You can select your prefered subtitle language by using the  CC  button in the player control bar.

Paracetamol use during pregnancy might put babies at risk of neurodevelopmental disorders 

MD-FM Thursday February 27, 2014



 

SARAH:

Welcome to MD-FM: Medical News from around the world with Peter Goodwin

 

SEGMENT 1: ADHD: First research shows link between paracetamol use during pregnancy and ADHD in children

 

PETER:

Hello, and with me is Sarah Maxwell. Taking paracetamol –also known as acetaminophen –while you’re pregnant might increase your baby’s risk later on of getting neurodevelopmental syndromes like attention-deficit hyperactivity disorder.

 

SARAH:

Yes a population-based cohort study published in JAMA Pediatrics has reported that babies born to mothers who’d taken paracetamol during pregnancy were at higher risk of having a hyperkinetic disorder, of using the ADHD drug methylphenidate and having ADHD-like behavior at seven years of age. The risk apparently increased with exposure to paracetamol  — even after adjusting for confounding factors. Dr. Beate Ritz, co-author of the study:

 

RITZ:

We also asked women whether they had a psychiatric diagnosis of depression or anxiety, we controlled for other medications they had taken, fevers, infections --It did not change anything. So, that doesn’t mean that this is causal, it’s just that we found no alternate explanation. In practice, nobody will tell a woman who has a medical need to not take medication but she should very well define how necessary it is to take that medication. So the casual over-the-counter use of acetaminophen is certainly not what we want to encourage.

 

SARAH:

That was Dr. Beate Ritz, from UCLA School of Public Health, in Los Angeles.  She told MD-FM they chose to investigate acetaminophen partly because it’s so widely used — more than half of the women in the study reported using it — and that it had previously been shown to affect hormones, which can influence brain development. But she said more studies are needed to replicate these findings and to investigate whether the association is causal. And Kate Langley, who wrote an editorial on the study, told us the public should not be alarmed:

 

LANGLEY:

You know there are many reasons why a woman might take paracetamol during their pregnancy and it’s possible that it’s one of these factors, rather than taking the paracetamol itself, which leads to the higher risk of childhood ADHD. So these findings should be taken with caution and shouldn’t change practice at this point.

 

SARAH:

That was Dr. Kate Langley, from Cardiff University, in the UK. And the Los Angeles team is now investigating the association with other neurodevelopmental disorders, such as autism.

 

SEGMENT 2: A 12-hour modified acetyl-cysteine treatment for paracetamol poisoning reduced side effects associated with standard approach


PETER:

A a randomized study has reported in The Lancet that in patients with paracetamol overdose, a shorter course of a modified acetyl-cysteine regimen (lasting only12 hours), with or without ondansetron pre-treatment, induced less vomiting, led to fewer anaphylactoid reactions and reduced the need for interrupting the treatment compared to the standard regimen of 20 to 25 hours. But the authors note that the efficacy of the shorter modified regimen still needs to be evaluated.

 

SEGMENT 3: New hope for patients with highly resistant metastatic colorectal cancer

 

PETER:

A treatment might be on its way for patients with metastatic colorectal cancer who, after failing initial chemotherapy, also become refractory to agents targeting the epidermal growth factor receptor EGFR…

 

SARAH:

Yes. First of all: only 10 to 20% of patients with metastatic colorectal cancer actually have the genetic profile that makes them eligible for anti-EGFR therapy. And unfortunately, even the best responders eventually become refractory. Well now, in Science Translational Medicine, researchers have reported that combining anti-EGFR agents to inhibitors of the MEK pathway might overturn this resistance and apparently a simple blood test can reveal when patients are developing resistance: Senior author Alberto Bardelli, from the University of Torino in Italy:

 

BARDELLI:

We do sophisticated analysis, which is called BEAMing, or digital PCR or next generation sequencing, on the DNA extracted from the blood and this DNA comes from tumor lesions that could be spread out in the body of the patient, that release the DNA into the circulation. Essentially this technology empowers us to look at one mutant allele in 10,000 wild-type alleles. This detection in the blood will help clinicians to rationally devise the next level of therapy.

 

SARAH:

Professor Bardelli’s team showed that anti-EGFR-resistance was due to the appearance of mutations that activate the MEK pathway. By treating resistant colon tumor cells with MEK-inhibitors, they managed to reverse resistance. These were pre-clinical experiments, but a human trial is on its way:

 

BARDELLI:

The next step is to take all this and to develop a clinical trial. That is: to test, formally, when we take patients and give them anti-EGFR therapy, they respond and if at relapse, the addition of the new drugs, which is rationally devised to intercept the mechanism of resistance, will give them benefit.

 

SARAH:

Alberto Bardelli, from Torino.

 

SEGMENT 4: First vaccines against hand, foot and mouth disease appear effective

 

PETER:

The first two vaccines against the C4 strain of human enterovirus 71- appear to protect children against hand, foot and mouth disease and herpangina (mouth blisters)

 

SARAH:

Yes, two phase III studies showed that a year after having two doses of either vaccine  — both of them inactivated whole-virus vaccines — 99 percent of children developed antibodies against the virus. There were 10,000 children in one study and 12 000 in the other  — all under six: that’s because EV71 infections can lead to serious neurological disorders, like encephalitis, at those young ages, although the studies were not able to show efficacy against these more serious consequences. Peter McMinn wrote an editorial in the New England Journal of Medicine:

 

McMINN:

A very small percentage of children, fewer than 1 percent who gets infected, develop the severe diseases. So neither study was powered to demonstrate protection against severe diseases. But it’s likely that the vaccine will prevent because it’s preventing infection, but it will really require much longer surveillance after the vaccines are put on the market to really establish that very clearly.

 

SARAH:

Dr. Peter McMinn, from the University of Sydney. And he also noted that even if these vaccines appear effective against the one strain of EV 71, the one that’s caused most epidemics in South East Asia, the C4 strain, they don’t provide cross-protection against other circulating lineages or against coxsackievirus A16 infection, which also triggers the same syndromes.

 

McMINN:

If you look at all of the strains that have been circulating in South East Asia, neither vaccine protects against all of those. So there is a need, in the longer term, to broaden out the strain types present in the vaccine and I think, ultimately, the vaccine also needs to include a strain that will protect against coxsackievirus A16.

 

SARAH:

Peter McMinn, from Australia.

SEGMENT 5: Adherence to recommended vaccination schedules protects children against non-vaccination-specific infections too

 

PETER:

In another context, a study in JAMA has reported that adhering to recommended vaccination schedules has been found to protect children not only against the diseases being targeted but also against non-related infections…

 

SARAH:

Yes: a population-based cohort study in Denmark showed that the rate of hospital admissions for infectious diseases was significantly lower in children who — as recommended — received the live vaccine against measles, mumps and rubella after the inactivated vaccine containing diphtheria, tetanus, pertussis, polio and Haemophilus influenzae B. But children who were vaccinated in the reverse order had significantly higher rates of admission. First author of the JAMA study, Dr. Signe Sorup:

 

SORUP:

We found that having MMR –the measles, mumps and rubella vaccine –as the most recent vaccine was associated with a 14 percent lower rate of admissions with any type of infection. So preferably children should follow the vaccination schedule for all their vaccines.

 

SARAH:

That was Signe Sorup, from the Statens Serum Institut in Copenhagen, Denmark. She said previous studies in low-income countries had already shown similar results with other live vaccines. The study also showed that delaying vaccination beyond the scheduled timing — in this case 15 month of age — also increased hospital admissions for infections. Dr. Elizabeth Miller wrote an editorial on the study:

 

MILLER:

50 percent did receive it around the time of the 15 months schedule lot, then the rest gradually got it between 15 months and two years and quite clearly a very clear message coming out is that it’s very important to have your vaccine on time.

 

SARAH:

Elizabeth Miller, from the UK’s Health Protection Agency, said mechanisms underlying this non-specific association are still unclear.



IN BRIEF 1: DNA testing superior to standard aneuploidy screening for detecting trisomies 18 and 21 in a general obstetrics population

 

PETER:

Finally, in brief: prenatal testing using cell-free DNA sequencing had significantly lower false positive rates than standard aneuploidy screening, using serum biochemical assays, for detecting trisomies 21 and 18 in a general obstetrics population. A study in the New England Journal of Medicine has reported that cell-free DNA testing was more valuable for positive prediction than standard screening, for both trisomies.

 

IN BRIEF 2: First non-invasive imaging method to identify and localize ruptured and high-risk coronary atherosclerotic plaques

 

PETER:

18F-fluoride positron emission tomography is the first non-invasive imaging method capable of identifying and localizing ruptured and high-risk coronary atherosclerotic plaques. This is what a prospective study published in The Lancet has concluded, after evaluating the technique in 80 patients with myocardial infarction or stable angina. Future studies are now needed to establish whether this form of PET scanning can improve the management and treatment of patients with coronary artery disease.

 

PETER:

That’s all from MDFM for now.  Sarah Maxwell and I will be with you again next week.  So until then, from me, Peter Goodwin, Goodbye!

 

RSS
Twitter
Facebook

Previous editions

Partnership

Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)

Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)
Url
Go to
with
Danone Institute International