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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_471"
                     title="Early Pregnancy Determines Late Outcomes (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/OBGYN/Pregnancy/tb/18405?impressionId=1265819357686"
                     
      &lt;p&gt;Growth of the fetus during the first trimester  --  when essential organ development is completed  --  lays the foundation for important outcomes in pregnancy and early childhood, Dutch researchers found.&lt;/p&gt;
&lt;p&gt;Restricted first-trimester growth appeared to more than double the risk of preterm birth, low birth weight, and small size for gestational age at birth in a prospective study led by Vincent W.V. Jaddoe, MD, PhD, of Erasmus Medical Center in Rotterdam.&lt;/p&gt;
&lt;p&gt;Infants who didn&apos;t grow as much as expected during the first trimester also showed accelerated &quot;catch-up&quot; growth up to their second birthday  --  a well-established risk factor for later metabolic and cardiovascular disease.&lt;/p&gt;
&lt;p&gt;&quot;It could be that growth as early as in the first trimester of pregnancy is associated with disease in adulthood, although longer follow-up studies are necessary to examine this relationship,&quot; the researchers wrote in the Feb. 10 &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;This and prior studies suggest that women at high risk of problems late in pregnancy could be identifiable in the first trimester, with the potential for trials of screening and early intervention, according to an accompanying editorial by Gordon C.S. Smith, MD, PhD, of the University of Cambridge, England.&lt;/p&gt;
&lt;p&gt;The challenge, Smith wrote, will be to &quot;produce robust screening tests with acceptable levels of detection and prediction, and to identify interventions that are effective in improving outcome when a pregnancy has been identified as high risk.&quot;&lt;/p&gt;
&lt;p&gt;The researchers&apos; population-based, prospective Generation R Study included 1,631 pregnant women in Rotterdam with a known and reliable first day of their last menstrual period and a regular menstrual cycle.&lt;/p&gt;
&lt;p&gt;Fetal crown-to-rump length, measured by ultrasound between the gestational age of 10 weeks 0 days and 13&lt;/p&gt;
&lt;p&gt;weeks 6 days, is typically used to determine gestational age. But in this study it served as the main parameter of first-trimester fetal growth.&lt;/p&gt;
&lt;p&gt;Predictors of restricted fetal growth in multivariate analyses included the following (given as standard deviation growth score): &lt;ul&gt; &lt;li&gt;Younger maternal age (0.10 per 4.68-year standard deviation increase, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) &lt;/li&gt; &lt;li&gt;Higher maternal diastolic blood pressure (&amp;#8722;0.05 per 9.52-mm Hg standard deviation increase, &lt;em&gt;P&lt;/em&gt;=0.03) &lt;/li&gt; &lt;li&gt;Higher hematocrit level (&amp;#8722;0.07 per 2.50% standard deviation increase, &lt;em&gt;P&lt;/em&gt;=0.02) &lt;/li&gt; &lt;li&gt;Smoking (&amp;#8722;0.13, &lt;em&gt;P&lt;/em&gt;=0.03)&lt;/li&gt; &lt;li&gt;Folic acid supplement use (0.17, &lt;em&gt;P&lt;/em&gt;=0.03) &lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;After adjustment for multiple testing, only hematocrit and maternal age remained significant factors, but smoking and nonoptimal use of folic acid supplements together produced a significant reduction in first-trimester fetal growth (SD score &amp;#8722;0.52, 95% CI &amp;#8722;0.78 to &amp;#8722;0.25, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for interaction).&lt;/p&gt;
&lt;p&gt;Higher hematocrit levels may indicate lower circulating plasma volume. That in turn could lead to suboptimal placental perfusion, the researchers suggested as a possible explanation for the importance of this factor.&lt;/p&gt;
&lt;p&gt;The impact on pregnancy outcomes was significant for all adverse birth outcomes assessed. Compared with normal first-trimester fetal growth, growth restriction was associated with the following risks: &lt;ul&gt; &lt;li&gt;2.12-fold higher adjusted odds of preterm birth before 37 weeks&apos; gestation (4.0% versus 7.2%, &lt;em&gt;P&lt;/em&gt;=0.006).&lt;/li&gt; &lt;li&gt;2.42-fold higher adjusted odds of low birth weight, defined as less than 2,500 g or 5 lb 8 oz (3.5% versus 7.5%, &lt;em&gt;P&lt;/em&gt;=0.001).&lt;/li&gt; &lt;li&gt;2.64-fold higher adjusted odds of being small for gestational age at birth, defined as in the lowest 20% (4.0% versus 10.6%, &lt;em&gt;P&lt;/em&gt;=0.001). &lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Independent of birth weight, fetal growth restriction in the first trimester accelerated postnatal growth until age 2 years (0.139 standard deviation score increase over two years per standard deviation fetal-crown-to-rump length decrease, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Even though they included only women with reliable menstrual cycles, the authors noted, misclassification of gestational age might still have been an issue, depending on timing of ovulation and implantation.&lt;/p&gt;
&lt;p&gt;&quot;Further studies are needed to assess the associations of first-trimester growth variation on the risks of disease in later childhood and adulthood,&quot; they concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The first phase of the Generation R Study was financially supported by the Erasmus Medical Center, the Erasmus University Rotterdam, and the Netherlands Organization for Health Research.&lt;/p&gt;&lt;p&gt;Jaddoe reported receipt of funding from the Netherlands Organization for Health Research.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;p&gt;Smith reported having been a member of preterm labor advisory boards for GlaxoSmithKline. He also reported funding from Cambridge National Institute for Health Research Biomedical Research Centre, Cambridge University Hospitals, NHS Foundation Trust.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_366"
                     title="Placental Infection Could Spur Asthma (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Pediatrics/Asthma/tb/18252?impressionId=1265819357686"
                     
      Preterm birth complicated by chorioamnionitis may modestly increase a child&apos;s risk of later asthma, researchers found.&lt;br&gt;
&lt;br&gt;Children born preterm after a pregnancy complicated by the bacterial infection of placenta and amniotic fluid (chorioamnionitis) were significantly more likely to develop asthma by age eight than preemies without such exposure, according to Darios Getahun, MD, MPH, of Kaiser Permanente Department of Research and Evaluation in Pasadena.&lt;br&gt;
&lt;br&gt;Asthma diagnosis was nearly threefold more common among chorioamnionitis-exposed children who had been born preterm than those carried to term, they wrote in the February &lt;em&gt;Archives of Pediatrics &amp;amp; Adolescent Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;Premature birth may not give an infant&apos;s lungs a chance to fully develop, leading to early infection and inflammation that elevate risk of chronic lung disease, such as asthma.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;However, in utero exposures could be an important contributor as well, Getahun explained in an interview.&lt;/p&gt;
&lt;p&gt;Chorioamnionitis is thought to be associated with more than half of all preterm births.&lt;/p&gt;
&lt;p&gt;Fetal lungs stay in contact with the amniotic fluid which, when infected, may expose the developing lung to microorganisms, toxic substances, and inflammatory mediators, the researchers wrote.&lt;/p&gt;
&lt;p&gt;Animal model evidence suggests the condition may lead to scarring and fibrosis in the lung and damage to other fetal organs &quot;during a very critical time at preterm gestation,&quot; Getahun told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;So, his group retrospectively studied Kaiser&apos;s matched perinatal records on 510,216 singleton children born at the managed care group&apos;s hospitals in Southern California between 1991 and 2007.&lt;/p&gt;
&lt;p&gt;Physician-diagnosed asthma incidence by age 8 years, as expected, was significantly higher overall for preemies born at 23 to 36 weeks&apos; gestation than for those carried full-term (60.2 versus 40.0 per 1,000 person-years).&lt;/p&gt;
&lt;p&gt;But chorioamnionitis diagnosed during pregnancy substantially boosted this risk.&lt;/p&gt;
&lt;p&gt;Incidence of asthma rose to 100.7 per 1,000 person-years in exposed children born preterm, versus 39.6 per 1,000 among exposed, full-term children (IR 2.9, 95% CI 2.6 to 3.3).&lt;/p&gt;
&lt;p&gt;This association between chorioamnionitis and asthma in preemies persisted (HR 1.68, 95% CI 1.52 to 1.87) after adjustment for important confounding variables, including maternal age, race or ethnicity, smoking during pregnancy, prenatal care, and maternal asthma.&lt;/p&gt;
&lt;p&gt;Although the asthma risk appeared to rise with greater prematurity in exposed children, the elevated risk associated with chorioamnionitis exposure in utero was seen in every category of prematurity: &lt;ul&gt; &lt;li&gt; 1.23 times higher risk in children born at 23 to 28 weeks (95% CI 1.02 to 1.49)&lt;/li&gt; &lt;li&gt; 1.51 times higher risk in children born at 28 to 33 weeks (95% CI 1.26 to 1.80)&lt;/li&gt; &lt;li&gt; 1.20 times higher risk in children born at 34 to 36 weeks (95% CI 1.03 to 1.47)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Additional adjustment for bronchopulmonary dysplasia  --  &quot;one of the mechanisms through which preterm birth is presumably associated with respiratory problems in early childhood&quot;  --  had little impact on the findings.&lt;/p&gt;
&lt;p&gt;Thus, the bacterial infection appeared to be an independent risk factor for asthma in prematurely born children, the researchers concluded.&lt;/p&gt;
&lt;p&gt;The risks were particularly high for children born to African-American women who developed chorioamnionitis, suggesting this may be an at-risk group to single out for attention clinically, they suggested.&lt;/p&gt;
&lt;p&gt;Getahun cautioned, though, that his group&apos;s study could not prove causality. The researchers also noted that the study was limited by lack of data on parental atopy and smoking.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by Kaiser Permanente Direct Community Benefit funds. The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_393"
                     title="SMFM: Gene Variants Linked to Preterm Labor (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/MeetingCoverage/SMFM/tb/18295?impressionId=1265819357686"
                     
      Genetic variants involved in regulating inflammation and the extracellular matrix may increase the risk of preterm birth, researchers say.&lt;br&gt;
&lt;br&gt;A single nucleotide polymorphism (SNP) in fetal interleukin-6 (&lt;em&gt;ILR6&lt;/em&gt;) and another in maternal tissue inhibitor of metalloproteinase 2 (&lt;em&gt;TIMP2&lt;/em&gt;) were each associated with a twofold increased risk of spontaneous preterm birth.&lt;br&gt;
&lt;br&gt;Roberto Romero, MD, of the National Institute of Child Health and Human Development, and colleagues reported the findings at the Society for Maternal-Fetal Medicine meeting in Chicago.&lt;/p&gt;
&lt;p&gt;&quot;The genetic makeup of both mother and fetus can contribute to the risk of premature labor,&quot; Romero told &lt;em&gt;MedPage Today&lt;/em&gt;. &quot;Our discovery . . . helps explain why some mothers have premature labor and delivery despite having optimal prenatal care.&quot;&lt;/p&gt;
&lt;p&gt;Inflammatory hormones have been shown to play a role in the labor process, and previous studies have found that a third of preterm infants are born to mothers with a silent amniotic infection.&lt;/p&gt;
&lt;p&gt;Now, the findings suggest that individual genetic variation involved in that inflammatory response may account for discrepancies in preterm births.&lt;/p&gt;
&lt;p&gt;&quot;We have a large body of evidence that proves silent infections are a frequent and important cause of premature labor,&quot; Romero said. &quot;These infections can also attack the fetus before it is born.&quot;&lt;/p&gt;
&lt;p&gt;He explained that the mother&apos;s hormones initiate the onset of labor to get rid of the infected tissue, and the fetus seeks to exit a hostile intrauterine environment that threatens its survival.&lt;/p&gt;
&lt;p&gt;To look at the mechanisms by which this process occurs, Romero and colleagues conducted a case-control study of mothers in Chile to assess genetic factors that could predispose women to spontaneous preterm labor and delivery.&lt;/p&gt;
&lt;p&gt;Patients who delivered prior to 37 weeks gestation served as cases, while women who delivered a normal neonate at term served as controls. There were 223 mothers and 179 fetuses in the case group, and 599 mothers and 628 fetuses in the control group.&lt;/p&gt;
&lt;p&gt;The researchers subsequently examined 190 candidate genes and 775 SNPs.&lt;/p&gt;
&lt;p&gt;They found that the strongest fetal single-locus association with risk of spontaneous preterm birth was in &lt;em&gt;ILR6&lt;/em&gt;, (OR 2.07, 95% CI 1.42 to 3.02,&lt;em&gt; P&lt;/em&gt;=0.0001).&lt;/p&gt;
&lt;p&gt;The strongest maternal single-locus association with spontaneous preterm labor and delivery was in tissue inhibitor of metalloproteinase &lt;em&gt;TIMP2&lt;/em&gt; (OR 1.98, 95% CI 1.38 to 2.83, &lt;em&gt;P&lt;/em&gt;=0.0002). This gene is involved in regulating the extracellular matrix, which holds cells within tissues.&lt;/p&gt;
&lt;p&gt;The associations remained significant after controlling for multiple comparisons, Romero said.&lt;/p&gt;
&lt;p&gt;Global haplotype analysis also indicated an association between a fetal DNA variant in insulin-like growth factor 2 (&lt;em&gt;P&lt;/em&gt;=0.004) as well as maternal alpha 3 type IV collagen isoform 1 (&lt;em&gt;COL4A3&lt;/em&gt;) (&lt;em&gt;P&lt;/em&gt;=0.007).&lt;/p&gt;
&lt;p&gt;&quot;Some women and fetuses carry gene variants that predispose them to the early onset of labor,&quot; Romero said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_343"
                     title="U.S. Marshals Seize Unapproved Ozone Generators"
                     score="0.007"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/EnvironmentalHealth/tb/18228?impressionId=1265819357686"
                     
      &lt;p&gt;WASHINGTON  --  U.S. Marshals have seized 77 unapproved ozone generators, valued at almost $76,000 from a California device manufacturer, the FDA announced.&lt;/p&gt;
&lt;p&gt;The devices were advertised as treatments for various conditions, including cancer, AIDS, hepatitis, herpes, and other diseases, but lacked approval or efficacy data to support the claims made on their behalf, an FDA release said.&lt;/p&gt;
&lt;p&gt;The raid came after the company, Applied Ozone Systems (AOS) of Auburn, Calif., failed to respond to a voluntary recall request last December, the agency said.&lt;/p&gt;
&lt;p&gt;The FDA raised concerns that patients using AOS-IM and AOS-IMD devices will consider it an appropriate treatment for an affliction and delay or stop FDA-approved and proven medical treatments. Patients using the devices may risk infection from contamination of the applicator or catheter, the release said.&lt;/p&gt;
&lt;p&gt;The FDA recommended that healthcare professionals and consumers cease use of the devices.&lt;/p&gt;
&lt;p&gt;The agency said it obtained an inspection warrant for the company&apos;s manufacturing facilities after the owner refused to admit FDA inspectors. It said the inspection revealed several breaches of the FDA&apos;s good manufacturing practice requirements for medical devices, which had never been approved in the first place.&lt;/p&gt;
&lt;p&gt;Ozone is an unstable allotrope of oxygen with three atoms, instead of the normal two. Ozone generators produce ozone from oxygen and have consumer and industrial applications, but ozone itself is harmful to the respiratory system, even at relatively low concentrations.&lt;/p&gt;
&lt;p&gt;Instructions with the Applied Ozone Systems devices suggest blowing ozoned air into the rectal and vaginal areas.&lt;/p&gt;
&lt;p&gt;Friday&apos;s seizure was part of a joint effort of the FDA and the California Department of Public Health to remove or prevent unapproved or unsafe medical devices from entering the market.&lt;/p&gt;
&lt;p&gt;A statement on the company&apos;s Web site said the two ozone generator models, which sold for $750 and $1,200 respectively, were no longer available by order of the FDA and California authorities.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_320"
                     title="Low Vitamin D Worsens Asthma (CME/CE)"
                     score="0.004"
                     href="http://www.medpagetoday.com/Pulmonology/Asthma/tb/18187?impressionId=1265819357686"
                     
      &lt;p&gt;Low levels of vitamin D correlated with poorer lung function, increased airway reactivity, and reduced response to steroid treatment in adult asthmatics, researchers said.&lt;/p&gt;
&lt;p&gt;For every 1-ng/mL increase in serum levels of 25-hydroxyvitamin D (25-OH-D), forced one-second expiratory volume (FEV&lt;sub&gt;1&lt;/sub&gt;) increased by 21 mL (&lt;em&gt;P&lt;/em&gt;=0.03, &lt;em&gt;r&lt;/em&gt;=0.8), reported E. Rand Sutherland, MD, MPH, of National Jewish Health in Denver, and colleagues online in the &lt;em&gt;American Journal of Respiratory and Critical Care Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The study of 54 adult patients with asthma also showed that airway hyperreactivity in those with serum 25-OH-D levels below 30 ng/mL  --  defined as vitamin D insufficiency  --  measured at almost twice the average levels seen in those with normal levels of 25-OH-D.&lt;/p&gt;
&lt;p&gt;The dose of methacholine required to induce a 20% drop in FEV&lt;sub&gt;1&lt;/sub&gt; was 1.03 mg/mL (SE 0.2) in those with low 25-OH-D levels, compared with 1.92 mg/mL (SD 0.2) in patients with higher serum vitamin D levels (&lt;em&gt;P&lt;/em&gt;=0.01), Sutherland and colleagues reported.&lt;/p&gt;
&lt;p&gt;Cellular responses in vitro to dexamethasone were also significantly correlated with 25-OH-D levels (&lt;em&gt;r&lt;/em&gt;=0.05, &lt;em&gt;P&lt;/em&gt;=0.02). Peripheral blood mononuclear cells from those with higher 25-OH-D levels demonstrated greater MAP kinase phosphatase expression after dexamethasone stimulation than cells from individuals with lower vitamin D levels.&lt;/p&gt;
&lt;p&gt;The effects observed were greater in those who had not received steroid treatment.&lt;/p&gt;
&lt;p&gt;&quot;In adults with persistent asthma, there is a significant and deleterious association between reduced serum vitamin D levels and lung function, airway hyperresponsiveness, and glucocorticoid sensitivity, which together constitute three important biomarkers of asthma severity, impairment, and prognosis,&quot; the researchers concluded.&lt;/p&gt;
&lt;p&gt;Sutherland and colleagues added that the findings suggest that vitamin D supplements might improve symptoms in some asthma patients, although they did not test the hypothesis.&lt;/p&gt;
&lt;p&gt;Their cross-sectional study included 54 patients with persistent asthma, mean age 38 and with FEV&lt;sub&gt;1&lt;/sub&gt; levels that were a mean 83% of predictions. Participants underwent a round of standard tests for lung function and asthma symptoms as well as laboratory measurements of 25-OH-D.&lt;/p&gt;
&lt;p&gt;Serum 25-OH-D levels averaged 28.1 ng/mL (SE 10.2), with 32 participants having levels below the insufficiency threshold of 30 ng/mL.&lt;/p&gt;
&lt;p&gt;The researchers found that vitamin D levels did not correlate only with asthma symptoms. Body mass index was also significantly and inversely associated with 25-OH-D.&lt;/p&gt;
&lt;p&gt;Each unit increase of BMI was associated with a decrease of 0.56 ng/mL (SE 0.18) in serum 25-OH-D (&lt;em&gt;r&lt;/em&gt;=0.4, &lt;em&gt;P&lt;/em&gt;=0.002) after adjusting for age, sex, and physical impairment.&lt;/p&gt;
&lt;p&gt;Sutherland and colleagues noted that earlier research had linked obesity with asthma risk, and also with reduced responses to corticosteroid treatment in asthmatic patients.&lt;/p&gt;
&lt;p&gt;They suggested that vitamin D &quot;may be one pathway by which obesity and reduced steroid response are related.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Funding for the study came from the National Institutes of Health.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>