Based on a new study of nearly 118,000 women, researchers estimated that nearly 500,000 pregnant women with gestational hypothyroidism may go undetected each year.

Asian women were almost five times more likely to test positive for gestational hypothyroidism than African-American women (19.3% compared with 6.7%) and slightly more likely than Caucasian and Hispanic women (16.4% and 15.2%, respectively).

Gestational hypothyroidism has been linked to medical complications for both mothers and babies. However, the appropriate diagnostic approach and management of the condition remains controversial. The researchers wanted to analyze the current status of testing for thyroid disease during pregnancy.

Of the pregnant women in the study, Asian women had the highest testing rate of 28% and African-American woman had the lowest rate at just 19%. Testing rates increased with maternal age.

The analysis found that women 35 to 40 years of age were 2.2 times more likely to be tested when compared than women between 18 and 24.  Weight was also a factor as those over 275 pounds  were 1.3 times more likely to be tested than those weighing between 100 and 124 pounds .

Younger women were slightly underrepresented in the study population and older women were slightly overrepresented. Given the higher rates of gestational hypothyroidism among older women, the authors suggested that the overall rate is slightly lower than what they report.

"Because national and international endocrine and obstetrical organizations may consider the implications of universal prenatal and antenatal screening, this study demonstrates that the proportion of women tested for gestational hypothyroidism is low," wrote the authors. "(I)f outcomes are shown to improve with intervention, then this may have a significant impact on the health of a large number of women and their children."

All three authors are employed by Quest Diagnostics.
Source reference:
Blatt AJ, et al "National status of testing for hypothyroidism during pregnancy and postpartum" J Clin Endocrinol Metab 2012; 97: DOI: 10.1210/jc.2011-2038.

Excerpted from an article by Erin White, Northwestern broadcast editor

Older women who take statins may be at an increased risk for developing type 2 diabetes, researchers found.   In an analysis of data from the Women's Health Initiative, postmenopausal women who were on a statin at study entry had almost a 50% greater risk of diabetes than those who weren't on the cholesterol-lowering drugs, Yunsheng Ma, MD, PhD, of the University of Massachusetts School of Medicine, and colleagues reported online in the Archives of Internal Medicine.

Recent research has suggested a potential link between statins and the development of diabetes -- most notably a meta-analysis that found a 9% increased risk of the disease with statin use (QJM 2011; 104(2): 109-124), Ma said.  Yet how the risk of diabetes with statin use varies across populations hasn't been thoroughly explored, he added. So he and colleagues looked at data from the Women's Health Initiative to assess the risk in postmenopausal women.

Data were available for 153,840 women, mean age 63, who didn't have diabetes when they were enrolled in the study in 1993. About 7% of them were on statins at that time.  Through follow-up ending in 2005, there were 10,242 cases of new-onset diabetes.

In initial analyses, Ma and colleagues found that statin use at baseline was associated with an increased risk of diabetes, and that association remained significant in analyses controlling for age, race, and weight. The risk was seen with all types of statins.   Risks were increased for all ethnicities, although they did vary slightly, with the highest risks seen among Asians.

The researchers also found that obesity appeared to be protective against disease; statin use was associated with a higher risk of diabetes in women with a body mass index (BMI) under 25 than in those who had a BMI of 30 or higher.   They said differences in phenotype, such as weight distribution, may explain the association.

These findings suggest  that different populations have different risks for diabetes associated with statin use, and that women on statins should be monitored for diabetes and liver dysfunction. .  It also may suggest that  we may be overusing statins and should encourage more lifestyle interventions as a primary means of treating high cholesterol.

Culver added that the findings emphasize current guidelines that recommend lifestyle intervention as the primary means of treating high cholesterol.

"Too many people are put on a statin who don't have to be," Ma said. "Patients should go on a statin if they can't control [their cholesterol] through dietary intervention, but once they're on that statin they should still continue lifestyle intervention."

Suzanne Steinbaum, MD, director of women and heart disease at Lenox Hill Hospital in Bronx, N.Y., said in an email that it's not yet clear from this one study what the clinical implications are for postmenopausal women on statins.   "Due to the extensive use of statins in the aging female population, it is critical that more studies are done to help understand the association with statins and the development of diabetes," she wrote. "Women who are taking statins should be aware of the need to check their blood sugars, along with their liver function tests."

The researchers said the study was limited by its observational nature, and because individual statin analysis may be confounded by the fact that women may have changed statin type before developing diabetes

Primary source: Archives of Internal Medicine
Source reference:
Culver AL, et al "Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative" Arch In

Is it more effective to freeze your love handles, killing the fat cells between two super-cooled plates in a procedure known as cryolipolysis, or vacuum them away with liposuction? And which lasts longer, a surgical facelift or facial skin tightening via a laser?

Consumers often are in the dark about the most effective and safest cosmetic dermatology procedures to improve skin texture and color and remove subcutaneous fat, a surging $10 billion industry in the United States. One reason is a dearth of comparable research trials, reports a new Northwestern Medicine study.  The study, published in the January issue of the journal Dermatologic Clinics, reviews existing research and identifies which procedures have been proven safe and effective and which ones have less evidence behind them.

“Many treatments gaining popularity are novel techniques that use complex devices, such as lasers and ultrasound, but there is sparse research evaluating their long-term effects,” said lead author Murad Alam, MD, chief of cutaneous and aesthetic surgery at Northwestern University Feinberg School of Medicine. “We need more prospective studies comparing different treatments for the same problem head-to-head, so doctors and consumers know what’s best and safest.”

Best-Known, Proven Procedures

Alam said the cosmetic dermatology surgical procedures that are well-known to be safe and effective when done by a trained, board-certified physician include: injected neurotoxins to smooth wrinkles; liposuction to remove fat; and lasers to treat broken blood vessels, port wine stains and rosacea and for removing brown spots and hair.

Newer, Lesser-Known Procedures

Other procedures that may be effective but have less evidence behind them include devices that use infrared light or ultrasound to purportedly shrink and tighten the skin, low-level laser light for fat removal, and fat “melting” by super cooling the fat cells, Alam noted. These are approved by the Food and Drug Administration (FDA), and data show they work and are safe short term. But these procedures are newer and therefore less is known about their long-term safety and effectiveness.

“Patients need to be smart consumers and ask their doctors better questions such as, ‘How does procedure A compare to procedure B?’”Alam said. "Is there research comparing treatments, such as a facelift versus non-invasive skin tightening? Is there evidence regarding the degree of improvement and how long the results will last? How long has a particular procedure or device been approved, and would the doctor be comfortable recommending it to a friend or family member?’”

Here are findings from Alam’s review of 98 studies on cosmetic dermatology procedures:

Injectable botulinum toxins tape A or neurotoxins: “These have been around for 20 years and during that entire period, when an approved pharmaceutical product in approved doses is used for cosmetic purposes, there have not been any instances of serious reactions,” Alam reported.

Liposuction: “Tumescent liposuction, the kind when you inject fluid into the area where you are removing fat, has been shown to be exceedingly safe,” Alam said. “The main potential complication, excessive bleeding, simply doesn’t occur with that form of liposuction when appropriate rules are followed because the anesthetic used in the procedure prevents bleeding.”

Low-level laser light for fat removal: “Some companies sell products they claim can cause changes in skin and subcutaneous tissue,” Alam said. “One of these devices has been approved for reducing fat. It’s safe, but we have very limited information about its degree of effectiveness or how long the result lasts.”

Fat freezing: A device sandwiches the fat on the abdomen or thighs between two cooling plates. The fat cells die and are absorbed by the body. “It’s FDA approved and does work,”Alam said, “but we don’t know how long it lasts or how many cubic centimeters of fat will go away in different patients. While it appears to be safe and is a promising treatment, we won’t know for several more years if there is a downside or if fat removal is truly permanent.”

Non-invasive skin tightening: These devices use radio-frequency energy or infrared light or ultrasound to heat and shrink the skin. “Some tightening definitely occurs,” Alam said. “What we don’t know is exactly how much tightening goes on, who it will work on or how long it will last.” One study compared facelifts to these minimally invasive methods and found that they provided approximately one-third the tightening benefits of surgical facelifts.

Obstacles to Big Research Trials

Several obstacles prevent conducting large-scale research trials on cosmetic procedures and devices, Alam said. Because the FDA’s approval mechanism for devices is less rigorous than for drugs, the agency doesn’t compel pharmaceutical companies to do large trials. Thus, companies may test a device on as few as 50 or 100 patients. As soon as a mechanism gets approval, companies aren’t motivated to do more testing or to compare one procedure to another.

Nor is there government funding for cosmetic surgery trials. Recently, the FDA asked companies with recently approved devices to continue monitoring patients even after approval to make sure no new problems are uncovered later.

Finding the Right Treatment

“Selecting the right cosmetic treatment for a patient is not a trivial matter,” Alam stressed. “Patients should get treatments from experienced practitioners with access to the data and an ability to evaluate it, rather than someone at a nearby spa who just has one laser, is minimally trained and is not able to evaluate the scientific evidence but eager to use this device for every patient complaint.”

Patients should be aware there are often many different types of treatment for the same cosmetic concern, Alam said. One of these may be most appropriate for the patient’s specific issues and personal preferences (such as degree of downtime that is tolerable). “Experienced physicians can help patients select the treatments that are best for them,” he noted.

To find a skilled cosmetic dermatologist, patients can look for members of major dermatology associations, such as the American Academy of Dermatology or the American Society for Dermatologic Surgery. Association websites will often provide contact information about such physicians in a specific geographic area. It is also useful to ask physicians if they have specific training in cosmetic dermatologic surgery and what types of procedures they do often.

By Marla Paul,  health sciences editor at Northwestern.

Source:   Alam M, Olson JM, Asgari MM.  Needs Assessment for Cosmetic Dermatologic Surgery. Dermatology Clinics, January 2012.