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Preliminary data from a retrospective study suggest that incidence of spontaneous subarachnoid hemorrhage (sSAH) may be increasing among pregnant women. Plus: Study finds lower risk of diabetes a benefit of breastfeeding. Also: Taking prenatal folic acid and multivitamins lowers the risk of autism, according to results of a new case-control study.
Preliminary data from a retrospective study presented at the American Stroke Association’s International Stroke Conference 2018 suggest that incidence of spontaneous subarachnoid hemorrhage (sSAH) may be increasing among pregnant women. An abnormality in the brain’s arteries that weakens the vessels, sSAH eventually leads to rupture of the blood vessels, causing hemorrhaging between the brain’s membranes.
For the analysis, the authors looked at data from the Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project for 2012 to 2014. NIS is one the largest administrative databases and designed to produce nationally weighted estimates. Records of women aged 15 to 49 years with sSAH were identified as were pregnancy and maternal diagnosis. Temporal trends and group comparisons were analyzed using Cochran-Armitrage trend and parametric tests.
From the NIS database, the authors identified 73,692 admissions for sSAH, 3978 of which were in pregnant women aged 15 to 49. The researchers discovered that over the 12 years of the study period, the proportion of sSAH occurring during pregnancy increased from 4.16% to 6.33% (P for trend <0.001) whereas rates slightly declined in women who were not pregnant. Among the patients studied, the proportion of sSAH during pregnancy was highest among African-Americans (8.19%) followed by Hispanics (7.11%) versus white women (3.83%). Looking at age, the researcher found that the proportion of sSAH during pregnancy was highest among those women with sSAH aged 20 to 29 (20.07%) versus 11.39% for those aged 15 to 19, 10.01% for aged 30 to 39, and 0.69% for women aged 40 to 49. Rates of in-hospital death were lower for sSAH during pregnancy than in women who were not pregnant (7.7% vs 17.4%; P<0.001) and rates of discharge to home were also higher in pregnant than in non-pregnant women (69.87% vs 53.85%; P < 0.001)
The authors noted a few limitations to their study. The entirety of the data used came from one national database that provides estimates of patients’ hospital stays. It does not, however, provide information on stroke severity. The researchers also said it’s possible that the database included cases that were misdiagnosed as a stroke. They recognize that more research is necessary but believe it important that physicians are aware of the increasing numbers in order to help provide proper care for patients with sSAH.
Lower risk of diabetes a benefit of breastfeeding
Results of a 30-year observational study show that breastfeeding is independently associated with lower incidence of diabetes. Published in JAMA Internal Medicine, the findings reflect outcomes in white and black women and document a 25% to 47% relative reduction in diabetes, depending on length of breastfeeding, which was unchanged by race, gestational diabetes (GD), or parity.
Some 1238 women (623 white; 615 black) from the Coronary Artery Risk Development in Young Adults (CARDA) study were included in the prospective cohort. All were aged 18 to 30 and did not have diabetes at baseline in 1985-1986. They all had at least 1 live birth after that, reported on how long they breastfed, and were screened for diabetes up to 7 times between 1986 and 2016.
Researchers examined the association between risk of development of diabetes and no breastfeeding and breastfeeding for up to 6 months, > 6 months to < 12 months, and 12 months or more. Outcomes were diabetes incidence rates per 1000 person-years and adjusted relative hazards (RH) with corresponding 95% confidence intervals (CI). Proportional hazards regression models were adjusted for biochemical, sociodemographic, and reproductive risk factors, family history of diabetes, lifestyle, and weight change during follow-up.
During 27,598 person-years, 182 incident diabetes cases were reported for an overall incidence rate of 6.6 cases per 1000 person-years (95% CI, 5.6-7.6). Rates for women with and without GD were 18.0 and 5.1, respectively (P for difference < .001). Duration of lactation was strongly and inversely associated with diabetes incidence, with RH from 0.75 for 0 to 6 months, to 0.52 for 6 months to < 12 months, to 0.53 for ≥ 12 months in comparison to no breastfeeding (P for trend = .01).
The authors said that their study provided longitudinal biochemical evidence that duration of lactation is independently associated with lower incidence of diabetes but the mechanism for that relationship requires further investigation.
Prenatal vitamins and risk of autism
Taking prenatal folic acid and multivitamins lowers the risk of autism, according to results of a new case-control study. Published in JAMA Psychiatry, the report by Israeli investigators the findings have important public health implications but the mechanisms for the protective action of the supplements have yet to be determined.
A total of 45,300 Israeli children (22,090 girls; 23,210 boys) born between January 1, 2003 and December 31, 2007 were included in the study and followed from birth to January 26, 2015 for risk of autism. Cases were all children diagnosed with autism and controls were a random sample of 33% of all live-born children. Exposure before and during pregnancy to folic acid, multivitamins containing vitamins A, B, C, and D, or any combination thereof was assessed. The authors quantified the association between maternal exposure to the vitamins and relative risk (RR) and 95% confidence intervals (CI) for autism in offspring.
Of the children in the study, 572 (1.3%) were diagnosed with autism. Risk of the disorder was statistically significantly lower in the children whose mothers were exposed to folic acid and/or multivitamins before pregnancy (RR, 03.9; 95% CI, 0.30-0.50; P < .001). A similar reduction in risk was seen with maternal exposure to folic acid and/or multivitamins during pregnancy (RR, 0.27; 95% CI, 0.22-0.33; P < .001). Risk ratios were also similar for maternal exposures to folic acid before pregnancy, to folic acid during pregnancy, to multivitamins before pregnancy, and to multivitamin supplements during pregnancy (all P < .001).
The authors concluded that maternal exposure to folic acids before and during pregnancy reduces risk of autism in offspring and postulated that epigenetic modifications may be among the mechanisms for the association.