Does early menstruation increase risk of GDM?


A new study looks at whether who begin menarche early in life are more likely to develop GDM. Plus: USPSTF issues their final recommendations on pelvic exams. Also, a look at the efficacy of vaginal progesterone in preventing preterm birth in twin pregnancy.

Women who develop menarche early in life may be at an increased risk of developing gestational diabetes mellitus (GDM), according to a new study in the American Journal of Epidemiology.

Researchers used data from 4749 women who participated in the Australian Longitudinal Study on Women’s Health between 2000 and 2012. The women were aged 22 to 27 years at the start of the study when they reported their age at start of menstruation. During the 12 years of the study, information on GDM diagnosis was obtained for every live birth. Log-binomial analysis was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) and analyses were adjusted for body mass index, polycystic ovary syndrome, mother’s highest educational qualification, nulliparity, and physical activity.

The mean age at start of menstruation was 12.9 years (standard deviation, 1.4) and a first diagnosis of GDM was reported by 357 women (7.5%). When compared to women who started menstruation at 13 years, women who started menstruation at age ≤ 11 years had a 51% higher risk of developing GDM (95% confidence interval: 1.10 - 2.07) following adjustment for known GDM risk factors.

The investigators believe their findings illustrate that young age at the start of menarche may be a way of identifying women who are higher risk of developing GDM. They say that further studies are needed to confirm these initial results and to illuminate the role of early start of menarche and later risk of GDM.

NEXT: USPSTF issues final recommendation on pelvic exam


USPSTF issues final recommendation on pelvic exam

Evidence is insufficient to assess balance versus risk of screening pelvic examination for asymptomatic, nonpregnant adult women, according to a Recommendation Statement issued by the US Preventive Services Task Force (USPSTF). Published in JAMA, the findings are based on a review of abstracts and full-text articles on screening pelvic examination published from 1946 to January 13, 2016.

The report also took into consideration comments from the public received after release of a draft version of the statement, which was posted from June 28, 2016 to July 25, 2016.

The literature review was designed to answer 3 questions:

1.           What is the direct evidence for the effectiveness of the pelvic examination in reducing all-cause mortality, cancer- and disease-specific morbidity and mortality, and improving quality of life?;

2.           What are the test performance characteristics of the pelvic examination in screening for gynecologic cancers and other gynecologic conditions?; and

3.           What are the adverse effects of screening using the pelvic examination?

The investigators found inadequate evidence on the accuracy or benefits of pelvic examination for detection of a range of gynecologic conditions. Evidence was similarly inadequate on harms of screening for a variety of gynecologic conditions. No studies were found that looked at pelvic examination’s benefit on all-cause mortality, disease-specific morbidity or quality of life.

The USPSTF acknowledged the difficulty of performing studies on the effectiveness of screening pelvic examination. The panel said that their findings do not apply to screening for cervical cancer, gonorrhea, or chlamydia, although some public comments mentioned that misperception. The authors also clarified, in response to public comments, that costs of preventive service are not considered when determining a recommendation grade.

“In the absence of clear evidence on the balance of benefits and harm of using pelvic examination to screen for asymptomatic gynecologic conditions,” USPSTF said in summary, “clinicians are encouraged to consider the patient’s risk factors for various gynecologic conditions and the patient’s values and preferences, and engage in shared decision making with the patient to determine whether to perform pelvic examination.”

The American College of Obstetricians and Gynecologists recommends performing pelvic examinations annually in all patients age 21 and older. 

NEXT: Can vaginal progesterone reduce PTB in women with twins?


Can vaginal progesterone reduce PTB in women with twins?

According to a meta-analysis published in Ultrasound in Obstetrics & Gynecology, using vaginal progesterone may reduce the risk of preterm birth.

Researchers searched Google Scholar, research registers of ongoing trials, MEDLINE, EMBASE, POPLINE, CINAHL, LILACS, and the Cochrane Central Register to look for randomized controlled trials (RCTs) which compared vaginal progesterone with placebo/no treatment in women with a twin gestation and a mid-trimester sonographic cervical length ≤ 25mm and that had individual patient data. Primary measured outcome was preterm birth < 33 weeks’ gestation. Two reviewers selected the studies independently, assessed the risk of bias and extracted the data. They found data for 303 women (159 assigned to vaginal progesterone and 144 assigned to placebo/no treatment) and their 606 fetuses/infants from 6 RCTs. One study provided 74% of the total sample size.

When compared with placebo or no treatment, vaginal progesterone was linked with a statistically significant reduction in the risk of preterm birth at < 33 weeks’ gestation (31.4% vs 43.1%; relative risk [RR], 0.69 [95% confidence interval {CI}, 0.51–0.93]; moderate-quality evidence). It was also linked with significant decrease in birth weight < 1500 g (RR, 0.53 [95% CI, 0.35–0.80]), neonatal death (RR, 0.53 [95% CI, 0.35–0.81]), preterm birth < 35, < 34, < 32 and < 30 weeks' gestation (RRs ranging from 0.47 to 0.83), composite neonatal morbidity and mortality (RR, 0.61 [95% CI, 0.34–0.98]), use of mechanical ventilation (RR, 0.54 [95% CI, 0.36–0.81]), and respiratory distress syndrome (RR, 0.70 [95% CI, 0.56–0.89]), all moderate evidence. Additionally, no significant difference was seen between vaginal progesterone and placebo groups in the neurodevelopmental outcomes for the children at 4 to 5 years of age.

The researchers concluded that administering vaginal progesterone to mothers with twin gestation and a short cervix mid-trimester will reduce the risk of preterm vaginal birth, neonatal mortality, and some neonatal morbidities. The use of progesterone also appears to show no negative effects on the neurodevelopment of offspring.

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