Fetal growth major risk for stillbirth
A LARGE cohort study in the UK has found that the single largest risk factor in stillbirth is unrecognised fetal growth restriction. The study, published in the BMJ, involved 92 218 normally formed singleton births, including 389 stillbirths, from 24 weeks of gestation. The researchers found that of potentially modifiable risk factors, maternal obesity, smoking in pregnancy and fetal growth restriction together accounted for 56.1% of the stillbirths. However, fetal growth restriction constituted the highest risk, involving 195 of the 389 stillbirths. In 160 (82%) of those cases it had not been detected antenatally. “Most cases of fetal growth restriction do not manifest until the third trimester of pregnancy, and in the absence of effective screening tests, prevention strategies need to include an enhanced level of surveillance throughout pregnancy”, the authors wrote. “Our findings suggest that early detection of fetal growth problems can substantially reduce the risk of stillbirth, and needs to become a cornerstone and key indicator of safety and effectiveness in antenatal care.” An accompanying editorial said the study findings highlighted the important contribution to stillbirth of the modifiable risk factors of fetal growth restriction, smoking and obesity.
No cancer link with folate
THE short-term use of folic acid supplements is unlikely to substantially increase or decrease overall cancer risk, according to a meta-analysis published in The Lancet. The review of all large randomised trials of folic acid supplementation (median daily dose of 2 mg, alone or in combination with other B vitamins) to the end of 2010 involved almost 50 000 people. It found little effect on the risk of developing any specific cancer, including cancer of the colon, prostate, lung and breast, among those who took daily folic acid for 5 years or less (7.7% new cancers) compared with placebo groups (7.3% new cancers). Even among those with the highest average intake of folic acid (40 mg per day) no significant increase in overall cancer incidence was found. There was also no evidence that the risk of developing cancer increased with longer folic acid treatment. An accompanying commentary said although the findings suggested that excess intake of folic acid, either from supplements or through food fortification, was of little concern with respect to increasing cancer incidence, “the data should be viewed with caution”.
Epilepsy drug impacts IQ
FETAL exposure to the epilepsy drug valproate has dose-dependent associations with reduced IQ at 6 years of age compared with children exposed to other commonly used antiepileptic drugs, according to research published in The Lancet Neurology. Valproate exposure was also associated with poorer verbal and memory abilities compared with the use of other antiepileptic drugs. The prospective observational study included 305 pregnant women with epilepsy on antiepileptic drug monotherapy (carbamazepine, lamotrigine, phenytoin, or valproate) and their 224 children who completed 6 years of follow-up. The authors wrote that outcomes in children exposed to low-dose valproate (<1000 mg per day) were similar to those in children exposed to the other low- or high-dose antiepileptic drugs, but warned that sample sizes might have restricted delineation of differences. “Most women with epilepsy cannot avoid use of antiepileptic drugs during pregnancy because of the risks from seizures to both mother and child”, the authors wrote. “Based on anatomical and cognitive risks, we propose that valproate is a poor first-choice antiepileptic drug for most women of childbearing potential.” The authors also noted a positive association of periconceptional folate with IQ at 6 years of age in children of mothers with epilepsy, but said this association needed further study.
Males dominate research misconduct
MALES are overrepresented among life science researchers who commit scientific misconduct, according to research published in mBio, the journal of the American Society for Microbiology. Researchers reviewed US Office of Research Integrity annual reports from 1994 to 2012 and identified 228 individuals who had committed misconduct, of which 94% involved fraud. Analysis of the data based on career stage and gender revealed that misconduct occurred “across the entire career spectrum from trainee to senior scientist and that two-thirds of the individuals found to have committed misconduct were male”, the researchers wrote. The male representation exceeded the overall proportion of males among life science researchers. The researchers said their observations raised the question of whether current efforts at ethics training were targeting the right individuals. “All countries should have independent agencies with the authority and resources to ensure proper conduct of scientific research. Although our findings may cause concern regarding the scientific enterprise, recognition is a first step toward solving a problem”, they wrote.
Hospital staph cases fall
CASES of Staphylococcus aureus bacteraemia (SAB) reported by Australian public hospital fell below the national benchmark of 2.0 cases per 10 000 patient days in 2011‒2012. The Australian Institute of Health and Welfare reported 1734 cases of hospital-associated SAB, of which 76% were methicillin sensitive, during approximately 18.5 million days of patient care. Rates ranged from 0.7 per 10 000 patient days in WA to 1.3 in the NT. The 2011‒2012 figures were slightly lower than the 1875 cases reported nationally in 2010‒2011. “Consistent with the public health importance of [health care-associated infections], a range of national and local initiatives have been established throughout Australia in recent years to reduce the occurrence of SAB”, the report said. These included the National Antimicrobial Stewardship Initiative, the National Hand Hygiene Initiative and the development of national infection control guidelines.
Posted 29 January 2013