Antidepressant use right before and during pregnancy may be linked with a higher risk of an autism spectrum disorder (ASD) in children, hints a new analysis of past research.

But pregnant women on antidepressant medications should not stop taking them, because the data that tie their use in pregnancy to ASDs are weak, said the study's senior author. Additionally, there could be consequences to not treating depression during pregnancy.

"Each prescription should be evaluated individually," said Dr. Florence Gressier, of the Bicetre University Hospital in Le Kremlin-Bicetre, France.

Gressier and colleagues write in JAMA Pediatrics that up to 15 percent of women have depression during pregnancy. Women with untreated depression are at an increased risk of complications and poor follow up for a number of chronic health conditions like diabetes and high blood pressure.

The use of antidepressants during pregnancy is increasing around the world, write the researchers. The most popular ones, known as selective serotonin reuptake inhibitors (SSRIs), are linked to a number of risks and some benefits during pregnancy.

The researchers add that other research suggests children exposed to antidepressants in the womb are at an increased risk for ASDs, which the U.S. National Institute of Mental Health says are a group of developmental disorders that may affect communication, social and other skills.

For the new analysis, the researchers combed academic databases for studies that examined the link between antidepressant exposure in the womb and the risk of ASDs. They found 10 studies with mixed results.

When the researchers looked at six studies with 117,737 participants that compared people with autism to people without, they found that children were 81 percent more likely to be diagnosed with an ASD if they were exposed to antidepressants during pregnancy.

Some of that excess risk, however, could be explained by the mothers' past history of mental illness.

The researchers found similar results when they looked at antidepressant exposure during specific trimesters.

There was no link between antidepressant use during pregnancy and ASDs when the researchers looked at two studies that followed 772,331 children over time.

Data from four studies did show 77 percent higher odds of ASDs among children born to women who used antidepressants before pregnancy, however.

"I think this is one of these situations where this gets a lot of attention in the media, but the results are actually pretty challenging to interpret," said Dr. Jeremy Veenstra-VanderWeele, of the Columbia University Department of Psychiatry in New York. "In some ways, the strongest association with preconception exposure and increased risk of ASDs suggests to me at least there is something hidden here."

Veenstra-VanderWeele, who was not involved with the new analysis, told Reuters Health it's difficult to account for several factors that may also explain the increased risk of ASDs. For example, the researchers can't control for the severity of the mother's mental illness and how resistant it is to treatment.

"From my perspective, the data on antidepressant use during pregnancy in relation to autism risk would not prevent me from prescribing these medicines," he said.

More detailed data are required, Gressier told Reuters Health. For example, researchers should collect data on - among other things - the mothers' depression during pregnancy, depression severity, if the mothers are taking their medications, the dose of the medication and use of other substances.

source: Reuters Health


Most people who complain to their general practitioner about first-time chest pain don’t get additional diagnostic testing to determine the cause, according to a recent UK study.

But doctors should take it as a possible warning sign because even when the pain is not readily explainable by heart-related or other causes, these people have a higher risk of heart attacks and other cardiac problems over the next five years, researchers say.

“Most people who consulted their GP with chest pain, the cause was not clear, and rather surprisingly the study team found most of these people still did not have a diagnosis for their chest pain six months later,” Dr. Peter Croft, one of the study authors, told Reuters Health by email.

“We followed this group up for 5 years and found they had a small but definite extra risk of heart disease compared with the group who had been given a definite diagnosis unrelated to heart disease (5 people per 100 in the ‘cause not clear’ group developed a heart-related problem over 5 years compared to 3 per 100 in the ‘cause unrelated to heart’ group),” said Croft of the Research Institute for Primary Care and Health Sciences at Keele University in Staffordshire.

Croft said patients should feel reassured, though, because the study also found that when people consulted their GPs about chest pain, the doctors were generally good at assessing who was most and least likely to have heart disease.

“If the GP decided the chest pain was not caused by heart disease but by other conditions like stomach problems or muscle strains or chest infection, then this group of patients had the lowest risk of future heart problems (measured over five years),” Croft said.

If the GP decided the chest pain was probably caused by heart disease or decided to send the patient for cardiac investigations anyway, then this group turned out to have the highest rate of future heart diagnoses, he added.

The study analyzed data from UK electronic health record databases for more than 170,000 adults with no history of heart disease who saw their doctors for chest pain for the first time between 2002 and 2009. The patients ranged from 18 years old to over 75, with half under age 49.

For 72 percent of patients, no cause for the chest pain was recorded by the doctor, the study team reports in The BMJ. Another 23 percent had a diagnosis of chest pain caused by issues not related to the heart, and about 5 percent had chest pain that was heart-related, known as angina.

Less than 12 percent of the patients with chest pain that didn’t have an established cause underwent further diagnostic testing for heart problems.

After a follow-up period of up to 5.5 years, the patients with unexplained chest pain were 36 percent more likely to have a heart attack compared to those whose pain got a diagnosis that wasn’t related to the heart.

Croft said he believes people whose chest pain remains undiagnosed could benefit from advice to reduce their cardiovascular risk.

“Even though an individual patient in this group is much less likely to have heart disease than a patient who right from the start gets a diagnosis of probable angina or a referral for cardiac investigations from their GP, the majority of people with chest pain who get a cardiovascular diagnosis in the next 5 years actually come from this ‘cause not clear’ group,” he said.

Chest pain is a potentially serious symptom so a person should always seek an explanation, said Dr. Tim Holt, a researcher with the Medical Sciences Division of the University of Oxford who wrote an editorial accompanying the study.

“As the BMJ study has shown, we are probably missing cases by relying too heavily on symptom patterns, and there is a case for doing more investigations if needed to either confirm heart disease or to find a clearer alternative explanation,” he told Reuters Health by email.

“If it is of sudden onset, severe, or associated with other symptoms such as breathlessness, dizziness, palpitations or nausea, this is an emergency, and it should be reported without delay,’ he said.

Holt said pain that could be described as "'tight,' 'heavy,' 'crushing,' 'like someone squeezing or sitting on the chest'" is of particular concern. “This type of pain is more likely to be due to heart disease.”

source: Reuters Health


Spinal manipulation therapy may work as well for easing lower back pain as anti-inflammatory medications, a research review concludes.
Based on data from 15 previously conducted trials involving a total of 1,711 adults, the study team found that spinal manipulation achieved meaningful reductions in pain and improvements in function after six weeks of treatment. The effect on pain was modest, and similar to what other studies have found with non-steroidal anti-inflammatory drugs (NSAIDS).
“Most doctors and patients have a good sense of what NSAIDs do - work great in some patients, don’t seem to work much at all in others, work somewhat in many more,” said senior study author Dr. Paul Shekelle of the West Los Angeles Veterans Affairs Medical Center.
“I think spinal manipulation therapy is much the same,” Shekelle said by email.
Lower back pain is one of the leading causes of disability and doctor visits for adults worldwide. It often goes away within a few weeks. But when it persists, lower back pain might be treated with spinal manipulation, medications like painkillers or muscle relaxers, heat, exercise or physical therapy.
Spinal manipulation is often done by chiropractors but may also be offered by physical therapists or physicians. It can include manually moving joints, massage and exercise. This type of treatment is designed to relieve pressure on joints and curb inflammation and it’s often used for back, neck or shoulder pain as well as for headaches.
For the current study, Shekelle and colleagues focused on the gold standard for determining the effectiveness and safety of medical treatments: randomized controlled trials that compare outcomes for patients who are randomly assigned to a specific treatment or to a dummy treatment or none at all.
In an analysis of data from 15 trials, they found spinal manipulation offered a meaningful reduction of pain within six weeks. Based on a review of 12 trials, the researchers also found spinal manipulation associated with statistically meaningful improvements in functional abilities.
None of the trials uncovered serious side effects of spinal manipulation. However, minor side effects like pain, muscle stiffness and headache were common.
One limitation of the analysis is that the original studies included in the review had a wide variety of designs, involved various kinds of providers with different training and compared spinal manipulation to assorted other types of treatment, the authors note.
There’s also not much agreement in the medical community about how big the reduction in back pain or improvement in function needs to be to make a clinically meaningful difference for patients, the researchers point out in JAMA.
Plus, back pain often clears up on its own within six weeks, the time frame researchers examined in the study, noted Dr. Richard Deyo, author of an accompanying editorial and a researcher at Oregon Health and Science University in Portland.
“Many patients don’t even need to see a doctor, and many episodes of back pain are like the common cold: extremely frustrating, but rarely serious, and usually destined to improve,” Deyo said by email.
Often, people may feel better after applying heat or taking over-the counter medications, Deyo said.
When that fails, new guidelines released this year from the American College of Physicians recommend non-drug options like spinal manipulation, massage, acupuncture and yoga before patients try prescription NSAIDs or muscle relaxants. (
“This study incorporates the most recent data and seems to confirm that spinal manipulation is at least as effective as conventional care,” Deyo added. “It is also one of the few systematic reviews to rigorously address safety, and concludes that serious complications are extremely rare.”


People who often eat fresh fruit are at lower risk of developing diabetes and related major vascular complications than people who rarely eat fruit, a new study said Tuesday.

The findings, published in the US journal PLOS Medicine, came from a seven-year study of half a million adults in China where fresh fruit consumption is much lower than in the United States and other developed countries.

“This is the first large prospective cohort study demonstrating clear beneficial associations of fresh fruit consumption with both development and progression of diabetes,” study author Huaidong Du from the University of Oxford said in a statement.

Although the health benefits of eating fresh fruit are well established, the sugar content of fruit has led to concerns about its potential harm for people with diabetes and consequently Chinese people diagnosed with diabetes tend to restrict their fruit intake.

In the new study, researchers from the University of Oxford, Peking University and the Chinese Academy of Medical Sciences studied 500,000 adults aged 35 to 74 years from 10 urban and rural areas across China, tracking their health through hospital records of illness and death registries.

During seven years of follow-up, the study found nearly 10,000 new cases of diabetes among participants who did not have the condition at the start of the study.

Among over 30,000 participants with pre-existing diabetes when they joined the study, there were 3,400 deaths and 11,000 cases of vascular diseases.

About 20 percent of the study participants reported eating fresh fruit daily, mainly apples or oranges, and six percent never or rarely ate fresh fruit.

The proportion of non-consumers was about three times higher in people with previously diagnosed diabetes than in those without diabetes: 19 percent vs six percent.

Compared with non-consumers, those who ate fresh fruit daily had a 12 percent lower risk of developing diabetes.

Among participants with diabetes, higher fresh fruit consumption also showed health benefits, with a 100g portion of fruit per day associated with 17 percent lower overall mortality, 13 percent lower risk of developing diabetes-related complications affecting large blood vessels such as ischaemic heart disease and stroke and 28 percent lower risk of developing complications affecting small blood vessels such as kidney and eye diseases.

“Our study provides strong supporting evidence for the existing dietary guidelines, including those for diabetes patients, that recommend a higher level of fresh fruit consumption,” said Zhengming Chen, a co-author from the University of Oxford.

“If this represents a real protective effect, it should help to improve prevention and management of diabetes in China and elsewhere.”

source: Manila Bulletin

Middle-aged people with risk factors for heart attacks and stroke are also more likely to develop changes in the brain that can lead to Alzheimer's disease, a new study suggests.

Previous research has linked so-called vascular risk factors, including obesity, diabetes, smoking, high cholesterol and elevated blood pressure, to higher odds of dementia, cognitive decline and Alzheimer’s disease.

But it’s been unclear whether these factors contribute indirectly by restricting blood flow in the brain, or if they directly cause a buildup of amyloid protein fragments that are linked to Alzheimer’s.

“In our study, we found an association between the number of risk factors that people without dementia had when they were middle-aged and the risk of having amyloid in their brain when they were older,” said lead study author Dr. Rebecca Gottesman of Johns Hopkins University School of Medicine in Baltimore.

“Each alone may not be enough to increase the risk of Alzheimer’s disease, but having a number of these risk factors appears to be associated with an even higher risk,” Gottesman said by email. “Although this doesn’t prove causation, it suggests that vascular risk factors might directly impact Alzheimer’s changes in the brain.”

Alzheimer’s disease is the most common cause of dementia among older adults. The progressive brain disorder slowly erodes memory and thinking skills and eventually leaves people unable to handle basic tasks in daily life. Scientists suspect that changes in the brain begin at least a decade before symptoms appear.

For the current study, researchers examined data from 346 adults who had been evaluated for vascular risk factors since the late 1980s, when they were 52 years old on average and none of them had dementia. More than two decades later, when participants were around 76 years old, they had brain scans that looked for evidence of Alzheimer’s.

At the start of the study, one in five participants had no vascular risk factors, while 38 percent had one and 42 percent had at least two.

A higher number of vascular risk factors in midlife, but not in late life, was associated with elevated brain amyloid, researchers report in JAMA.

Brain scans found that 31 percent of people with no vascular risk factors at the start of the study had elevated amyloid later in life, compared with 61 percent of the people who had at least two vascular risk factors in middle age.

Relationships between vascular risk factors and brain amyloid didn’t differ by race. There also wasn’t a meaningful difference based on whether people were carriers of what’s known as the ApoE4 allele, a version of a gene that’s associated with increased risk for Alzheimer’s disease.

“Brain amyloid is a risk factor that likely begins prior to the development of memory problems and thus, these findings are very intriguing,” Dr. Jeffrey Burns, co-director of the University of Kansas Alzheimer’s Disease Center in Kansas City, said by email. “We do need to be careful to recognize that amyloid in the brain does not equal Alzheimer’s disease.”

It’s possible that brain vascular disease might either lead to an increase in amyloid deposits or a decreased ability to remove amyloid that accumulates. But the study wasn’t designed to answer this question, Dr. Andrew Budson, a neurology researcher at The VA Boston Healthcare System and Boston University School of Medicine who wasn’t involved in the study, said by email.

Still, the results add to the evidence suggesting that people who focus on heart health earlier in life may also be safeguarding their brains, said Dr. Hannah Gardener, a neurology researcher at the University of Miami who wasn’t involved in the study.

“Patients and physicians need to work together to monitor and minimize the burden of vascular health factors like smoking, obesity, blood pressure, cholesterol and diabetes with the goal of protecting both heart and brain health decades before Alzheimer’s disease typically manifests,” Gardener said by email.

source: Reuters Health