational impaired glucose tolerance (GIGT), 2- or 3-hour GIGT, abnormal glucose challenge test (GCT) with normal glucose tolerance (NGT), and normal GCT with NGT (Diabetes Care 2008;31:1275–81). There were no significant differences among the groups with respect to mean age, smoking status, and parity.

The researchers noted the 1-hour GIGT group had adverse outcomes similar to the group with gestational diabetes mellitus, although the GIGT group did not have increased infant birth weight. The “Caesarian section rate was highest in the 1-hour GIGT group; there were no significant differences [among] the four non-GDM groups,” wrote Dr. Ravi Retnakaran of the Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, and his colleagues.

In addition, there were no significant differences among the four non-GDM groups with respect to length of gestation, infant sex, or Apgar scores.

At 3 months post partum, glycemic parameters progressively increased from normal glucose challenge test with normal glucose tolerance to abnormal glucose challenge test with normal glucose tolerance to 2- or 3-hour gestational impaired glucose tolerance to 1-hour GIGT to gestational diabetes mellitus. Insulin sensitivity and β-cell function progressively decreased across the groups in the same manner.

Participants in the normal GCT NGT group underwent the 3-hour oral glucose tolerance test at a median of 32 weeks' gestation, compared with a median of 29 weeks' gestation for the other four groups.

Gestational diabetes mellitus is a metabolically heterogeneous disorder, which could lead to a higher risk of developing type 2 diabetes in the years following pregnancy.

Short term, there is an increased risk of adverse obstetric outcomes related to fetal overgrowth and higher birth weight. Long term, women with a history of GDM have chronic insulin resistance and β-cell dysfunction.

One limitation of the current study is the relatively modest number of participants with GIGT (28), wrote Dr. Retnakaran and his colleagues. Still, they said the issue warrants further investigation, including long-term follow-up to determine the risk of type 2 diabetes and appropriate cost-benefit evaluation of postpartum care strategies.

Dr. Retnakaran also is in the division of endocrinology and metabolism at the University of Toronto.

The study was supported by a grant from the Canadian Institutes of Health Research.

Gestational impaired glucose tolerance, defined by a single abnormal value at 1 hour during the oral glucose tolerance test, is associated with many of the same adverse outcomes as gestational diabetes mellitus, including postpartum glycemia, insulin resistance, and β-cell dysfunction, according to the results of a recent study.

Investigators evaluated metabolic function and outcomes in a cohort of more than 360 women stratified by glucose tolerance status during pregnancy. The participants underwent an antepartum glucose challenge test (GCT) and a 3-hour oral glucose tolerance test (OGTT), an assessment of obstetric outcome at delivery, and a metabolic characterization by OGTT at 3 months post partum.

The investigators identified five study groups: those with gestational diabetes mellitus (GDM), 1-hour gestational impaired glucose tolerance (GIGT), 2- or 3-hour GIGT, abnormal glucose challenge test (GCT) with normal glucose tolerance (NGT), and normal GCT with NGT (Diabetes Care 2008;31:1275–81). There were no significant differences among the groups with respect to mean age, smoking status, and parity.

The researchers noted the 1-hour GIGT group had adverse outcomes similar to the group with gestational diabetes mellitus, although the GIGT group did not have increased infant birth weight. The “Caesarian section rate was highest in the 1-hour GIGT group; there were no significant differences [among] the four non-GDM groups,” wrote Dr. Ravi Retnakaran of the Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, and his colleagues.

In addition, there were no significant differences among the four non-GDM groups with respect to length of gestation, infant sex, or Apgar scores.

At 3 months post partum, glycemic parameters progressively increased from normal glucose challenge test with normal glucose tolerance to abnormal glucose challenge test with normal glucose tolerance to 2- or 3-hour gestational impaired glucose tolerance to 1-hour GIGT to gestational diabetes mellitus. Insulin sensitivity and β-cell function progressively decreased across the groups in the same manner.

Participants in the normal GCT NGT group underwent the 3-hour oral glucose tolerance test at a median of 32 weeks' gestation, compared with a median of 29 weeks' gestation for the other four groups.

Gestational diabetes mellitus is a metabolically heterogeneous disorder, which could lead to a higher risk of developing type 2 diabetes in the years following pregnancy.

Short term, there is an increased risk of adverse obstetric outcomes related to fetal overgrowth and higher birth weight. Long term, women with a history of GDM have chronic insulin resistance and β-cell dysfunction.

One limitation of the current study is the relatively modest number of participants with GIGT (28), wrote Dr. Retnakaran and his colleagues. Still, they said the issue warrants further investigation, including long-term follow-up to determine the risk of type 2 diabetes and appropriate cost-benefit evaluation of postpartum care strategies.

Dr. Retnakaran also is in the division of endocrinology and metabolism at the University of Toronto.

The study was supported by a grant from the Canadian Institutes of Health Research.

Facial resurfacing using a CO₂ laser is a safe and effective treatment for rhytids demonstrating long-term results, according to a retrospective study of 47 patients who underwent an entire facial resurfacing procedure.

Dr. Shan R. Baker of the department of otolaryngology-head and neck surgery at the University of Michigan, Ann Arbor, performed the procedure from December 1996 to December 2004 using a commercially available CO₂ laser to assess long-term effects and complications of full-face CO₂ laser resurfacing. Particular attention was given to the incidence of hypopigmentation that was evident by photographic review, according to Dr. Baker and Dr. P. Daniel Ward, also of the university (Arch. Facial Plast. Surg. 2008;10:238–43).

Sixty-two patients who underwent entire facial laser resurfacing initially were identified. Complete data were available in 46 patients with Fitzpatrick skin types I, II, or III and 1 with skin type IV. The mean follow-up was 2.3 years. Many of the patients had other procedures at the time of the resurfacing, including dermabrasion, blepharoplasty, brow lift, and rhytidectomy.

The mean improvement in facial rhytid score was 45%, according to the researchers.

Reported complications included milia or acne in 14 cases (30%), hyperpigmentation in 8 cases (17%), hypopigmentation in 6 cases (13%), infection in 1 case (2%), and ectropion in 1 case (2%). The only complications present after 1 year of follow-up were six cases of hypopigmentation and one case of hyperpigmentation. Postprocedure hyperpigmentation was treated with topical hydroquinone. The case of persistent hyperpigmentation at the 1-year follow-up had resolution within 2 years of the procedure.

Patient response to treatment was assessed by comparing the mean improvement in rhytid scores with and without hypopigmentation. The researchers noted that patients with hypopigmentation had a greater response to treatment, with 73.9% mean improvement, than did patients who did not develop hypopigmentation (41.8% mean improvement), a statistically significant difference.

The researchers, who had no conflicts to report, said the results confirm previous studies that found CO₂ laser resurfacing leads to long-term improvement in facial rhytidosis.

Facial resurfacing using a CO₂ laser is a safe and effective treatment for rhytids demonstrating long-term results, according to a retrospective study of 47 patients who underwent an entire facial resurfacing procedure.

Dr. Shan R. Baker of the department of otolaryngology-head and neck surgery at the University of Michigan, Ann Arbor, performed the procedure from December 1996 to December 2004 using a commercially available CO₂ laser to assess long-term effects and complications of full-face CO₂ laser resurfacing. Particular attention was given to the incidence of hypopigmentation that was evident by photographic review, according to Dr. Baker and Dr. P. Daniel Ward, also of the university (Arch. Facial Plast. Surg. 2008;10:238–43).

Sixty-two patients who underwent entire facial laser resurfacing initially were identified. Complete data were available in 46 patients with Fitzpatrick skin types I, II, or III and 1 with skin type IV. The mean follow-up was 2.3 years. Many of the patients had other procedures at the time of the resurfacing, including dermabrasion, blepharoplasty, brow lift, and rhytidectomy.

The mean improvement in facial rhytid score was 45%, according to the researchers.

Reported complications included milia or acne in 14 cases (30%), hyperpigmentation in 8 cases (17%), hypopigmentation in 6 cases (13%), infection in 1 case (2%), and ectropion in 1 case (2%). The only complications present after 1 year of follow-up were six cases of hypopigmentation and one case of hyperpigmentation. Postprocedure hyperpigmentation was treated with topical hydroquinone. The case of persistent hyperpigmentation at the 1-year follow-up had resolution within 2 years of the procedure.

Patient response to treatment was assessed by comparing the mean improvement in rhytid scores with and without hypopigmentation. The researchers noted that patients with hypopigmentation had a greater response to treatment, with 73.9% mean improvement, than did patients who did not develop hypopigmentation (41.8% mean improvement), a statistically significant difference.

The researchers, who had no conflicts to report, said the results confirm previous studies that found CO₂ laser resurfacing leads to long-term improvement in facial rhytidosis.

Facial resurfacing using a CO₂ laser is a safe and effective treatment for rhytids demonstrating long-term results, according to a retrospective study of 47 patients who underwent an entire facial resurfacing procedure.

Dr. Shan R. Baker of the department of otolaryngology-head and neck surgery at the University of Michigan, Ann Arbor, performed the procedure from December 1996 to December 2004 using a commercially available CO₂ laser to assess long-term effects and complications of full-face CO₂ laser resurfacing. Particular attention was given to the incidence of hypopigmentation that was evident by photographic review, according to Dr. Baker and Dr. P. Daniel Ward, also of the university (Arch. Facial Plast. Surg. 2008;10:238–43).

Sixty-two patients who underwent entire facial laser resurfacing initially were identified. Complete data were available in 46 patients with Fitzpatrick skin types I, II, or III and 1 with skin type IV. The mean follow-up was 2.3 years. Many of the patients had other procedures at the time of the resurfacing, including dermabrasion, blepharoplasty, brow lift, and rhytidectomy.

The mean improvement in facial rhytid score was 45%, according to the researchers.

Reported complications included milia or acne in 14 cases (30%), hyperpigmentation in 8 cases (17%), hypopigmentation in 6 cases (13%), infection in 1 case (2%), and ectropion in 1 case (2%). The only complications present after 1 year of follow-up were six cases of hypopigmentation and one case of hyperpigmentation. Postprocedure hyperpigmentation was treated with topical hydroquinone. The case of persistent hyperpigmentation at the 1-year follow-up had resolution within 2 years of the procedure.

Patient response to treatment was assessed by comparing the mean improvement in rhytid scores with and without hypopigmentation. The researchers noted that patients with hypopigmentation had a greater response to treatment, with 73.9% mean improvement, than did patients who did not develop hypopigmentation (41.8% mean improvement), a statistically significant difference.

The researchers, who had no conflicts to report, said the results confirm previous studies that found CO₂ laser resurfacing leads to long-term improvement in facial rhytidosis.

Gestational impaired glucose tolerance, defined by a single abnormal value at 1 hour during the oral glucose tolerance test, is associated with many of the same adverse outcomes as gestational diabetes mellitus, including postpartum glycemia, insulin resistance, and b-cell dysfunction.

Investigators evaluated the obstetric outcomes of postpartum metabolic function in a cohort of more than 360 women stratified by glucose tolerance status during pregnancy. The women underwent an antepartum glucose challenge test (GCT) and a 3-hour oral glucose tolerance test (OGTT), an assessment of obstetric outcome at delivery, and a metabolic characterization by OGTT at 3 months post partum.

Five study groups were identified: those with gestational diabetes mellitus (GDM), 1-hour gestational impaired glucose tolerance (GIGT), 2- or 3-hour GIGT, abnormal glucose challenge test (GCT) with normal glucose tolerance (NGT), and normal GCT with NGT (Diabetes Care 2008;31:1275–81).

There were no significant differences among the groups with respect to mean age, smoking status, and parity.

The researchers noted the 1-hour GIGT group had adverse outcomes similar to the group with gestational diabetes mellitus, although the GIGT group did not have increased infant birth weight. The c-section rate was highest in the 1-hour GIGT group, but there were no significant differences among the four non-GDM groups, wrote Dr. Ravi Retnakaran of the Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, and the division of endocrinology and metabolism at the University of Toronto, and his colleagues. There were also no significant differences among the four non-GDM groups with respect to length of gestation, infant sex, or Apgar scores.

At 3 months post partum, glycemic parameters progressively increased from normal glucose challenge test with normal glucose tolerance to abnormal glucose challenge test with normal glucose tolerance to 2- or 3-hour gestational impaired glucose tolerance to 1-hour GIGT to gestational diabetes mellitus. Insulin sensitivity and β-cell function progressively decreased across the groups in the same manner.

Participants in the normal GCT NGT group underwent the 3-hour oral glucose tolerance test at a median of 32 weeks' gestation, compared with a median of 29 weeks' gestation for the other four groups.

One limitation of the current study was the small number of subjects with GIGT (28). Still, the authors said further investigation is warranted to determine the risk of type 2 diabetes and to conduct a cost-benefit evaluation of postpartum care strategies.

The study was supported by a grant from the Canadian Institutes of Health Research.

Gestational impaired glucose tolerance, defined by a single abnormal value at 1 hour during the oral glucose tolerance test, is associated with many of the same adverse outcomes as gestational diabetes mellitus, including postpartum glycemia, insulin resistance, and b-cell dysfunction.

Investigators evaluated the obstetric outcomes of postpartum metabolic function in a cohort of more than 360 women stratified by glucose tolerance status during pregnancy. The women underwent an antepartum glucose challenge test (GCT) and a 3-hour oral glucose tolerance test (OGTT), an assessment of obstetric outcome at delivery, and a metabolic characterization by OGTT at 3 months post partum.

Five study groups were identified: those with gestational diabetes mellitus (GDM), 1-hour gestational impaired glucose tolerance (GIGT), 2- or 3-hour GIGT, abnormal glucose challenge test (GCT) with normal glucose tolerance (NGT), and normal GCT with NGT (Diabetes Care 2008;31:1275–81).

There were no significant differences among the groups with respect to mean age, smoking status, and parity.

The researchers noted the 1-hour GIGT group had adverse outcomes similar to the group with gestational diabetes mellitus, although the GIGT group did not have increased infant birth weight. The c-section rate was highest in the 1-hour GIGT group, but there were no significant differences among the four non-GDM groups, wrote Dr. Ravi Retnakaran of the Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, and the division of endocrinology and metabolism at the University of Toronto, and his colleagues. There were also no significant differences among the four non-GDM groups with respect to length of gestation, infant sex, or Apgar scores.

At 3 months post partum, glycemic parameters progressively increased from normal glucose challenge test with normal glucose tolerance to abnormal glucose challenge test with normal glucose tolerance to 2- or 3-hour gestational impaired glucose tolerance to 1-hour GIGT to gestational diabetes mellitus. Insulin sensitivity and β-cell function progressively decreased across the groups in the same manner.

Participants in the normal GCT NGT group underwent the 3-hour oral glucose tolerance test at a median of 32 weeks' gestation, compared with a median of 29 weeks' gestation for the other four groups.

One limitation of the current study was the small number of subjects with GIGT (28). Still, the authors said further investigation is warranted to determine the risk of type 2 diabetes and to conduct a cost-benefit evaluation of postpartum care strategies.

The study was supported by a grant from the Canadian Institutes of Health Research.

Gestational impaired glucose tolerance, defined by a single abnormal value at 1 hour during the oral glucose tolerance test, is associated with many of the same adverse outcomes as gestational diabetes mellitus, including postpartum glycemia, insulin resistance, and b-cell dysfunction.

Investigators evaluated the obstetric outcomes of postpartum metabolic function in a cohort of more than 360 women stratified by glucose tolerance status during pregnancy. The women underwent an antepartum glucose challenge test (GCT) and a 3-hour oral glucose tolerance test (OGTT), an assessment of obstetric outcome at delivery, and a metabolic characterization by OGTT at 3 months post partum.

Five study groups were identified: those with gestational diabetes mellitus (GDM), 1-hour gestational impaired glucose tolerance (GIGT), 2- or 3-hour GIGT, abnormal glucose challenge test (GCT) with normal glucose tolerance (NGT), and normal GCT with NGT (Diabetes Care 2008;31:1275–81).

There were no significant differences among the groups with respect to mean age, smoking status, and parity.

The researchers noted the 1-hour GIGT group had adverse outcomes similar to the group with gestational diabetes mellitus, although the GIGT group did not have increased infant birth weight. The c-section rate was highest in the 1-hour GIGT group, but there were no significant differences among the four non-GDM groups, wrote Dr. Ravi Retnakaran of the Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, and the division of endocrinology and metabolism at the University of Toronto, and his colleagues. There were also no significant differences among the four non-GDM groups with respect to length of gestation, infant sex, or Apgar scores.

At 3 months post partum, glycemic parameters progressively increased from normal glucose challenge test with normal glucose tolerance to abnormal glucose challenge test with normal glucose tolerance to 2- or 3-hour gestational impaired glucose tolerance to 1-hour GIGT to gestational diabetes mellitus. Insulin sensitivity and β-cell function progressively decreased across the groups in the same manner.

Participants in the normal GCT NGT group underwent the 3-hour oral glucose tolerance test at a median of 32 weeks' gestation, compared with a median of 29 weeks' gestation for the other four groups.

One limitation of the current study was the small number of subjects with GIGT (28). Still, the authors said further investigation is warranted to determine the risk of type 2 diabetes and to conduct a cost-benefit evaluation of postpartum care strategies.

The study was supported by a grant from the Canadian Institutes of Health Research.

Physicians can take measures to mitigate the impact of climate change, the British Medical Association urged in an online report.

Rising temperatures, changing sea levels, and extreme weather patterns have resulted in a broad range of climate change that has affected all countries, especially developing nations. The results include a range of consequences from economic development to the transmission patterns of communicable diseases.

The BMA said the purpose of its report is to highlight practical actions that health professionals and health organizations can take to “reduce their carbon footprint and to protect and promote the health of the public.”

Specifically, climate change will result in an increase in water-borne infections and food-related illnesses, and will have acute consequences for health, according to the report.

If unaddressed, growing greenhouse emissions could contribute to more cancer, heart disease, obesity, diabetes, and osteoporosis.

Still, the BMA wrote, there are practical measures physicians can take to address climate change and to encourage environmental responsibility.

Those measures include:

▸ Unplugging electrical appliances when not in use.

▸ Reducing heat and air-conditioning.

▸ Minimizing waste.

▸ Recycling items when possible and not oversupplying products that may reach their expiration date before use.

In addition, physicians are urged to opt for spray faucets to conserve water, and they should convert their toilets to models that have more efficient systems for flushing.

Health care providers also should report or repair leaks and make use of natural ventilation in their offices.

The report also promotes the use of teleconferences, electronic communication with patients and other physicians, and a shift to electronic health records to avoid unnecessary printouts.

For a copy of the full report and other recommendations for reducing one's carbon footprint, go to http://www.bma.org.uk/ap.nsf/Content/climatechange~climatechangerecommendations

Physicians can take measures to mitigate the impact of climate change, the British Medical Association urged in an online report.

Rising temperatures, changing sea levels, and extreme weather patterns have resulted in a broad range of climate change that has affected all countries, especially developing nations. The results include a range of consequences from economic development to the transmission patterns of communicable diseases.

The BMA said the purpose of its report is to highlight practical actions that health professionals and health organizations can take to “reduce their carbon footprint and to protect and promote the health of the public.”

Specifically, climate change will result in an increase in water-borne infections and food-related illnesses, and will have acute consequences for health, according to the report.

If unaddressed, growing greenhouse emissions could contribute to more cancer, heart disease, obesity, diabetes, and osteoporosis.

Still, the BMA wrote, there are practical measures physicians can take to address climate change and to encourage environmental responsibility.

Those measures include:

▸ Unplugging electrical appliances when not in use.

▸ Reducing heat and air-conditioning.

▸ Minimizing waste.

▸ Recycling items when possible and not oversupplying products that may reach their expiration date before use.

In addition, physicians are urged to opt for spray faucets to conserve water, and they should convert their toilets to models that have more efficient systems for flushing.

Health care providers also should report or repair leaks and make use of natural ventilation in their offices.

The report also promotes the use of teleconferences, electronic communication with patients and other physicians, and a shift to electronic health records to avoid unnecessary printouts.

For a copy of the full report and other recommendations for reducing one's carbon footprint, go to http://www.bma.org.uk/ap.nsf/Content/climatechange~climatechangerecommendations

Physicians can take measures to mitigate the impact of climate change, the British Medical Association urged in an online report.

Rising temperatures, changing sea levels, and extreme weather patterns have resulted in a broad range of climate change that has affected all countries, especially developing nations. The results include a range of consequences from economic development to the transmission patterns of communicable diseases.

The BMA said the purpose of its report is to highlight practical actions that health professionals and health organizations can take to “reduce their carbon footprint and to protect and promote the health of the public.”

Specifically, climate change will result in an increase in water-borne infections and food-related illnesses, and will have acute consequences for health, according to the report.

If unaddressed, growing greenhouse emissions could contribute to more cancer, heart disease, obesity, diabetes, and osteoporosis.

Still, the BMA wrote, there are practical measures physicians can take to address climate change and to encourage environmental responsibility.

Those measures include:

▸ Unplugging electrical appliances when not in use.

▸ Reducing heat and air-conditioning.

▸ Minimizing waste.

▸ Recycling items when possible and not oversupplying products that may reach their expiration date before use.

In addition, physicians are urged to opt for spray faucets to conserve water, and they should convert their toilets to models that have more efficient systems for flushing.

Health care providers also should report or repair leaks and make use of natural ventilation in their offices.

The report also promotes the use of teleconferences, electronic communication with patients and other physicians, and a shift to electronic health records to avoid unnecessary printouts.

For a copy of the full report and other recommendations for reducing one's carbon footprint, go to http://www.bma.org.uk/ap.nsf/Content/climatechange~climatechangerecommendations

Men and women who were delivered in breech presentation have more than twice the risk of having their firstborn children delivered in breech position, according to a study published online in BMJ.

A population-based study by researchers at the University of Bergen, Norway, found the intergenerational recurrence risk of breech delivery in offspring was equally high when transmitted through fathers and mothers.

Tone Irene Nordtveit, a Ph.D. student, and colleagues cited genetic inheritance predominantly through the fetus as a factor in the observed pattern of familial predisposition to breech delivery at term. Breech delivery is associated with significantly increased perinatal mortality and morbidity (BMJ 2008 [doi:10.1136/bmj.39505.436539.BE]).

The data were taken from the Medical Birth Registry of Norway, including all births reported from 1967 to 2004. In Norway, all live births and stillbirths of at least 16 weeks' gestation are registered, for a total of 2.2 million births.

Several factors are associated with an increased risk of breech delivery, such as older mother, first baby, and low gestational age and birth weight. But these account for one in seven of all breech births, according to the study. The researchers said the current findings are important because there are no data that show whether genes also could be a factor in breech delivery.

“A considerable number of breech presentations are not detected before labor, despite careful antenatal surveillance,” Ms. Nordtveit said in an interview. The proportion of undiagnosed breech deliveries at admission to hospital has been reported to be as high as 31%. “To avoid undiagnosed breech deliveries, information about the mother's and the father's own presentation at birth will be valuable in the evaluation of fetal presentation in the third trimester.”

The researchers linked the birth records of mothers and fathers by national identification numbers to birth records of their offspring, providing 451,393 generation files on mothers and their offspring and 295,253 records of fathers and their offspring. All births delivered in breech position were considered breech delivery, regardless of whether they involved elective or emergency cesarean section.

The researchers then excluded multiple pregnancies and infants who weighed less than 500 g in both generations and restricted the study to firstborn offspring in the second generation. As a result, the study had 232,704 mother-offspring units and 154,851 father-offspring units. All of the mothers and fathers were born during 1967–1986, and 98% of the second generation was born during 1987–2004. The proportion of breech births was 2.5% in 1967–1976, 3.0% in 1977–1986, 3.2% in 1987–1996, and 3.5% in 1997–2004.

Among 318,855 males and 301,438 females who were born in 1967–1976, 96.8% and 97.6%, respectively, lived to age 18 years. The mortality in those delivered in breech position was four times the mortality of those delivered in the cephalic presentation.

The highest risk of recurrence of breech delivery was seen in babies of firstborn men and women who themselves were delivered in breech position at term, with an odds ratio of 2.2.

The strongest risks were found for vaginally delivered offspring and were equally strong for men and women. There was no recurrence between generations for men and women born preterm. The prevalence of breech presentation is 15% at 29–32 weeks' gestation and 3%–4% at term.

Men delivered in breech presentation seem to carry genes predisposing to breech delivery that are transferred to their offspring, increasing their partners' risk of breech deliveries. Fetal genes also can be transmitted from women delivered in breech, according to the study.

The researchers said they had no conflict to report.

Men and women who were delivered in breech presentation have more than twice the risk of having their firstborn children delivered in breech position, according to a study published online in BMJ.

A population-based study by researchers at the University of Bergen, Norway, found the intergenerational recurrence risk of breech delivery in offspring was equally high when transmitted through fathers and mothers.

Tone Irene Nordtveit, a Ph.D. student, and colleagues cited genetic inheritance predominantly through the fetus as a factor in the observed pattern of familial predisposition to breech delivery at term. Breech delivery is associated with significantly increased perinatal mortality and morbidity (BMJ 2008 [doi:10.1136/bmj.39505.436539.BE]).

The data were taken from the Medical Birth Registry of Norway, including all births reported from 1967 to 2004. In Norway, all live births and stillbirths of at least 16 weeks' gestation are registered, for a total of 2.2 million births.

Several factors are associated with an increased risk of breech delivery, such as older mother, first baby, and low gestational age and birth weight. But these account for one in seven of all breech births, according to the study. The researchers said the current findings are important because there are no data that show whether genes also could be a factor in breech delivery.

“A considerable number of breech presentations are not detected before labor, despite careful antenatal surveillance,” Ms. Nordtveit said in an interview. The proportion of undiagnosed breech deliveries at admission to hospital has been reported to be as high as 31%. “To avoid undiagnosed breech deliveries, information about the mother's and the father's own presentation at birth will be valuable in the evaluation of fetal presentation in the third trimester.”

The researchers linked the birth records of mothers and fathers by national identification numbers to birth records of their offspring, providing 451,393 generation files on mothers and their offspring and 295,253 records of fathers and their offspring. All births delivered in breech position were considered breech delivery, regardless of whether they involved elective or emergency cesarean section.

The researchers then excluded multiple pregnancies and infants who weighed less than 500 g in both generations and restricted the study to firstborn offspring in the second generation. As a result, the study had 232,704 mother-offspring units and 154,851 father-offspring units. All of the mothers and fathers were born during 1967–1986, and 98% of the second generation was born during 1987–2004. The proportion of breech births was 2.5% in 1967–1976, 3.0% in 1977–1986, 3.2% in 1987–1996, and 3.5% in 1997–2004.

Among 318,855 males and 301,438 females who were born in 1967–1976, 96.8% and 97.6%, respectively, lived to age 18 years. The mortality in those delivered in breech position was four times the mortality of those delivered in the cephalic presentation.

The highest risk of recurrence of breech delivery was seen in babies of firstborn men and women who themselves were delivered in breech position at term, with an odds ratio of 2.2.

The strongest risks were found for vaginally delivered offspring and were equally strong for men and women. There was no recurrence between generations for men and women born preterm. The prevalence of breech presentation is 15% at 29–32 weeks' gestation and 3%–4% at term.

Men delivered in breech presentation seem to carry genes predisposing to breech delivery that are transferred to their offspring, increasing their partners' risk of breech deliveries. Fetal genes also can be transmitted from women delivered in breech, according to the study.

The researchers said they had no conflict to report.

Men and women who were delivered in breech presentation have more than twice the risk of having their firstborn children delivered in breech position, according to a study published online in BMJ.

A population-based study by researchers at the University of Bergen, Norway, found the intergenerational recurrence risk of breech delivery in offspring was equally high when transmitted through fathers and mothers.

Tone Irene Nordtveit, a Ph.D. student, and colleagues cited genetic inheritance predominantly through the fetus as a factor in the observed pattern of familial predisposition to breech delivery at term. Breech delivery is associated with significantly increased perinatal mortality and morbidity (BMJ 2008 [doi:10.1136/bmj.39505.436539.BE]).

The data were taken from the Medical Birth Registry of Norway, including all births reported from 1967 to 2004. In Norway, all live births and stillbirths of at least 16 weeks' gestation are registered, for a total of 2.2 million births.

Several factors are associated with an increased risk of breech delivery, such as older mother, first baby, and low gestational age and birth weight. But these account for one in seven of all breech births, according to the study. The researchers said the current findings are important because there are no data that show whether genes also could be a factor in breech delivery.

“A considerable number of breech presentations are not detected before labor, despite careful antenatal surveillance,” Ms. Nordtveit said in an interview. The proportion of undiagnosed breech deliveries at admission to hospital has been reported to be as high as 31%. “To avoid undiagnosed breech deliveries, information about the mother's and the father's own presentation at birth will be valuable in the evaluation of fetal presentation in the third trimester.”

The researchers linked the birth records of mothers and fathers by national identification numbers to birth records of their offspring, providing 451,393 generation files on mothers and their offspring and 295,253 records of fathers and their offspring. All births delivered in breech position were considered breech delivery, regardless of whether they involved elective or emergency cesarean section.

The researchers then excluded multiple pregnancies and infants who weighed less than 500 g in both generations and restricted the study to firstborn offspring in the second generation. As a result, the study had 232,704 mother-offspring units and 154,851 father-offspring units. All of the mothers and fathers were born during 1967–1986, and 98% of the second generation was born during 1987–2004. The proportion of breech births was 2.5% in 1967–1976, 3.0% in 1977–1986, 3.2% in 1987–1996, and 3.5% in 1997–2004.

Among 318,855 males and 301,438 females who were born in 1967–1976, 96.8% and 97.6%, respectively, lived to age 18 years. The mortality in those delivered in breech position was four times the mortality of those delivered in the cephalic presentation.

The highest risk of recurrence of breech delivery was seen in babies of firstborn men and women who themselves were delivered in breech position at term, with an odds ratio of 2.2.

The strongest risks were found for vaginally delivered offspring and were equally strong for men and women. There was no recurrence between generations for men and women born preterm. The prevalence of breech presentation is 15% at 29–32 weeks' gestation and 3%–4% at term.

Men delivered in breech presentation seem to carry genes predisposing to breech delivery that are transferred to their offspring, increasing their partners' risk of breech deliveries. Fetal genes also can be transmitted from women delivered in breech, according to the study.

The researchers said they had no conflict to report.