Type 2 diabetes, obesity increase risk of dementia

A study published this week in the journal Neurology is getting a lot of attention for linking type 2 diabetes and Alzheimer’s disease.  In tracking 1,000 Japanese seniors for 11 years, researchers found that those with type 2 diabetes were twice as likely to develop Alzheimer’s, compared to people who did not have type 2 diabetes.

This information is of high importance in North America, where we are currently experiencing an epidemic of diabetes.  However, this is not the first study of its kind.  The brains of Alzheimer’s patients have altered insulin receptors and hyperinsulinemia.  Alzheimer’s and type 2 diabetes appear to “aggravate” each other, by both damaging blood vessels in the brain (Park 2011).  As well, just being “overweight” or “obese” increases the risk of developing Alzheimer’s disease or other dementias (odd ratio: 1.71, 3.88) (Xu et al. 2011).

Take home message: Take care of your body to take care of your brain.

Birth control pill recall

Qualitest Pharmaceuticals announced they are recalling their birth control pills after a “packaging error.”  A spokesman for the company stated there is no immediate health risk, but women “may unintentionally become pregnant” while taking the drug.  Uh…

Apparently the weekly orientation of the pills are reversed, so that users may not be getting adequate hormone to prevent pregnancy.

The pills affected are: Cyclafem 7/7/7; Cyclafem 1/35; Emoquette; Gildess FE 1.5/30; Gildess FE 1/20; Orsythia; Previfem; Tri-Previfem.  If you are currently taking one of these, begin to use an alternative form of birth control immediately and contact your doctor for a new prescription.  Doctors should prepare for an influx of calls concerning this issue.

What does “infertility” mean to you?

“Infertility” has many meanings and connotations, yet it’s so often treated as one thing.  Whether “infertility” brings up feelings of fear, hope, inquiry, confusion, devastation, empathy; whether you have personal experience, know someone who has or just have an opinion- I want to know what it means to you.  Write a sentence or two.  I’ll compile the results anonymously and report back.  Let’s change the outlook of how infertility is viewed and treated.

To respond:

Leave a comment here or on our Facebook page.

Tweet #infertilitytome

 

Email me: nicolette@nestconsulting.ca

 

Debate over new gestational diabetes testing

Researchers and clinicians at the European Association for the Study of Diabetes Annual Meeting this week are arguing over the new tests for gestational diabetes (GD).

The international guidelines for GD screening released in 2010 recommend two tests for pregnant women: an oral glucose tolerance test (OGTT) at the first prenatal visit and a second OGTT at 24-28 weeks.

Some researchers argue the two step process is cost-effective, as the cost of testing is less than the cost of caring for complications associated with untreated gestational diabetes. Others cite that this process will be too costly- it could raise the prevalence of GD from 7% to 16%.

Maybe the larger issue is one that isn’t being debated.  Is this new testing process better for pregnant women and their babies or not?  A significantly larger percentage of women will be diagnosed with gestational diabetes as a result.  Will this lead to better prenatal care, unnecessary intervention, healthier mothers and babies?

Is it safe to use ibuprofen and aspirin during pregnancy?

A report appeared this week in the Canadian Medical Association Journal linking the use of nonsteroidal anti-inflammatory drugs (NSAIDs)- Advil, Motrin, Aleve, naproxen, aspirin, Execedrin, etc.- to miscarriage.

Nakhai-Pour et al. analyzed data from 4705 Quebec women who experienced a spontaneous miscarriage and 47050  women who were pregnant without miscarriage.  The risk of miscarriage associated with NSAID use was [OR] 2.43.

However, the actual percentages of women who use NSAIDs during pregnancy and experience miscarriage should be noted.  7.5% of women who had miscarriages used NSAIDs.  2.6% of women who did not have miscarriages used NSAIDs.

The use of Advil, Motrin, Aleve, naproxen, aspirin and Execedrin has not been ‘proven’ to cause miscarriage.  However, pregnant women must carefully assess the benefit versus potential risk when using drugs of this class during pregnancy.  More data is needed to determine a causal relationship.

Five things that can cut your risk of developing diabetes

Making positive lifestyle choices could cut your risk of developing type 2 diabetes by as much as 80% according to a large study conducted at the National Institute of Health (NIH).

Reis et al. analyzed 114,996 men and 92,483 women aged 50-71 who did not initially have heart disease, cancer, or diabetes.  The group identified five lifestyle choices that led to substantive protection against the development adult onset diabetes: diet, physical activity, smoking status, alcohol consumption and obesity.  These factors are unsurprising to many Americans.  However, the study identified that positive choices in each category may cut diabetes risk up to 31% in men and 39% in women.

Predicting pregnancy in IVF

Can pregnancy after an IVF cycle be predicted?

A new study by Ben-Haroush et al. concludes that the volume of a woman’s ovary and the
number of small follicles growing at the time of IVF treatment are significant predictors of whether the woman will become pregnant.  Women in this study with 10 or more small antral follicles (2-5 mm diameter) and an ovarian volume of greater than 1400 mm^3 had a significantly higher rate of pregnancy (58.3%) compared to women who did not (30.1%; p=0.049).

The next step will be determining whether follicle development and ovarian volume affect pregnancy likelihood, or are simply products of an already healthy environment for pregnancy.

Flame retardant bad for mothers, bad for babies

We reported earlier this month that pregnant women in California had the highest ever recorded levels of PBDE, a flame retardant chemical, in their blood.

Now a new study by Harley et al. has linked this chemical with reduced birth weights in infants born to California mothers exposed to PBDE.  For every 10-fold increase in exposure level above threshold, infants lost 4.1 oz of weight.  Although the majority of infants included in the study had birth weights above 5 lb 8 oz, the link should not be ignored.  Especially given the association between PBDE and thyroid dysfunction in pregnant women.

PBDE is no longer used in manufacturing due to health hazards.  However, this flame retardant is still present in older vehicles, furniture and electronics.

Eat chocolate for a healthy pregnancy

Because pregnant women need more reason to eat chocolate. A new study by Saftlas et al. suggests eating choclate during pregnancy may reduce a mother’s risk of developing blood pressure complications.

Women who ate at least 1-3 servings of chocolate per week during their first and third trimesters had a reduced risk of developing preeclampsia (adjusted odd ratios: 0.55 and 0.56).  First trimester chocolate consumption was also linked to a reduced risk of developing gestational hypertension (adjusted odd ratio: 0.64).

Why might eating chocolate prevent preeclampsia?  It’s hypothesized that one cause of preeclampsia is “defective placentation” which occurs in the first trimester.  If the placenta does not attach properly to the mother’s uterus, oxidative stress and inflammation on site can eventually trigger irritation in the lining of blood vessels throughout the mother’s body.  Cocoa, especially dark chocolate, can lower blood pressure and induce dilation of blood vessels.

Pregnant women (especially those at risk for preeclampsia) should enjoy chocolate in addition to, and not in place of, more nutrient-dense foods.

Practice makes perfect in preventing maternal complications during delivery

Pregnant women with a care provider attending fewer than 7 deliveries per year are at greater risk for complications during delivery (Janakiraman et al.).

Obstetricians/ family practice doctors with “low provider volume” had a 50% higher rate of lacerations, hemorrhage, infections, and thromboses in their pregnant patients compared to doctors with 90 or more deliveries per year.

What can be done to assist doctors who deliver fewer babies?  These may be doctors who practice in rural or less populous areas.  The increased rate of complications is not necessarily a lack of skill, but more likely a lack of opportunity to practice.

A partnership with midwives should be encouraged.  Midwives already have a lower incidence of lacerations (7% versus 23% of OBGYNs) and other maternal complications (0.4 versus 0.7), even when pregnancy risk classification is controlled for (Oakley et al.). This may be due to greater practice, as midwives see pregnant and post-partum women exclusively, while family practice doctors cannot.