Risk of preterm birth in primiparous women with exposure to antidepressant medication before pregnancy and/or during pregnancy – impact of body mass index

Introduction: Preterm birth is a major cause of infant mortality. It is unknown whether body mass index (BMI) influences the risk of preterm birth in women, who prenatally use antidepressants.Materials and methods: The study cohort (N = 6920) consists of all primiparous European born women without previously diagnosed diabetes from the city of Vantaa, Finland, who delivered a singleton child between 2009 and 2015. Data on births, pre-pregnancy BMI and purchases of antidepressants from 12 months before conception until delivery were obtained from Finnish National Registers.Results: Of the primiparous women, 9.9% used antidepressants. The overall prevalence of preterm birth was 5.2%. In women with a pre-pregnancy BMI <18.5 kg/m², the Odds Ratio (OR) for preterm birth among antidepressant users compared with those who were non-users was 1.91 (95% confidence intervals [CI] 0.40 to 9.15, adjusted for age, smoking, education, use of fertility treatments and number of previous pregnancies) while in women with a pre-pregnancy BMI ≥30 kg/m², the OR was 0.53 (95% CI 0.21–1.36), respectively.Discussion: Primiparous women using antidepressants, who were underweight before conception should be closely monitored and provided tailored care in a maternity clinic to minimize the risk of preterm birth.

Key messages

• In primiparous women, one in ten used antidepressant medications before pregnancy and/or during pregnancy.
• In primiparous women, the prevalence of preterm birth was 5%.
• Underweight primiparous women using antidepressants should be closely monitored and provided tailored care in a maternity clinic.

     

Effect of Body Mass Index on Outcomes of Peritoneal Dialysis Patients in India

♦ Objectives: We studied the effect of body mass index (BMI) at peritoneal dialysis (PD) initiation on patient and technique survival and on peritonitis during follow-up.♦ Methods: We followed 328 incident patients on PD (176 with diabetes; 242 men; mean age: 52.6 ± 12.6 years; mean BMI: 21.9 ± 3.8 kg/m²) for 20.0 ± 14.3 months. Patients were categorized into four BMI groups: obese, ≥25 kg/m²; overweight, 23 - 24.9 kg/m²; normal, 18.5 - 22.9 kg/m² (reference category); and underweight, <18.5 kg/m². The outcomes of interest were compared between the groups.♦ Results: Of the 328 patients, 47 (14.3%) were underweight, 171 (52.1%) were normal weight, 53 (16.2%) were overweight, and 57 (17.4%) were obese at commencement of PD therapy. The crude hazard ratio (HR) for mortality (p = 0.004) and the HR adjusted for age, subjective global assessment, comorbidities, albumin, diabetes, and residual glomerular filtration rate (p = 0.02) were both significantly greater in the underweight group than in the normal-weight group. In comparison with the reference category, the HR for mortality was significantly greater for underweight PD patients with diabetes [2.7; 95% confidence interval (CI): 1.5 to 5.0; p = 0.002], but similar for all BMI categories of nondiabetic PD patients.Median patient survival was statistically inferior in underweight patients than in patients having a normal BMI. Median patient survival in underweight, normal, overweight, and obese patients was, respectively, 26 patient-months (95% CI: 20.9 to 31.0 patient-months), 50 patient-months (95% CI: 33.6 to 66.4 patient-months), 57.7 patient-months (95% CI: 33.2 to 82.2 patient-months), and 49 patient-months (95% CI: 18.4 to 79.6 patient-months; p = 0.015). Death-censored technique survival was statistically similar in all BMI categories. In comparison with the reference category, the odds ratio for peritonitis occurrence was 1.8 (95% CI: 0.9 to 3.4; p = 0.086) for underweight patients; 1.7 (95% CI: 0.9 to 3.2; p = 0.091) for overweight patients; and 3.4 (95% CI: 1.8 to 6.4; p < 0.001) for obese patients.♦ Conclusions: In our PD patients, mean BMI was within the normal range. The HR for mortality was significantly greater for underweight diabetic PD patients than for patients in the reference category. Death-censored technique survival was similar in all BMI categories. Obese patients had a greater risk of peritonitis.     

Body mass index and mortality in patients with acute venous thromboembolism: findings from the RIETE registry

Summary.  Background:  There is little information on the influence of body mass index (BMI) on mortality in patients with acute venous thromboembolism (VTE). Patients and methods:  RIETE is an ongoing registry of consecutive patients with symptomatic, objectively confirmed, acute VTE. We examined the association between BMI and mortality during the first 3 months of therapy. Results:  Of the 10 114 patients enrolled as of March 2007: 153 (1.5%) were underweight (BMI < 18.5); 2882 (28%) had a normal weight (BMI 18.5–24.9); 4327 (43%) were overweight (BMI 25.0–30); and 2752 (27%) were obese (BMI > 30). The overweight and obese patients were significantly older, and were less likely to have had cancer, recent immobility or renal insufficiency. After 3 months of therapy their death rates were 28%, 12%, 6.2% and 4.2%, respectively. In multivariate analysis, the relative risks for death after adjusting for confounding variables including age, cancer, renal insufficiency or idiopathic VTE were: 2.1 (95% CI, 1.5–2.7); 1.0 (reference); 0.6 (95% CI, 0.5–0.7); and 0.5 (95% CI, 0.4–0.6), respectively. The rates of fatal pulmonary embolism (2.0%, 2.1%, 1.2% and 0.8%, respectively) also decreased with BMI. There were no differences in the rate of fatal bleeding, but patients who were underweight had an increased incidence of major bleeding complications (7.2% vs. 2.7%; odds ratio, 2.7; 95% CI, 1.4–5.1). Conclusions:  Obese patients with acute VTE have less than half the mortality rate when compared with normal BMI patients. This reduction in mortality rates was consistent among all subgroups and persisted after multivariate adjustment.     

Obesity and risk of venous thromboembolism among postmenopausal women: differential impact of hormone therapy by route of estrogen administration. The ESTHER Study

BACKGROUND: Oral estrogen use and elevated body mass index (BMI) increase the risk of venous thromboembolism (VTE). Recent data suggest that transdermal estrogen might be safe with respect to thrombotic risk. However, the impact of transdermal estrogen on the association between overweight (25 kg m(-2) < BMI < or = 30 kg m(-2)) or obesity (BMI >30 kg m(-2)) and VTE risk has not been investigated. METHODS: We carried a multicenter case-control study of VTE among postmenopausal women aged 45-70 years, between 1999 and 2005, in France. Case population consisted of women with a first documented idiopathic VTE. We recruited 191 hospital cases matched with 416 hospital controls and 62 outpatient cases matched with 181 community controls. RESULTS: The odds ratio (OR) for VTE was 2.5 [95% confidence interval (CI):1.7-3.7] for overweight and 3.9 (95% CI: 2.2-6.9) for obesity. Oral, not transdermal, estrogen was associated with an increased VTE risk (OR = 4.5; 95% CI: 2.6-7.7 and OR = 1.1; 95% CI: 0.7-1.7, respectively). Compared with non-users with normal weight, the combination of oral estrogen use and overweight or obesity further enhanced VTE risk (OR = 10.2; 95% CI: 3.5-30.2 and OR = 20.6; 95% CI: 4.8-88.1, respectively). However, transdermal users with increased BMI had similar risk as non-users with increased BMI (OR = 2.9; 95% CI: 1.5-5.8 and OR = 2.7; 95% CI: 1.7-4.5 respectively for overweight; OR = 5.4; 95% CI: 2.1-14.1 and OR = 4.0; 95% CI: 2.1-7.8 respectively for obesity). CONCLUSIONS: In contrast to oral estrogen, transdermal estrogen does not confer an additional risk of idiopathic VTE in women with increased BMI. The safety of transdermal estrogen on thrombotic risk has to be confirmed.     

Being overweight or obese is associated with decreased mortality in critically ill patients: A retrospective analysis of a large regional Italian multicenter cohort

Purpose

To describe the epidemiology of obesity in a large cohort of intensive care unit (ICU) patients and study its impact on outcomes.

Methods

All 3902 patients admitted to one of 24 ICUs in the Piedmont region of Italy from April 3 to September 29, 2006, were included in this retrospective analysis of data from a prospective, multicenter study.

Results

Mean body mass index (BMI) was 26.0 ± 5.4 kg/m²: 32.8% of patients had a normal BMI, 2.6% were underweight, 45.1% overweight, 16.5% obese, and 2.9% morbidly obese. ICU mortality was significantly (P < .05) lower in overweight (18.8%) and obese (17.5%) patients than in those of normal BMI (22%). In multivariate logistic regression analysis, being overweight (OR = 0.73; 95%CI: 0.58-0.91, P = .007) or obese (OR = 0.62; 95%CI: 50.45-0.85, P = .003) was associated with a reduced risk of ICU death. Being morbidly obese was independently associated with an increased risk of death in elective surgery patients whereas being underweight was independently associated with an increased risk of death in patients admitted for short-term monitoring and after elective surgery.

Conclusions

In this cohort, overweight and obese patients had a reduced risk of ICU death. Being underweight or morbidly obese was associated with an increased risk of death in some subgroups of patients.     

Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury

OBJECTIVE: To determine the association between body mass index (BMI) and hospital mortality for critically ill adults. DESIGN: Retrospective cohort study. SETTING: One-hundred six intensive care units (ICUs) in 84 hospitals. PATIENTS: Mechanically ventilated adults (n=1,488) with acute lung injury (ALI) included in the Project IMPACT database between December 1995 and September 2001. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Over half of the cohort had a BMI above the normal range. Unadjusted analyses showed that BMI was higher among subjects who survived to hospital discharge vs. those who did not (p<.0001). ICU and hospital mortality rates were lower in higher BMI categories. After risk-adjustment, BMI was independently associated with hospital mortality (p<.0001) when modeled as a continuous variable. The adjusted odds were highest at the lowest BMIs and then declined to a minimum between 35 and 40 kg/m2. Odds increased after the nadir but remained below those seen at low BMIs. With use of a categorical designation, BMI was also independently associated with hospital mortality (p=.0055). The adjusted odds were highest for the underweight BMI group (adjusted odds ratio [OR], 1.94; 95% confidence interval [CI], 1.05-3.60) relative to the normal BMI group. As in the analysis using the continuous BMI variable, the odds of hospital mortality were decreased for the groups with higher BMIs (overweight adjusted OR, 0.72; 95% CI, 0.51-1.02; obese adjusted OR, 0.67; 95% CI, 0.46-0.97; severely obese adjusted OR, 0.78; 95% CI, 0.44-1.38). Differences in the use of heparin prophylaxis mediated some of the protective effect of severe obesity. CONCLUSIONS: BMI was associated with risk-adjusted hospital mortality among mechanically ventilated adults with ALI. Lower BMIs were associated with higher odds of death, whereas overweight and obese BMIs were associated with lower odds.     

Relationship of Body Mass Index With Total Mortality,Cardiovascular Mortality,and Myocardial Infarction After Coronary Revascularization: Evidence From a Meta-analysis

ObjectiveTo investigate the relationship of body mass index (BMI) with total mortality, cardiovascular (CV) mortality, and myocardial infarction (MI) after coronary revascularization procedures (coronary artery bypass grafting [CABG] and percutaneous coronary intervention [PCI]).Patients and MethodsSystematic search of studies was conducted using PubMed, CINAHL, Cochran CENTRAL, Scopus, and the Web of Science databases. We identified studies reporting the rate of MI, CV mortality, and total mortality among coronary artery disease patients' postcoronary revascularization procedures in various BMI categories: less than 20 (underweight), 20-24.9 (normal reference), 25-29.9 (overweight), 30-34.9 (obese), and 35 or more (severely obese). Event rates were compared using a random effects model assuming interstudy heterogeneity.ResultsA total of 36 studies (12 CABG; 26 PCI) were selected for final analyses. The risk of total mortality (relative risk [RR], 2.59; 95% CI, 2.09-3.21), CV mortality (RR, 2.67; 95% CI, 1.63-4.39), and MI (RR, 1.79; 95% CI, 1.28-2.50) was highest among patients with low BMI at the end of a mean follow-up period of 1.7 years. The risk of CV mortality was lowest among overweight patients (RR, 0.81; 95% CI, 0.68-0.95). Increasing degree of adiposity as assessed by BMI had a neutral effect on the risk of MI for overweight (RR, 0.92; 95% CI, 0.84-1.01), obese (RR, 0.99; 95% CI, 0.85-1.15), and severely obese (RR, 0.93; 95% CI, 0.78-1.11) patients.ConclusionAfter coronary artery disease revascularization procedures (PCI and CABG), the risk of total mortality, CV mortality, and MI was highest among underweight patients as defined by low BMI and CV mortality was lowest among overweight patients.     

Obesity is a risk factor for peritonitis in the Australian and New Zealand peritoneal dialysis patient populations.

OBJECTIVE: The aim of the present investigation was to examine the association between body mass index (BMI) and peritonitis rates among incident peritoneal dialysis (PD) patients in a large cohort with long-term follow-up. DESIGN: Retrospective observational cohort study of the Australian and New Zealand PD patient population. SETTING: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. PARTICIPANTS: The study included all incident adult patients (n = 10 709) who received PD in Australia and New Zealand in the 12-year period between 1 April 1991 and 31 March 2003. Patients were classified as obese (BMI > or = 30 kg/m2), overweight (BMI 25.0 - 29.9 kg/m2), normal weight (20 - 24.9 kg/m2), or underweight (< 20 kg/m2). MAIN MEASUREMENTS: Time to first peritonitis and episodes of peritonitis per patient-year were recorded over the 12-year period. RESULTS: Higher BMI was associated with a shorter time to first peritonitis episode, independent of other risk factors [hazard ratio 1.08 for each 5-kg/m2 increase in BMI, 95% confidence interval (CI) 1.04 - 1.12, p < 0.001]. When peritonitis outcomes were analyzed as episodes of peritonitis per patient-year, these rates were significantly higher among patients with higher BMI: underweight 0.69 episodes/year (95% CI 0.66 - 0.73), normal weight 0.79 (95% CI 0.77 - 0.81), overweight 0.88 (95% CI 0.85 - 0.90), obese 1.06 (95% CI 1.02 - 1.09). Coronary artery disease and chronic lung disease were associated with both shorter time to first peritonitis and higher peritonitis rates, independently of these other factors. There was also a "vintage effect," with lower peritonitis rates seen among people who commenced dialysis in more recent years. CONCLUSIONS: Higher BMI at the commencement of renal replacement therapy is a significant risk factor for peritonitis. The mechanisms for this remain undefined.     

BMI: new aspects of a classical risk factor for hypertensive disorders in pregnancy

HDP (hypertensive diseases in pregnancy) are one of the leading causes of maternal and fetal mortality and morbidity. BMI (body mass index) is an established risk factor for pre-eclampsia, but its role in HELLP syndrome is unknown. We therefore investigated BMI as a risk factor in the development of HELLP syndrome. At the beginning of pregnancy, BMI was measured in 1067 women with a history of HDP and 1063 controls. Diagnoses of HDP were classified according to ISSHP (International Society for the Study of Hypertension in Pregnancy) and BMI according to WHO (World Health Organization) criteria. After verification of exclusion criteria and matching for confounders, 687 women with hypertensive diseases in pregnancy and 601 controls remained for statistical evaluation by chi(2) test and multiple logistic regressions. As a continuous variable, the increase in BMI was associated with an increase in the development of gestational hypertension {OR (odds ratio), 1.1 [95% CI (confidence interval) 1.062-1.197]} and pre-eclampsia [OR, 1.1 (95% CI, 1.055-1.144)]}, but not for HELLP syndrome. According to WHO definitions, overweight women (BMI > or =25 and <30 kg/m(2)) had a 2-fold (95% CI, 1.365-2.983) risk and obese women (BMI > or =30 kg/m(2)) had a 3.2-fold (95% CI, 1.7-5.909) risk of developing pre-eclampsia when compared with women of normal weight (BMI > or =15.5 and <25 kg/m(2)). Being overweight or having obesity had no effect on the risk of HELLP syndrome. As an increased BMI is correlated with the risk of developing pre-eclampsia but not HELLP syndrome, both diseases have a different risk profile. This finding supports that underlying physiological mechanisms in pre-eclampsia vary from those in HELLP syndrome.     

成都地区中老年人群体质量指数及腹型肥胖对糖尿病患病率及空腹血糖水平的影响

目的研究成都地区中老年人群体质量指数(BMI)及腹型肥胖对糖尿病患病率及空腹血糖水平的影响。方法 2007年5月,采用随机抽样方法抽取50～80岁中老年人685人进行心血管危险因素调查,其男394人,女291人,年龄(63.3±0.2)岁。结果成都地区中老年人群的超重和肥胖所占的比例较大(约44.3%),按BMI分组(BMI<24 kg/m2;24 kg/m2≤BMI<28 kg/m2;BMI≥28 kg/m2)的糖尿病患病率分别为14.0%、18.7%及23.3%,组间差异有统计学意义(P=0.031)。男女分别按腹型肥胖标准分组(男性切点=85 cm,女性切点=80 cm),男性糖尿病患病率在非腹型肥胖及腹型肥胖组分别为17.9%及18.7%组间差异无统计学意义(P=0.849),女性糖尿病患病率分别为9.7%及18.4%,组间差异有统计学意义(P=0.034)。整个人群中,空腹血糖无随BMI增加而升高的趋势(P=0.071);女性人群中,空腹血糖随腰围的增加而升高(P=0.001);而在男性人群中无此趋势。在调整相关指标后,logistic回归分析提示BMI对糖尿病患病率独立影响,以BMI正常为参照,超重及肥胖的OR值分别为:1.412[95%CI(0.818,2.437),P=0.215]及2.200[95%CI(1.034,5.178),P=0.046]。在调整相关指标后,腹型肥胖在女性人群中对糖尿病患病率独立影响,以非腹型肥胖为参考,腹型肥胖的OR值为:1.394[95%CI(1.080,3.205),P=0.041],而在男性人群中无此关系。结论成都地区中老年人群超重及肥胖所占的比重较大,BMI可影响糖尿病患病率及空腹血糖水平;腹型肥胖能够影响女性人群糖尿病患病率及空腹血糖水平,但在男性人群中无此关系。     

喀什地区疏附县维吾尔族人群血脂异常率及相关危险因素分析

目的 了解南疆喀什地区疏附县维吾尔族人群血脂异常分布情况及其影响因素,为该人群血脂异常的防控提供参考依据。 方法 采用整群随机抽样方法,对该地区≥18岁的维吾尔族常住居民进行调查,主要包括问卷调查、体格检查和实验室检测。 分析该人群血脂异常的分布特点,并采用多因素非条件logistic回归分析血脂异常的影响因素。 结果 共纳入研究对象4 504人,该人群总血脂异常患病率为50.84%,低高密度脂蛋白胆固醇（HDL-C）血症患病率为46.65%,其次为高甘油三酯（TG）血症（12.79%）,高低密度脂蛋白胆固醇（LDL-C）血症（3.46%）,高总胆固醇（TC）血症患病率最低,为1.18%,年龄标化率分别为49.41%、45.87%、11.47%、2.98%和0.95%。 多因素非条件logistic回归分析结果显示,男性发生血脂异常的风险是女性的1.56倍（OR＝2.56,95%CI:2.22 ~ 2.95）,超重（男:OR＝1.52,95%CI:1.16 ~ 1.98;女:OR＝1.55,95%CI:1.27 ~ 1.89）、肥胖（男:OR＝3.15,95%CI:2.16 ~ 4.61;女:OR＝2.09,95%CI:1.69 ~ 2.60）、腹型肥胖（男:OR＝2.01,95%CI:1.53 ~ 2.65;女:OR＝1.78,95%CI:1.43 ~ 2.22）及女性糖尿病（OR＝1.64,95%CI:1.27 ~ 2.12）人群血脂异常的患病风险增加。 与女性体质指数（BMI）＜24 kg/m2相比,男、女性超重、肥胖者血脂异常患病率随BMI逐渐增加（χ2＝384.69,P＜0.001）,男性超重（OR＝5.55,95%CI:4.03 ~ 7.63）、肥胖（OR＝11.77,95%CI:7.94 ~ 17.45）使血脂异常的患病风险增加更为显著（P_交互＝0.030）,且该人群低HDL-C血症的患病风险也显著增加（P_交互＝0.039）。 结论 该地区维吾尔族人群血脂异常患病率处于较高水平,以低HDL-C血症为主。 体质指数与性别间对于血脂异常及低HDL-C血症患病率增加具有显著协同作用。 应重点关注超重、肥胖、腹型肥胖者,特别是男性超重、肥胖人群的血脂控制。      

The role of body mass index in the development of thromboembolic events among cancer patients with PICCs: a systematic review

ObjectivePeripherally inserted central catheters (PICC) guarantee a stable and safe vascular access to administer irritants or vesicants therapies. However, they may occasionally be affected by relevant thrombotic complications especially in patients with hypercoagulability such as oncological patients. Among the identification of independent risk factors, the role of body mass index (BMI) ≥25 kg/m² is now emerging in literature with conflicting results. The aim of this systematic review is to analyze the available scientific literature in order to determine whether BMI could represent a risk factor in the development of thromboembolic event among cancer patients with PICCs.Data sources and review methodsA scientific literature review was performed in Pubmed, Embase and Cinahl from Jan 1, 2010 to September 10, 2020 in which we identified 100 records. Of these, 88 were excluded and 14 were reviewed in full text. Among the reviewed records, 6 articles satisfied the inclusion criteria for analysis. These criteria included the English language, oncological patients with PICCs, the evaluation of catheter-related thrombosis as well as the stratification of patients according to BMI. Studies off topic and lacking data on PICC related complications among overweight and underweight patients were excluded. The includedstudies, judged with Newcastle-Ottawa Scale, was fair-lower quality. The primary endpoint was the relative risk (RR) of PICC-related thrombosis of overweight/obese vs normal weight/underweight (i.e., BMI ≥25 vs <25 kg/m²) in cancer patients.ResultsA total of 2431 patients were included in the analysis. Overall, 15.1% of patients developed PICC-related thrombosis within a median time of 23.2 days (range 11.0-42.5) after PICC implantation. Concerning BMI, 52.6% of the entire population was overweight/obese. We assessed the proportion of patients with PICC-related thrombotic events in the two groups, with 28% (95% CI, 12%-45%) of events registered in the overweight/obese patients cohort, and 13% (95% CI, 6%-19%) in the normal weight/underweight cohort. The pooled relative risk (RR) was 2.06 (95% CI, 1.21-3.49, p<0.001) in overweight/obese vs normal weight/underweight patients.ConclusionThis review showed a two-fold risk of thrombosis in overweight/obese compared to normal weight/underweight oncological patients with PICCs. Underweight condition could also play a role in thrombosis development, especially in nasopharyngeal and digestive system cancer. Future prospective studies are needed to achieve reliable results and produce useful conclusion.     

孕前体质量指数与妊娠不良结局的相关性研究

目的探讨孕前体质量指数(BMI)与妊娠不良结局相关性。方法收集4 614例分娩的孕妇临床资料,根据孕前BMI不同将其分为低体质量组、正常体质量组、超重组和肥胖组,比较各组的子痫前期、妊娠期糖尿病、剖宫产、新生儿死亡、妊娠高血压、巨大胎儿、胎膜早破、耐糖量异常、产后出血等妊娠不良结局的发病率。结果低体质量组占13.5%,正常体质量组占70.5%,超重组占13.4%和肥胖组占2.6%。随着孕前BMI的增大,妊娠期的不良结局的风险也越来越大。除新生儿死亡以外,在其他妊娠不良结局中超重组和肥胖组的发病率要明显要高于正常体质量组,差异具有统计学意义(P0.05)。低体质量组的产后出血、耐糖量异常、新生儿死亡、剖宫产、妊娠期糖尿病的发病率与正常体质量组相比无明显的差异(P0.05),而子痫前期、妊娠高血压、巨大胎儿、胎膜早破的发生率明显低于正常体质量组,差异具有统计学意义(P0.05)。结论孕妇的孕前BMI对妊娠不良结局有较大的影响,加强对孕妇的孕前BMI控制,可以减少母婴并发症。     

Correlates of patient acceptance of the cardioverter defibrillator: cross-validation of the Florida Patient Acceptance Survey in Danish patients

Background: Device acceptance may comprise one of the keys to identifying implantable cardioverter defibrillator (ICD) patients at risk for adverse health outcomes in clinical practice. We examined (1) the validity and reliability of the Florida Patient Acceptance Survey (FPAS) and (2) correlates of device acceptance in a large sample of Danish patients.
Methods: A cohort of consecutive patients (N = 566; 82.2% males; mean age = 61.9 ± 14.3) implanted with an ICD since 1989 and still alive on November 1, 2006, completed a set of psychological questionnaires.
Results: The four-factor structure and the validity of the FPAS were confirmed, with the four factors accounting for 64.3% of the variance. The reliability, measured by Cronbach's α, was acceptable for the total scale and all subscales, ranging from 0.73 to 0.85. Correlates of poor device acceptance included older age (OR: 1.03; 95% CI: 1.01–1.05), symptomatic heart failure (OR: 3.59; 95% CI: 2.12–6.08), Type D personality (OR: 3.51; 95% CI: 1.95–6.30), anxiety (OR: 2.33; 95% CI: 1.24–4.38), depressive symptoms (OR: 2.24; 95% CI: 1.00–5.00), and ICD concerns (OR: 4.16; 95% CI: 2.55–6.80); having a partner was associated with better acceptance (OR: 0.53; 95% CI: 0.31–0.91), adjusting for demographic and clinical factors including shocks. Shocks were not associated with outcome (P = 0.59).
Conclusions: The FPAS was shown to be a valid and reliable measure of device acceptance in a large sample of Danish ICD patients. Psychological factors rather than clinical factors were the primary correlates of poor device acceptance, whereas having a partner was associated with better acceptance. These preliminary findings suggest that screening for psychological factors may aid clinicians in identifying patients at risk of poor device acceptance.     

Antipsychotic Use in Early Pregnancy and the Risk of Maternal and Neonatal Complications

ObjectiveTo assess the association between antipsychotic use in early pregnancy and the risk of maternal and neonatal metabolic complications.MethodsWe conducted a population-based retrospective cohort study (January 1, 2010, to December 31, 2016) using the Health and Welfare Database in Taiwan. Pregnant women (18 to 49 years of age) were grouped as antipsychotic users (ie, received oral antipsychotic monotherapy during the first 20 weeks of pregnancy) and nonusers. Antipsychotic users were further categorized into first-generation antipsychotic and second-generation antipsychotic users. Propensity score methods, including matching and inverse probability of treatment weighting, were used to balance covariates. Conditional logistic regression and Cox proportional hazards models were used to compare risks of maternal (gestational diabetes mellitus, preterm birth) and neonatal (low birth weight [LBW], macrosomia) outcomes.ResultsAntipsychotic users had a notably higher risk of preterm birth compared with nonusers (adjusted HR, 1.29; 95% CI, 1.04 to 1.60), but the risk of gestational diabetes mellitus (HR, 1.21; 95% CI, 0.94 to 1.56), LBW (odds ratio [OR], 1.07; 95% CI, 0.84 to 1.37), and macrosomia (OR, 1.36; 95% CI, 0.63 to 2.92) did not differ between the two groups. Among women who received antipsychotics, the odds of LBW were significantly higher in second-generation antipsychotic users compared with first-generation antipsychotic users (adjusted OR, 1.32; 95% CI, 1.04 to 1.68).ConclusionThis study found that using antipsychotics in early pregnancy did not result in a greater risk of metabolic complications both for mothers and newborns. For women requiring treatment with antipsychotics during pregnancy, they should be monitored for the risk of preterm birth and low infant birth weight.     

Overweight is associated with improved survival and outcomes in patients with atrial fibrillation

Background

The aim of this study was to investigate the association of body mass index (BMI) with mortality and cardiovascular events in Chinese patients with atrial fibrillation (AF).

Methods and results

This study consecutively enrolled AF patients presenting to an emergency department at 20 hospitals in China from November 2008 to October 2011. A total of 2,016 AF patients was enrolled, and patients were categorized as underweight (BMI <18.5), normal (BMI 18.5 to <24), overweight (BMI 24 to <28), and obese (BMI ≥28 all kg/m²). Multivariate Cox proportional hazards regression was used on all the patients. End points of the analyses were all-cause mortality, cardiovascular mortality, and combined end events. Among overall patients, mean BMI was 23.5 ± 3.6 kg/m²; 279 (13.8 %) patients died during 12-month follow-up, and so did 23.2 % underweight, 16.3, 9.5 and 9.2 % normal weight, overweight, and obese patients, respectively (P < 0.001). Cardiovascular mortality was 8.3% in all patients, and in underweight, normal weight, overweight and obese categories were 16.5, 9.0, 5.4 and 6.9 %, respectively (P < 0.001). On multivariate analysis, as continuous variable, BMI was not a risk factor for all-cause mortality in AF patients (hazard ratio [HR] 0.94; 95 % confidence interval [CI] 0.91–0.97; P = 0.001). As categorical variable, underweight (HR 1.57, 95 % CI 1.02–2.42, P = 0.041) and normal weight (HR 1.53, 95 % CI 1.13–2.06, P = 0.005) categories were associated with higher all-cause mortality as compared with overweight category. Underweight (HR 2.01, 95 % CI 1.76–3.43, P = 0.011) and normal weight patients (HR 1.53, 95 % CI 1.03–2.28, P = 0.037) also had higher cardiovascular mortality as compared with the overweight category.

Conclusions

Obesity and overweight were not risk factors for 12-month mortality in Chinese AF patients. Overweight AF patients have better survival and outcomes than normal weight (BMI 18.5–24 kg/m²) and underweight patients.     

Lower short- and long-term mortality associated with overweight and obesity in a large cohort study of adult intensive care unit patients

Introduction

Two thirds of United States adults are overweight or obese, which puts them at higher risk of developing chronic diseases and of death compared with normal-weight individuals. However, recent studies have found that overweight and obesity by themselves may be protective in some contexts, such as hospitalization in an intensive care unit (ICU). Our objective was to determine the relation between body mass index (BMI) and mortality at 30 days and 1 year after ICU admission.

Methods

We performed a cohort analysis of 16,812 adult patients from MIMIC-II, a large database of ICU patients at a tertiary care hospital in Boston, Massachusetts. The data were originally collected during the course of clinical care, and we subsequently extracted our dataset independent of the study outcome.

Results

Compared with normal-weight patients, obese patients had 26% and 43% lower mortality risk at 30 days and 1 year after ICU admission, respectively (odds ratio (OR), 0.74; 95% confidence interval (CI), 0.64 to 0.86) and 0.57 (95% CI, 0.49 to 0.67)); overweight patients had nearly 20% and 30% lower mortality risk (OR, 0.81; 95% CI, 0.70 to 0.93) and OR, 0.68 (95% CI, 0.59 to 0.79)). Severely obese patients (BMI ≥ 40 kg/m²) did not have a significant survival advantage at 30 days (OR, 0.94; 95% CI, 0.74 to 1.20), but did have 30% lower mortality risk at 1 year (OR, 0.70 (95% CI, 0.54 to 0.90)). No significant difference in admission acuity or ICU and hospital length of stay was found across BMI categories.

Conclusion

Our study supports the hypothesis that patients who are overweight or obese have improved survival both 30 days and 1 year after ICU admission.     

Thrombophilic polymorphisms – factor V Leiden, prothrombin G20210A, and methylenetetrahydrofolate reductase C677T mutations – and preterm birth

AIM OF THE STUDY: To evaluate the influence of three common thrombophilic polymorphisms, factor V Leiden (FV), prothrombin G20210A (PT), and methylenetetrahydrofolate reductase (MTHFR) C677T mutations, on preterm birth of unknown cause. PATIENTS AND METHODS: A single-centre case-control study of women with preterm infants < or =35 weeks of gestation, in whom obvious maternal, uterine, and fetal causes responsible for preterm birth were excluded (n = 35). The controls were 54 women with term infants hospitalised in the same ward. RESULTS: There were no significant differences between the groups of mothers in history of fetal loss, venous or familial thrombosis, or previous preterm birth. FV was found in 8.6% of the cases, PT in 5.7%, and MTHFR mutation (homozygous) in 4.8% compared with 5.4% (p=0.292, OR 1.594, CI95% 0.303-8.384), 7.4% (p=0.379, OR 0.758, CI95% 0.131-4.374), and 4.5% (p = 0.485, OR 1.050, CI95% 0.090-12.276), respectively, in the controls. Differences in the three thrombophilic polymorphisms in the two groups of infants were also not significant. CONCLUSION: We could not demonstrate a distinct association between these thrombophilic polymorphisms and preterm birth.     

Variability on red blood cell transfusion practices among Brazilian neonatal intensive care units

BACKGROUND: Guidelines for red blood cell (RBC) transfusions exist; however, transfusion practices vary among centers. This study aimed to analyze transfusion practices and the impact of patients and institutional characteristics on the indications of RBC transfusions in preterm infants.
STUDY DESIGN AND METHODS: RBC transfusion practices were investigated in a multicenter prospective cohort of preterm infants with a birth weight of less than 1500 g born at eight public university neonatal intensive care units of the Brazilian Network on Neonatal Research. Variables associated with any RBC transfusions were analyzed by logistic regression analysis.
RESULTS: Of 952 very-low-birth-weight infants, 532 (55.9%) received at least one RBC transfusion. The percentages of transfused neonates were 48.9, 54.5, 56.0, 61.2, 56.3, 47.8, 75.4, and 44.7%, respectively, for Centers 1 through 8. The number of transfusions during the first 28 days of life was higher in Center 4 and 7 than in other centers. After 28 days, the number of transfusions decreased, except for Center 7. Multivariate logistic regression analysis showed higher likelihood of transfusion in infants with late onset sepsis (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.8-4.4), intraventricular hemorrhage (OR, 9.4; 95% CI, 3.3-26.8), intubation at birth (OR, 1.7; 95% CI, 1.0-2.8), need for umbilical catheter (OR, 2.4; 95% CI, 1.3-4.4), days on mechanical ventilation (OR, 1.1; 95% CI, 1.0-1.2), oxygen therapy (OR, 1.1; 95% CI, 1.0-1.1), parenteral nutrition (OR, 1.1; 95% CI, 1.0-1.1), and birth center (p < 0.001).
CONCLUSIONS: The need of RBC transfusions in very-low-birth-weight preterm infants was associated with clinical conditions and birth center. The distribution of the number of transfusions during hospital stay may be used as a measure of neonatal care quality.