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Last Updated: 2006-12-01 16:47:25 -0400 (Reuters Health)
By Will Boggs, MD
NEW YORK (Reuters Health) - Pregnant women with type 1 diabetes who maintain good control of their blood sugar levels during the second trimester are at decreased risk for developing preeclampsia, a potentially serious pregnancy complication involving high blood pressure and fluid retention, according to a report in the journal BJOG.
"Achieving excellent (sugar) control in the second trimester of pregnancy (rather than in first or third) may reduce the risk of preeclampsia in women with...diabetes," Dr. Rosemary C. Temple told Reuters Health. Diabetes type 1, also called juvenile diabetes, tends to begin during childhood and is potentially more serious than type 2 diabetes, which typically develops in adulthood in people who are overweight.Temple and colleagues from Norfolk and Norwich University Hospital NHS Trust, UK, examined the relationship between sugar control at different stages of pregnancy and the risk of preeclampsia during 290 pregnancies in 178 women with type 1 diabetes.
Women who developed preeclampsia had significantly worse sugar control at 24 weeks than those who did not develop preeclampsia and at 12 weeks, the investigators report.
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In contrast, the results indicate, sugar control in the first and third trimesters did not differ significantly between women who did and did not develop preeclampsia.
"Greater attention must be given to supporting women to optimize (sugar) control during the second trimester if further progress is to be made," the team concludes.
"Ideal management of blood (sugar) levels during pregnancy in women with type 1 diabetes should include women testing blood (sugar) at least seven times daily (before and 1-2 hours after meals)" and then administering insulin to achieve recommended levels, Temple said.
"We would advise all women to use a glucometer with a memory facility so the physician can download data at each clinic visit to verify all blood (sugar) levels," she added.
"We would hope to do future studies using continuous (sugar) monitoring systems and/or subcutaneous insulin infusions to see if using these new technologies would help to improve (sugar) control and reduce risk of preeclampsia in women with type 1 diabetes," Temple commented.
Last Updated: 2006-12-01 16:29:25 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Survivors of childhood leukemia and brain tumors have an increased risk of stroke later in life, a study shows. This is particularly true for children treated with radiation therapy to the head at doses greater than 30 Gy.
These findings justify the continuation of efforts to reduce radiation doses in children being treated for leukemia or brain tumors when possible, conclude Dr. Daniel C. Bowers from The University of Texas Southwestern Medical School, Dallas, and colleagues.
The study, which was published in the Journal of Clinical Oncology, included 4,828 leukemia survivors and 1,871 brain tumor survivors. These subjects, who were younger than 21 years when they were diagnosed between 1970 and 1986, were compared with a group of 3,846 of their siblings.
This is the first study, the authors point out, to look at the risk of late-occurring stroke among childhood leukemia survivors and is "by far the largest study" to examine the risk of stroke in childhood brain tumor survivors.
According to the team, 37 leukemia survivors and 63 brain tumor survivors experienced a stroke 5 or more years after diagnosis.
Compared with the sibling group, the leukemia survivors had 6.4-fold greater risk of stroke, and the risk for brain tumor survivors was increased by 29.0-fold.
In children who received radiotherapy at an average dose of 30 Gy or greater had a stroke risk that increased in a dose-dependent fashion.
"Importantly, although the risk of stroke among leukemia and brain tumor survivors is significantly increased, it is still a relatively uncommon event during the first two decades after the cancer diagnosis," the authors note.
The rate of late-occurring stroke for leukemia survivors was 57.9 per 100,000 per year, and 267.6 per 100,000 per year for brain tumor survivors.
"How this risk will change as these cancer survivors age is not known," the study team points out.
SOURCE: Journal of Clinical Oncology, November 20, 2006.
