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Women who gain weight too quickly during the first three months of pregnancy are more prone to develop pregnancy-related diabetes, new research shows.

“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.

The introduction of effective drugs against HIV, the virus that causes AIDS, has not changed gay men’s risk of contracting the virus during a single act of anal sex, new research from Australia shows.

This finding was “unexpected,” the study’s authors admit, given that treatment with AIDS drugs sharply reduces the concentration of HIV in a person’s blood, which would theoretically make it more difficult to transmit the virus.

Being the “receptive” partner in unprotected anal sex with an HIV-positive man is gay men’s main risk factor for contracting the virus, Dr. Fengyi Jin of the National Center in HIV Epidemiology and Clinical Research at the University of New South Wales in Darlinghurst and colleagues note. Less is known about the risks for the “insertive” partner, they add, although there is evidence that it may be lower for circumcised men.

To estimate the risk of contracting HIV for each instance of unprotected anal sex of either type, the researchers enrolled 1,427 men who reported having had sex with another man at least once in the past five years between June 2001 and December 2004. The study participants were interviewed about their sexual behavior every six months, and tested for HIV every year until June 2007. During follow-up, 53 men contracted HIV.

The riskiest type of sexual activity was receptive anal sex with ejaculation into the rectum; each such act carried a 1.43 percent risk of contracting HIV. If a man’s partner withdrew before ejaculation, the risk dropped to 0.65 percent. Circumcised men had a 0.11 percent risk of contracting HIV for every insertive sex act, while the risk for circumcised men was 0.62 percent.

The findings are “very similar” to a US study done in the early 1990s, the researchers note, which found an 0.82 percent risk of contracting HIV for every instance of receptive anal sex (whether or not withdrawal occurred).

Rates of HIV testing among gay men in Australia are “very high,” the researchers note, while 70 percent of HIV-positive men are receiving treatment with powerful AIDS drugs. And three quarters of these men have no detectable virus in their blood. So it is “surprising,” the researchers say, that the risks associated with unprotected sex are so similar to what they were in the early 1990s, when it would have been rare for an HIV-positive man to have undetectable levels of the virus in his blood.

The findings apply to the population of gay men as a whole, the researchers add, and “caution should be exercised before interpreting the results at the level of individual men.” Genes and other biological factors can influence the risk of both transmitting and contracting the virus, they explain.

For example, they note, 12 of the men in the study contracted HIV after having unprotected anal sex less than 10 times, while there were six study participants who didn’t contract the virus even though they had “extremely large numbers” of receptive anal sex episodes with HIV-positive partners.

SOURCE: AIDS

The type of treatment received by prostate cancer patients is influenced by the kind of health care facility where they receive care, a new U.S. study has found.

Surgery was more common among patients treated in county hospitals, while patients in private facilities were more likely to undergo radiation or hormone therapy, according to the report published online Jan. 25 in the journal Cancer.

In the study, Dr. J. Kellogg Parsons, of the Moores Comprehensive Cancer Center at the University of California, San Diego and the VA Medical Center San Diego, along with colleagues at the University of California, Los Angeles, analyzed the care given to 559 prostate cancer patients enrolled in a state-funded program for low-income patients. Between 2001 and 2006, 315 of the patients were treated at county hospitals and 244 were treated at private facilities.

Tumor characteristics were similar in both groups, but those treated in private facilities were more likely than those treated in county hospitals to be white (35 percent versus 10 percent) and less likely to undergo surgery (29 percent versus 54 percent).

Patients treated in private facilities were nearly 2.5 times more likely than those in county hospitals to receive radiation and more than 4.5 times more likely to initially receive hormone therapy instead of surgery, the researchers found.

The type of doctor handling a patient’s case may be one reason for the different treatment decisions, the study authors noted. At county hospitals, patients were initially under the care of urologists, while initial care for patients at private facilities was directed by a mix of urologists, radiation oncologists and medical oncologists.

“The fact that prostate cancer patients are treated differently based on the type of hospital has implications for health policy, quality of care, and equality of care — particularly because public hospitals are funded by city and state governments to provide health care for underserved, poor populations,” Parsons said in a news release.

SOURCE: Cancer, news releas

Parents who’ve ever suspected their youngster had an ear infection might have been inclined to call the doctor, schedule a visit and expect an antibiotics prescription.

That’s been the ritual. But no more.

“Until eight or nine years ago, we’d treat each ear infection at diagnosis,” said Dr. David Tunkel, director of pediatric otolaryngology at Johns Hopkins School of Medicine and chairman of the pediatrics committee for the American Academy of Otolaryngology.

“The thought was, you would reduce the symptoms quicker,” Tunkel said. “Then it became clear that many children who weren’t treated with antibiotics actually did well without the initial treatment.”

As a result, Tunkel said, guidelines issued in 2004 by the American Academy of Pediatrics and the American Academy of Otolaryngology began to encourage what doctors call an “observation option.” That means that children 2 years and older who are otherwise healthy can be observed for a short period of time before being given antibiotics.

Ear infections are the most common illness among infants and young children, according to the U.S. National Institutes of Health, with an estimated three of every four kids having an ear infection before age 4. Usually infection occurs in the middle ear and is called otitis media. It’s called otitis media with effusion when fluid and mucus build up in the tubes of the middle ear.

Ear infections often clear up on their own. But another pediatric otolaryngologist, Dr. Richard Rosenfeld, stressed that “observation is different than no treatment.” Rosenfeld is chairman of otolaryngology at Long Island College Hospital and the State University of New York Downstate Medical Center and a consultant for the American Academy of Pediatrics on the ear infection guidelines.

When recommending observation before medication, he said, doctors might send parents home with a “safety net” prescription, one to have on hand in case the situation worsens. Parents should ask the doctor for specifics on the timeline for observation, which typically ranges from one to three days.

And while watching and waiting, the focus would be on pain relief.

But observation isn’t advised for all kids, even if they’re healthy and 2 years or older, Tunkel said. For instance, a child with a fever of 102 or more would typically be treated.

“We don’t want to withhold antibiotics from kids,” he said.

Rather, the guidelines are aimed to address concerns about resistance to antibiotics that can develop from overuse, he said.

Also, a study reported in the British journal BMJ in July found that ear infections come back more often in kids who’ve been treated with antibiotics. In the three years after being treated for an ear infection, 63 percent of the kids who were given the antibiotic amoxicillin had recurrent ear infections, compared with 43 percent of those not treated with an antibiotic.

“Parents are becoming used to the idea that antibiotics are not the first choice,” Tunkel said.

Rather, pain control and pain management might need to take center stage, at least initially. For pain, Rosenfeld suggests ibuprofen over acetaminophen because, he said, “it lasts longer.”

“If our goal is to get your child to sleep through the night, you are going to achieve that better with ibuprofen than acetaminophen,” he said.

“You have to be prepared to give lots of analgesics,” he said, with the exact amount something that must be discussed individually with the pediatrician.

Anesthetic ear drops, which usually require a prescription, can help but don’t produce prolonged relief, Rosenfeld said. And the practice of putting warm compresses on the outside of the ear can’t hurt, he said, but there’s no real proof that it works, either.

Someday, kids might be able to be vaccinated against ear infections. Scientists are working on developing such a vaccine and testing ways to deliver it, including rubbing it on the skin rather than injecting it, according to a presentation at the 2009 annual meeting of the American Society of Microbiology.

In the meantime, parents can take some simple measures to reduce the likelihood of their child developing an ear infection, Tunkel said. If parents smoke, stopping will reduce exposure to cigarette smoke, which is a risk factor for ear infections. And parents who choose a day-care setting with as few children as possible can, at least theoretically, reduce the pool of circulating germs, he said.