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THE LEADERIN NEWSANDMEETINGCOVERAGE
Fetal Cardiac,BrainDefects Are Linked
BY AMY ROTHMANSCHONFELD
Contributing Writer
N
EW
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RLEANS
— Fetal MRIshows that almost 60% offetus-es with cardiac defects also have brain abnormalities, according tothe findings ofan imaging studyconducted in Vienna. A total of57 pregnant womenwhose fetuses had cardiac mal-formations identified by ultra-sound were studied. The find-ings were presented by Dr.Gregor Kasprian at the Ameri-can Society ofNeuroradiology.The fetuses had a variety ofcar-diac malformations, including:Fallot’s tetralogy (nine cases);transposition ofthe great vessels(three); ventricle septum defectwith or without associated car-diac malformations (nine); rhab-domyoma (three); aortic steno-sis at the isthmus (three);arteriovenous canal (three); car-diomegaly (unilateral or bilater-al) (three); or other pathologiessuch as an aneurysm, cardiacteratoma, missing inferior venacava, and double-outlet rightventricle. In some cases, it wastoo early to classify the defect.When these fetuses then un-derwent fetal MRI between 20and 38 gestational weeks (with a1.5-T superconducting system us-ing ultrafast T2-weighted, T1-weighted, diffusion-weighted, andecho-planar sequences in threeorthogonal section planes), brainpathology was found in 33 cases(59%), said Dr. Kasprian, a radiol-ogist at the Medical University of Vienna. This rate is generallyhigher than that reported using prenatal ultrasonographyThe study was carried out un-der the auspices ofthe Fetal MRIWork Group, led by Dr. DanielaPrayer, also ofthe Medical Uni-versity ofVienna.Eighteen fetuses demonstrated brain malformations, such ascommissural anomalies (threecases), holoprosencephaly (one),
This coronal T2 image(top) of a fetus diagnosedwith an aberrantpulmonary vein showsagenesis of the corpuscallosum, abnormal andretarded gyration,malrotation of bothhippocampi, andassociated signalabnormalities of thedeveloping white matterat 28 weeks.The brain of a fetus(bottom) with Fallot’stetralogy shows bilateralgerminolytic cysts in thecaudothalamic groove at25 weeks.
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Defects
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Median Income for Ob.Gyns.
0$200,000$250,000$300,000ActualAdjusted*20072006200520042003
*Adjusted for inflation to 2000 dollars.Source: Medical Group Management Association
$237,191$280,629$221,980$233,066
VITAL SIGNS
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The Leading Independent Newspaper for the Obstetrician/Gynecologist—Since 1966
A
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15, 2008
www.obgynnews.com
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BY ROBERT FINN
San Francisco Bureau
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. — Women who take the anticon-vulsant lamotrigine during theirfirst trimester ofpregnancy havea 10-fold greater risk ofhaving a baby with nonsyndromal cleftlip, cleft palate, or both, accord-ing to a peer-reviewed study. Among 684 women enrolledin the North American Anti-Epileptic Drug (AED) PregnancyRegistry who reported taking lamotrigine monotherapy during their first trimester, there were 16infants born with major malfor-mations, Dr. Lewis B. Holmessaid at the annual meeting oftheTeratology Society. This trans-lates to a rate of2.3%, comparedwith a baseline rate of1.6% in un-exposed newborn infants (Neu-rology 2008;70:2152-8). Although this difference in com- bined major malformation rateswas not statistically significant, theinvestigators observed a signifi-cantly increased risk when they re-stricted the analysis to oral clefts.Three ofthe infants had an iso-lated cleft palate, one had an iso-lated cleft lip, and one had bilater-al cleft lip and palate, for an overall
Three new studies contradict past results.
HT May BenefitPostmenopausalCognition, Memory
First-Trimester LamotrigineUse Linked to Oral Clefts
BY MICHELE G.SULLIVAN
Mid-Atlantic Bureau
C
HICAGO
— Hormone thera-py might preserve cognition andmemory in postmenopausalwomen, and even attenuatesome ofthe cognitive deficitsthat occur in Alzheimer’s disease,new research suggests.Controversy exists over thepossible cognitive benefits ofhor-mone therapy in older women,Dr. Mary Tierney said at the In-ternational Conference on Alzheimer’s Disease. “While pre-clinical and observational studieshave shown a positive effect of estradiol on the brain and cogni-tive function, randomized con-trolled trials using conjugatedequine estrogens have shown notreatment effects in women atrisk for Alzheimer’s disease, or inwomen who have the illness.”These concerns, plus her ownhypothesis that the “minidoses”ofhormones used in many ran-domized trials might be too lowto offer protective benefit,prompted Dr. Tierney oftheSunnybrook Health SciencesCentre, Toronto, and her col-leagues to undertake a new study.The 2-year trial randomized 142women aged 61-87 years to eitherplacebo or to 1 mg estradiol dai-ly plus 0.35 mg progestin 3 daysper week.The primary outcome was the
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Cognition
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Lamotrigine
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I
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Induction Effect
Declines in mean birthweight and gestational ageare linked to an increase inlabor induction.
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Preterm Triggers
Low HDL cholesterol andhigh homocysteine levels maybe keys to preterm delivery.
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Trump the Triad
Education and professionalteamwork can prevent the female athlete triad.
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Health Politics
Sen. John McCain proposesto replace the tax exclusion for employee health benefitswith a tax credit.
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