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Depressive symptoms are a major part of bipolar disorder, which affects about four percent of Americans at some point in their lives. There are several approved treatments for bipolar disorder, but some patients do not respond to these therapies.

Ketamine acts on the brain’s glutamatergic system, which plays a role in information processing and memory formation. Recent research suggests that dysfunction in this brain system may contribute to bipolar disorder, noted Dr. Nancy Diazgranados and colleagues at the U.S. National Institute of Health.

Their study included 18 patients with bipolar depression that didn’t improve when treated with the medications lithium or valproate. Two-thirds of the patients were on psychiatric disability and nearly all of them were unemployed.

The patients received an intravenous infusion of either ketamine or a placebo on two days two weeks apart. The order of the infusions was randomly assigned.

The patients’ depressive symptoms were assessed before each injection and then 40, 80, 120 and 230 minutes, and one, two, three, seven, 10 and 14 days afterward. Within 40 minutes of receiving ketamine, the patients showed significant improvements in depressive symptoms compared to those who received the placebo. The improvements were most noticeable at day two and remained significant through day three.

At some point during the study, 71 percent of patients responded to ketamine and six percent responded to the placebo. No serious side effects were reported during the trial.

The study, published in the August issue of the journal Archives of General Psychiatry, provides evidence that the brain’s glutamatergic system may play a role in bipolar disorder and that targeting it may lead to better treatments, the researchers wrote.

They also said that future research should explore how ketamine’s rapid effect on depression can be maintained over the long-term.

Although ketamine has been used off-label as an experimental treatment for depression, it has not been approved by the U.S Food and Drug Administration for that use, according to the U.S. National Institutes of Health.

SOURCES: JAMA/Archives journals

The risk was the same even when women took hormone replacement therapy, which doctors once prescribed expressly to prevent heart disease, the researchers said at a meeting of the Endocrine Society in San Diego.

“It is important for women to know that early menopause is a potential risk factor for cardiovascular disease, the number one killer of American women,” Dr. Melissa Wellons of the University of Alabama at Birmingham, who led the study, said in a statement.

“They can then work harder to improve their modifiable risk factors, such as high cholesterol and blood pressure, by exercising and following a healthy diet,” Wellons said.

Doctors should routinely ask older women when they experienced menopause, she said. The average age of menopause is 51.

Her team studied more than 2,500 women who were 45 to 84 when the study started in 2000. Nearly 28 percent of them reported early menopause; 446 women or 18 percent had natural menopause and 10 percent had menopause caused by having their ovaries removed.

None of the women had a heart attack, stroke, chest pain known as angina, heart bypass surgery or a suddenly stopped heart before the age of 55.

But after that, the women who had early menopause were more likely to have had one of these things happen than the others. They were more than two times as likely to have one of these heart events, even when the researchers accounted for any extra weight gain.

Nearly 6 percent of women who went though menopause early had some sort of heart event, compared to 2.6 percent of women who had not gone through menopause or who went through it after age 47, they told the meeting.

“Our study is observational; therefore, we cannot conclude that early menopause somehow causes future cardiovascular disease,” Wellons said. “However, our findings do support the possible use of age at menopause as a marker of future heart and vascular disease risk.”

Before 2002, doctors widely prescribed hormone replacement therapy, or HRT, to lower the risk of heart disease or osteoporosis, both of which go up sharply after menopause.

But use of HRT plummeted in 2002 after the publication of the Women’s Health Initiative study, which found an increased risk of ovarian cancer, breast cancer, strokes and other problems from hormone therapy. Studies have also found HRT does not protect against heart disease.

Sales of U.S. market leader Wyeth’s combined estrogen-progestin therapy Prempro have fallen by about 50 per cent since 2001 to around $1 billion a year. Wyeth is now owned by Pfizer.

Using molecular imaging, researchers examined the function of esophageal muscles in 49 people with suspected or confirmed gastro-esophageal reflux disease (GERD), and found what they described as strong evidence that poor esophageal muscle tone plays a role in the condition, whether people have mild, moderate or severe cases.

The findings were to be presented during the annual meeting of the Society of Nuclear Medicine, being held June 5-9 in Salt Lake City.

GERD is thought to affect from 15 percent to 35 percent of the U.S. population. In people with the condition, the circular muscle that seals off the stomach from the esophagus does not close properly. This enables the acidic stomach contents to rise up, or reflux, into the esophagus, resulting in inflammation and acid indigestion, or heartburn. Chronic reflux — occurring more than twice a week — is considered GERD, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases. Long-term exposure to stomach acid can lead to serious damage of esophageal tissue and, possibly, cancer.

“If the findings of this study are confirmed by similar larger studies, it may lead to the use of medications to correct the abnormal muscular movements in the esophageal wall,” Alok Pawaskar, a consultant in the nuclear medicine department at Apollo Hospitals, based in Chennai, India, said in a news release from the society. “These medications, when used in combination with common antacids that reduce the acidity of the stomach’s contents, could provide patients with long-term relief from reflux disease.”

SOURCE: Society for Nuclear Medicine, news release.

The first was that higher oxygen levels improve preterm infants’ survival but increase the risk for a condition that can damage the retina.

The second was that a treatment typically used for adults with sleep apnea also is as effective as the traditional ventilator and surfactant therapy used to treat breathing difficulties in preterm infants — and may result in fewer complications. The treatment relies on a continuous positive airway pressure (CPAP) machine to blow air through a preterm infant’s nostrils, to gently inflate the lungs.

These findings appear in two articles published online by The New England Journal of Medicine. The study results also will be presented on May 16 at the American Thoracic Society 2010 International Conference in New Orleans.

“Until the current study, CPAP had shown promise in treating respiratory distress in preterm infants, but had never been compared to ventilator therapy in this group of patients,” said Alan E. Guttmacher, M.D., acting director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), one of the NIH Institutes that provided infrastructure and funding for the study. “The study results indicate that CPAP is an effective initial alternative to ventilator therapy for very preterm infants of 24-27 weeks gestational age.”

The study was conducted by the 20 academic medical centers participating in the NICHD’s Neonatal Research Network. The study also received funding from the NIH’s National Heart, Lung, and Blood Institute.

The lead author of the article comparing oxygen saturation levels was Waldemar A. Carlo, M.D., of the University of Alabama at Birmingham. The lead author of the article comparing CPAP therapy to ventilator and surfactant therapy was Neil N. Finer, M.D., of the University of California at San Diego. The NICHD author of both papers was Rosemary D. Higgins, M.D.

“Balancing the benefits of supplemental oxygen against the risks in these very premature babies has been a concern of doctors and parents for decades,” said NHLBI Acting Director Susan B. Shurin, M.D., a board-certified pediatrician. “The results of this large clinical trial of extremely low birthweight infants will help inform management decisions to improve chances of survival and reduce complications associated with breathing problems in these vulnerable patients.”

The study enrolled 1,316 babies born between the 24th and 27th weeks of pregnancy. A full-term pregnancy is 40 weeks long. The very premature babies in the study had an average weight of less than two pounds.

The study was divided into two arms that provided the findings for the articles. Each arm proceeded at the same time, in the same group of infants. In the first arm, each infant had a 50 percent chance of receiving higher oxygen target saturation levels, and a 50 percent chance of receiving lower levels. In the second arm, each infant had a 50 percent chance of receiving oxygen by CPAP and a 50 percent chance of receiving intubation with surfactant, a viscous substance that helps keep the lungs’ air sacs open. Although surfactant normally is produced by the lung, premature infants are not ready to make surfactant at first and suffer from severe breathing difficulties.

Researchers Compare Higher Oxygen Levels To Lower Levels

Higher oxygen levels have been linked to an increase in the risk of retinopathy of prematurity (ROP), a condition affecting the retina. The current study was undertaken to determine if slightly reduced oxygen levels would allow infants to remain healthy while reducing their risk for ROP. Information on ROP (http://www.nei.nih.gov/health/rop/rop.asp) is available from the National Eye Institute.

For the arm of the study that compared oxygen levels, the infants were assigned at random to receive oxygen at one of two levels. The lower level consisted of 85 to 89 percent oxygen saturation in the babies’ blood; the higher level 91 to 95 percent. The infants also were assigned at random to receive oxygen either through a ventilator or a CPAP machine.

The researchers evaluated the infants at the two oxygen saturation levels in a single combined measure, referred to as the combined outcome of their survival and their likelihood of experiencing ROP. No overall difference emerged between the groups in terms of this measure. However, there was a striking difference when survival and likelihood of experiencing ROP were considered separately.

More of the infants on the low oxygen level died than did infants on the higher level: 19.9 percent compared to 16.2 percent. But among those who survived, fewer on the lower level of oxygen developed ROP: 8.6 percent versus 17.9 percent in the higher-oxygen group.

“Many doctors believe that optimal oxygen saturation levels fall between 85 and 95 percent,” Dr. Carlo said. “Our results offer much needed data on which to base treatment decisions.”

CPAP Compared to Traditional Ventilator-Surfactant Therapy

A second arm of the study compared the standard ventilator treatment and surfactant for preterm respiratory distress to treatment with CPAP (http://www.nhlbi.nih.gov/health/dci/Diseases/cpap/cpap_what.html), which involves passing air through an infant’s nose via prongs that rest in the nostrils. The standard ventilator (http://www.nhlbi.nih.gov/health/dci/Diseases/vent/vent_what.html) treatment involves placing a breathing tube in a newborn’s windpipe to provide oxygen and surfactant. It is not possible to deliver surfactant with CPAP.

In this arm of the study, newborns who were randomly assigned to the ventilator-surfactant treatment had a breathing tube placed in their windpipes within an hour of birth and received a dose of surfactant. Those who obtained CPAP treatment received oxygen through prongs placed in their nostrils, also within the first hour of life. Any infant receiving CPAP who subsequently did not achieve adequate oxygen levels in their blood was placed on a ventilator. Of the infants who received CPAP treatment initially, 83 percent required a ventilator tube in the windpipe and 67 percent received surfactant.

“Surfactant and intubation together have been shown to reduce the risk of serious complications and death in preterm infants,” Dr. Finer said. “But the use of CPAP also grew during the last 10 or 15 years, without randomized studies to test it and compare it to surfactant.”

The researchers looked at mortality and at a lung condition called bronchopulmonary dysplasia, which is characterized by a need for oxygen therapy when the baby is four weeks short of his or her original due date, or 36 weeks after the mother’s last menstrual period. When researchers compared CPAP to surfactant on a combined measure of mortality and bronchopulmonary dysplasia, the two types of breathing therapy were practically identical.

“The study shows that CPAP is an effective alternative to surfactant in preterm infants,” Dr. Higgins said. “Because it is less invasive than ventilator therapy, CPAP appears to be an appropriate first treatment for preterm newborns. If CPAP is unsuccessful, an infant can be placed on a ventilator and given surfactant.”

By other measures, children initially placed on CPAP actually fared somewhat better than children who had received surfactant with the ventilator. They were more likely to have survived and to not require breathing therapy a week after being born. They were also less likely to need steroid treatment for their lungs; and they spent less time overall on ventilators.

Furthermore, the earliest preterm infants in the study, born at 24 to 25 weeks gestation, were less likely to die if they had received CPAP than if they had received surfactant as the initial treatment in the study.

The team will evaluate the children again when they are 18 to 22 months old, to learn whether any differences arise among the children who took part in the different treatments arms of the study.

For more information on this study (NCT 00233324), visit www.clinicaltrials.gov.

Five studies and an editorial in the May issue of the Archives of Internal Medicine explore the side effects associated with proton pump inhibitors, including bone fractures among older women and Clostridium difficile infections that can cause life-threatening diarrhea and gastrointestinal upset in older people.

Overall, proton pump inhibitors are safe, experts stressed. Even so, evidence suggests the drugs are being prescribed unnecessarily and that potential side effects are not being taken seriously enough.

“Generally speaking, proton pump inhibitors are safe medications. Proton pump inhibitors are commonly used and generally very well-tolerated,” said Dr. Amy Linsky, lead author of one of the studies and a general internal medicine fellow at Boston Medical Center. “But in the last few years, there is more information coming out about some adverse effects associated with them. Prescribers and patients should be aware of what some of those risks are, and each patient needs to assess what their risk vs. benefits could be.”

Proton pump inhibitors are sold under the brand names Prilosec, Prevacid and Nexium, among others. About 113 million prescriptions for proton pump inhibitors are filled each year, accounting for nearly $14 billion in sales, according to an accompanying editorial.

The medications, which decrease production of stomach acid, are used to treat inflammation of the esophagus, gastroesophageal reflux disease (GERD) and ulcers, among other conditions. Yet evidence suggests that between 53 percent and 69 percent of prescriptions are for “inappropriate indications,” such as indigestion or heartburn without ulcers, according to the editorial.

Instead, those patients should be prescribed proton pump inhibitors for only brief periods or not at all, according to the editorial. Patients could instead try eating smaller meals, especially before bed, losing weight, quitting smoking, reducing stress and raising the head of the bed.

Proton pump inhibitors may also be over-prescribed among hospital patients, said Dr. Michael Howell, author of another report on the drugs in the journal.

Hospital patients, especially those in intensive care units, can be prone to developing ulcers, possibly because of changes to blood flow to the stomach. Decades ago, doctors tried to prevent ulcers with antacids. Today, about half of hospital patients, even those not in ICUS, are given proton pump inhibitors as a preventive measure, said Howell, who is director of critical care quality at Beth Israel Deaconess Medical Center and an instructor of medicine at Harvard Medical School.

The problem is that there is little reason to believe all of those people are at risk of ulcers and would benefit from medication, Howell said. Many of those patients continue taking proton pump inhibitors after leaving the hospital.

“Stress ulcers almost only happen in the sickest of the sick ICU patients,” Howell said. “There has never been a trial that shows others would benefit. What our study adds to this are some of the concrete risks.”

Howell and his colleagues analyzed data on more than 100,000 patients discharged from the hospital over a five-year period and found that taking a proton pump inhibitor each day increased the chances of a C. difficile infection by 74 percent. Patients who took proton pump inhibitors longer than that had more than double the chance. That translates to about one additional case of C. difficule for every 533 people taking proton pump inhibitors.

While the risk is relatively small, there are so many people taking proton pump inhibitors that it translates into thousands of additional deaths, Howell said. Previous research has shown C. difficile kills about one in every 14 adults over 65 who gets it, Howell said.

Among the other findings:
Postmenopausal women who took proton pump inhibitors were at increased risk of fractures. Researchers from University of Washington, Seattle, followed nearly 162,000 women aged 50 to 79 taking part in the Women’s Health Initiative Study for about eight years. Women who took proton pump inhibitors were at increased risk of spine, forearm and wrist fractures, though not hip fractures. Researchers also found no decrease in bone mineral density.
Surviving C. difficile once doesn’t mean you’re out of the woods. Researchers from Boston Medical Center studied about 1,200 patients being treated for C. difficile and found those also treated with proton pump inhibitors had a 42 percent increased risk of getting the infection again.
Taking high-dose proton pump inhibitors don’t reduce rates of bleeding, surgeries or death in patients with bleeding ulcers compared to regular proton pump inhibitor therapy, according to researchers in Taiwan.
Establishing guidelines for the appropriate use of proton pump inhibitors reduced the numbers of patients taking them from 27 percent to 16 percent at one hospital, according to a study by researchers from Massachusetts General Hospital and Harvard Medical School. Prescriptions at the time of discharge decreased from 16 percent to 10 percent.

The articles are part of the journal’s series, “Less Is More,” exploring areas in which too much health care — diagnostic tests, medications or surgeries — can leave patients worse off.

SOURCES: Amy Linsky, M.D., general internal medicine fellow, Boston Medical Center, Boston; Michael Howell, M.D., M.P.H., director, critical care quality, and associate director, medical critical care, Beth Israel Deaconess Medical Center, Boston;

These “insensitive” mosquitoes have defects in their ability to smell the compound, and this genetically determined trait is easily passed from generation to generation, the researchers reported in the May 3-7 online edition of the Proceedings of the National Academy of Sciences.

The findings, from researchers in the United Kingdom and Sweden, could present new molecular targets, paving the way for better, safer repellents to stave off the flying vermin of summer.

“DEET is one of the most effective insect repellents of four that are approved,” said Michel Slotman, assistant professor in entomology at Texas A&M University in College Station, who was not involved in the study. “But we haven’t understood how it works.”

“These [newly discovered] molecular targets will pave the way for the discovery of novel insect repellents if resistance to DEET becomes a problem a few decades down the road,” added Walter S. Leal, professor of entomology at the University of California-Davis, and the scientist who discovered that mosquitoes are repelled by the smell of DEET. “Now that it has been corroborated that mosquitoes smell and avoid insect repellents, let the race for identification of DEET-sensitive odorant receptors begin,” he said.

Before Leal determined that mosquitoes dislike DEET’s smell, researchers had thought the compound interfered with the insects’ ability to smell.

N,N-Diethyl-m-toluamide, or DEET — the most common active ingredient in bug repellents — is used by about 200 million people worldwide to protect against disease-carrying insects, according to the U.S. Department of Agriculture. Mosquitoes can cause malaria, encephalitis, West Nile and yellow fever.

Although DEET is deemed safe and effective, many people don’t like to use it because “it smells and leaves an oily residue,” Slotman said. “It’s not the most pleasant thing to apply.”

And even it’s highly effective, some mosquitoes are not deterred by the smell, and scientists have wanted to know why.

The authors of the new study identified female yellow fever mosquitoes (Aedes aegypti) that were not repelled by DEET.

They then bred these females with a random group of male mosquitoes and found that the “insensitivity” gene was dominant and quickly passed on.

In just one generation, the proportion of DEET-resistant mosquitoes jumped from 13 percent to higher than 50 percent.

As it turned out, “smell” receptors on the antenna predicted how a mosquito responded to DEET. Differences in these neurons may explain why some mosquitoes stay away from DEET-lathered humans and some do not.

“[The researchers] found olfactory receptor neurons on the antennae of female mosquitoes that respond to DEET in a dose-dependent manner,” Leal explained. “These authors showed that repellency is directly correlated with the sensitivity of these DEET-detecting olfactory receptor neurons.”

In other words, the sensitivity of the neurons on the antennae determine the mosquito’s ability to detect DEET. Some mosquitoes have a “defect in DEET detection,” Leal said.

But DEET is still likely to be the mainstay of summer defenses against mosquitoes and other bothersome insects.

“It is not entirely surprising that mosquitoes develop resistance to DEET as all insects develop resistance to human-made compounds,” Leal said. “The good news is that DEET resistance in wild populations develops so slowly that it has been used for almost five decades and it is still a ‘gold standard’ insect repellent.”

SOURCES: Walter S. Leal, Ph.D., professor of entomology, University of California-Davis; Michel Slotman, Ph.D., assistant professor in entomology, Texas A&M University, College Station, Texas;

Working with cotton exposes people to dust and endotoxin, a substance produced by bacteria that can trigger inflammation in the airways. It’s known that workers in the industry have increased rates of breathing problems, including chronic cough and chronic bronchitis — persistent inflammation in the lungs that causes symptoms like breathlessness and wheezing. However, it has been unclear whether those effects are at least partly reversible.

In the new study, reported in the American Journal of Respiratory and Critical Care Medicine, researchers followed 447 Chinese men and women working in the cotton textile industry, along with 472 workers in the silk industry — where workers are not exposed to high levels of endotoxin.

Over 25 years, the researchers periodically measured the workers’ lung function using a standard test that gauges the amount of air a person can forcibly exhale in one second. They also questioned the workers about any respiratory symptoms.

Overall, the study found, cotton workers’ lung function improved after retirement, particularly within the first 10 years.

What’s more, their rates of certain respiratory problems declined over time. At the start of the study in 1981, 21.5 percent of cotton workers had chronic bronchitis, and a similar percentage had chronic cough. Fifteen years later, those figures were 5 percent and 2 percent, respectively.

In addition, the rate of byssinosis — a lung disease specifically linked to on-the-job exposure to cotton dust — declined from 8 percent to less than 2 percent.

The proportion of cotton workers reporting bouts of breathlessness increased over time — from 15 percent to 20 percent. But that rate also increased among silk workers, from 4 percent to 14 percent, and such effects can be related to aging.

Overall, the findings suggest that the lung damage from working in the cotton industry is partially reversible, according to the researchers, led by Dr. Jing Shi of the University of Science and Technology in Beijing. “Partially,” they note, because, on average, cotton workers’ lung function did not reach that of silk workers after retirement.

Shi’s team also found that cotton workers who smoked suffered greater effects on lung function than non-smokers during their working years. But they also improved more rapidly than non-smokers did after retirement.

As for the silk workers in the study, their lung function also generally improved after retirement.

Similarly, their rates of chronic cough and chronic bronchitis, while always lower than those of cotton workers, also dipped (from just under 8 percent to 6 percent for bronchitis, and from 7 percent to 3 percent for chronic cough).

The reason for that, Shi’s team writes, is not entirely clear, as silk workers were not exposed to cotton dust or higher-than-normal endotoxin levels. Some other, “unmeasured exposure,” according to the researchers, may have affected silk workers’ lung health.

SOURCE: American Journal of Respiratory and Critical Care Medicine

The condition, called dysmenorrhea, affects 45 percent to 90 percent of women of child-bearing age and is the leading cause of school and job absenteeism among women in their teens and 20s, according to a news release from the American Chemical Society. Existing treatments, such as pain relievers, anti-inflammatory drugs and oral contraceptives, are ineffective in nearly one-third of women with moderate to severe dysmenorrhea, the news release noted.

Menstrual cramps are caused by contractions of the uterus. In dysmenorrhea, the uterus contracts with increased frequency.

The British pharmaceutical company Vantia Ltd. has developed an investigational pill, called VA111913, that’s designed to block the hormone vasopressin, which plays a role in regulating contraction of the uterus.

Last year, a stage 1 clinical trial showed that VA111913 was safe. The drug is currently in Phase 2 clinical trials to evaluate how well it works to control pain in women with dysmenorrhea. The results of the studies, which are being conducted by Vantia, are expected later this year.

“We hope that the drug will provide a more effective treatment option for millions of women worldwide with this painful condition,” Vantia’s Andrzej R. Batt, said in the news release. “Dysmenorrhea not only diminishes the quality of life for millions of women, but also has a hidden, society-wide economic cost that involves an enormous number of days lost from work and school.”

Details about the drug were to be presented Tuesday at the national meeting of the American Chemical Society in San Francisco.

SOURCE: American Chemical Society, news release.

“We found the association was stronger among women who were overweight at the start of pregnancy,” Dr. Monique M. Hedderson of Kaiser Permanente Medical Group in Oakland, California, noted in an email to Reuters Health.

This study, she added, suggests that weight gain in early pregnancy may be a modifiable risk factor for pregnancy-related, or “gestational,” diabetes.

Gestational diabetes occurs when a woman’s pancreas can no longer keep up with the body’s growing demands for the blood-sugar-regulating hormone insulin. Left untreated, high blood sugar in pregnancy can cause the fetus to grow abnormally large, increasing the risk of injury to baby and mother during delivery. While a woman’s glucose (sugar) metabolism usually returns to normal after her pregnancy is over, she runs a higher risk of developing type 2 diabetes later on.

Women typically undergo an oral glucose tolerance test between the 24th and 28th weeks of pregnancy to assess whether their body is producing enough insulin. To date, Hedderson and her colleagues note in the journal Obstetrics & Gynecology, just three small studies have looked at weight gain before this test and gestational diabetes risk.

The Institute of Medicine published guidelines on healthy weight gain in pregnancy in 2009, but stated that there is not enough evidence to say whether how much weight a woman gains influences her likelihood of developing diabetes during pregnancy.

To investigate, Hedderson and her team compared 345 women who developed gestational diabetes to 800 women who did not, all of whom delivered their babies between 1996 and 1998 and had oral glucose tolerance tests at 24 to 28 weeks’ gestation.

Women who gained weight the most slowly during their first trimester (less than a third of a kilogram per week, or just over half a pound) had the lowest risk of gestational diabetes.

Risk went up as a woman’s rate of first trimester weight gain increased; for women gaining between 0.3 and 0.4 kilograms (0.6 to 0.9 pounds), diabetes risk was about 40 percent higher; for women who gained more than 0.4 kilograms (0.9 pounds), risk increased 74 percent.

The Institute of Medicine’s weight gain recommendations are based on a woman’s body mass index (a standard measure of weight in relation to height used to gauge whether someone is overweight); for example, normal-weight women should gain between 25 and 35 pounds total during pregnancy, at the rate of about a pound a week, according to the IOM; underweight women should gain more, and overweight and obese women should gain less. Hedderson and her colleagues found that women who exceeded these recommendations were at 50 percent higher risk of gestational diabetes.

“The new IOM guidelines are the commonly accepted and used weight gain recommendations,” Hedderson said. “However, talking to women about their weight is a sensitive topic and not all OB/GYNs counsel on weight gain during pregnancy, or they wait until they see that the woman has gained too much wait before discussing it.”

She urges doctors to “talk to their patients early in their pregnancy about the appropriate weight gain, especially during the first trimester, and help women monitor their weight gain. Women should check in with their health care providers at the start of their pregnancy to plan for healthy weight gain throughout their pregnancy.”

SOURCE: Obstetrics & Gynecology.