Dietary advice interventions in pregnancy for preventing gestational diabetes mellitus.
Cochrane Database Syst Rev. 2017 01 03;1:CD006674
Authors: Tieu J, Shepherd E, Middleton P, Crowther CA
BACKGROUND: Gestational diabetes mellitus (GDM) is a form of diabetes occurring during pregnancy which can result in short- and long-term adverse outcomes for women and babies. With an increasing prevalence worldwide, there is a need to assess strategies, including dietary advice interventions, that might prevent GDM.
OBJECTIVES: To assess the effects of dietary advice interventions for preventing GDM and associated adverse health outcomes for women and their babies.
SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (3 January 2016) and reference lists of retrieved studies.
SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs assessing the effects of dietary advice interventions compared with no intervention (standard care), or to different dietary advice interventions. Cluster-RCTs were eligible for inclusion but none were identified.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of the included studies. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach.
MAIN RESULTS: We included 11 trials involving 2786 women and their babies, with an overall unclear to moderate risk of bias. Six trials compared dietary advice interventions with standard care; four compared low glycaemic index (GI) with moderate- to high-GI dietary advice; one compared specific (high-fibre focused) with standard dietary advice. Dietary advice interventions versus standard care (six trials) Considering primary outcomes, a trend towards a reduction in GDM was observed for women receiving dietary advice compared with standard care (average risk ratio (RR) 0.60, 95% confidence interval (CI) 0.35 to 1.04; five trials, 1279 women; Tau² = 0.20; I² = 56%; P = 0.07; GRADE: very low-quality evidence); subgroup analysis suggested a greater treatment effect for overweight and obese women receiving dietary advice. While no clear difference was observed for pre-eclampsia (RR 0.61, 95% CI 0.25 to 1.46; two trials, 282 women; GRADE: low-quality evidence) a reduction in pregnancy-induced hypertension was observed for women receiving dietary advice (RR 0.30, 95% CI 0.10 to 0.88; two trials, 282 women; GRADE: low-quality evidence). One trial reported on perinatal mortality, and no deaths were observed (GRADE: very low-quality evidence). None of the trials reported on large-for-gestational age or neonatal mortality and morbidity.For secondary outcomes, no clear differences were seen for caesarean section (average RR 0.98, 95% CI 0.78 to 1.24; four trials, 1194 women; Tau² = 0.02; I² = 36%; GRADE: low-quality evidence) or perineal trauma (RR 0.83, 95% CI 0.23 to 3.08; one trial, 759 women; GRADE: very low-quality evidence). Women who received dietary advice gained less weight during pregnancy (mean difference (MD) -4.70 kg, 95% CI -8.07 to -1.34; five trials, 1336 women; Tau² = 13.64; I² = 96%; GRADE: low-quality evidence); the result should be interpreted with some caution due to considerable heterogeneity. No clear differences were seen for the majority of secondary outcomes reported, including childhood/adulthood adiposity (skin-fold thickness at six months) (MD -0.10 mm, 95% CI -0.71 to 0.51; one trial, 132 children; GRADE: low-quality evidence). Women receiving dietary advice had a lower well-being score between 14 and 28 weeks, more weight loss at three months, and were less likely to have glucose intolerance (one trial).The trials did not report on other secondary outcomes, particularly those related to long-term health and health service use and costs. We were not able to assess the following outcomes using GRADE: postnatal depression; maternal type 2 diabetes; neonatal hypoglycaemia; childhood/adulthood type 2 diabetes; and neurosensory disability. Low-GI dietary advice versus moderate- to high-GI dietary advice (four trials) Considering primary outcomes, no clear differences were shown in the risks of GDM (RR 0.91, 95% CI 0.63 to 1.31; four trials, 912 women; GRADE: low-quality evidence) or large-for-gestational age (average RR 0.60, 95% CI 0.19 to 1.86; three trials, 777 babies; Tau² = 0.61; P = 0.07; I² = 62%; GRADE: very low-quality evidence) between the low-GI and moderate- to high-GI dietary advice groups. The trials did not report on: hypertensive disorders of pregnancy; perinatal mortality; neonatal mortality and morbidity.No clear differences were shown for caesarean birth (RR 1.27, 95% CI 0.79 to 2.04; two trials, 201 women; GRADE: very low-quality evidence) and gestational weight gain (MD -1.23 kg, 95% CI -4.08 to 1.61; four trials, 787 women; Tau² = 7.31; I² = 90%; GRADE: very low-quality evidence), or for other reported secondary outcomes.The trials did not report the majority of secondary outcomes including those related to long-term health and health service use and costs. We were not able to assess the following outcomes using GRADE: perineal trauma; postnatal depression; maternal type 2 diabetes; neonatal hypoglycaemia; childhood/adulthood adiposity; type 2 diabetes; and neurosensory disability. High-fibre dietary advice versus standard dietary advice (one trial) The one trial in this comparison reported on two secondary outcomes. No clear difference between the high-fibre and standard dietary advice groups observed for mean blood glucose (following an oral glucose tolerance test at 35 weeks), and birthweight.
AUTHORS' CONCLUSIONS: Very low-quality evidence from five trials suggests a possible reduction in GDM risk for women receiving dietary advice versus standard care, and low-quality evidence from four trials suggests no clear difference for women receiving low- versus moderate- to high-GI dietary advice. A possible reduction in pregnancy-induced hypertension for women receiving dietary advice was observed and no clear differences were seen for other reported primary outcomes. There were few outcome data for secondary outcomes.For outcomes assessed using GRADE, evidence was considered to be low to very low quality, with downgrading based on study limitations (risk of bias), imprecision, and inconsistency.More high-quality evidence is needed to determine the effects of dietary advice interventions in pregnancy. Future trials should be designed to monitor adherence, women's views and preferences, and powered to evaluate effects on short- and long-term outcomes; there is a need for such trials to collect and report on core outcomes for GDM research. We have identified five ongoing studies and four are awaiting classification. We will consider these in the next review update.
PMID: 28046205 [PubMed - indexed for MEDLINE]
Price comparison of high-cost originator medicines in European countries.
Expert Rev Pharmacoecon Outcomes Res. 2017 Apr;17(2):221-230
Authors: Vogler S, Zimmermann N, Babar ZU
BACKGROUND: In recent years, high-cost medicines have increasingly been challenging the public health
budget in all countries including high-income economies. In this context, this study aims to survey, analyze and compare prices of medicines that likely contribute to high expenditure for the public payers in high-income countries.
METHODS: We chose the following 16 European countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Hungary, Ireland
, Italy, the Netherlands, Portugal, Sweden, Slovakia, Spain and United Kingdom. The ex-factory price data of 30 medicines in these countries were collected in national databases accessible through the Pharmaceutical Price Information (PPI) service of Gesundheit Österreich GmbH (Austrian Public Health Institute).
RESULTS: The ex-factory prices (median) per unit (e.g. per tablet, vial) ranged from 10.67 cent (levodopa + decarboxylase inhibitor) to 17,000 euro (ipilimumab). A total of 53% of the medicines surveyed had a unit ex-factory price (median) above 200 Euro. For two thirds of the medicines, price differences between the highest-priced country and lowest-priced country ranged between 25 and 100%; the remaining medicines, mainly low-priced medicines, had higher price differential, up to 251%. Medicines with unit prices of a few euros or less were medicines for the treatment of diseases in the nervous system (anti-depressants, medicines to treat Parkinson and for the management of neuropathic pain), of obstructive airway diseases and cardio-vascular medicines (lipid modifying agents). High-priced medicines were particularly cancer medicines.
CONCLUSION: Medicine prices of Greece, Hungary, Slovakia and UK were frequently at the lower end, German and Swedish, as well as Danish and Irish
prices at the upper end. For high-priced medicines, actual paid prices are likely to be lower due to confidential discounts and similar funding arrangements between industry and public payers. Pricing authorities refer to the higher undiscounted prices when they use price data from other countries for their pricing decisions.
PMID: 27658050 [PubMed - indexed for MEDLINE]
Authors: Daly B, Arroll B, Sheridan N, Kenealy T, Scragg R.
Source: Prim Health Care Res Dev. 2016 Jan 8:1-6. [Epub ahead of print]
Authors: O'Connell R, Bradshaw C.
Source: Midwifery. 2015 Dec 19. pii: S0266-6138(15)00343-5. doi: 10.1016/j.midw.2015.12.005. [Epub ahead of print]
Authors: Sugrue, Sheila; Stuart, Cornelia
Source: Health Service Executive
Authors: Begum R, Riordan S.
Source: J Psychiatr Ment Health Nurs. 2016 Feb;23(1):45-53. doi: 10.1111/jpm.12276.
Authors: Alisic E, Hoysted C, Kassam-Adams N, Landolt MA, Curtis S, Kharbanda AB, Lyttle MD, Parri N, Stanley R, Babl FE; Pediatric Emergency Research Canada (PERC); Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics (PEMCRC); Pediatric Emergency Research in the United Kingdom and Ireland (PERUKI); Research in European Pediatric Emergency Medicine (REPEM); Pediatric Emergency Care Applied Research Network (PECARN); Pediatric Research in Emergency Departments International Collaborative (PREDICT); Pediatric Emergency Research Networks (PERN); Pediatric Emergency Research Canada PERC; Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics PEMCRC; Pediatric Emergency Research in the United Kingdom and Ireland PERUKI; Research in European Pediatric Emergency Medicine REPEM; Pediatric Emergency Care Applied Research Network PECARN; Pediatric Research in Emergency Departments International Collaborative PREDICT; Pediatric Emergency Research Networks PERN.
Source: J Pediatr. 2015 Dec 17. pii: S0022-3476(15)01306-2. doi: 10.1016/j.jpeds.2015.10.067. [Epub ahead of print]
Authors: Hanratty J, Livingstone N, Robalino S, Terwee CB, Glod M, Oono IP, Rodgers J, Macdonald G, McConachie H.
Source: PLoS One. 2015 Dec 14;10(12):e0144649. doi: 10.1371/journal.pone.0144649.
Authors: Malone C, Sharif F, Glennon-Slattery C.
Source: Ir J Med Sci. 2015 Nov 16. [Epub ahead of print]
Authors: Devaux M, Sassi F
Source: Eur J Public Health. 2015 Nov 19. pii: ckv190. [Epub ahead of print]
Authors: Hynes SM
Source: Aging Clin Exp Res. 2015 Nov 18. [Epub ahead of print]
Authors: Murphy A, Walsh E.
Source: Value Health. 2015 Nov;18(7):A554. doi: 10.1016/j.jval.2015.09.1788. Epub 2015 Oct 20.
Authors: National Self-Harm Registry Ireland
Source: National Office for Suicide Prevention
Authors: McVeigh TP, Sweeney KJ, Kerin MJ, Gallagher DJ.
Source: Ir J Med Sci. 2015 Oct 23. [Epub ahead of print]
Authors: Portwood, S.G., Shears, J., Brooks K.E. Nelson, M. Thomas L.M.
Source: Child & Family Social Work, 20: 480–493. doi: 10.1111/cfs.12097
Authors: Dennis M, Sandercock P, Graham C, Forbes J.
Source: Health Technol Assess. 2015 Sep;19(76):1-90. doi: 10.3310/hta19760.
Authors: World Health Organisation
Source: World Health Organisation
Authors: McHugh SM, Tyrrell E, Johnson B, Healy O, Perry IJ, Normand C.
Source: Health Policy. 2015 Sep 4. pii: S0168-8510(15)00218-3. doi: 10.1016/j.healthpol.2015.08.014. [Epub ahead of print]
Authors: Gvozdenović E1, Wolterbeek R, Allaart CF, Brenol C, Dougados M, Emery P, Ferraccioli G, van der Heijde D, Huizinga TW, Kay J, Martin Mola E, Moots RJ, da Silva JA, Smolen J, Veale D, Landewé RB.
Source: J Clin Rheumatol. 2015 Oct;21(7):349-54. doi: 10.1097/RHU.0000000000000296.
Authors: Costa E, Giardini A, Savin M, Menditto E, Lehane E, Laosa O, Pecorelli S, Monaco A, Marengoni A.
Source: Patient Prefer Adherence. 2015 Sep 14;9:1303-14. doi: 10.2147/PPA.S87551. eCollection 2015.
Authors: Sheridan-Pereira M, Murphy J, Sloan J, Crispino G, Leahy A, Corcoran JD, Dempsey E, Elnazir B, Gavin P, Sharif F, Gul R, Satas S, Murphy J, Gormally S, Shanaa I, Waldron D, Mc Mahon P, Carson J, Blanken M, Bont L, Paes B.
Source: Pediatr Infect Dis J. 2015 Sep 16. [Epub ahead of print]
Authors: Campana K.L., Hammoud S.
Source: Journal of Nursing Management 2015, 23, 716–725.
Authors: Henderson, A.
Source: Journal of Nursing Management, 23: 693–694. doi: 10.1111/jonm.12336
Source: Dementia Services, Information and Development Centre
Authors: Phillips CM, Perry IJ.
Source: Psychoneuroendocrinology. 2015 Jul 17;62:47-53. doi: 10.1016/j.psyneuen.2015.07.168. [Epub ahead of print]
Authors: Richardson N1, Osborne A, O'Neill B, Griffin P, McNamara J, Roche C, van Doorn D.
Source: J Agromedicine. 2015;20(3):381-5. doi: 10.1080/1059924X.2015.1047551.
Authors: Department of Children and Youth Affairs
Source: Department of Children and Youth Affairs
Authors: Murphy A, McElroy B.
Source: Ir J Med Sci. 2015 Mar;184(1):47-51. doi: 10.1007/s11845-014-1114-3. Epub 2014 Apr 18.