Sherry Boschert

SAN DIEGO — The recent merger of two obesity associations to create the Obesity Society is expected to consolidate efforts to influence government programs and funding for the obesity epidemic, Richard M. Downey, J.D., said at a symposium on obesity sponsored by the American Society of Bariatric Physicians.

Mr. Downey is a staff member for the North American Association for the Study of Obesity, which has been renamed the Obesity Society.

In December 2006, the organization completed a merger with the American Obesity Association, where he previously served as executive director.

The new Obesity Society will push for creation of a National Institute of Obesity Research, he said.

The Obesity Society is likely to demand better evaluation of obesity prevention programs, Mr. Downey said. The lack of coordination and evaluation of programs to prevent childhood obesity makes it difficult to learn from experience and replicate successes, a recent Institute of Medicine report suggested.

SAN DIEGO — The recent merger of two obesity associations to create the Obesity Society is expected to consolidate efforts to influence government programs and funding for the obesity epidemic, Richard M. Downey, J.D., said at a symposium on obesity sponsored by the American Society of Bariatric Physicians.

Mr. Downey is a staff member for the North American Association for the Study of Obesity, which has been renamed the Obesity Society.

In December 2006, the organization completed a merger with the American Obesity Association, where he previously served as executive director.

The new Obesity Society will push for creation of a National Institute of Obesity Research, he said.

The Obesity Society is likely to demand better evaluation of obesity prevention programs, Mr. Downey said. The lack of coordination and evaluation of programs to prevent childhood obesity makes it difficult to learn from experience and replicate successes, a recent Institute of Medicine report suggested.

SAN DIEGO — The recent merger of two obesity associations to create the Obesity Society is expected to consolidate efforts to influence government programs and funding for the obesity epidemic, Richard M. Downey, J.D., said at a symposium on obesity sponsored by the American Society of Bariatric Physicians.

Mr. Downey is a staff member for the North American Association for the Study of Obesity, which has been renamed the Obesity Society.

In December 2006, the organization completed a merger with the American Obesity Association, where he previously served as executive director.

The new Obesity Society will push for creation of a National Institute of Obesity Research, he said.

The Obesity Society is likely to demand better evaluation of obesity prevention programs, Mr. Downey said. The lack of coordination and evaluation of programs to prevent childhood obesity makes it difficult to learn from experience and replicate successes, a recent Institute of Medicine report suggested.

SAN FRANCISCO — After the onset of labor, using a classical incision for C-section delivery of a very-low-birth-weight neonate in nonvertex position reduced the risk of intraventricular hemorrhage, compared with a transverse incision or transverse incision with extension, a study of 148 deliveries found.

The decrease in risk was more pronounced for more severe intraventricular hemorrhage (IVH), Dr. Kai Ling Tan and associates reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Previous studies have shown that vaginal delivery is safe for infants in vertex position weighing less than 1,000 g, but data are sparse on rates of IVH after delivery of very-low-birth-weight (VLBW) infants in breech, transverse, or oblique positions.

“It is a constant debate among ob.gyns. in the [morbidity and mortality] conferences in my institution whether to do a classical or a low transverse incision” in these cases, said Dr. Tan of the Medical College of Wisconsin Affiliated Hospitals, Wauwatosa, Wis., in an interview at the poster session.

The current retrospective review found no significant difference in IVH rates between the 93 neonates delivered by classical C-section (27% with IVH) and 58 delivered using one of the two low transverse incisions (34% with IVH). For 94 women who went to C-section after the onset of labor, however, 27% of neonates in the classical incision group had IVH, compared with 54% in the low transverse incisions group, a significant difference.

In the laboring group, severe IVH (grade 3–4) or death occurred in 18% of neonates after a classical incision, and in 50% after a low transverse incision, which also was significant. The lead author of the poster was Dr. Jeffery Garland of Wheaton Franciscan Healthcare-St. Joseph, Milwaukee.

In general, physicians who encounter difficulty delivering an infant through a low transverse incision sometimes use a J or T extension of the incision. VLBW infants may be more vulnerable in these situations, Dr. Tan said. The most common reason for extending uterine incisions is to deliver a nonvertex infant, some reports suggest.

The association between classical incision and decreased risk for IVH in nonvertex, VLBW infants after labor remained significant after controlling for potential confounders, the investigators said.

SAN FRANCISCO — After the onset of labor, using a classical incision for C-section delivery of a very-low-birth-weight neonate in nonvertex position reduced the risk of intraventricular hemorrhage, compared with a transverse incision or transverse incision with extension, a study of 148 deliveries found.

The decrease in risk was more pronounced for more severe intraventricular hemorrhage (IVH), Dr. Kai Ling Tan and associates reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Previous studies have shown that vaginal delivery is safe for infants in vertex position weighing less than 1,000 g, but data are sparse on rates of IVH after delivery of very-low-birth-weight (VLBW) infants in breech, transverse, or oblique positions.

“It is a constant debate among ob.gyns. in the [morbidity and mortality] conferences in my institution whether to do a classical or a low transverse incision” in these cases, said Dr. Tan of the Medical College of Wisconsin Affiliated Hospitals, Wauwatosa, Wis., in an interview at the poster session.

The current retrospective review found no significant difference in IVH rates between the 93 neonates delivered by classical C-section (27% with IVH) and 58 delivered using one of the two low transverse incisions (34% with IVH). For 94 women who went to C-section after the onset of labor, however, 27% of neonates in the classical incision group had IVH, compared with 54% in the low transverse incisions group, a significant difference.

In the laboring group, severe IVH (grade 3–4) or death occurred in 18% of neonates after a classical incision, and in 50% after a low transverse incision, which also was significant. The lead author of the poster was Dr. Jeffery Garland of Wheaton Franciscan Healthcare-St. Joseph, Milwaukee.

In general, physicians who encounter difficulty delivering an infant through a low transverse incision sometimes use a J or T extension of the incision. VLBW infants may be more vulnerable in these situations, Dr. Tan said. The most common reason for extending uterine incisions is to deliver a nonvertex infant, some reports suggest.

The association between classical incision and decreased risk for IVH in nonvertex, VLBW infants after labor remained significant after controlling for potential confounders, the investigators said.

SAN FRANCISCO — After the onset of labor, using a classical incision for C-section delivery of a very-low-birth-weight neonate in nonvertex position reduced the risk of intraventricular hemorrhage, compared with a transverse incision or transverse incision with extension, a study of 148 deliveries found.

The decrease in risk was more pronounced for more severe intraventricular hemorrhage (IVH), Dr. Kai Ling Tan and associates reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Previous studies have shown that vaginal delivery is safe for infants in vertex position weighing less than 1,000 g, but data are sparse on rates of IVH after delivery of very-low-birth-weight (VLBW) infants in breech, transverse, or oblique positions.

“It is a constant debate among ob.gyns. in the [morbidity and mortality] conferences in my institution whether to do a classical or a low transverse incision” in these cases, said Dr. Tan of the Medical College of Wisconsin Affiliated Hospitals, Wauwatosa, Wis., in an interview at the poster session.

The current retrospective review found no significant difference in IVH rates between the 93 neonates delivered by classical C-section (27% with IVH) and 58 delivered using one of the two low transverse incisions (34% with IVH). For 94 women who went to C-section after the onset of labor, however, 27% of neonates in the classical incision group had IVH, compared with 54% in the low transverse incisions group, a significant difference.

In the laboring group, severe IVH (grade 3–4) or death occurred in 18% of neonates after a classical incision, and in 50% after a low transverse incision, which also was significant. The lead author of the poster was Dr. Jeffery Garland of Wheaton Franciscan Healthcare-St. Joseph, Milwaukee.

In general, physicians who encounter difficulty delivering an infant through a low transverse incision sometimes use a J or T extension of the incision. VLBW infants may be more vulnerable in these situations, Dr. Tan said. The most common reason for extending uterine incisions is to deliver a nonvertex infant, some reports suggest.

The association between classical incision and decreased risk for IVH in nonvertex, VLBW infants after labor remained significant after controlling for potential confounders, the investigators said.

SAN FRANCISCO — To optimize maternal and neonatal outcomes in pregnancies complicated by placenta previa, administer antenatal steroids at 35 weeks' and 5 days' gestation, and follow with delivery at 36 weeks, Dr. Marya Zlatnik said at the annual meeting of the Society for Maternal-Fetal Medicine.

She and her associates conducted a decision analysis modeling study to weigh the risks to mothers and babies at various times of delivery in the setting of placenta previa. In general, earlier deliveries would benefit mothers by minimizing the risk of bleeding, but later deliveries allow fetuses to increase gestational age and avoid potential complications of preterm births.

A typical recommendation used in clinical practice calls for amniocentesis to check for fetal lung maturity followed by delivery at 26–37 weeks' gestation, yet there are no randomized controlled trial data to support that, noted Dr. Zlatnik, of the University of California, San Francisco. A randomized study would need 10,000 women in each arm and is unlikely to be conducted.

The present study compared total maternal and neonatal quality-adjusted life years after delivery at gestational ages ranging from 34 to 38 weeks.

The model looked at four delivery strategies. The first entailed amniocentesis for fetal lung maturity, with expectant management if results were negative. The second scenario used amniocentesis for lung maturity plus administration of antenatal steroids if results were negative, followed by delivery in 48 hours. The third strategy involved giving steroids to all women followed by delivery in 48 hours. The fourth option skipped amniocentesis and steroids and called for immediate delivery at the gestational age being studied.

The investigators assumed a risk of emergent bleeding ranging from 5% at 35 weeks to 29% at 38 weeks, and a risk for hysterectomy ranging from 2% with scheduled deliveries to 6% for delivery after emergent bleeding.

Total quality-adjusted life years peaked for women with delivery at 36 weeks with or without use of steroids. Adding antenatal steroids improved fetal outcomes. The modeling did not incorporate potential long-term effects from use of steroids.

“For situations in which administration of steroids at term is considered unsafe, or steroids were administered early in pregnancy, delivery at 36 weeks” without further steroids was the best option, she said.

The results remained the same unless the risk for maternal bleeding was more than four times higher than estimates used, or the risk for adverse neonatal outcomes (respiratory distress syndrome or cerebral palsy) were more than 160% of estimates used.

The modeling did not control for the effects of diabetes, which could affect the conclusions, Dr. Zlatnik said. She hoped to stratify maternal risks for women with a history of bleeding in a future analysis.

For every 100,000 women with placenta previa delivered at 36 weeks under the current study's modeling, 15,040 would have emergent bleeds, 2,225 would have hysterectomies, and 31 would die. For neonates, 3,290 would have respiratory distress syndrome. “Most of the strategies achieved fairly similar results, with the absolute differences being minimal, especially between the 36-week options, so there is some room for obstetric practices to determine the optimal time for delivery for each patient,” she said.

Decision analysis study techniques are useful but simplify the clinical situation, and some data on probabilities of risk come from small sample sizes, Dr. Zlatnik commented. Choosing strategies that maximize quality-adjusted life years may not coincide with individual preferences, she added.

Approximately 3 per 1,000 pregnant women with singletons have placenta previa at term, with higher risk levels in some subgroups. Placenta previa caused 7% of maternal deaths between 1979 and 2002, Dr. Zlatnik said.

Placenta previa is known to have caused 7% of maternal deaths between 1979 and 2002. DR. ZLATNIK

SAN FRANCISCO — To optimize maternal and neonatal outcomes in pregnancies complicated by placenta previa, administer antenatal steroids at 35 weeks' and 5 days' gestation, and follow with delivery at 36 weeks, Dr. Marya Zlatnik said at the annual meeting of the Society for Maternal-Fetal Medicine.

She and her associates conducted a decision analysis modeling study to weigh the risks to mothers and babies at various times of delivery in the setting of placenta previa. In general, earlier deliveries would benefit mothers by minimizing the risk of bleeding, but later deliveries allow fetuses to increase gestational age and avoid potential complications of preterm births.

A typical recommendation used in clinical practice calls for amniocentesis to check for fetal lung maturity followed by delivery at 26–37 weeks' gestation, yet there are no randomized controlled trial data to support that, noted Dr. Zlatnik, of the University of California, San Francisco. A randomized study would need 10,000 women in each arm and is unlikely to be conducted.

The present study compared total maternal and neonatal quality-adjusted life years after delivery at gestational ages ranging from 34 to 38 weeks.

The model looked at four delivery strategies. The first entailed amniocentesis for fetal lung maturity, with expectant management if results were negative. The second scenario used amniocentesis for lung maturity plus administration of antenatal steroids if results were negative, followed by delivery in 48 hours. The third strategy involved giving steroids to all women followed by delivery in 48 hours. The fourth option skipped amniocentesis and steroids and called for immediate delivery at the gestational age being studied.

The investigators assumed a risk of emergent bleeding ranging from 5% at 35 weeks to 29% at 38 weeks, and a risk for hysterectomy ranging from 2% with scheduled deliveries to 6% for delivery after emergent bleeding.

Total quality-adjusted life years peaked for women with delivery at 36 weeks with or without use of steroids. Adding antenatal steroids improved fetal outcomes. The modeling did not incorporate potential long-term effects from use of steroids.

“For situations in which administration of steroids at term is considered unsafe, or steroids were administered early in pregnancy, delivery at 36 weeks” without further steroids was the best option, she said.

The results remained the same unless the risk for maternal bleeding was more than four times higher than estimates used, or the risk for adverse neonatal outcomes (respiratory distress syndrome or cerebral palsy) were more than 160% of estimates used.

The modeling did not control for the effects of diabetes, which could affect the conclusions, Dr. Zlatnik said. She hoped to stratify maternal risks for women with a history of bleeding in a future analysis.

For every 100,000 women with placenta previa delivered at 36 weeks under the current study's modeling, 15,040 would have emergent bleeds, 2,225 would have hysterectomies, and 31 would die. For neonates, 3,290 would have respiratory distress syndrome. “Most of the strategies achieved fairly similar results, with the absolute differences being minimal, especially between the 36-week options, so there is some room for obstetric practices to determine the optimal time for delivery for each patient,” she said.

Decision analysis study techniques are useful but simplify the clinical situation, and some data on probabilities of risk come from small sample sizes, Dr. Zlatnik commented. Choosing strategies that maximize quality-adjusted life years may not coincide with individual preferences, she added.

Approximately 3 per 1,000 pregnant women with singletons have placenta previa at term, with higher risk levels in some subgroups. Placenta previa caused 7% of maternal deaths between 1979 and 2002, Dr. Zlatnik said.

Placenta previa is known to have caused 7% of maternal deaths between 1979 and 2002. DR. ZLATNIK

SAN FRANCISCO — To optimize maternal and neonatal outcomes in pregnancies complicated by placenta previa, administer antenatal steroids at 35 weeks' and 5 days' gestation, and follow with delivery at 36 weeks, Dr. Marya Zlatnik said at the annual meeting of the Society for Maternal-Fetal Medicine.

She and her associates conducted a decision analysis modeling study to weigh the risks to mothers and babies at various times of delivery in the setting of placenta previa. In general, earlier deliveries would benefit mothers by minimizing the risk of bleeding, but later deliveries allow fetuses to increase gestational age and avoid potential complications of preterm births.

A typical recommendation used in clinical practice calls for amniocentesis to check for fetal lung maturity followed by delivery at 26–37 weeks' gestation, yet there are no randomized controlled trial data to support that, noted Dr. Zlatnik, of the University of California, San Francisco. A randomized study would need 10,000 women in each arm and is unlikely to be conducted.

The present study compared total maternal and neonatal quality-adjusted life years after delivery at gestational ages ranging from 34 to 38 weeks.

The model looked at four delivery strategies. The first entailed amniocentesis for fetal lung maturity, with expectant management if results were negative. The second scenario used amniocentesis for lung maturity plus administration of antenatal steroids if results were negative, followed by delivery in 48 hours. The third strategy involved giving steroids to all women followed by delivery in 48 hours. The fourth option skipped amniocentesis and steroids and called for immediate delivery at the gestational age being studied.

The investigators assumed a risk of emergent bleeding ranging from 5% at 35 weeks to 29% at 38 weeks, and a risk for hysterectomy ranging from 2% with scheduled deliveries to 6% for delivery after emergent bleeding.

Total quality-adjusted life years peaked for women with delivery at 36 weeks with or without use of steroids. Adding antenatal steroids improved fetal outcomes. The modeling did not incorporate potential long-term effects from use of steroids.

“For situations in which administration of steroids at term is considered unsafe, or steroids were administered early in pregnancy, delivery at 36 weeks” without further steroids was the best option, she said.

The results remained the same unless the risk for maternal bleeding was more than four times higher than estimates used, or the risk for adverse neonatal outcomes (respiratory distress syndrome or cerebral palsy) were more than 160% of estimates used.

The modeling did not control for the effects of diabetes, which could affect the conclusions, Dr. Zlatnik said. She hoped to stratify maternal risks for women with a history of bleeding in a future analysis.

For every 100,000 women with placenta previa delivered at 36 weeks under the current study's modeling, 15,040 would have emergent bleeds, 2,225 would have hysterectomies, and 31 would die. For neonates, 3,290 would have respiratory distress syndrome. “Most of the strategies achieved fairly similar results, with the absolute differences being minimal, especially between the 36-week options, so there is some room for obstetric practices to determine the optimal time for delivery for each patient,” she said.

Decision analysis study techniques are useful but simplify the clinical situation, and some data on probabilities of risk come from small sample sizes, Dr. Zlatnik commented. Choosing strategies that maximize quality-adjusted life years may not coincide with individual preferences, she added.

Approximately 3 per 1,000 pregnant women with singletons have placenta previa at term, with higher risk levels in some subgroups. Placenta previa caused 7% of maternal deaths between 1979 and 2002, Dr. Zlatnik said.

Placenta previa is known to have caused 7% of maternal deaths between 1979 and 2002. DR. ZLATNIK

SAN FRANCISCO — Two oral medications deserve further investigation as alternative therapies for gestational diabetes, results of separate small studies suggest.

Acarbose or metformin might be helpful additions to the therapeutic armamentarium if additional research supports these preliminary findings, investigators said in separate poster presentations at the annual meeting of the Society for Maternal-Fetal Medicine.

Neither drug is approved for the treatment of gestational diabetes. Both are Food and Drug Administration pregnancy category B. Injected insulin or oral glyburide are approved to treat gestational diabetes.

Having an oral option other than glyburide might allow patients to be managed on one or potentially two oral agents before resorting to injections of insulin, Dr. Jacquelyn Cortez said in an interview at one of the posters.

She and associates conducted a prospective, double-blind trial that randomized 59 women who were diagnosed with gestational diabetes in their second or third trimester, prior to 34 weeks' gestation, to 50 mg acarbose t.i.d. or identical placebo pills taken with meals. All patients had failed diet therapy.

At regular follow-ups, if more than half of the patient's fasting glucose values were above 95 mg/dL, or more than half of her postprandial glucose values were above 135 mg/dL, the dosage was increased to 100 mg t.i.d.

If this did not control blood glucose levels, the patient was considered to have failed single-agent therapy and was started on a second agent.

Fewer patients in the acarbose group failed monotherapy and required a second agent, compared with the placebo group, but the difference did not quite reach statistical significance in this small study.

Women in the acarbose group gained significantly less weight (19 pounds) than did women on placebo (27 pounds), said Dr. Cortez of the department of reproductive medicine at the University of California, San Diego.

Postprandial blood glucose levels were significantly lower on acarbose therapy (122 mg/dL), compared with placebo (130 mg/dL).

There were no differences between groups in perinatal outcomes, including gestational age at delivery, mode of delivery, or rate of macrosomia.

The failure rate with acarbose in this study and failure rates with glyburide in other studies both are high, but women on acarbose in the present study did not develop the hypoglycemia sometimes seen with glyburide, Dr. Cortez noted.

Acarbose is a glycosidase inhibitor that prevents intestinal breakdown of starches to glucose in the upper small bowel.

Metformin, an insulin sensitizer, was the subject of a separate review of data from two randomized trials in which 67 women with gestational diabetes took the drug. Of these patients, 59 met glycemic goals of fasting glucose values lower than 105 mg/dL and 2-hour postprandial glucose values lower than 120 mg/dL, reported Dr. Lisa E. Moore and associates.

The eight women who did not meet glycemic goals started insulin therapy, said Dr. Moore of the University of New Mexico, Albuquerque.

Macrosomia occurred in four infants (6%), and all were delivered vaginally.

The primary cesarean delivery rate (excluding elective repeat C-sections) was 15% (10 patients).

There were no cases of fetal anomalies or maternal or fetal hypoglycemia. Eight neonates had hyperbilirubinemia and two had 5-minute Apgar scores that were lower than 5.

The efficacy rate with metformin appeared to be similar to success rates with glyburide in other studies, Dr. Moore commented.

“[Metformin] is certainly better at controlling the fasting blood sugar than glyburide,” she added.

Failure of metformin was not predicted by maternal body mass index or by the value of the 1-hour glucose challenge test.

Although metformin is not approved in the United States for this indication, there is a wealth of data from other countries on its use in gestational diabetes, she noted.

Dr. Cortez and Dr. Moore have no financial relationships with the companies that make the medications studied.

SAN FRANCISCO — Two oral medications deserve further investigation as alternative therapies for gestational diabetes, results of separate small studies suggest.

Acarbose or metformin might be helpful additions to the therapeutic armamentarium if additional research supports these preliminary findings, investigators said in separate poster presentations at the annual meeting of the Society for Maternal-Fetal Medicine.

Neither drug is approved for the treatment of gestational diabetes. Both are Food and Drug Administration pregnancy category B. Injected insulin or oral glyburide are approved to treat gestational diabetes.

Having an oral option other than glyburide might allow patients to be managed on one or potentially two oral agents before resorting to injections of insulin, Dr. Jacquelyn Cortez said in an interview at one of the posters.

She and associates conducted a prospective, double-blind trial that randomized 59 women who were diagnosed with gestational diabetes in their second or third trimester, prior to 34 weeks' gestation, to 50 mg acarbose t.i.d. or identical placebo pills taken with meals. All patients had failed diet therapy.

At regular follow-ups, if more than half of the patient's fasting glucose values were above 95 mg/dL, or more than half of her postprandial glucose values were above 135 mg/dL, the dosage was increased to 100 mg t.i.d.

If this did not control blood glucose levels, the patient was considered to have failed single-agent therapy and was started on a second agent.

Fewer patients in the acarbose group failed monotherapy and required a second agent, compared with the placebo group, but the difference did not quite reach statistical significance in this small study.

Women in the acarbose group gained significantly less weight (19 pounds) than did women on placebo (27 pounds), said Dr. Cortez of the department of reproductive medicine at the University of California, San Diego.

Postprandial blood glucose levels were significantly lower on acarbose therapy (122 mg/dL), compared with placebo (130 mg/dL).

There were no differences between groups in perinatal outcomes, including gestational age at delivery, mode of delivery, or rate of macrosomia.

The failure rate with acarbose in this study and failure rates with glyburide in other studies both are high, but women on acarbose in the present study did not develop the hypoglycemia sometimes seen with glyburide, Dr. Cortez noted.

Acarbose is a glycosidase inhibitor that prevents intestinal breakdown of starches to glucose in the upper small bowel.

Metformin, an insulin sensitizer, was the subject of a separate review of data from two randomized trials in which 67 women with gestational diabetes took the drug. Of these patients, 59 met glycemic goals of fasting glucose values lower than 105 mg/dL and 2-hour postprandial glucose values lower than 120 mg/dL, reported Dr. Lisa E. Moore and associates.

The eight women who did not meet glycemic goals started insulin therapy, said Dr. Moore of the University of New Mexico, Albuquerque.

Macrosomia occurred in four infants (6%), and all were delivered vaginally.

The primary cesarean delivery rate (excluding elective repeat C-sections) was 15% (10 patients).

There were no cases of fetal anomalies or maternal or fetal hypoglycemia. Eight neonates had hyperbilirubinemia and two had 5-minute Apgar scores that were lower than 5.

The efficacy rate with metformin appeared to be similar to success rates with glyburide in other studies, Dr. Moore commented.

“[Metformin] is certainly better at controlling the fasting blood sugar than glyburide,” she added.

Failure of metformin was not predicted by maternal body mass index or by the value of the 1-hour glucose challenge test.

Although metformin is not approved in the United States for this indication, there is a wealth of data from other countries on its use in gestational diabetes, she noted.

Dr. Cortez and Dr. Moore have no financial relationships with the companies that make the medications studied.

SAN FRANCISCO — Two oral medications deserve further investigation as alternative therapies for gestational diabetes, results of separate small studies suggest.

Acarbose or metformin might be helpful additions to the therapeutic armamentarium if additional research supports these preliminary findings, investigators said in separate poster presentations at the annual meeting of the Society for Maternal-Fetal Medicine.

Neither drug is approved for the treatment of gestational diabetes. Both are Food and Drug Administration pregnancy category B. Injected insulin or oral glyburide are approved to treat gestational diabetes.

Having an oral option other than glyburide might allow patients to be managed on one or potentially two oral agents before resorting to injections of insulin, Dr. Jacquelyn Cortez said in an interview at one of the posters.

She and associates conducted a prospective, double-blind trial that randomized 59 women who were diagnosed with gestational diabetes in their second or third trimester, prior to 34 weeks' gestation, to 50 mg acarbose t.i.d. or identical placebo pills taken with meals. All patients had failed diet therapy.

At regular follow-ups, if more than half of the patient's fasting glucose values were above 95 mg/dL, or more than half of her postprandial glucose values were above 135 mg/dL, the dosage was increased to 100 mg t.i.d.

If this did not control blood glucose levels, the patient was considered to have failed single-agent therapy and was started on a second agent.

Fewer patients in the acarbose group failed monotherapy and required a second agent, compared with the placebo group, but the difference did not quite reach statistical significance in this small study.

Women in the acarbose group gained significantly less weight (19 pounds) than did women on placebo (27 pounds), said Dr. Cortez of the department of reproductive medicine at the University of California, San Diego.

Postprandial blood glucose levels were significantly lower on acarbose therapy (122 mg/dL), compared with placebo (130 mg/dL).

There were no differences between groups in perinatal outcomes, including gestational age at delivery, mode of delivery, or rate of macrosomia.

The failure rate with acarbose in this study and failure rates with glyburide in other studies both are high, but women on acarbose in the present study did not develop the hypoglycemia sometimes seen with glyburide, Dr. Cortez noted.

Acarbose is a glycosidase inhibitor that prevents intestinal breakdown of starches to glucose in the upper small bowel.

Metformin, an insulin sensitizer, was the subject of a separate review of data from two randomized trials in which 67 women with gestational diabetes took the drug. Of these patients, 59 met glycemic goals of fasting glucose values lower than 105 mg/dL and 2-hour postprandial glucose values lower than 120 mg/dL, reported Dr. Lisa E. Moore and associates.

The eight women who did not meet glycemic goals started insulin therapy, said Dr. Moore of the University of New Mexico, Albuquerque.

Macrosomia occurred in four infants (6%), and all were delivered vaginally.

The primary cesarean delivery rate (excluding elective repeat C-sections) was 15% (10 patients).

There were no cases of fetal anomalies or maternal or fetal hypoglycemia. Eight neonates had hyperbilirubinemia and two had 5-minute Apgar scores that were lower than 5.

The efficacy rate with metformin appeared to be similar to success rates with glyburide in other studies, Dr. Moore commented.

“[Metformin] is certainly better at controlling the fasting blood sugar than glyburide,” she added.

Failure of metformin was not predicted by maternal body mass index or by the value of the 1-hour glucose challenge test.

Although metformin is not approved in the United States for this indication, there is a wealth of data from other countries on its use in gestational diabetes, she noted.

Dr. Cortez and Dr. Moore have no financial relationships with the companies that make the medications studied.

SAN FRANCISCO — Adjustments made to maternal serum alpha fetoprotein values in pregnant diabetics may be inadequate to screen for neural tube defects or Down syndrome, Dr. Loralei L. Thornburg reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

She and her associates studied data on 77 pregnant women with type 1 diabetes, 75 with type 2 diabetes, and 304 nondiabetic pregnant women with normal glucose levels who had maternal serum alpha fetoprotein (MSAFP) levels drawn between July 2001 and August 2003 at the same institution. MSAFP levels are used in prenatal screening for neural tube defects and Down syndrome. Previous studies have shown that MSAFP values are lower in type 1 diabetics than in nondiabetics, and MSAFP in type 2 diabetics is not well studied.

Usually clinicians apply a 20% upward adjustment of the MSAFP multiple-of-the-median value for pregnant type 1 diabetics, and they use a lower cut-off for normal to improve the sensitivity of screening for neural tube defects.

In the study population, a 10% correction factor appeared to be a more appropriate adjustment to MSAFP values in both type 1 and type 2 diabetics. In addition, correction for both diabetes and weight were needed to normalize MSAFP values, said Dr. Thornburg of the University of Rochester (N.Y.).

With the 20% correction factor, the MSAFP multiple-of-the-median value was significantly higher in both diabetic groups than in control patients. After the correction factor was decreased to 10% in the diabetes groups, the MSAFP multiple-of-the-median value did not differ significantly between the three groups. All medians were specific to gestational age and race. Fifty-five (73%) of patients with type 2 diabetes were on insulin therapy.

The MSAFP multiple-of-the-median values before correction for diabetes differed between patients with type 1 and type 2 diabetes until correction for weight.

Correction for weight and the 10% correction for diabetes were needed to control for significant differences between the control group and either diabetes group in MSAFP multiple-of-the-median values.

The retrospective study excluded patients with an MSAFP multiple-of-the-median value greater than 2.0, patients whose serum samples were drawn too early or redrawn, patients who underwent early chorionic villi sampling, and patients with fetal anomalies, aneuploidy, multiple gestations, or no information on diabetes type.

SAN FRANCISCO — Adjustments made to maternal serum alpha fetoprotein values in pregnant diabetics may be inadequate to screen for neural tube defects or Down syndrome, Dr. Loralei L. Thornburg reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

She and her associates studied data on 77 pregnant women with type 1 diabetes, 75 with type 2 diabetes, and 304 nondiabetic pregnant women with normal glucose levels who had maternal serum alpha fetoprotein (MSAFP) levels drawn between July 2001 and August 2003 at the same institution. MSAFP levels are used in prenatal screening for neural tube defects and Down syndrome. Previous studies have shown that MSAFP values are lower in type 1 diabetics than in nondiabetics, and MSAFP in type 2 diabetics is not well studied.

Usually clinicians apply a 20% upward adjustment of the MSAFP multiple-of-the-median value for pregnant type 1 diabetics, and they use a lower cut-off for normal to improve the sensitivity of screening for neural tube defects.

In the study population, a 10% correction factor appeared to be a more appropriate adjustment to MSAFP values in both type 1 and type 2 diabetics. In addition, correction for both diabetes and weight were needed to normalize MSAFP values, said Dr. Thornburg of the University of Rochester (N.Y.).

With the 20% correction factor, the MSAFP multiple-of-the-median value was significantly higher in both diabetic groups than in control patients. After the correction factor was decreased to 10% in the diabetes groups, the MSAFP multiple-of-the-median value did not differ significantly between the three groups. All medians were specific to gestational age and race. Fifty-five (73%) of patients with type 2 diabetes were on insulin therapy.

The MSAFP multiple-of-the-median values before correction for diabetes differed between patients with type 1 and type 2 diabetes until correction for weight.

Correction for weight and the 10% correction for diabetes were needed to control for significant differences between the control group and either diabetes group in MSAFP multiple-of-the-median values.

The retrospective study excluded patients with an MSAFP multiple-of-the-median value greater than 2.0, patients whose serum samples were drawn too early or redrawn, patients who underwent early chorionic villi sampling, and patients with fetal anomalies, aneuploidy, multiple gestations, or no information on diabetes type.

SAN FRANCISCO — Adjustments made to maternal serum alpha fetoprotein values in pregnant diabetics may be inadequate to screen for neural tube defects or Down syndrome, Dr. Loralei L. Thornburg reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

She and her associates studied data on 77 pregnant women with type 1 diabetes, 75 with type 2 diabetes, and 304 nondiabetic pregnant women with normal glucose levels who had maternal serum alpha fetoprotein (MSAFP) levels drawn between July 2001 and August 2003 at the same institution. MSAFP levels are used in prenatal screening for neural tube defects and Down syndrome. Previous studies have shown that MSAFP values are lower in type 1 diabetics than in nondiabetics, and MSAFP in type 2 diabetics is not well studied.

Usually clinicians apply a 20% upward adjustment of the MSAFP multiple-of-the-median value for pregnant type 1 diabetics, and they use a lower cut-off for normal to improve the sensitivity of screening for neural tube defects.

In the study population, a 10% correction factor appeared to be a more appropriate adjustment to MSAFP values in both type 1 and type 2 diabetics. In addition, correction for both diabetes and weight were needed to normalize MSAFP values, said Dr. Thornburg of the University of Rochester (N.Y.).

With the 20% correction factor, the MSAFP multiple-of-the-median value was significantly higher in both diabetic groups than in control patients. After the correction factor was decreased to 10% in the diabetes groups, the MSAFP multiple-of-the-median value did not differ significantly between the three groups. All medians were specific to gestational age and race. Fifty-five (73%) of patients with type 2 diabetes were on insulin therapy.

The MSAFP multiple-of-the-median values before correction for diabetes differed between patients with type 1 and type 2 diabetes until correction for weight.

Correction for weight and the 10% correction for diabetes were needed to control for significant differences between the control group and either diabetes group in MSAFP multiple-of-the-median values.

The retrospective study excluded patients with an MSAFP multiple-of-the-median value greater than 2.0, patients whose serum samples were drawn too early or redrawn, patients who underwent early chorionic villi sampling, and patients with fetal anomalies, aneuploidy, multiple gestations, or no information on diabetes type.

SAN FRANCISCO — Accelerated fetal growth in the midtrimester, as assessed by individualized growth potentials and ultrasound imaging, helped predict macrosomia in a study of 70 women who developed gestational diabetes.

“Early suggestion of accelerated fetal growth offers a window of opportunity to optimize glycemic management” of the mother and potentially prevent macrosomic stillbirth and perinatal morbidity, Dr. Anita Manogura reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

She and her colleagues prospectively followed 70 women who went on to develop gestational diabetes. The women underwent serial assessments, including standardized ultrasound exams for nuchal translucency screening (11–14 weeks' gestation), detailed evaluation of anatomy (18–20 weeks' gestation), and formal fetal echocardiogram (22–24 weeks' gestation and then every 4 weeks thereafter), wrote Dr. Manogura of the University of Maryland, Baltimore, and her associates.

They used the Gardosi method to predict individual fetal growth potentials based on fetal gender and the mother's height, weight, parity, ethnicity, and other characteristics. Estimated fetal weights from imaging were converted to percentiles, with large for gestational age (LGA) defined as above the 90th percentile.

Early differences were seen between the 27 LGA infants and infants born at normal weights. By 24 weeks' gestation, LGA infants had a median estimated fetal weight in the 54th percentile, significantly higher than the 48th percentile for normal-weight neonates. At 24 weeks, an estimated weight that was above the 58th percentile predicted an LGA baby with a sensitivity of 30% and specificity of 84%.

If this trend continued at 28 weeks, then the odds of having an LGA baby were four times higher. At 28 weeks, future LGA babies were at a median 72nd percentile of estimated fetal weight, compared with the 51st percentile for normal-weight infants. An estimated fetal weight of greater than the 58th percentile at 28 weeks increased the sensitivity of predicting macrosomia to 63%, with a specificity of 87%.

“The potential to interrupt this progression by intensive midtrimester glycemic management deserves further study,” the investigators concluded.

Elevated estimated fetal weight percentiles on ultrasound did not predict adverse perinatal outcomes such as shoulder dystocia, cesarean delivery, or neonatal complications.

SAN FRANCISCO — Accelerated fetal growth in the midtrimester, as assessed by individualized growth potentials and ultrasound imaging, helped predict macrosomia in a study of 70 women who developed gestational diabetes.

“Early suggestion of accelerated fetal growth offers a window of opportunity to optimize glycemic management” of the mother and potentially prevent macrosomic stillbirth and perinatal morbidity, Dr. Anita Manogura reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

She and her colleagues prospectively followed 70 women who went on to develop gestational diabetes. The women underwent serial assessments, including standardized ultrasound exams for nuchal translucency screening (11–14 weeks' gestation), detailed evaluation of anatomy (18–20 weeks' gestation), and formal fetal echocardiogram (22–24 weeks' gestation and then every 4 weeks thereafter), wrote Dr. Manogura of the University of Maryland, Baltimore, and her associates.

They used the Gardosi method to predict individual fetal growth potentials based on fetal gender and the mother's height, weight, parity, ethnicity, and other characteristics. Estimated fetal weights from imaging were converted to percentiles, with large for gestational age (LGA) defined as above the 90th percentile.

Early differences were seen between the 27 LGA infants and infants born at normal weights. By 24 weeks' gestation, LGA infants had a median estimated fetal weight in the 54th percentile, significantly higher than the 48th percentile for normal-weight neonates. At 24 weeks, an estimated weight that was above the 58th percentile predicted an LGA baby with a sensitivity of 30% and specificity of 84%.

If this trend continued at 28 weeks, then the odds of having an LGA baby were four times higher. At 28 weeks, future LGA babies were at a median 72nd percentile of estimated fetal weight, compared with the 51st percentile for normal-weight infants. An estimated fetal weight of greater than the 58th percentile at 28 weeks increased the sensitivity of predicting macrosomia to 63%, with a specificity of 87%.

“The potential to interrupt this progression by intensive midtrimester glycemic management deserves further study,” the investigators concluded.

Elevated estimated fetal weight percentiles on ultrasound did not predict adverse perinatal outcomes such as shoulder dystocia, cesarean delivery, or neonatal complications.

SAN FRANCISCO — Accelerated fetal growth in the midtrimester, as assessed by individualized growth potentials and ultrasound imaging, helped predict macrosomia in a study of 70 women who developed gestational diabetes.

“Early suggestion of accelerated fetal growth offers a window of opportunity to optimize glycemic management” of the mother and potentially prevent macrosomic stillbirth and perinatal morbidity, Dr. Anita Manogura reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

She and her colleagues prospectively followed 70 women who went on to develop gestational diabetes. The women underwent serial assessments, including standardized ultrasound exams for nuchal translucency screening (11–14 weeks' gestation), detailed evaluation of anatomy (18–20 weeks' gestation), and formal fetal echocardiogram (22–24 weeks' gestation and then every 4 weeks thereafter), wrote Dr. Manogura of the University of Maryland, Baltimore, and her associates.

They used the Gardosi method to predict individual fetal growth potentials based on fetal gender and the mother's height, weight, parity, ethnicity, and other characteristics. Estimated fetal weights from imaging were converted to percentiles, with large for gestational age (LGA) defined as above the 90th percentile.

Early differences were seen between the 27 LGA infants and infants born at normal weights. By 24 weeks' gestation, LGA infants had a median estimated fetal weight in the 54th percentile, significantly higher than the 48th percentile for normal-weight neonates. At 24 weeks, an estimated weight that was above the 58th percentile predicted an LGA baby with a sensitivity of 30% and specificity of 84%.

If this trend continued at 28 weeks, then the odds of having an LGA baby were four times higher. At 28 weeks, future LGA babies were at a median 72nd percentile of estimated fetal weight, compared with the 51st percentile for normal-weight infants. An estimated fetal weight of greater than the 58th percentile at 28 weeks increased the sensitivity of predicting macrosomia to 63%, with a specificity of 87%.

“The potential to interrupt this progression by intensive midtrimester glycemic management deserves further study,” the investigators concluded.

Elevated estimated fetal weight percentiles on ultrasound did not predict adverse perinatal outcomes such as shoulder dystocia, cesarean delivery, or neonatal complications.

SAN FRANCISCO — Pregnant women with type 1 diabetes mellitus were more likely to improve glycemic control and less likely to deliver by cesarean section if they used insulin pumps rather than self-injections of insulin, Dr. Yvonne W. Cheng said.

Among 60 women in the pump group, 25% had hemoglobin A_1c (HbA_1c) values below 6%, compared with 13% of 628 women in the injection group of a retrospective cohort study, she reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Half of women in the pump group delivered by C-section, compared with 63% in the injection group, said Dr. Cheng of the University of California, San Francisco, and her associates.

After controlling for the effects of maternal age, parity, ethnicity, body mass index, gestational weight gain, and gestational age at enrollment in the California Diabetes and Pregnancy Program, women in the pump group were three times as likely to have HbA_1c values below 6% and were half as likely to have a C-section, compared with the injection group.

The conclusions support results from a 2004 study that found improved glycemic control with use of an insulin pump instead of injections by pregnant women with type 1 diabetes.

Three other studies in 1988, 2000, and 2005 found no significant differences in results among groups, she noted. All the previous studies were smaller than the present study, with only 11–36 patients in the pump groups.

The current study also found that women in the pump group were more likely to be white, to speak English as their primary language, and to have a higher education level than did women in the injection group.

There were no differences between the pump and injections groups in rates of preterm delivery, large-for-gestational-age babies, or admissions to intensive care nurseries.

“In nonpregnant diabetics, most people are switching over to pumps” because studies have shown better glycemic control, Dr. Cheng said in an interview.

The pump provides continuous release of insulin, functioning more like the pancreas than do timed injections of insulin.

To be candidates for pumps, women must be able to count carbohydrates, operate the machine, and program it.

Dr. Cheng has no association with companies that make insulin pumps or injection products.

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO — Pregnant women with type 1 diabetes mellitus were more likely to improve glycemic control and less likely to deliver by cesarean section if they used insulin pumps rather than self-injections of insulin, Dr. Yvonne W. Cheng said.

Among 60 women in the pump group, 25% had hemoglobin A_1c (HbA_1c) values below 6%, compared with 13% of 628 women in the injection group of a retrospective cohort study, she reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Half of women in the pump group delivered by C-section, compared with 63% in the injection group, said Dr. Cheng of the University of California, San Francisco, and her associates.

After controlling for the effects of maternal age, parity, ethnicity, body mass index, gestational weight gain, and gestational age at enrollment in the California Diabetes and Pregnancy Program, women in the pump group were three times as likely to have HbA_1c values below 6% and were half as likely to have a C-section, compared with the injection group.

The conclusions support results from a 2004 study that found improved glycemic control with use of an insulin pump instead of injections by pregnant women with type 1 diabetes.

Three other studies in 1988, 2000, and 2005 found no significant differences in results among groups, she noted. All the previous studies were smaller than the present study, with only 11–36 patients in the pump groups.

The current study also found that women in the pump group were more likely to be white, to speak English as their primary language, and to have a higher education level than did women in the injection group.

There were no differences between the pump and injections groups in rates of preterm delivery, large-for-gestational-age babies, or admissions to intensive care nurseries.

“In nonpregnant diabetics, most people are switching over to pumps” because studies have shown better glycemic control, Dr. Cheng said in an interview.

The pump provides continuous release of insulin, functioning more like the pancreas than do timed injections of insulin.

To be candidates for pumps, women must be able to count carbohydrates, operate the machine, and program it.

Dr. Cheng has no association with companies that make insulin pumps or injection products.

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO — Pregnant women with type 1 diabetes mellitus were more likely to improve glycemic control and less likely to deliver by cesarean section if they used insulin pumps rather than self-injections of insulin, Dr. Yvonne W. Cheng said.

Among 60 women in the pump group, 25% had hemoglobin A_1c (HbA_1c) values below 6%, compared with 13% of 628 women in the injection group of a retrospective cohort study, she reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Half of women in the pump group delivered by C-section, compared with 63% in the injection group, said Dr. Cheng of the University of California, San Francisco, and her associates.

After controlling for the effects of maternal age, parity, ethnicity, body mass index, gestational weight gain, and gestational age at enrollment in the California Diabetes and Pregnancy Program, women in the pump group were three times as likely to have HbA_1c values below 6% and were half as likely to have a C-section, compared with the injection group.

The conclusions support results from a 2004 study that found improved glycemic control with use of an insulin pump instead of injections by pregnant women with type 1 diabetes.

Three other studies in 1988, 2000, and 2005 found no significant differences in results among groups, she noted. All the previous studies were smaller than the present study, with only 11–36 patients in the pump groups.

The current study also found that women in the pump group were more likely to be white, to speak English as their primary language, and to have a higher education level than did women in the injection group.

There were no differences between the pump and injections groups in rates of preterm delivery, large-for-gestational-age babies, or admissions to intensive care nurseries.

“In nonpregnant diabetics, most people are switching over to pumps” because studies have shown better glycemic control, Dr. Cheng said in an interview.

The pump provides continuous release of insulin, functioning more like the pancreas than do timed injections of insulin.

To be candidates for pumps, women must be able to count carbohydrates, operate the machine, and program it.

Dr. Cheng has no association with companies that make insulin pumps or injection products.

ELSEVIER GLOBAL MEDICAL NEWS

SAN DIEGO — The recent merger of two obesity associations to create the Obesity Society is expected to consolidate efforts to influence government programs and funding for the obesity epidemic, Richard M. Downey, J.D., said at a symposium on obesity sponsored by the American Society of Bariatric Physicians.

Mr. Downey is a staff member for the North American Association for the Study of Obesity, which has been renamed the Obesity Society. In December 2006, the organization completed a merger with the American Obesity Association, where he previously served as executive director. The new Obesity Society will push for creation of a National Institute of Obesity Research, he said.

The Obesity Society is likely to demand better evaluation of obesity prevention programs, Mr. Downey said. The lack of coordination and evaluation of programs to prevent childhood obesity makes it difficult to learn from experience and replicate successes, a recent Institute of Medicine report suggested.

SAN DIEGO — The recent merger of two obesity associations to create the Obesity Society is expected to consolidate efforts to influence government programs and funding for the obesity epidemic, Richard M. Downey, J.D., said at a symposium on obesity sponsored by the American Society of Bariatric Physicians.

Mr. Downey is a staff member for the North American Association for the Study of Obesity, which has been renamed the Obesity Society. In December 2006, the organization completed a merger with the American Obesity Association, where he previously served as executive director. The new Obesity Society will push for creation of a National Institute of Obesity Research, he said.

The Obesity Society is likely to demand better evaluation of obesity prevention programs, Mr. Downey said. The lack of coordination and evaluation of programs to prevent childhood obesity makes it difficult to learn from experience and replicate successes, a recent Institute of Medicine report suggested.

SAN DIEGO — The recent merger of two obesity associations to create the Obesity Society is expected to consolidate efforts to influence government programs and funding for the obesity epidemic, Richard M. Downey, J.D., said at a symposium on obesity sponsored by the American Society of Bariatric Physicians.

Mr. Downey is a staff member for the North American Association for the Study of Obesity, which has been renamed the Obesity Society. In December 2006, the organization completed a merger with the American Obesity Association, where he previously served as executive director. The new Obesity Society will push for creation of a National Institute of Obesity Research, he said.

The Obesity Society is likely to demand better evaluation of obesity prevention programs, Mr. Downey said. The lack of coordination and evaluation of programs to prevent childhood obesity makes it difficult to learn from experience and replicate successes, a recent Institute of Medicine report suggested.

SAN FRANCISCO — Moderate consumption of alcohol can be part of a healthy lifestyle to prevent cardiac disease, but not if you drink too fast, Dr. Mary O. Gray said at a meeting sponsored by the California chapter of the American College of Cardiology.

The cardioprotective benefits of alcohol appear to be limited to one drink per day for women or two drinks per day for men. Beyond that, alcohol is cardiotoxic, said Dr. Gray of San Francisco General Hospital.

Binge drinking—defined as consuming three or more drinks in 1 or 2 hours—doubled the risk of death from any cause in a recent study of 2,000 patients treated for acute MI (Circulation 2005;112:3839–45). Regular consumption of alcohol reduced risk of death, but binge drinking blocked or attenuated this benefit.

The negative effects of binge drinking applied regardless of whether a person was a light or heavy drinker overall, she said at the meeting, also sponsored by the University of California, San Francisco.

Heavy drinking for a long time can cause alcoholic cardiomyopathy. Heavy drinkers with hypertension or heart failure should be advised to stop drinking to preserve their hearts. Data on very heavy drinkers suggest that those who develop heart failure may recover cardiovascular function if they stop drinking. Recovery is more likely if the patient has no other cardiovascular risk factors for disease.

Heavy drinkers often are malnourished, so treatment should include attention to a healthy diet including thiamine supplementation, Dr. Gray advised. Treat cardiac arrhythmias or systemic hypertension promptly in heavy drinkers, she added.

Most heavy drinkers also are heavy cigarette smokers. Dr. Gray and associates plan to study the interplay between cigarette smoking and alcohol consumption.

SAN FRANCISCO — Moderate consumption of alcohol can be part of a healthy lifestyle to prevent cardiac disease, but not if you drink too fast, Dr. Mary O. Gray said at a meeting sponsored by the California chapter of the American College of Cardiology.

The cardioprotective benefits of alcohol appear to be limited to one drink per day for women or two drinks per day for men. Beyond that, alcohol is cardiotoxic, said Dr. Gray of San Francisco General Hospital.

Binge drinking—defined as consuming three or more drinks in 1 or 2 hours—doubled the risk of death from any cause in a recent study of 2,000 patients treated for acute MI (Circulation 2005;112:3839–45). Regular consumption of alcohol reduced risk of death, but binge drinking blocked or attenuated this benefit.

The negative effects of binge drinking applied regardless of whether a person was a light or heavy drinker overall, she said at the meeting, also sponsored by the University of California, San Francisco.

Heavy drinking for a long time can cause alcoholic cardiomyopathy. Heavy drinkers with hypertension or heart failure should be advised to stop drinking to preserve their hearts. Data on very heavy drinkers suggest that those who develop heart failure may recover cardiovascular function if they stop drinking. Recovery is more likely if the patient has no other cardiovascular risk factors for disease.

Heavy drinkers often are malnourished, so treatment should include attention to a healthy diet including thiamine supplementation, Dr. Gray advised. Treat cardiac arrhythmias or systemic hypertension promptly in heavy drinkers, she added.

Most heavy drinkers also are heavy cigarette smokers. Dr. Gray and associates plan to study the interplay between cigarette smoking and alcohol consumption.

SAN FRANCISCO — Moderate consumption of alcohol can be part of a healthy lifestyle to prevent cardiac disease, but not if you drink too fast, Dr. Mary O. Gray said at a meeting sponsored by the California chapter of the American College of Cardiology.

The cardioprotective benefits of alcohol appear to be limited to one drink per day for women or two drinks per day for men. Beyond that, alcohol is cardiotoxic, said Dr. Gray of San Francisco General Hospital.

Binge drinking—defined as consuming three or more drinks in 1 or 2 hours—doubled the risk of death from any cause in a recent study of 2,000 patients treated for acute MI (Circulation 2005;112:3839–45). Regular consumption of alcohol reduced risk of death, but binge drinking blocked or attenuated this benefit.

The negative effects of binge drinking applied regardless of whether a person was a light or heavy drinker overall, she said at the meeting, also sponsored by the University of California, San Francisco.

Heavy drinking for a long time can cause alcoholic cardiomyopathy. Heavy drinkers with hypertension or heart failure should be advised to stop drinking to preserve their hearts. Data on very heavy drinkers suggest that those who develop heart failure may recover cardiovascular function if they stop drinking. Recovery is more likely if the patient has no other cardiovascular risk factors for disease.

Heavy drinkers often are malnourished, so treatment should include attention to a healthy diet including thiamine supplementation, Dr. Gray advised. Treat cardiac arrhythmias or systemic hypertension promptly in heavy drinkers, she added.

Most heavy drinkers also are heavy cigarette smokers. Dr. Gray and associates plan to study the interplay between cigarette smoking and alcohol consumption.

SAN FRANCISCO — Two oral medications deserve further investigation as alternative therapies for gestational diabetes, results of separate small studies suggest.

Acarbose or metformin might be helpful additions to the therapeutic armamentarium if additional research supports these preliminary findings, investigators said in separate poster presentations at the annual meeting of the Society for Maternal-Fetal Medicine.

Neither drug is approved for the treatment of gestational diabetes. Both are Food and Drug Administration pregnancy category B. Injected insulin or oral glyburide are approved to treat gestational diabetes.

Having an oral option other than glyburide might allow patients to be managed on one or potentially two oral agents before resorting to injections of insulin, Dr. Jacquelyn Cortez said in an interview at one of the posters.

She and her associates conducted a prospective, double-blind trial that randomized 59 women who were diagnosed with gestational diabetes in their second or third trimester, prior to 34 weeks' gestation, to 50 mg acarbose t.i.d. or identical placebo pills taken with meals. All patients had failed diet therapy.

At regular follow-ups, if more than half of the patient's fasting glucose values were above 95 mg/dL, or more than half of her postprandial glucose values were above 135 mg/dL, the dosage was increased to 100 mg t.i.d. If this did not control blood glucose levels, the patient was considered to have failed single-agent therapy and was started on a second agent.

Fewer patients in the acarbose group failed monotherapy and required a second agent, compared with the placebo group, but the difference did not quite reach statistical significance in this small study. Women in the acarbose group gained significantly less weight (19 pounds) than did women on placebo (27 pounds), said Dr. Cortez of the department of reproductive medicine at the University of California, San Diego.

Postprandial blood glucose levels were significantly lower on acarbose therapy (122 mg/dL), compared with placebo (130 mg/dL).

There were no differences between groups in perinatal outcomes, including gestational age at delivery, mode of delivery, or rate of macrosomia.

The failure rate with acarbose in this study and failure rates with glyburide in other studies both are high, but women on acarbose in the present study did not develop the hypoglycemia sometimes seen with glyburide, Dr. Cortez noted.

Acarbose is a glycosidase inhibitor that prevents intestinal breakdown of starches to glucose in the upper small bowel.

Metformin, an insulin sensitizer, was the subject of a separate review of data from two randomized trials in which 67 women with gestational diabetes took the drug. Of these patients, 59 met glycemic goals of fasting glucose values lower than 105 mg/dL and 2-hour postprandial glucose values lower than 120 mg/dL, reported Dr. Lisa E. Moore and her associates.

The eight women who did not meet glycemic goals started insulin therapy, said Dr. Moore of the University of New Mexico, Albuquerque.

Macrosomia occurred in four infants (6%), and all were delivered vaginally. The primary cesarean delivery rate (excluding elective repeat C-sections) was 15% (10 patients). There were no cases of fetal anomalies or maternal or fetal hypoglycemia. Eight neonates had hyperbilirubinemia, and two had 5-minute Apgar scores lower than 5.

The efficacy rate with metformin appeared to be similar to success rates with glyburide in other studies, Dr. Moore said. “[Metformin] is certainly better at controlling the fasting blood sugar than glyburide,” she added.

Failure of metformin was not predicted by maternal body mass index or by the value of the 1-hour glucose challenge test.

Although metformin is not approved in the United States for this indication, there is a wealth of data from other countries on its use in gestational diabetes, she noted.

Neither Dr. Cortez nor Dr. Moore reported any financial relationships with the companies that make the medications studied.

SAN FRANCISCO — Two oral medications deserve further investigation as alternative therapies for gestational diabetes, results of separate small studies suggest.

Acarbose or metformin might be helpful additions to the therapeutic armamentarium if additional research supports these preliminary findings, investigators said in separate poster presentations at the annual meeting of the Society for Maternal-Fetal Medicine.

Neither drug is approved for the treatment of gestational diabetes. Both are Food and Drug Administration pregnancy category B. Injected insulin or oral glyburide are approved to treat gestational diabetes.

Having an oral option other than glyburide might allow patients to be managed on one or potentially two oral agents before resorting to injections of insulin, Dr. Jacquelyn Cortez said in an interview at one of the posters.

She and her associates conducted a prospective, double-blind trial that randomized 59 women who were diagnosed with gestational diabetes in their second or third trimester, prior to 34 weeks' gestation, to 50 mg acarbose t.i.d. or identical placebo pills taken with meals. All patients had failed diet therapy.

At regular follow-ups, if more than half of the patient's fasting glucose values were above 95 mg/dL, or more than half of her postprandial glucose values were above 135 mg/dL, the dosage was increased to 100 mg t.i.d. If this did not control blood glucose levels, the patient was considered to have failed single-agent therapy and was started on a second agent.

Fewer patients in the acarbose group failed monotherapy and required a second agent, compared with the placebo group, but the difference did not quite reach statistical significance in this small study. Women in the acarbose group gained significantly less weight (19 pounds) than did women on placebo (27 pounds), said Dr. Cortez of the department of reproductive medicine at the University of California, San Diego.

Postprandial blood glucose levels were significantly lower on acarbose therapy (122 mg/dL), compared with placebo (130 mg/dL).

There were no differences between groups in perinatal outcomes, including gestational age at delivery, mode of delivery, or rate of macrosomia.

The failure rate with acarbose in this study and failure rates with glyburide in other studies both are high, but women on acarbose in the present study did not develop the hypoglycemia sometimes seen with glyburide, Dr. Cortez noted.

Acarbose is a glycosidase inhibitor that prevents intestinal breakdown of starches to glucose in the upper small bowel.

Metformin, an insulin sensitizer, was the subject of a separate review of data from two randomized trials in which 67 women with gestational diabetes took the drug. Of these patients, 59 met glycemic goals of fasting glucose values lower than 105 mg/dL and 2-hour postprandial glucose values lower than 120 mg/dL, reported Dr. Lisa E. Moore and her associates.

The eight women who did not meet glycemic goals started insulin therapy, said Dr. Moore of the University of New Mexico, Albuquerque.

Macrosomia occurred in four infants (6%), and all were delivered vaginally. The primary cesarean delivery rate (excluding elective repeat C-sections) was 15% (10 patients). There were no cases of fetal anomalies or maternal or fetal hypoglycemia. Eight neonates had hyperbilirubinemia, and two had 5-minute Apgar scores lower than 5.

The efficacy rate with metformin appeared to be similar to success rates with glyburide in other studies, Dr. Moore said. “[Metformin] is certainly better at controlling the fasting blood sugar than glyburide,” she added.

Failure of metformin was not predicted by maternal body mass index or by the value of the 1-hour glucose challenge test.

Although metformin is not approved in the United States for this indication, there is a wealth of data from other countries on its use in gestational diabetes, she noted.

Neither Dr. Cortez nor Dr. Moore reported any financial relationships with the companies that make the medications studied.

SAN FRANCISCO — Two oral medications deserve further investigation as alternative therapies for gestational diabetes, results of separate small studies suggest.

Acarbose or metformin might be helpful additions to the therapeutic armamentarium if additional research supports these preliminary findings, investigators said in separate poster presentations at the annual meeting of the Society for Maternal-Fetal Medicine.

Neither drug is approved for the treatment of gestational diabetes. Both are Food and Drug Administration pregnancy category B. Injected insulin or oral glyburide are approved to treat gestational diabetes.

Having an oral option other than glyburide might allow patients to be managed on one or potentially two oral agents before resorting to injections of insulin, Dr. Jacquelyn Cortez said in an interview at one of the posters.

She and her associates conducted a prospective, double-blind trial that randomized 59 women who were diagnosed with gestational diabetes in their second or third trimester, prior to 34 weeks' gestation, to 50 mg acarbose t.i.d. or identical placebo pills taken with meals. All patients had failed diet therapy.

At regular follow-ups, if more than half of the patient's fasting glucose values were above 95 mg/dL, or more than half of her postprandial glucose values were above 135 mg/dL, the dosage was increased to 100 mg t.i.d. If this did not control blood glucose levels, the patient was considered to have failed single-agent therapy and was started on a second agent.

Fewer patients in the acarbose group failed monotherapy and required a second agent, compared with the placebo group, but the difference did not quite reach statistical significance in this small study. Women in the acarbose group gained significantly less weight (19 pounds) than did women on placebo (27 pounds), said Dr. Cortez of the department of reproductive medicine at the University of California, San Diego.

Postprandial blood glucose levels were significantly lower on acarbose therapy (122 mg/dL), compared with placebo (130 mg/dL).

There were no differences between groups in perinatal outcomes, including gestational age at delivery, mode of delivery, or rate of macrosomia.

The failure rate with acarbose in this study and failure rates with glyburide in other studies both are high, but women on acarbose in the present study did not develop the hypoglycemia sometimes seen with glyburide, Dr. Cortez noted.

Acarbose is a glycosidase inhibitor that prevents intestinal breakdown of starches to glucose in the upper small bowel.

Metformin, an insulin sensitizer, was the subject of a separate review of data from two randomized trials in which 67 women with gestational diabetes took the drug. Of these patients, 59 met glycemic goals of fasting glucose values lower than 105 mg/dL and 2-hour postprandial glucose values lower than 120 mg/dL, reported Dr. Lisa E. Moore and her associates.

The eight women who did not meet glycemic goals started insulin therapy, said Dr. Moore of the University of New Mexico, Albuquerque.

Macrosomia occurred in four infants (6%), and all were delivered vaginally. The primary cesarean delivery rate (excluding elective repeat C-sections) was 15% (10 patients). There were no cases of fetal anomalies or maternal or fetal hypoglycemia. Eight neonates had hyperbilirubinemia, and two had 5-minute Apgar scores lower than 5.

The efficacy rate with metformin appeared to be similar to success rates with glyburide in other studies, Dr. Moore said. “[Metformin] is certainly better at controlling the fasting blood sugar than glyburide,” she added.

Failure of metformin was not predicted by maternal body mass index or by the value of the 1-hour glucose challenge test.

Although metformin is not approved in the United States for this indication, there is a wealth of data from other countries on its use in gestational diabetes, she noted.

Neither Dr. Cortez nor Dr. Moore reported any financial relationships with the companies that make the medications studied.