Lifestyle after bariatric surgery: a multicenter, prospective cohort study in pregnant women.

BACKGROUND: To ensure a good pregnancy outcome after bariatric surgery, a healthy life-style and a multidisciplinary prenatal follow-up is recommended. The aim of this prospective multicenter trial was to compare diet quality and physical activity (PA) of pregnant women with bariatric surgery with current lifestyle recommendations. METHODS: Pregnant women (>18 years, prepregnancy BMI 28 ± 6 kg/m², 39 % nulliparae, 25 % smokers) with a history of bariatric surgery were recruited and allocated to two groups according to surgery type: restrictive (N = 18) and bypass group (N = 31). One 7-day dietary record and one Kaiser questionnaire on PA were collected during the first and second trimester. Dietary quality was assessed using the Healthy Eating Index. RESULTS: The diet quality did not change during pregnancy (restrictive group p = 0.050; bypass group p = 0.975) and was comparable between groups (first trimester p = 0.426; second trimester p = 0.937). During the first trimester, 15 % of the pregnant women had a healthy diet quality, 82 % had a diet that needed improvement, and 3 % had a poor diet quality. This was independent of surgery type and was comparable in the second trimester (p = 0.525). No difference between groups was observed for the PA level, but the PA level in the bypass group significantly decreased from the first to the second trimester (p = 0.033). CONCLUSIONS: Nutritional advice and lifestyle coaching in this high-risk population seems recommendable since only 15 % of the pregnant women had a healthy diet quality, 25 % was smoking at the beginning of pregnancy, and the reported PA levels were low.

The incidence and outcome of concealed pregnancies among hospital deliveries: an 11-year population-based study in South Glamorgan.

Denial of pregnancy has been implicated in potentially jeopardising prenatal care and subsequent safe planned deliveries. This population-based study of hospital deliveries over an 11-year period, reveals that concealed pregnancies have an incidence of one in 2,500 deliveries. Among this cohort, 12% were married and 58% were multiparous with 8% having had a previous caesarean section. Some 20% of women had a medical disorder complicating the antenatal period. There was a preponderance of concealed pregnancies in the winter months compared with booked deliveries (p = 0.02). Mode of delivery was similar between the booked and concealed pregnancies with a low incidence of maternal morbidity in the latter. Prematurity rates (p = 0.0002) were significantly higher in the concealed pregnancy cohort. A total of 20% of infants had depressed Apgar scores at 1 min and 8% at 5 min. There was no documentation of counselling or follow-up in this group. Despite the low incidence of maternal morbidity, these women should be regarded as high-risk labour due to the increased perinatal morbidity. Greater effort needs to be made towards ensuring these women have adequate counselling and follow-up during the postnatal period.

Hallucinations in children caused by oxolamine citrate.

Twenty reports in Australia, Belgium and The Netherlands have implicated oxolamine-citrate cough-mixtures as a cause of hallucinations in children of less than 10 years of age. Fever is not thought to be a likely alternative explanation. Similar reactions in older children and adults have not been reported and it is possible that the recommended doses for young children are too high. Information about the use of the drug in Australia suggests that such reactions are uncommon, but the information should be interpreted cautiously.

Anaphylactic reactions to cinoxacin.

During 1981 to mid-1988 three cases of anaphylactic shock after treatment with the quinolone derivative cinoxacin were reviewed by the Netherlands Centre for Monitoring of Adverse Reactions to Drugs and 17 cases of an anaphylactic type of reaction notified to the World Health Organisation Collaborating Centre for International Drug Monitoring. In five out of six patients for whom data were available the reaction began shortly after taking a single capsule of a second or next course of treatment. Cinoxacin is related to nalidixic acid, and one patient previously treated with that agent subsequently had an anaphylactoid reaction to cinoxacin and later developed a skin reaction to nalidixic acid. There were no deaths, and patients treated as an emergency with plasma expanders or with adrenaline and corticosteroids generally recovered promptly and uneventfully. In view of the potentially fatal consequences of anaphylactic reactions to cinoxacin and other quinolones doctors should take care when prescribing these drugs.