Certain Antidepressants May Raise Lung Risk in Newborns

 Pregnant women who use certain popular antidepressants may have a twofold increased risk for delivering babies with a rare but serious lung disorder, a new study finds.

Researchers analyzed national registry data from 1.6 million births in five Nordic countries in an effort to determine if using selective serotonin reuptake inhibitor (SSRI) antidepressants during pregnancy raises the risk for neonatal pulmonary hypertension, a life-threatening condition in newborns that normally occurs in one to two births in 1,000.

SSRIs such as Celexa, Lexapro, Paxil, Prozac, and Zoloft are the most widely prescribed class of antidepressants, and millions of women in the U.S. have used them during pregnancy.

Persistent pulmonary hypertension in newborns (PPHN) is a respiratory disorder in which the arteries leading to the lungs remain constricted after birth, limiting blood flow and oxygen.

Risk factors for PPHN include maternal obesity, diabetes, and smoking, and between 5% and 10% babies with the disorder do not survive.

A 2006 study first linked SSRI use during pregnancy to the disorder, finding a sixfold increase in the incidence of neonatal pulmonary hypertension in babies exposed to the antidepressants in the last months before birth.

Studies conducted since then have been mixed, with some supporting the association and others finding no increase in risk associated with SSRI use.

In the newly published study, researchers from Stockholm, Sweden’s, Karolinska Institute examined birth registry data from all babies born between 1996 and 2007 in Denmark, Finland, Iceland, Norway, and Sweden.

About 30,000 women used SSRIs during pregnancy, and about 11,000 filled prescriptions for them in their fifth month of pregnancy or later.

There were 33 cases of persistent pulmonary hypertension among babies whose mothers took SSRIs late in pregnancy, or about three cases per 1,000 births.

This was about double the number of cases that would have been expected in the general population of newborns, but babies born to mothers with a history of a previous hospitalization for a psychiatric disorder who were not taking SSRIs during pregnancy also had a slightly increased risk for the disorder.

Gideon Koren, MD, of Toronto’s Hospital for Sick Children, says the study raises more questions than it answers.

“This is by far the largest study to examine SSRI use and PPHN, but the fact that women with untreated depression had a higher risk for the disorder raises new doubts about this link,” Koren says. “Many doubts remain, and they should be shared with patients.”

Koren directs the Toronto hospital’s “Motherisk” program, which advises women about drug safety during pregnancy.

“We talk to about 200 women a day from all over North America and other parts of the world,” he says, adding that questions about SSRI safety are common.

Climate Tied to Inflammatory Bowel Disease Risk

 Living in a sunny climate appears to reduce women’s risk of developing inflammatory bowel disease, a large new study shows.

An estimated 1.4 million people in the U.S. live with an inflammatory bowel disease, either Crohn’s disease or ulcerative colitis.

Both cause persistent diarrhea, abdominal pain and cramping, fever, and sometimes rectal bleeding. Symptoms can become very severe and sometimes require surgery.

Yet little is known about the causes of these diseases, which are thought to involve a dysfunction of the immune system.

For the new study, researchers combed through data on more than 238,000 women taking part in the long-running Nurses’ Health Study, which began in 1976.

The study collected information on where the women were living at birth, age 15, and age 30. It also recorded any diagnosis of an inflammatory bowel disease up to 2003.

Researchers also followed up with women who reported having inflammatory bowel disease and verified their diagnoses through medical records.

They found that women who lived in Southern regions that got a lot of sunlight had a 52% lower risk of being diagnosed with Crohn’s disease by age 30 and a 38% lower risk of getting ulcerative colitis than those who lived in Northern regions.

That result held up even when researchers tried to rule out other things that might increase a person’s risk for an inflammatory bowel disease, like having a family history.

“The differences are pretty drastic. That’s what surprised us the most. Especially when it comes to Crohn’s disease. We’re seeing a 40% to 50% reduction in risk,” says researcher Hamed Khalili, MD, a gastroenterologist at Massachusetts General Hospital in Boston.

The study is published in the journal Gut.

This study confirms previous research from Europe, and it suggests that the amount of UV light exposure from sunlight may play an important role in the development of inflammatory bowel disease, though researchers aren’t sure why.

One theory is that people in sunnier states may have higher exposure to UV light, leading to higher vitamin D levels. Vitamin D is known to help regulate immunity and inflammation.

Regional differences in environmental pollution or infections could offer other explanations.

“The study was well done,” says Amnon Sonnenberg, MD, MSc, a gastroenterologist at Oregon Health & Science University, in Portland. “The authors are to be commended,” says Sonnenberg, an expert on inflammatory bowel disease who was not involved in the study.

“We know quite well that there is a north-south gradient, and this north-south gradient applies to the American continent as well as to Europe,” he says.

But he says the reasons behind the regional differences are far from clear cut.

For example, he says, studies have shown that miners -- who spend their working hours underground and out of the sunlight -- have less inflammatory bowel disease.

For that reason, he cautions patients against thinking that taking more vitamin D might help their symptoms or lessen their risk if they have a family member who’s affected.

People tend to think “vitamin D is going to protect me,” Sonnenberg says, “And there is absolutely no evidence for this.”

Colorful Meals May Appeal to Picky Eaters

 Is your child a picky eater? A new study may help you expand his or her palate.

Children prefer much more color and variety in food presentation, compared to adults, according to the study. For example, children preferred twice as many colors and different items on their plates.

Children also responded well to figurative designs on their plate, like bacon “smiles” and peas arranged into a heart shape.

Researchers say the results suggest that parents can encourage picky eaters to eat healthier by introducing more color and creativity to their plates.

“What kids find visually appealing is very different than what appeals to their parents,” Brian Wansink, PhD, professor of marketing at Cornell University, says in a news release. “Our study shows how to make the changes so the broccoli and fish look tastier than they otherwise would to little Casey or little Audrey.”

In the study, published in Acta Paediatrica, researchers showed 23 pre-teen children and 46 adults full-size photos of different combinations of food on plates and asked them to choose which food presentations they liked the most.

The results showed children preferred plates with seven different items and six different colors, while adults favored plates with only three items and three colors.

“Compared with adults, children not only prefer plates with more elements and colors, but also their entrees placed in the front of the plate and with figurative designs,” researcher Kevin Kniffin, PhD, of Cornell University, says in the release.

Researchers found simple steps, like shaping a bacon strip into a smile at the bottom of the plate or arranging vegetables into fun shapes, made the food presentation much more appealing to children.

They say the next step is to test whether picky eaters actually eat what they say looks good enough to eat.

If so, giving children a wide array of foods on their plates may widen their palates and help them eat healthier.

Diabetes Medications May Double as Weight Loss Drugs

Two drugs approved to treat type 2 diabetes may also aid weight loss in overweight people with or without diabetes, a new study shows.

The drugs Byetta and Victoza mimic gut hormones that decrease appetite.

They are typically prescribed when patients need medication to help control their blood sugar. A new research review, published in BMJ, reanalyzed data from 25 separate studies.

The review reveals that the drugs helped overweight people without diabetes shed an average of 7 pounds and those with diabetes lose an average of 6 pounds when injected daily or weekly for at least five months.

That makes these agents promising treatments for obesity, study authors say.

“It’s not a cure, but it’s a good treatment. And you still need to combine it with lifestyle changes,” says researcher Tina Vilsboll, MD, DMSc, an endocrinologist and associate professor at Gentofte Hospital in Hellerup, Denmark.

Vilsboll says the modest weight loss many of her diabetic patients see on the drugs helps encourage them to kick up their diet and exercise programs to lose even more weight.

“They use it as a tool for changing their lifestyle,” she says.

The medications also appear to lower blood pressure and cholesterol slightly, which may help heart disease risks.

But the drugs, known as glucagon-like peptide-1 (GLP-1) receptor agonists, also come with side effects. They work, in part, by slowing the movement of food through the stomach. That can sometimes cause a good deal of nausea or even vomiting, especially after a large meal.

But Vilsboll says that side effect generally fades over time and doesn’t usually cause people to stop taking the medication.

Experts who were not involved in the review say they are cautiously optimistic about the drugs’ prospects for weight loss.

“We do have an obesity epidemic. Weight loss by traditional means -- diet and exercise -- is extremely hard, and for people who are successful initially, it’s also very hard to maintain,” says Susan Spratt, MD, an endocrinologist and the director of diabetes services at Duke University Health System in Durham, N.C.

“If we could use these drugs just in people with obesity and know that it’s safe, I think it would be a fantastic addition to our ability to treat obesity,” Spratt says.

“I’ve had [diabetic] patients lose 60 pounds with these medications. Now, those folks were 400 pounds, so they lost 10% to 15% of their body weight,” she says. “Somebody who’s 200 pounds isn’t going to lose that much.”

Because the drugs are already on the market, doctors have the ability to prescribe them solely for weight loss.

But experts say such “off-label” use of the drugs can be risky.

Exercise, Talk Therapy by Phone May Help Relieve Fibromyalgia Pain

 Exercise and/or talking with a therapist on the phone once a week may significantly reduce chronic pain, a new study shows.

About 20% to 40% of adults report experiencing chronic pain, Seth Berkowitz, MD, and Mitchell Katz, MD, of the Los Angeles County Department of Health Services write in an accompanying editorial. Up to 20% of visits to a primary health care provider generate a prescription for a narcotic painkiller, or opioid, they say.

While three non-opioid drugs -- Cymbalta, Lyrica, and Savella -- have been approved by the FDA to treat fibromyalgia pain, none adequately controls the disorder’s multiple symptoms, the authors of the new study write.

The scientists assigned almost 450 patients with chronic widespread pain, some of whom had fibromyalgia, to get either “talk therapy” by phone, exercise, both talk therapy and excerise, or their usual treatment.

Four therapists underwent three days of training to learn how to provide psychological help to study participants receiving talk therapy. Patients chose goals, such as identifying and evaluating unhelpful thinking styles or making lifestyle changes.

After an initial assessment that lasted an hour, those participants receiving talk therapy spoke on the phone with a therapist for 30 to 45 minutes once a week for seven weeks. That was followed by a phone session three months and six months after the study began.

Evidence suggests that this talk therapy delivered by phone is as effective as face-to-face therapy, researcher John McBeth, PhD, an epidemiologist at the University of Manchester, tells WebMD in an email.

Those in the exercise group were invited to meet with a fitness instructor once a month for six months. The goal was to improve their fitness by exercising 20 minutes to an hour at least twice a week.

Three months after the study ended, the phone therapy and/or exercise patients showed more improvement than those who’d stayed with their usual care.

The people who engaged in both talk therapy and exercise did only slightly better than those who received one or the other. Perhaps the therapists included messages about exercise, the authors speculate. Or, they write, perhaps each treatment was so effective that there wasn’t much room for improvement by combining them.

The new study is the latest addition to an “extensive” body of clinical trials demonstrating talk therapy’s effectiveness in treating chronic pain and headache, says Russell Portenoy, MD, chair of the department of pain medicine and palliative care at New York’s Beth Israel Medical Center.

“Cognitive behavioral therapy [talk therapy] should be offered to a far larger proportion of patients with chronic pain than currently is done,” Portenoy, who was not involved in the study, tells WebMD.

He cited several obstacles: Too few therapists trained to provide it, inadequate insurance coverage, a tendency among doctors to focus on medical strategies due to a lack of knowledge about talk therapy, and a lack of reimbursement incentives to offer other treatments.