Doug Brunk

Inflammatory bowel disease is likely to be associated with other chronic inflammatory disorders, results from two recent population-based studies have found.

Investigators observed an increased prevalence of asthma, arthritis, chronic renal disease, multiple sclerosis, and psoriasis, among other conditions, in patients with IBD, compared with population controls.

The findings “remind us that the effects of IBD extend to every corner of the body, including the lung and the central nervous system,” Edward V. Loftus Jr., M.D., of the division of gastroenterology and hepatology at Mayo Clinic College of Medicine, Rochester, Minn., wrote in an editorial about the studies (Gastroenterology 2005;129:1117–20). They “lend credence to the emerging concept that patients with one immune-mediated condition are more likely than the general population to have another autoimmune disease.”

In the larger of the two studies, Gauree Gupta, M.D., and associates at the University of Pennsylvania, Philadelphia, identified 20,173 patients from the United Kingdom's General Practice Research Database diagnosed with Crohn's disease and ulcerative colitis between January 1988 and October 1997.

Each patient was randomly matched for age, gender, and primary care practice to 4 controls, which amounted to 80,666 controls (Gastroenterology 2005;129:819–26.)

On cross-sectional analysis, the investigators found that the relative odds of a diagnosis of multiple sclerosis, demyelination, and/or optic neuritis in patients with Crohn's disease and ulcerative colitis as compared with their matched controls was 1.54 and 1.75, respectively.

“These observations are important to confirm the previously hypothesized association of IBD and demyelinating disorders,” the investigators wrote. They are also “essential to help place into context reports of the onset or exacerbation of demyelinating disorders in patients taking anti-TNF? therapies for conditions such as rheumatoid arthritis, psoriasis, and IBD.”

In a similar study led by Charles N. Bernstein, M.D., of the University of Manitoba, Winnipeg, investigators set out to determine the relationship between IBD and common respiratory and neurologic diseases. They analyzed data from the University of Manitoba IBD database, which included 8,072 patients diagnosed with IBD between 1984 and 2003 (Gastroenterology 2005;129:827–36). Each patient was randomly matched for age, gender, and geographic location to 10 people in the general population.

Compared with controls, Crohn's disease and ulcerative colitis patients were significantly more likely to have arthritis, asthma, bronchitis, psoriasis, and pericarditis. The investigators also observed an increased risk for chronic renal disease and multiple sclerosis among ulcer patients but not Crohn's disease patients, while arthritis and asthma ranked as the most common nonintestinal comorbidities.

Dr. Bernstein and his associates wrote that the “link between these diseases and IBD may stimulate research pursuing the link of these organ systems on an immune basis. More practically, these data reinforce that respiratory complaints in patients with IBD should be taken seriously and, at the least, standard pulmonary function tests should be performed. However, routine pulmonary function testing cannot be recommended at this time.”

The study was partially supported by the Crohn's and Colitis Foundation of Canada and the Canadian Institutes of Health Research.

Inflammatory bowel disease is likely to be associated with other chronic inflammatory disorders, results from two recent population-based studies have found.

Investigators observed an increased prevalence of asthma, arthritis, chronic renal disease, multiple sclerosis, and psoriasis, among other conditions, in patients with IBD, compared with population controls.

The findings “remind us that the effects of IBD extend to every corner of the body, including the lung and the central nervous system,” Edward V. Loftus Jr., M.D., of the division of gastroenterology and hepatology at Mayo Clinic College of Medicine, Rochester, Minn., wrote in an editorial about the studies (Gastroenterology 2005;129:1117–20). They “lend credence to the emerging concept that patients with one immune-mediated condition are more likely than the general population to have another autoimmune disease.”

In the larger of the two studies, Gauree Gupta, M.D., and associates at the University of Pennsylvania, Philadelphia, identified 20,173 patients from the United Kingdom's General Practice Research Database diagnosed with Crohn's disease and ulcerative colitis between January 1988 and October 1997.

Each patient was randomly matched for age, gender, and primary care practice to 4 controls, which amounted to 80,666 controls (Gastroenterology 2005;129:819–26.)

On cross-sectional analysis, the investigators found that the relative odds of a diagnosis of multiple sclerosis, demyelination, and/or optic neuritis in patients with Crohn's disease and ulcerative colitis as compared with their matched controls was 1.54 and 1.75, respectively.

“These observations are important to confirm the previously hypothesized association of IBD and demyelinating disorders,” the investigators wrote. They are also “essential to help place into context reports of the onset or exacerbation of demyelinating disorders in patients taking anti-TNF? therapies for conditions such as rheumatoid arthritis, psoriasis, and IBD.”

In a similar study led by Charles N. Bernstein, M.D., of the University of Manitoba, Winnipeg, investigators set out to determine the relationship between IBD and common respiratory and neurologic diseases. They analyzed data from the University of Manitoba IBD database, which included 8,072 patients diagnosed with IBD between 1984 and 2003 (Gastroenterology 2005;129:827–36). Each patient was randomly matched for age, gender, and geographic location to 10 people in the general population.

Compared with controls, Crohn's disease and ulcerative colitis patients were significantly more likely to have arthritis, asthma, bronchitis, psoriasis, and pericarditis. The investigators also observed an increased risk for chronic renal disease and multiple sclerosis among ulcer patients but not Crohn's disease patients, while arthritis and asthma ranked as the most common nonintestinal comorbidities.

Dr. Bernstein and his associates wrote that the “link between these diseases and IBD may stimulate research pursuing the link of these organ systems on an immune basis. More practically, these data reinforce that respiratory complaints in patients with IBD should be taken seriously and, at the least, standard pulmonary function tests should be performed. However, routine pulmonary function testing cannot be recommended at this time.”

The study was partially supported by the Crohn's and Colitis Foundation of Canada and the Canadian Institutes of Health Research.

Inflammatory bowel disease is likely to be associated with other chronic inflammatory disorders, results from two recent population-based studies have found.

Investigators observed an increased prevalence of asthma, arthritis, chronic renal disease, multiple sclerosis, and psoriasis, among other conditions, in patients with IBD, compared with population controls.

The findings “remind us that the effects of IBD extend to every corner of the body, including the lung and the central nervous system,” Edward V. Loftus Jr., M.D., of the division of gastroenterology and hepatology at Mayo Clinic College of Medicine, Rochester, Minn., wrote in an editorial about the studies (Gastroenterology 2005;129:1117–20). They “lend credence to the emerging concept that patients with one immune-mediated condition are more likely than the general population to have another autoimmune disease.”

In the larger of the two studies, Gauree Gupta, M.D., and associates at the University of Pennsylvania, Philadelphia, identified 20,173 patients from the United Kingdom's General Practice Research Database diagnosed with Crohn's disease and ulcerative colitis between January 1988 and October 1997.

Each patient was randomly matched for age, gender, and primary care practice to 4 controls, which amounted to 80,666 controls (Gastroenterology 2005;129:819–26.)

On cross-sectional analysis, the investigators found that the relative odds of a diagnosis of multiple sclerosis, demyelination, and/or optic neuritis in patients with Crohn's disease and ulcerative colitis as compared with their matched controls was 1.54 and 1.75, respectively.

“These observations are important to confirm the previously hypothesized association of IBD and demyelinating disorders,” the investigators wrote. They are also “essential to help place into context reports of the onset or exacerbation of demyelinating disorders in patients taking anti-TNF? therapies for conditions such as rheumatoid arthritis, psoriasis, and IBD.”

In a similar study led by Charles N. Bernstein, M.D., of the University of Manitoba, Winnipeg, investigators set out to determine the relationship between IBD and common respiratory and neurologic diseases. They analyzed data from the University of Manitoba IBD database, which included 8,072 patients diagnosed with IBD between 1984 and 2003 (Gastroenterology 2005;129:827–36). Each patient was randomly matched for age, gender, and geographic location to 10 people in the general population.

Compared with controls, Crohn's disease and ulcerative colitis patients were significantly more likely to have arthritis, asthma, bronchitis, psoriasis, and pericarditis. The investigators also observed an increased risk for chronic renal disease and multiple sclerosis among ulcer patients but not Crohn's disease patients, while arthritis and asthma ranked as the most common nonintestinal comorbidities.

Dr. Bernstein and his associates wrote that the “link between these diseases and IBD may stimulate research pursuing the link of these organ systems on an immune basis. More practically, these data reinforce that respiratory complaints in patients with IBD should be taken seriously and, at the least, standard pulmonary function tests should be performed. However, routine pulmonary function testing cannot be recommended at this time.”

The study was partially supported by the Crohn's and Colitis Foundation of Canada and the Canadian Institutes of Health Research.

SAN DIEGO — Results from the first population-based study of its kind have found that about one in three mothers of inconsolable, crying infants reported having postpartum depressive symptoms, Pamela C. High, M.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Dr. High and her associates analyzed data from Rhode Island's Pregnancy Risk Assessment Monitoring System (PRAMS) that was weighted to represent all births that occurred in the state in 2002 and 2003. Sponsored by the Centers for Disease Control and Prevention, PRAMS is an ongoing state-specific population-based survey that identifies and monitors selected maternal behaviors and experiences before, during, and after pregnancy. Rhode Island is one of 32 states that has the system.

The investigators mailed a survey to 4,214 mothers that included a question about their infants' consolability as well as a question about maternal depressive symptoms, said Dr. High, director of developmental and behavioral pediatrics at Rhode Island Hospital/Hasbro Children's Hospital, Providence.

Of the 4,214 mothers, 2,947 returned questionnaires, for a response rate of 70%.

Nearly 10% of respondents were in their teens, almost half in their 20s and an additional 27% were aged 30–34 years. The majority of them (87%) were white, while 8% were black. The rest were of Hispanic, Asian, or American Indian background.

The mean infant age was 16 weeks and nearly half were males.

Overall, mothers identified 8.3% of the infants as being “somewhat difficult” or “very difficult” to console. Infants who weighed less than 2,500 g at birth were reported to be more difficult to console compared with heavier newborns (11.2% vs. 8.1%, respectively).

Among the respondents, 7.7% of whites, 9.4% of blacks, and 17.1% of those from other racial backgrounds said they had infants who were difficult to console.

No significant differences were seen with maternal age, Hispanic ethnicity, maternal education, marital status, household income, parity, or breast-feeding.

In the assessment, 19.2% of mothers reported that in the months after delivery, they felt “moderately depressed,” “very depressed,” or “very depressed and had to get help.”

Higher levels of postpartum depression were reported by mothers who had not completed high school or who only had a high school education. Other risk factors included being unmarried, having an annual household income of less than $40,000, and being on public health insurance.

Mothers of infants who weighed less than 2,500 g at birth reported more depression than did those with heavier newborns (29.2% vs. 18.4%), while mothers with unintended pregnancies reported more depression than did those with planned pregnancies (22.8% vs. 16.8%).

Maternal age, race, ethnicity, and parity did not predict depression in these mothers. Slightly more than one-third of mothers with inconsolable infants (34.7%) also reported postpartum depressive symptoms, compared with 17.4% of mothers with infants described as more easily consoled. Physicians, then, should consider screening for postpartum depression when a new mother comes in with an inconsolable infant, the researchers suggested.

Logistic regression analysis, adjusted for socioeconomic factors, revealed that mothers with postpartum depressive symptoms were 2.59 times more likely to report infant inconsolability than were mothers who did not report postpartum depressive symptoms.

Dr. High called the association between maternal depression and infant inconsolability “robust,” but noted that a limitation of the study includes the fact that infant inconsolability and maternal depression were measured by a single question. “Also, the population sampled is not necessarily representative of the rest of the United States,” she said.

SAN DIEGO — Results from the first population-based study of its kind have found that about one in three mothers of inconsolable, crying infants reported having postpartum depressive symptoms, Pamela C. High, M.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Dr. High and her associates analyzed data from Rhode Island's Pregnancy Risk Assessment Monitoring System (PRAMS) that was weighted to represent all births that occurred in the state in 2002 and 2003. Sponsored by the Centers for Disease Control and Prevention, PRAMS is an ongoing state-specific population-based survey that identifies and monitors selected maternal behaviors and experiences before, during, and after pregnancy. Rhode Island is one of 32 states that has the system.

The investigators mailed a survey to 4,214 mothers that included a question about their infants' consolability as well as a question about maternal depressive symptoms, said Dr. High, director of developmental and behavioral pediatrics at Rhode Island Hospital/Hasbro Children's Hospital, Providence.

Of the 4,214 mothers, 2,947 returned questionnaires, for a response rate of 70%.

Nearly 10% of respondents were in their teens, almost half in their 20s and an additional 27% were aged 30–34 years. The majority of them (87%) were white, while 8% were black. The rest were of Hispanic, Asian, or American Indian background.

The mean infant age was 16 weeks and nearly half were males.

Overall, mothers identified 8.3% of the infants as being “somewhat difficult” or “very difficult” to console. Infants who weighed less than 2,500 g at birth were reported to be more difficult to console compared with heavier newborns (11.2% vs. 8.1%, respectively).

Among the respondents, 7.7% of whites, 9.4% of blacks, and 17.1% of those from other racial backgrounds said they had infants who were difficult to console.

No significant differences were seen with maternal age, Hispanic ethnicity, maternal education, marital status, household income, parity, or breast-feeding.

In the assessment, 19.2% of mothers reported that in the months after delivery, they felt “moderately depressed,” “very depressed,” or “very depressed and had to get help.”

Higher levels of postpartum depression were reported by mothers who had not completed high school or who only had a high school education. Other risk factors included being unmarried, having an annual household income of less than $40,000, and being on public health insurance.

Mothers of infants who weighed less than 2,500 g at birth reported more depression than did those with heavier newborns (29.2% vs. 18.4%), while mothers with unintended pregnancies reported more depression than did those with planned pregnancies (22.8% vs. 16.8%).

Maternal age, race, ethnicity, and parity did not predict depression in these mothers. Slightly more than one-third of mothers with inconsolable infants (34.7%) also reported postpartum depressive symptoms, compared with 17.4% of mothers with infants described as more easily consoled. Physicians, then, should consider screening for postpartum depression when a new mother comes in with an inconsolable infant, the researchers suggested.

Logistic regression analysis, adjusted for socioeconomic factors, revealed that mothers with postpartum depressive symptoms were 2.59 times more likely to report infant inconsolability than were mothers who did not report postpartum depressive symptoms.

Dr. High called the association between maternal depression and infant inconsolability “robust,” but noted that a limitation of the study includes the fact that infant inconsolability and maternal depression were measured by a single question. “Also, the population sampled is not necessarily representative of the rest of the United States,” she said.

SAN DIEGO — Results from the first population-based study of its kind have found that about one in three mothers of inconsolable, crying infants reported having postpartum depressive symptoms, Pamela C. High, M.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Dr. High and her associates analyzed data from Rhode Island's Pregnancy Risk Assessment Monitoring System (PRAMS) that was weighted to represent all births that occurred in the state in 2002 and 2003. Sponsored by the Centers for Disease Control and Prevention, PRAMS is an ongoing state-specific population-based survey that identifies and monitors selected maternal behaviors and experiences before, during, and after pregnancy. Rhode Island is one of 32 states that has the system.

The investigators mailed a survey to 4,214 mothers that included a question about their infants' consolability as well as a question about maternal depressive symptoms, said Dr. High, director of developmental and behavioral pediatrics at Rhode Island Hospital/Hasbro Children's Hospital, Providence.

Of the 4,214 mothers, 2,947 returned questionnaires, for a response rate of 70%.

Nearly 10% of respondents were in their teens, almost half in their 20s and an additional 27% were aged 30–34 years. The majority of them (87%) were white, while 8% were black. The rest were of Hispanic, Asian, or American Indian background.

The mean infant age was 16 weeks and nearly half were males.

Overall, mothers identified 8.3% of the infants as being “somewhat difficult” or “very difficult” to console. Infants who weighed less than 2,500 g at birth were reported to be more difficult to console compared with heavier newborns (11.2% vs. 8.1%, respectively).

Among the respondents, 7.7% of whites, 9.4% of blacks, and 17.1% of those from other racial backgrounds said they had infants who were difficult to console.

No significant differences were seen with maternal age, Hispanic ethnicity, maternal education, marital status, household income, parity, or breast-feeding.

In the assessment, 19.2% of mothers reported that in the months after delivery, they felt “moderately depressed,” “very depressed,” or “very depressed and had to get help.”

Higher levels of postpartum depression were reported by mothers who had not completed high school or who only had a high school education. Other risk factors included being unmarried, having an annual household income of less than $40,000, and being on public health insurance.

Mothers of infants who weighed less than 2,500 g at birth reported more depression than did those with heavier newborns (29.2% vs. 18.4%), while mothers with unintended pregnancies reported more depression than did those with planned pregnancies (22.8% vs. 16.8%).

Maternal age, race, ethnicity, and parity did not predict depression in these mothers. Slightly more than one-third of mothers with inconsolable infants (34.7%) also reported postpartum depressive symptoms, compared with 17.4% of mothers with infants described as more easily consoled. Physicians, then, should consider screening for postpartum depression when a new mother comes in with an inconsolable infant, the researchers suggested.

Logistic regression analysis, adjusted for socioeconomic factors, revealed that mothers with postpartum depressive symptoms were 2.59 times more likely to report infant inconsolability than were mothers who did not report postpartum depressive symptoms.

Dr. High called the association between maternal depression and infant inconsolability “robust,” but noted that a limitation of the study includes the fact that infant inconsolability and maternal depression were measured by a single question. “Also, the population sampled is not necessarily representative of the rest of the United States,” she said.

SAN DIEGO — Spouses of men and women with mild cognitive impairment are assuming the role of caregiver and are experiencing the caregiver burden associated with the role, Linda Garand, Ph.D., said at the annual meeting of the American Association for Geriatric Psychiatry.

In a pilot study, nursing tasks such as administration of medication were significantly associated with symptoms of depression in the caregiver, while lifestyle constraints were significantly associated with symptoms of anxiety, she reported.

The finding suggests that spouses of people with mild cognitive impairment (MCI) “may be ideal targets for preventive interventions, to prevent the later development of psychiatric morbidity in the event that they do progress to become a dementia caregiver,” said Dr. Garand of the University of Pittsburgh.

Although the negative mental health effects of dementia caregiving are firmly established in the medical literature, she added, “We know very little about what it's like to give care to a person with milder levels of [cognitive impairment].”

In a 7-month study funded by the National Institute of Mental Health, Dr. Garand and her associates conducted a cross-sectional study of 23 women and 4 men whose spouses met Alzheimer's Disease Research Center criteria for MCI. Spouses lived with the patients at home and understood English.

Self-reported cross-sectional data were collected in the home. The investigators used a variety of measures, including the Caregiver Burden Inventory, the Memory and Behavior Problem Checklist, the Center for Epidemiologic Studies-Depression scale, and the state portion of the State-Trait Anxiety Inventory.

Most of the spousal caregivers were white, married for almost 5 decades, and lived alone with their spouse. They ranged in age from 54 to 82 years, with an average age of 70 years. About three-quarters had at least a bachelor's degree.

Spouses performed an average of four household management tasks per day and 0–1 nursing tasks per day. The amount of time to self received the highest caregiver burden rating, while the amount of privacy and the amount of vacation time received the lowest caregiver burden rating.

The most common MCI-related behaviors spouses reported of their loved ones were asking the same question over and over again, having trouble remembering recent events, and losing or misplacing things. Spouses who performed nursing tasks such as administration of medication were significantly more likely to have depressive symptoms, while those with perceived lifestyle constraints were significantly more likely to have anxiety symptoms.

“The caregiving responsibilities in this sample were very diverse,” Dr. Garand commented. “The fact that many of these responsibilities were introduced since the person had been diagnosed with MCI suggests that the burden and psychiatric morbidity are directly associated with the MCI in their spouse.”

She noted that all of the spouses who reported responsibility for transportation, running the errands, and managing business affairs also acknowledged that these were new responsibilities since their spouse developed MCI.

Nearly one-half of the spouses reported being responsible for administering medications for their loved one, and a large proportion of that subsample said that it was a new responsibility since the onset of MCI.

Dr. Garand proposes an in-home intervention with spouses of men and women with MCI that will be built into another study. The intervention will include 1 month of in-home education followed by 2 months of support via telephone. The intervention “is going to be based on problem-solving therapy,” she explained.

“I'm hoping that if I can equip these spouses with some real problem-solving tools early in their caregiving trajectory, I may be able to help them down the road as they become dementia caregivers, so they don't become so depressed or anxious.”

SAN DIEGO — Spouses of men and women with mild cognitive impairment are assuming the role of caregiver and are experiencing the caregiver burden associated with the role, Linda Garand, Ph.D., said at the annual meeting of the American Association for Geriatric Psychiatry.

In a pilot study, nursing tasks such as administration of medication were significantly associated with symptoms of depression in the caregiver, while lifestyle constraints were significantly associated with symptoms of anxiety, she reported.

The finding suggests that spouses of people with mild cognitive impairment (MCI) “may be ideal targets for preventive interventions, to prevent the later development of psychiatric morbidity in the event that they do progress to become a dementia caregiver,” said Dr. Garand of the University of Pittsburgh.

Although the negative mental health effects of dementia caregiving are firmly established in the medical literature, she added, “We know very little about what it's like to give care to a person with milder levels of [cognitive impairment].”

In a 7-month study funded by the National Institute of Mental Health, Dr. Garand and her associates conducted a cross-sectional study of 23 women and 4 men whose spouses met Alzheimer's Disease Research Center criteria for MCI. Spouses lived with the patients at home and understood English.

Self-reported cross-sectional data were collected in the home. The investigators used a variety of measures, including the Caregiver Burden Inventory, the Memory and Behavior Problem Checklist, the Center for Epidemiologic Studies-Depression scale, and the state portion of the State-Trait Anxiety Inventory.

Most of the spousal caregivers were white, married for almost 5 decades, and lived alone with their spouse. They ranged in age from 54 to 82 years, with an average age of 70 years. About three-quarters had at least a bachelor's degree.

Spouses performed an average of four household management tasks per day and 0–1 nursing tasks per day. The amount of time to self received the highest caregiver burden rating, while the amount of privacy and the amount of vacation time received the lowest caregiver burden rating.

The most common MCI-related behaviors spouses reported of their loved ones were asking the same question over and over again, having trouble remembering recent events, and losing or misplacing things. Spouses who performed nursing tasks such as administration of medication were significantly more likely to have depressive symptoms, while those with perceived lifestyle constraints were significantly more likely to have anxiety symptoms.

“The caregiving responsibilities in this sample were very diverse,” Dr. Garand commented. “The fact that many of these responsibilities were introduced since the person had been diagnosed with MCI suggests that the burden and psychiatric morbidity are directly associated with the MCI in their spouse.”

She noted that all of the spouses who reported responsibility for transportation, running the errands, and managing business affairs also acknowledged that these were new responsibilities since their spouse developed MCI.

Nearly one-half of the spouses reported being responsible for administering medications for their loved one, and a large proportion of that subsample said that it was a new responsibility since the onset of MCI.

Dr. Garand proposes an in-home intervention with spouses of men and women with MCI that will be built into another study. The intervention will include 1 month of in-home education followed by 2 months of support via telephone. The intervention “is going to be based on problem-solving therapy,” she explained.

“I'm hoping that if I can equip these spouses with some real problem-solving tools early in their caregiving trajectory, I may be able to help them down the road as they become dementia caregivers, so they don't become so depressed or anxious.”

SAN DIEGO — Spouses of men and women with mild cognitive impairment are assuming the role of caregiver and are experiencing the caregiver burden associated with the role, Linda Garand, Ph.D., said at the annual meeting of the American Association for Geriatric Psychiatry.

In a pilot study, nursing tasks such as administration of medication were significantly associated with symptoms of depression in the caregiver, while lifestyle constraints were significantly associated with symptoms of anxiety, she reported.

The finding suggests that spouses of people with mild cognitive impairment (MCI) “may be ideal targets for preventive interventions, to prevent the later development of psychiatric morbidity in the event that they do progress to become a dementia caregiver,” said Dr. Garand of the University of Pittsburgh.

Although the negative mental health effects of dementia caregiving are firmly established in the medical literature, she added, “We know very little about what it's like to give care to a person with milder levels of [cognitive impairment].”

In a 7-month study funded by the National Institute of Mental Health, Dr. Garand and her associates conducted a cross-sectional study of 23 women and 4 men whose spouses met Alzheimer's Disease Research Center criteria for MCI. Spouses lived with the patients at home and understood English.

Self-reported cross-sectional data were collected in the home. The investigators used a variety of measures, including the Caregiver Burden Inventory, the Memory and Behavior Problem Checklist, the Center for Epidemiologic Studies-Depression scale, and the state portion of the State-Trait Anxiety Inventory.

Most of the spousal caregivers were white, married for almost 5 decades, and lived alone with their spouse. They ranged in age from 54 to 82 years, with an average age of 70 years. About three-quarters had at least a bachelor's degree.

Spouses performed an average of four household management tasks per day and 0–1 nursing tasks per day. The amount of time to self received the highest caregiver burden rating, while the amount of privacy and the amount of vacation time received the lowest caregiver burden rating.

The most common MCI-related behaviors spouses reported of their loved ones were asking the same question over and over again, having trouble remembering recent events, and losing or misplacing things. Spouses who performed nursing tasks such as administration of medication were significantly more likely to have depressive symptoms, while those with perceived lifestyle constraints were significantly more likely to have anxiety symptoms.

“The caregiving responsibilities in this sample were very diverse,” Dr. Garand commented. “The fact that many of these responsibilities were introduced since the person had been diagnosed with MCI suggests that the burden and psychiatric morbidity are directly associated with the MCI in their spouse.”

She noted that all of the spouses who reported responsibility for transportation, running the errands, and managing business affairs also acknowledged that these were new responsibilities since their spouse developed MCI.

Nearly one-half of the spouses reported being responsible for administering medications for their loved one, and a large proportion of that subsample said that it was a new responsibility since the onset of MCI.

Dr. Garand proposes an in-home intervention with spouses of men and women with MCI that will be built into another study. The intervention will include 1 month of in-home education followed by 2 months of support via telephone. The intervention “is going to be based on problem-solving therapy,” she explained.

“I'm hoping that if I can equip these spouses with some real problem-solving tools early in their caregiving trajectory, I may be able to help them down the road as they become dementia caregivers, so they don't become so depressed or anxious.”

Routine dietary supplementation with oral calcium and vitamin D3, either alone or in combination, had no impact on reducing the incidence of low-trauma secondary fractures in patients aged 70 years and older, a large randomized trial demonstrated.

The findings run counter to the conclusions of at least four published prevention trials, but “our study population was younger and less frail [than theirs] … and most were mobile and living in the community,” wrote the investigators, whose primary author was Adrian M. Grant, M.D., of the University of Aberdeen (Scotland). “Therefore, the participants in our trial might have been less likely to have vitamin D insufficiency and secondary hyperparathyroidism than those in the [other] trials.”

The investigators enrolled 5,292 patients aged 70 and older who were mobile before developing a low trauma fracture. They randomized the patients to one of four groups—800 IU daily oral vitamin D, 1,000 mg calcium, oral vitamin D combined with calcium, or placebo—and followed them for a median of 45 months (Lancet 2005;365:1621–8).

Every 4 months, study participants were asked via mailed questionnaire how many times in the last 7 days they had taken their tablets. They were also asked about general health status, hospital admission, falls, and possible adverse events. The investigators obtained information on further fractures and death from the questionnaires, from hospital staff, family and friends of study participants, and from national health statistics. Additional confirmation of radiologically confirmed fractures was sought from a second source.

The mean age of patients was 77, and most (85%) were women.

Of the 5,292 patients, 698 (13%) sustained a new low-trauma fracture. Of these, 183 (26%) were hip fractures.

Investigators observed no significant differences in the incidence of new, low-trauma fractures between patients who received calcium vs. those who did not (12.6% vs. 13.7%, respectively); between those who received vitamin D3 vs. those who did not (13.3% vs. 13.1%, respectively) or between patients who received combination treatment and those who received placebo (12.6% vs. 13.4%).

There were also no differences between the groups in terms of the incidence of all new fractures, fractures confirmed by radiography, hip fractures, death, number of falls, or quality of life.

The investigators concluded that the best pharmaceutical intervention to prevent secondary low-trauma fractures in the elderly is with “antiresorptive drugs, such as bisphosphonates, which have rarely been assessed in patients who have not been taking calcium or vitamin D,” they wrote. “This trial was not designed to directly address whether supplementation should be used as a primary-prevention measure or in those who live in a care-home environment. Clarification of the role of supplementation in these settings awaits the results of other trials.”

Routine dietary supplementation with oral calcium and vitamin D3, either alone or in combination, had no impact on reducing the incidence of low-trauma secondary fractures in patients aged 70 years and older, a large randomized trial demonstrated.

The findings run counter to the conclusions of at least four published prevention trials, but “our study population was younger and less frail [than theirs] … and most were mobile and living in the community,” wrote the investigators, whose primary author was Adrian M. Grant, M.D., of the University of Aberdeen (Scotland). “Therefore, the participants in our trial might have been less likely to have vitamin D insufficiency and secondary hyperparathyroidism than those in the [other] trials.”

The investigators enrolled 5,292 patients aged 70 and older who were mobile before developing a low trauma fracture. They randomized the patients to one of four groups—800 IU daily oral vitamin D, 1,000 mg calcium, oral vitamin D combined with calcium, or placebo—and followed them for a median of 45 months (Lancet 2005;365:1621–8).

Every 4 months, study participants were asked via mailed questionnaire how many times in the last 7 days they had taken their tablets. They were also asked about general health status, hospital admission, falls, and possible adverse events. The investigators obtained information on further fractures and death from the questionnaires, from hospital staff, family and friends of study participants, and from national health statistics. Additional confirmation of radiologically confirmed fractures was sought from a second source.

The mean age of patients was 77, and most (85%) were women.

Of the 5,292 patients, 698 (13%) sustained a new low-trauma fracture. Of these, 183 (26%) were hip fractures.

Investigators observed no significant differences in the incidence of new, low-trauma fractures between patients who received calcium vs. those who did not (12.6% vs. 13.7%, respectively); between those who received vitamin D3 vs. those who did not (13.3% vs. 13.1%, respectively) or between patients who received combination treatment and those who received placebo (12.6% vs. 13.4%).

There were also no differences between the groups in terms of the incidence of all new fractures, fractures confirmed by radiography, hip fractures, death, number of falls, or quality of life.

The investigators concluded that the best pharmaceutical intervention to prevent secondary low-trauma fractures in the elderly is with “antiresorptive drugs, such as bisphosphonates, which have rarely been assessed in patients who have not been taking calcium or vitamin D,” they wrote. “This trial was not designed to directly address whether supplementation should be used as a primary-prevention measure or in those who live in a care-home environment. Clarification of the role of supplementation in these settings awaits the results of other trials.”

Routine dietary supplementation with oral calcium and vitamin D3, either alone or in combination, had no impact on reducing the incidence of low-trauma secondary fractures in patients aged 70 years and older, a large randomized trial demonstrated.

The findings run counter to the conclusions of at least four published prevention trials, but “our study population was younger and less frail [than theirs] … and most were mobile and living in the community,” wrote the investigators, whose primary author was Adrian M. Grant, M.D., of the University of Aberdeen (Scotland). “Therefore, the participants in our trial might have been less likely to have vitamin D insufficiency and secondary hyperparathyroidism than those in the [other] trials.”

The investigators enrolled 5,292 patients aged 70 and older who were mobile before developing a low trauma fracture. They randomized the patients to one of four groups—800 IU daily oral vitamin D, 1,000 mg calcium, oral vitamin D combined with calcium, or placebo—and followed them for a median of 45 months (Lancet 2005;365:1621–8).

Every 4 months, study participants were asked via mailed questionnaire how many times in the last 7 days they had taken their tablets. They were also asked about general health status, hospital admission, falls, and possible adverse events. The investigators obtained information on further fractures and death from the questionnaires, from hospital staff, family and friends of study participants, and from national health statistics. Additional confirmation of radiologically confirmed fractures was sought from a second source.

The mean age of patients was 77, and most (85%) were women.

Of the 5,292 patients, 698 (13%) sustained a new low-trauma fracture. Of these, 183 (26%) were hip fractures.

Investigators observed no significant differences in the incidence of new, low-trauma fractures between patients who received calcium vs. those who did not (12.6% vs. 13.7%, respectively); between those who received vitamin D3 vs. those who did not (13.3% vs. 13.1%, respectively) or between patients who received combination treatment and those who received placebo (12.6% vs. 13.4%).

There were also no differences between the groups in terms of the incidence of all new fractures, fractures confirmed by radiography, hip fractures, death, number of falls, or quality of life.

The investigators concluded that the best pharmaceutical intervention to prevent secondary low-trauma fractures in the elderly is with “antiresorptive drugs, such as bisphosphonates, which have rarely been assessed in patients who have not been taking calcium or vitamin D,” they wrote. “This trial was not designed to directly address whether supplementation should be used as a primary-prevention measure or in those who live in a care-home environment. Clarification of the role of supplementation in these settings awaits the results of other trials.”

SAN DIEGO — Nearly half of adult patients who received care at a municipal hospital diabetes clinic did not recognize the term A_1c, and fewer than one-quarter knew what their hemoglobin A_1c level should be, Mary K. Rhee, M.D., reported at the annual scientific sessions of the American Diabetes Association.

“This lack of recognition and knowledge occurs despite a formal diabetes education and reinforcement at each patient visit,” said Dr. Rhee of the department of medicine at Emory University, Atlanta.

“However, patients who recognize the term A_1c and know the goal have better glycemic control. In light of these findings, education programs should include strategies that ensure that patients achieve and retain appropriate understanding of A_1c and the A_1c goal,” she said.

To test a theory that patients who know the American Diabetes Association goal for hemoglobin A_1c level have better glycemic control, Dr. Rhee and her associates surveyed 97 patients who received care at a diabetes clinic affiliated with Emory University. All patients new to the clinic attend an 8-hour education program which includes instruction about the importance of glycemic control, what A_1c is, and what the A_1c goal is.

“The program begins at the initial visit and continues over several visits in the first 6 months,” Dr. Rhee explained. “The nurse providers are also expected to routinely discuss individual A_1c results and reemphasize the A_1c goal with each patient.”

The average age of study participants was 59 years, and 54% were female. Almost all the patients (95%) were African American, and their average body mass index was 35 kg/m

The average duration of diabetes was 10 years, and time since the initial education was 6.5 years. Participants had an average of 3.7 visits to the clinic per year, and the mean A_1c level of study participants at the time of the survey was 7.8%.

Based on their response to the question, “What should your A_1c be?” patients were divided into three groups. Group 1 consisted of those who did not know either the A_1c term or the A_1c goal (47%), group 2 recognized the A_1c term but did not know the goal (30%), and group 3 knew both the A_1c term and the correct A_1c goal (23%).

Even though patient characteristics were similar in the three groups, those in group 3 had lower A_1c levels (6.9%), compared with their counterparts in group 2 (7.7%) and group 1 (8.4%).

Moreover, knowing the A_1c term and goal was independently associated with lower A_1c levels after the investigators adjusted for other risk factors. Poor patient knowledge was independently associated with higher A_1c levels.

Fewer than 45% of patients in groups 1 and 2 were able to reach an A_1c level of less than 7%, while 64% of those in group 3 reached that goal.

“Therefore, better patient knowledge was associated with better glycemic control,” Dr. Rhee concluded.

SAN DIEGO — Nearly half of adult patients who received care at a municipal hospital diabetes clinic did not recognize the term A_1c, and fewer than one-quarter knew what their hemoglobin A_1c level should be, Mary K. Rhee, M.D., reported at the annual scientific sessions of the American Diabetes Association.

“This lack of recognition and knowledge occurs despite a formal diabetes education and reinforcement at each patient visit,” said Dr. Rhee of the department of medicine at Emory University, Atlanta.

“However, patients who recognize the term A_1c and know the goal have better glycemic control. In light of these findings, education programs should include strategies that ensure that patients achieve and retain appropriate understanding of A_1c and the A_1c goal,” she said.

To test a theory that patients who know the American Diabetes Association goal for hemoglobin A_1c level have better glycemic control, Dr. Rhee and her associates surveyed 97 patients who received care at a diabetes clinic affiliated with Emory University. All patients new to the clinic attend an 8-hour education program which includes instruction about the importance of glycemic control, what A_1c is, and what the A_1c goal is.

“The program begins at the initial visit and continues over several visits in the first 6 months,” Dr. Rhee explained. “The nurse providers are also expected to routinely discuss individual A_1c results and reemphasize the A_1c goal with each patient.”

The average age of study participants was 59 years, and 54% were female. Almost all the patients (95%) were African American, and their average body mass index was 35 kg/m

The average duration of diabetes was 10 years, and time since the initial education was 6.5 years. Participants had an average of 3.7 visits to the clinic per year, and the mean A_1c level of study participants at the time of the survey was 7.8%.

Based on their response to the question, “What should your A_1c be?” patients were divided into three groups. Group 1 consisted of those who did not know either the A_1c term or the A_1c goal (47%), group 2 recognized the A_1c term but did not know the goal (30%), and group 3 knew both the A_1c term and the correct A_1c goal (23%).

Even though patient characteristics were similar in the three groups, those in group 3 had lower A_1c levels (6.9%), compared with their counterparts in group 2 (7.7%) and group 1 (8.4%).

Moreover, knowing the A_1c term and goal was independently associated with lower A_1c levels after the investigators adjusted for other risk factors. Poor patient knowledge was independently associated with higher A_1c levels.

Fewer than 45% of patients in groups 1 and 2 were able to reach an A_1c level of less than 7%, while 64% of those in group 3 reached that goal.

“Therefore, better patient knowledge was associated with better glycemic control,” Dr. Rhee concluded.

SAN DIEGO — Nearly half of adult patients who received care at a municipal hospital diabetes clinic did not recognize the term A_1c, and fewer than one-quarter knew what their hemoglobin A_1c level should be, Mary K. Rhee, M.D., reported at the annual scientific sessions of the American Diabetes Association.

“This lack of recognition and knowledge occurs despite a formal diabetes education and reinforcement at each patient visit,” said Dr. Rhee of the department of medicine at Emory University, Atlanta.

“However, patients who recognize the term A_1c and know the goal have better glycemic control. In light of these findings, education programs should include strategies that ensure that patients achieve and retain appropriate understanding of A_1c and the A_1c goal,” she said.

To test a theory that patients who know the American Diabetes Association goal for hemoglobin A_1c level have better glycemic control, Dr. Rhee and her associates surveyed 97 patients who received care at a diabetes clinic affiliated with Emory University. All patients new to the clinic attend an 8-hour education program which includes instruction about the importance of glycemic control, what A_1c is, and what the A_1c goal is.

“The program begins at the initial visit and continues over several visits in the first 6 months,” Dr. Rhee explained. “The nurse providers are also expected to routinely discuss individual A_1c results and reemphasize the A_1c goal with each patient.”

The average age of study participants was 59 years, and 54% were female. Almost all the patients (95%) were African American, and their average body mass index was 35 kg/m

The average duration of diabetes was 10 years, and time since the initial education was 6.5 years. Participants had an average of 3.7 visits to the clinic per year, and the mean A_1c level of study participants at the time of the survey was 7.8%.

Based on their response to the question, “What should your A_1c be?” patients were divided into three groups. Group 1 consisted of those who did not know either the A_1c term or the A_1c goal (47%), group 2 recognized the A_1c term but did not know the goal (30%), and group 3 knew both the A_1c term and the correct A_1c goal (23%).

Even though patient characteristics were similar in the three groups, those in group 3 had lower A_1c levels (6.9%), compared with their counterparts in group 2 (7.7%) and group 1 (8.4%).

Moreover, knowing the A_1c term and goal was independently associated with lower A_1c levels after the investigators adjusted for other risk factors. Poor patient knowledge was independently associated with higher A_1c levels.

Fewer than 45% of patients in groups 1 and 2 were able to reach an A_1c level of less than 7%, while 64% of those in group 3 reached that goal.

“Therefore, better patient knowledge was associated with better glycemic control,” Dr. Rhee concluded.

SAN DIEGO — Despite a rise in the number of treatment regimens for adults with type 2 diabetes during the 1990s, national surveys showed no improvement in the number of adults who achieved glycemic control, Tao Fan reported in a poster session at the annual scientific sessions of the American Diabetes Association.

The finding suggests “there should be more aggressive therapy—particularly pharmacotherapy—for type 2 diabetes patients,” Mr. Fan told FAMILY PRACTICE NEWS.

He and his associates analyzed a sample of 1,215 subjects from National Health and Nutrition Examination Survey III (NHANES III, 1988–1994) and 758 subjects from NHANES 1999–2002.

All subjects reported a diagnosis of type 2 diabetes and had data on diabetes medication and hemoglobin A_1c levels, Mr. Fan said. He is a doctoral student in the department of pharmaceutical health services research at the University of Maryland, Baltimore.

The researchers defined four therapeutic regimens: diet only, insulin only, oral antidiabetic drugs (OADs) only, or OADs plus insulin.

From NHANES III to NHANES 1999–2002, glycemic control rates dropped from 44.3% to 39.8% in subjects aged 65 years and older, but increased from 15.8% to 16.2% in those aged 20–44 and from 39.9% to 44.0% in those aged 45–64.

Diet as sole therapy decreased from 27.4% to 18.7% between the two surveys, as did insulin-only therapy (from 24.2% to 14.0%).

At the same time, the use of OADs alone increased from 45.4% to 57.4% and the use of OADs plus insulin increased from 3.1% to 10%.

Mr. Tao and his associates adjusted the analysis for age, gender, ethnicity, body mass index, and duration of diabetes. When they adjusted for these factors, they found that the likelihood of insulin use only and diet only as diabetes treatment declined from NHANES III to NHANES 1999–2002, while the likelihood of OAD use only and OAD plus insulin use increased.

Multivariate analysis revealed no change in the likelihood of glycemic control between NHANESIIIand NHANES1999–2002.

“This trend does not improve the rates of cardiovascular, renal, and other diabetic complications that may have an impact on health care costs,” the researchers reported in their poster that was presented.

GlaxoSmithKline funded the study.

SAN DIEGO — Despite a rise in the number of treatment regimens for adults with type 2 diabetes during the 1990s, national surveys showed no improvement in the number of adults who achieved glycemic control, Tao Fan reported in a poster session at the annual scientific sessions of the American Diabetes Association.

The finding suggests “there should be more aggressive therapy—particularly pharmacotherapy—for type 2 diabetes patients,” Mr. Fan told FAMILY PRACTICE NEWS.

He and his associates analyzed a sample of 1,215 subjects from National Health and Nutrition Examination Survey III (NHANES III, 1988–1994) and 758 subjects from NHANES 1999–2002.

All subjects reported a diagnosis of type 2 diabetes and had data on diabetes medication and hemoglobin A_1c levels, Mr. Fan said. He is a doctoral student in the department of pharmaceutical health services research at the University of Maryland, Baltimore.

The researchers defined four therapeutic regimens: diet only, insulin only, oral antidiabetic drugs (OADs) only, or OADs plus insulin.

From NHANES III to NHANES 1999–2002, glycemic control rates dropped from 44.3% to 39.8% in subjects aged 65 years and older, but increased from 15.8% to 16.2% in those aged 20–44 and from 39.9% to 44.0% in those aged 45–64.

Diet as sole therapy decreased from 27.4% to 18.7% between the two surveys, as did insulin-only therapy (from 24.2% to 14.0%).

At the same time, the use of OADs alone increased from 45.4% to 57.4% and the use of OADs plus insulin increased from 3.1% to 10%.

Mr. Tao and his associates adjusted the analysis for age, gender, ethnicity, body mass index, and duration of diabetes. When they adjusted for these factors, they found that the likelihood of insulin use only and diet only as diabetes treatment declined from NHANES III to NHANES 1999–2002, while the likelihood of OAD use only and OAD plus insulin use increased.

Multivariate analysis revealed no change in the likelihood of glycemic control between NHANESIIIand NHANES1999–2002.

“This trend does not improve the rates of cardiovascular, renal, and other diabetic complications that may have an impact on health care costs,” the researchers reported in their poster that was presented.

GlaxoSmithKline funded the study.

SAN DIEGO — Despite a rise in the number of treatment regimens for adults with type 2 diabetes during the 1990s, national surveys showed no improvement in the number of adults who achieved glycemic control, Tao Fan reported in a poster session at the annual scientific sessions of the American Diabetes Association.

The finding suggests “there should be more aggressive therapy—particularly pharmacotherapy—for type 2 diabetes patients,” Mr. Fan told FAMILY PRACTICE NEWS.

He and his associates analyzed a sample of 1,215 subjects from National Health and Nutrition Examination Survey III (NHANES III, 1988–1994) and 758 subjects from NHANES 1999–2002.

All subjects reported a diagnosis of type 2 diabetes and had data on diabetes medication and hemoglobin A_1c levels, Mr. Fan said. He is a doctoral student in the department of pharmaceutical health services research at the University of Maryland, Baltimore.

The researchers defined four therapeutic regimens: diet only, insulin only, oral antidiabetic drugs (OADs) only, or OADs plus insulin.

From NHANES III to NHANES 1999–2002, glycemic control rates dropped from 44.3% to 39.8% in subjects aged 65 years and older, but increased from 15.8% to 16.2% in those aged 20–44 and from 39.9% to 44.0% in those aged 45–64.

Diet as sole therapy decreased from 27.4% to 18.7% between the two surveys, as did insulin-only therapy (from 24.2% to 14.0%).

At the same time, the use of OADs alone increased from 45.4% to 57.4% and the use of OADs plus insulin increased from 3.1% to 10%.

Mr. Tao and his associates adjusted the analysis for age, gender, ethnicity, body mass index, and duration of diabetes. When they adjusted for these factors, they found that the likelihood of insulin use only and diet only as diabetes treatment declined from NHANES III to NHANES 1999–2002, while the likelihood of OAD use only and OAD plus insulin use increased.

Multivariate analysis revealed no change in the likelihood of glycemic control between NHANESIIIand NHANES1999–2002.

“This trend does not improve the rates of cardiovascular, renal, and other diabetic complications that may have an impact on health care costs,” the researchers reported in their poster that was presented.

GlaxoSmithKline funded the study.

SAN DIEGO – There appear to be no differences in the mean head circumference between children with and without autism, results from a population-based case-control study show.

The finding differs from other smaller studies that have reported increased rates of macrocephaly in autistic children, Carrie Jones, M.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Those studies have proposed that accelerated brain growth in the first years of life is an early biologic marker for a subgroup of children with autism, “but the results are based on very small groups of children, and they may or may not be representative of the general population of kids with autism,” said Dr. Jones of the Mind Institute at the University of California, Davis. “Also, they have rarely been correlated with other growth parameters such as weight and height, [and] they rarely have been paired with children from the same population.”

For the study, known as Childhood Autism Risks from Genetics and the Environment (CHARGE), Dr. Jones and her associates recruited 175 children with autism aged 2–5 years through six centers that provide developmental disability services to children and adults in Northern and Southern California. Diagnoses were confirmed with the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observational Schedule.

The investigators used birth records to identify 43 control children from the general population who were matched to the case population for age, gender, and geographic location.

All study participants received a medical exam that included measurement of head circumference, weight, and height. All parameters were plotted by age and gender on National Health and Nutrition Examination Survey III growth charts.

Dr. Jones and her associates found that the mean head circumference of both cases and controls was at the 59th percentile. About 12% of both cases and controls were at or above the 95th percentile, which was higher than expected.

“In linear regression models, the strongest predictor of head circumference was weight,” Dr. Jones said. “The heavier kids tended to have bigger heads, but autism vs. general population group membership did not predict head circumference.”

The next steps in the study are to examine earlier growth parameters from medical records for trajectories over time in both groups. Dr. Jones said the investigators also planned to measure parent head circumference to assess the correlation with children head circumference.

SAN DIEGO – There appear to be no differences in the mean head circumference between children with and without autism, results from a population-based case-control study show.

The finding differs from other smaller studies that have reported increased rates of macrocephaly in autistic children, Carrie Jones, M.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Those studies have proposed that accelerated brain growth in the first years of life is an early biologic marker for a subgroup of children with autism, “but the results are based on very small groups of children, and they may or may not be representative of the general population of kids with autism,” said Dr. Jones of the Mind Institute at the University of California, Davis. “Also, they have rarely been correlated with other growth parameters such as weight and height, [and] they rarely have been paired with children from the same population.”

For the study, known as Childhood Autism Risks from Genetics and the Environment (CHARGE), Dr. Jones and her associates recruited 175 children with autism aged 2–5 years through six centers that provide developmental disability services to children and adults in Northern and Southern California. Diagnoses were confirmed with the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observational Schedule.

The investigators used birth records to identify 43 control children from the general population who were matched to the case population for age, gender, and geographic location.

All study participants received a medical exam that included measurement of head circumference, weight, and height. All parameters were plotted by age and gender on National Health and Nutrition Examination Survey III growth charts.

Dr. Jones and her associates found that the mean head circumference of both cases and controls was at the 59th percentile. About 12% of both cases and controls were at or above the 95th percentile, which was higher than expected.

“In linear regression models, the strongest predictor of head circumference was weight,” Dr. Jones said. “The heavier kids tended to have bigger heads, but autism vs. general population group membership did not predict head circumference.”

The next steps in the study are to examine earlier growth parameters from medical records for trajectories over time in both groups. Dr. Jones said the investigators also planned to measure parent head circumference to assess the correlation with children head circumference.

SAN DIEGO – There appear to be no differences in the mean head circumference between children with and without autism, results from a population-based case-control study show.

The finding differs from other smaller studies that have reported increased rates of macrocephaly in autistic children, Carrie Jones, M.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Those studies have proposed that accelerated brain growth in the first years of life is an early biologic marker for a subgroup of children with autism, “but the results are based on very small groups of children, and they may or may not be representative of the general population of kids with autism,” said Dr. Jones of the Mind Institute at the University of California, Davis. “Also, they have rarely been correlated with other growth parameters such as weight and height, [and] they rarely have been paired with children from the same population.”

For the study, known as Childhood Autism Risks from Genetics and the Environment (CHARGE), Dr. Jones and her associates recruited 175 children with autism aged 2–5 years through six centers that provide developmental disability services to children and adults in Northern and Southern California. Diagnoses were confirmed with the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observational Schedule.

The investigators used birth records to identify 43 control children from the general population who were matched to the case population for age, gender, and geographic location.

All study participants received a medical exam that included measurement of head circumference, weight, and height. All parameters were plotted by age and gender on National Health and Nutrition Examination Survey III growth charts.

Dr. Jones and her associates found that the mean head circumference of both cases and controls was at the 59th percentile. About 12% of both cases and controls were at or above the 95th percentile, which was higher than expected.

“In linear regression models, the strongest predictor of head circumference was weight,” Dr. Jones said. “The heavier kids tended to have bigger heads, but autism vs. general population group membership did not predict head circumference.”

The next steps in the study are to examine earlier growth parameters from medical records for trajectories over time in both groups. Dr. Jones said the investigators also planned to measure parent head circumference to assess the correlation with children head circumference.

SAN DIEGO – When it comes to helping adolescents with Down syndrome and other cognitive disabilities transition to adult services, the earlier the better, William I. Cohen, M.D., advised at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Such an approach “makes perfect sense at one level, and at another level it's very hard to do, because some families don't start looking ahead early enough,” said Dr. Cohen, medical director of the Down Syndrome Center of Western Pennsylvania at Children's Hospital of Pittsburgh.

“When you receive a diagnosis of a disorder that is associated with cognitive disabilities, the crushing blow is knowing that forever and ever your child is going to be different. And [parents] begin to think about all of these things in the future. That is what I think terrifies them.”

He pointed out that needs of the adolescent and the family may exist on different levels. For example, the adolescent may want to live independently or in a group home when he or she turns 18, while the family may feel obligated to care for the child at home for the foreseeable future.

“Identify key individuals who can assist in this process and start with the end in mind,” he recommended. “Decide where you want to end up so you can begin early on” heading toward that goal as opposed to it all of a sudden springing up on you: All of a sudden the child is 13–18 years of age with all of these needs.

Dr. Cohen called the transition to adult services “a journey, not a destination. It is a continuous and dynamic process and is variable depending on the individual, family, community, and state in which they live, and the financial and emotional resources [of the family] as well.”

He and his associate, Sheila A. Cannon, offered the following tips on making transition planning run as smoothly as possible:

▸ Identify the educational needs. By the time the child turns 14 years of age, families should identify a course of study that matches the teen's interests and goals, and consider the need for supplemental services such as occupational therapy, speech/language therapy, and physical therapy. Then they should identify community resources and interagency responsibilities.

By law, all people with cognitive disabilities qualify for school services through age 21. Some remain in high school past age 18 to receive such services, but others choose to graduate with their peers and move on to other educational programs in the community that prepare them for employment, money management, and independent living skills.

Ms. Cannon's daughter, who has Down syndrome, was adamant about not going back to high school after graduating. “She took a certificate and opted for a program that is sponsored by another organization and provides vocational training on a college campus,” said Ms. Cannon, coordinator at the Down Syndrome Center of Western Pennsylvania. “So she is with her same-age peers” and the school district provides transportation.

She advises adolescents with cognitive disabilities to undergo a vocational assessment at their local offices of vocational rehabilitation. That way, the local agencies may be able to match an employment need based on their interests and skill levels.

“The transition plan should encourage students to take courses or have some type of planning in nutrition or fitness,” Ms. Cannon said, adding that her daughter attends a behavioral health class at a local college once a week.

Courses that address sexuality and self-esteem also are important. “It's important to have those options available for kids to learn about appropriate social distance and appropriate social interaction,” she said.

▸ Help the family identify an appropriate primary care physician. In the shift from pediatrician/family physician to internist or another physician, the real dilemma for patients and their families is the loss of their medical home, Dr. Cohen said. “Families will ask, 'Who can be my child's primary care physicians?' We ask the parents, 'Could it be your own physician, or someone you have a relationship with and would be willing to take on that role?' “

A key quality for the new physician is a willingness to partner with the family and other clinicians on behalf of the adolescent. “Even if they don't know much about the particular condition, their willingness to partner with the family and use available resources is most important,” Dr. Cohen said.

The new physician must be able to address chronic health problems, understand specific medical vulnerabilities, manage acute illness, and identify adult specialists.

If all else fails in the search for a new physician, have the family call its health insurer or managed care organization, Ms. Cannon said. “Often they have a special needs case manager that the family can connect with. They can give them a list of physicians who take that insurance.”

Dr. Cohen noted that young adults with Down syndrome who show signs of depression are often misinterpreted as having early Alzheimer's disease.

“We've known for quite some time that individuals with cognitive disabilities get depressed the same as other individuals for the same kinds of things, such as siblings moving on, loss of a caregiver or a roommate, or death of a parent,” he said. “We have seen a number of young adults who have developed some significant reactions to the loss of support, in terms of depression. They find themselves floundering.”

Obsessive compulsive disorder also may emerge as a coping mechanism.

▸ Talk about living arrangements. Ms. Cannon pointed out that most opportunities for independent living or community living arrangements for young adults with cognitive disabilities are handled through state offices of mental retardation. In Pennsylvania, for example, candidates for housing must prove they have a cognitive disability before the age of 21. Then they're put on a waiting list.

“If families don't do a reassessment of need every year, they can be dropped from the system,” Ms. Cannon cautioned.

She called the transition to adult services “as stressful and as unknown as when parents got the initial diagnosis for the child. It's really important to do educational planning and health care planning, to do as much as we can to help these families know what's really out there.”

For resources on transition planning, visit the “tools and solutions” section of the Healthy and Ready to Work National Center, a federally funded clearinghouse of information, at www.hrtw.org

SAN DIEGO – When it comes to helping adolescents with Down syndrome and other cognitive disabilities transition to adult services, the earlier the better, William I. Cohen, M.D., advised at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Such an approach “makes perfect sense at one level, and at another level it's very hard to do, because some families don't start looking ahead early enough,” said Dr. Cohen, medical director of the Down Syndrome Center of Western Pennsylvania at Children's Hospital of Pittsburgh.

“When you receive a diagnosis of a disorder that is associated with cognitive disabilities, the crushing blow is knowing that forever and ever your child is going to be different. And [parents] begin to think about all of these things in the future. That is what I think terrifies them.”

He pointed out that needs of the adolescent and the family may exist on different levels. For example, the adolescent may want to live independently or in a group home when he or she turns 18, while the family may feel obligated to care for the child at home for the foreseeable future.

“Identify key individuals who can assist in this process and start with the end in mind,” he recommended. “Decide where you want to end up so you can begin early on” heading toward that goal as opposed to it all of a sudden springing up on you: All of a sudden the child is 13–18 years of age with all of these needs.

Dr. Cohen called the transition to adult services “a journey, not a destination. It is a continuous and dynamic process and is variable depending on the individual, family, community, and state in which they live, and the financial and emotional resources [of the family] as well.”

He and his associate, Sheila A. Cannon, offered the following tips on making transition planning run as smoothly as possible:

▸ Identify the educational needs. By the time the child turns 14 years of age, families should identify a course of study that matches the teen's interests and goals, and consider the need for supplemental services such as occupational therapy, speech/language therapy, and physical therapy. Then they should identify community resources and interagency responsibilities.

By law, all people with cognitive disabilities qualify for school services through age 21. Some remain in high school past age 18 to receive such services, but others choose to graduate with their peers and move on to other educational programs in the community that prepare them for employment, money management, and independent living skills.

Ms. Cannon's daughter, who has Down syndrome, was adamant about not going back to high school after graduating. “She took a certificate and opted for a program that is sponsored by another organization and provides vocational training on a college campus,” said Ms. Cannon, coordinator at the Down Syndrome Center of Western Pennsylvania. “So she is with her same-age peers” and the school district provides transportation.

She advises adolescents with cognitive disabilities to undergo a vocational assessment at their local offices of vocational rehabilitation. That way, the local agencies may be able to match an employment need based on their interests and skill levels.

“The transition plan should encourage students to take courses or have some type of planning in nutrition or fitness,” Ms. Cannon said, adding that her daughter attends a behavioral health class at a local college once a week.

Courses that address sexuality and self-esteem also are important. “It's important to have those options available for kids to learn about appropriate social distance and appropriate social interaction,” she said.

▸ Help the family identify an appropriate primary care physician. In the shift from pediatrician/family physician to internist or another physician, the real dilemma for patients and their families is the loss of their medical home, Dr. Cohen said. “Families will ask, 'Who can be my child's primary care physicians?' We ask the parents, 'Could it be your own physician, or someone you have a relationship with and would be willing to take on that role?' “

A key quality for the new physician is a willingness to partner with the family and other clinicians on behalf of the adolescent. “Even if they don't know much about the particular condition, their willingness to partner with the family and use available resources is most important,” Dr. Cohen said.

The new physician must be able to address chronic health problems, understand specific medical vulnerabilities, manage acute illness, and identify adult specialists.

If all else fails in the search for a new physician, have the family call its health insurer or managed care organization, Ms. Cannon said. “Often they have a special needs case manager that the family can connect with. They can give them a list of physicians who take that insurance.”

Dr. Cohen noted that young adults with Down syndrome who show signs of depression are often misinterpreted as having early Alzheimer's disease.

“We've known for quite some time that individuals with cognitive disabilities get depressed the same as other individuals for the same kinds of things, such as siblings moving on, loss of a caregiver or a roommate, or death of a parent,” he said. “We have seen a number of young adults who have developed some significant reactions to the loss of support, in terms of depression. They find themselves floundering.”

Obsessive compulsive disorder also may emerge as a coping mechanism.

▸ Talk about living arrangements. Ms. Cannon pointed out that most opportunities for independent living or community living arrangements for young adults with cognitive disabilities are handled through state offices of mental retardation. In Pennsylvania, for example, candidates for housing must prove they have a cognitive disability before the age of 21. Then they're put on a waiting list.

“If families don't do a reassessment of need every year, they can be dropped from the system,” Ms. Cannon cautioned.

She called the transition to adult services “as stressful and as unknown as when parents got the initial diagnosis for the child. It's really important to do educational planning and health care planning, to do as much as we can to help these families know what's really out there.”

For resources on transition planning, visit the “tools and solutions” section of the Healthy and Ready to Work National Center, a federally funded clearinghouse of information, at www.hrtw.org

SAN DIEGO – When it comes to helping adolescents with Down syndrome and other cognitive disabilities transition to adult services, the earlier the better, William I. Cohen, M.D., advised at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Such an approach “makes perfect sense at one level, and at another level it's very hard to do, because some families don't start looking ahead early enough,” said Dr. Cohen, medical director of the Down Syndrome Center of Western Pennsylvania at Children's Hospital of Pittsburgh.

“When you receive a diagnosis of a disorder that is associated with cognitive disabilities, the crushing blow is knowing that forever and ever your child is going to be different. And [parents] begin to think about all of these things in the future. That is what I think terrifies them.”

He pointed out that needs of the adolescent and the family may exist on different levels. For example, the adolescent may want to live independently or in a group home when he or she turns 18, while the family may feel obligated to care for the child at home for the foreseeable future.

“Identify key individuals who can assist in this process and start with the end in mind,” he recommended. “Decide where you want to end up so you can begin early on” heading toward that goal as opposed to it all of a sudden springing up on you: All of a sudden the child is 13–18 years of age with all of these needs.

Dr. Cohen called the transition to adult services “a journey, not a destination. It is a continuous and dynamic process and is variable depending on the individual, family, community, and state in which they live, and the financial and emotional resources [of the family] as well.”

He and his associate, Sheila A. Cannon, offered the following tips on making transition planning run as smoothly as possible:

▸ Identify the educational needs. By the time the child turns 14 years of age, families should identify a course of study that matches the teen's interests and goals, and consider the need for supplemental services such as occupational therapy, speech/language therapy, and physical therapy. Then they should identify community resources and interagency responsibilities.

By law, all people with cognitive disabilities qualify for school services through age 21. Some remain in high school past age 18 to receive such services, but others choose to graduate with their peers and move on to other educational programs in the community that prepare them for employment, money management, and independent living skills.

Ms. Cannon's daughter, who has Down syndrome, was adamant about not going back to high school after graduating. “She took a certificate and opted for a program that is sponsored by another organization and provides vocational training on a college campus,” said Ms. Cannon, coordinator at the Down Syndrome Center of Western Pennsylvania. “So she is with her same-age peers” and the school district provides transportation.

She advises adolescents with cognitive disabilities to undergo a vocational assessment at their local offices of vocational rehabilitation. That way, the local agencies may be able to match an employment need based on their interests and skill levels.

“The transition plan should encourage students to take courses or have some type of planning in nutrition or fitness,” Ms. Cannon said, adding that her daughter attends a behavioral health class at a local college once a week.

Courses that address sexuality and self-esteem also are important. “It's important to have those options available for kids to learn about appropriate social distance and appropriate social interaction,” she said.

▸ Help the family identify an appropriate primary care physician. In the shift from pediatrician/family physician to internist or another physician, the real dilemma for patients and their families is the loss of their medical home, Dr. Cohen said. “Families will ask, 'Who can be my child's primary care physicians?' We ask the parents, 'Could it be your own physician, or someone you have a relationship with and would be willing to take on that role?' “

A key quality for the new physician is a willingness to partner with the family and other clinicians on behalf of the adolescent. “Even if they don't know much about the particular condition, their willingness to partner with the family and use available resources is most important,” Dr. Cohen said.

The new physician must be able to address chronic health problems, understand specific medical vulnerabilities, manage acute illness, and identify adult specialists.

If all else fails in the search for a new physician, have the family call its health insurer or managed care organization, Ms. Cannon said. “Often they have a special needs case manager that the family can connect with. They can give them a list of physicians who take that insurance.”

Dr. Cohen noted that young adults with Down syndrome who show signs of depression are often misinterpreted as having early Alzheimer's disease.

“We've known for quite some time that individuals with cognitive disabilities get depressed the same as other individuals for the same kinds of things, such as siblings moving on, loss of a caregiver or a roommate, or death of a parent,” he said. “We have seen a number of young adults who have developed some significant reactions to the loss of support, in terms of depression. They find themselves floundering.”

Obsessive compulsive disorder also may emerge as a coping mechanism.

▸ Talk about living arrangements. Ms. Cannon pointed out that most opportunities for independent living or community living arrangements for young adults with cognitive disabilities are handled through state offices of mental retardation. In Pennsylvania, for example, candidates for housing must prove they have a cognitive disability before the age of 21. Then they're put on a waiting list.

“If families don't do a reassessment of need every year, they can be dropped from the system,” Ms. Cannon cautioned.

She called the transition to adult services “as stressful and as unknown as when parents got the initial diagnosis for the child. It's really important to do educational planning and health care planning, to do as much as we can to help these families know what's really out there.”

For resources on transition planning, visit the “tools and solutions” section of the Healthy and Ready to Work National Center, a federally funded clearinghouse of information, at www.hrtw.org

SAN DIEGO – While the bulk of current literature suggests that young girls exhibit less verbal and physical aggressive behavior than young boys, results from a new analysis funded by the National Institute of Mental Health suggest that may not be the case at all.

“Young girls–particularly those 5–6 years old–are more physically and verbally aggressive than we're giving them credit for,” Mariann Suarez, Ph.D., said in an interview during a poster session at the annual meeting of the Society for Developmental and Behavioral Pediatrics. “We typically think of boys as more physically and verbally aggressive and girls as more relationally aggressive, when in fact both [genders are all three types]. Little kids are very aggressive at a very young age.”

The finding is important because pediatricians may be misidentifying aggressive symptoms in girls due to biased gender norms, said Dr. Suarez of the department of pediatrics at the MetroHealth campus of Case Western Reserve University, Cleveland.

As part of a larger NIMH study, Dr. Suarez and her associate, James J. Snyder, Ph.D., set out to investigate the gender differences in the development of verbal, physical, and relational aggression in a sample of 161 kindergarten and first-grade students at a public elementary school in Wichita, Kan. Dr. Suarez conducted the work while she was a graduate student at Wichita State University.

For nearly 2 years, the investigators used the Behavioral Playground Observation Coding System and a 12-item peer nomination measure to assess the youngsters' pattern of behavior. Assessment periods for the coding system were six 5-minute periods during the first and second halves of kindergarten and four 5-minute periods during the first half of first grade.

Study participants completed the peer nomination measure during the fall and spring of kindergarten. The investigators found that girls displayed increasing rates of verbal/physical aggression, while boys displayed relational aggression at a rate that surpassed girls. “That surprised me,” Dr. Suarez said. In kindergarten, more acts of verbal and physical aggression were observed among boys, compared with girls, but there were no gender differences among the first-graders.

SAN DIEGO – While the bulk of current literature suggests that young girls exhibit less verbal and physical aggressive behavior than young boys, results from a new analysis funded by the National Institute of Mental Health suggest that may not be the case at all.

“Young girls–particularly those 5–6 years old–are more physically and verbally aggressive than we're giving them credit for,” Mariann Suarez, Ph.D., said in an interview during a poster session at the annual meeting of the Society for Developmental and Behavioral Pediatrics. “We typically think of boys as more physically and verbally aggressive and girls as more relationally aggressive, when in fact both [genders are all three types]. Little kids are very aggressive at a very young age.”

The finding is important because pediatricians may be misidentifying aggressive symptoms in girls due to biased gender norms, said Dr. Suarez of the department of pediatrics at the MetroHealth campus of Case Western Reserve University, Cleveland.

As part of a larger NIMH study, Dr. Suarez and her associate, James J. Snyder, Ph.D., set out to investigate the gender differences in the development of verbal, physical, and relational aggression in a sample of 161 kindergarten and first-grade students at a public elementary school in Wichita, Kan. Dr. Suarez conducted the work while she was a graduate student at Wichita State University.

For nearly 2 years, the investigators used the Behavioral Playground Observation Coding System and a 12-item peer nomination measure to assess the youngsters' pattern of behavior. Assessment periods for the coding system were six 5-minute periods during the first and second halves of kindergarten and four 5-minute periods during the first half of first grade.

Study participants completed the peer nomination measure during the fall and spring of kindergarten. The investigators found that girls displayed increasing rates of verbal/physical aggression, while boys displayed relational aggression at a rate that surpassed girls. “That surprised me,” Dr. Suarez said. In kindergarten, more acts of verbal and physical aggression were observed among boys, compared with girls, but there were no gender differences among the first-graders.

SAN DIEGO – While the bulk of current literature suggests that young girls exhibit less verbal and physical aggressive behavior than young boys, results from a new analysis funded by the National Institute of Mental Health suggest that may not be the case at all.

“Young girls–particularly those 5–6 years old–are more physically and verbally aggressive than we're giving them credit for,” Mariann Suarez, Ph.D., said in an interview during a poster session at the annual meeting of the Society for Developmental and Behavioral Pediatrics. “We typically think of boys as more physically and verbally aggressive and girls as more relationally aggressive, when in fact both [genders are all three types]. Little kids are very aggressive at a very young age.”

The finding is important because pediatricians may be misidentifying aggressive symptoms in girls due to biased gender norms, said Dr. Suarez of the department of pediatrics at the MetroHealth campus of Case Western Reserve University, Cleveland.

As part of a larger NIMH study, Dr. Suarez and her associate, James J. Snyder, Ph.D., set out to investigate the gender differences in the development of verbal, physical, and relational aggression in a sample of 161 kindergarten and first-grade students at a public elementary school in Wichita, Kan. Dr. Suarez conducted the work while she was a graduate student at Wichita State University.

For nearly 2 years, the investigators used the Behavioral Playground Observation Coding System and a 12-item peer nomination measure to assess the youngsters' pattern of behavior. Assessment periods for the coding system were six 5-minute periods during the first and second halves of kindergarten and four 5-minute periods during the first half of first grade.

Study participants completed the peer nomination measure during the fall and spring of kindergarten. The investigators found that girls displayed increasing rates of verbal/physical aggression, while boys displayed relational aggression at a rate that surpassed girls. “That surprised me,” Dr. Suarez said. In kindergarten, more acts of verbal and physical aggression were observed among boys, compared with girls, but there were no gender differences among the first-graders.

Maternal celiac disease, undiagnosed at the time of delivery, is a risk factor for adverse fetal outcomes, but celiac disease diagnosed before giving birth is not associated with such outcomes, results from a large Swedish population study suggest.

“Our results underline the importance of screening for CD [celiac disease] among women of reproductive age, because some 1% of young people may have CD, and treatment seems to reduce dramatically the rate of complications in pregnancy,” reported the investigators, led by Jonas F. Ludvigsson, M.D., of the pediatric department at Örebro University Hospital, Sweden.

Celiac disease is a chronic intestinal malabsorption disorder caused by intolerance to gluten. Diagnosis is suspected on the basis of symptoms, enhanced by laboratory and x-ray studies, and confirmed by biopsy. A gluten-free diet is the only treatment.

Using a national medical registry, Ludvigsson and his associates identified 2,078 women aged 15–44 with a diagnosis of CD who gave birth to singleton live-born infants between 1973 and 2001. A total of 1,149 women were diagnosed with CD before giving birth, and 929 were diagnosed after giving birth (Gastroenterology 2005;129:454–63).

After adjusting for potential confounding factors such as smoking, age, parity, and diabetes mellitus, the subjects diagnosed with CD after birth were associated with an increased risk of intrauterine growth retardation (odds ratio of 1.62), preterm birth (OR 1.71), cesarean section (OR 1.82), low birth weight (OR 2.13), and very low birth weight (OR 2.45). Subjects diagnosed with CD before the birth of their offspring were not significantly associated with a higher risk of these outcomes.

The risk for nearly all adverse outcomes was highest in women who received a diagnosis of CD within 5 years after childbirth.

They postulated that insufficient fetal nutrition causes the increased risk of intrauterine growth retardation and low birth weight seen in offspring of women diagnosed after giving birth. “It has previously been shown that undiagnosed adult patients with CD have lower serum ferritin, vitamin B₁₂, and erythrocyte folate,” the investigators wrote. “A second explanation for the IUGR [intrauterine growth retardation] and low birth weight could be CD-mediated inflammation or dysregulation of the immune system. The latter explanation is particularly attractive when trying to explain the shorter pregnancy duration seen in offspring to patients with undiagnosed celiac disease.”

A limitation of the study, the authors acknowledged, is the risk of low sensitivity. “Not all patients with CD are admitted to a hospital, and our unexposed women certainly include several false-negative patients,” they said. “This is, however, unlikely to affect our risk estimates because the number of cases is large, and healthy women without CD vastly outnumber false-negative cases, now classified as unexposed.”

Maternal celiac disease, undiagnosed at the time of delivery, is a risk factor for adverse fetal outcomes, but celiac disease diagnosed before giving birth is not associated with such outcomes, results from a large Swedish population study suggest.

“Our results underline the importance of screening for CD [celiac disease] among women of reproductive age, because some 1% of young people may have CD, and treatment seems to reduce dramatically the rate of complications in pregnancy,” reported the investigators, led by Jonas F. Ludvigsson, M.D., of the pediatric department at Örebro University Hospital, Sweden.

Celiac disease is a chronic intestinal malabsorption disorder caused by intolerance to gluten. Diagnosis is suspected on the basis of symptoms, enhanced by laboratory and x-ray studies, and confirmed by biopsy. A gluten-free diet is the only treatment.

Using a national medical registry, Ludvigsson and his associates identified 2,078 women aged 15–44 with a diagnosis of CD who gave birth to singleton live-born infants between 1973 and 2001. A total of 1,149 women were diagnosed with CD before giving birth, and 929 were diagnosed after giving birth (Gastroenterology 2005;129:454–63).

After adjusting for potential confounding factors such as smoking, age, parity, and diabetes mellitus, the subjects diagnosed with CD after birth were associated with an increased risk of intrauterine growth retardation (odds ratio of 1.62), preterm birth (OR 1.71), cesarean section (OR 1.82), low birth weight (OR 2.13), and very low birth weight (OR 2.45). Subjects diagnosed with CD before the birth of their offspring were not significantly associated with a higher risk of these outcomes.

The risk for nearly all adverse outcomes was highest in women who received a diagnosis of CD within 5 years after childbirth.

They postulated that insufficient fetal nutrition causes the increased risk of intrauterine growth retardation and low birth weight seen in offspring of women diagnosed after giving birth. “It has previously been shown that undiagnosed adult patients with CD have lower serum ferritin, vitamin B₁₂, and erythrocyte folate,” the investigators wrote. “A second explanation for the IUGR [intrauterine growth retardation] and low birth weight could be CD-mediated inflammation or dysregulation of the immune system. The latter explanation is particularly attractive when trying to explain the shorter pregnancy duration seen in offspring to patients with undiagnosed celiac disease.”

A limitation of the study, the authors acknowledged, is the risk of low sensitivity. “Not all patients with CD are admitted to a hospital, and our unexposed women certainly include several false-negative patients,” they said. “This is, however, unlikely to affect our risk estimates because the number of cases is large, and healthy women without CD vastly outnumber false-negative cases, now classified as unexposed.”

Maternal celiac disease, undiagnosed at the time of delivery, is a risk factor for adverse fetal outcomes, but celiac disease diagnosed before giving birth is not associated with such outcomes, results from a large Swedish population study suggest.

“Our results underline the importance of screening for CD [celiac disease] among women of reproductive age, because some 1% of young people may have CD, and treatment seems to reduce dramatically the rate of complications in pregnancy,” reported the investigators, led by Jonas F. Ludvigsson, M.D., of the pediatric department at Örebro University Hospital, Sweden.

Celiac disease is a chronic intestinal malabsorption disorder caused by intolerance to gluten. Diagnosis is suspected on the basis of symptoms, enhanced by laboratory and x-ray studies, and confirmed by biopsy. A gluten-free diet is the only treatment.

Using a national medical registry, Ludvigsson and his associates identified 2,078 women aged 15–44 with a diagnosis of CD who gave birth to singleton live-born infants between 1973 and 2001. A total of 1,149 women were diagnosed with CD before giving birth, and 929 were diagnosed after giving birth (Gastroenterology 2005;129:454–63).

After adjusting for potential confounding factors such as smoking, age, parity, and diabetes mellitus, the subjects diagnosed with CD after birth were associated with an increased risk of intrauterine growth retardation (odds ratio of 1.62), preterm birth (OR 1.71), cesarean section (OR 1.82), low birth weight (OR 2.13), and very low birth weight (OR 2.45). Subjects diagnosed with CD before the birth of their offspring were not significantly associated with a higher risk of these outcomes.

The risk for nearly all adverse outcomes was highest in women who received a diagnosis of CD within 5 years after childbirth.

They postulated that insufficient fetal nutrition causes the increased risk of intrauterine growth retardation and low birth weight seen in offspring of women diagnosed after giving birth. “It has previously been shown that undiagnosed adult patients with CD have lower serum ferritin, vitamin B₁₂, and erythrocyte folate,” the investigators wrote. “A second explanation for the IUGR [intrauterine growth retardation] and low birth weight could be CD-mediated inflammation or dysregulation of the immune system. The latter explanation is particularly attractive when trying to explain the shorter pregnancy duration seen in offspring to patients with undiagnosed celiac disease.”

A limitation of the study, the authors acknowledged, is the risk of low sensitivity. “Not all patients with CD are admitted to a hospital, and our unexposed women certainly include several false-negative patients,” they said. “This is, however, unlikely to affect our risk estimates because the number of cases is large, and healthy women without CD vastly outnumber false-negative cases, now classified as unexposed.”