The concurrent validity between leptin, BMI and skin folds during pregnancy and the year after.

BACKGROUND: From a public health perspective it is important to know which of the currently used methods to estimate changes in maternal body fat during pregnancy and the year thereafter is the most adequate. OBJECTIVES: To evaluate the concurrent validity between leptin and surrogates of fat measures: body mass index (BMI) and the sum of four skin folds. DESIGN: Data from the New Life(style) intervention study were analysed as a cohort study. SETTING: Midwife practices in The Netherlands. POPULATION: Healthy pregnant nulliparous women. METHODS: Anthropometric measurements were done and blood was collected at 15, 25 and 35 weeks of pregnancy and at 6, 26 and 52 weeks after delivery. Data were used if at least 4 out of the 6 measurements were available, leaving 87 women in the analyses. Spearman's correlation coefficients between leptin and BMI and between leptin and the sum of skin folds were calculated for each time point and for the changes between the time points. RESULTS: Correlations between leptin and BMI varied from 0.69 to 0.81. Correlations between leptin and the sum of skin folds were comparable, varying between 0.65 and 0.81.Correlations between changes in leptin and changes in BMI and the sum of skin folds, respectively, were much lower compared with cross-sectional correlations. CONCLUSION: Because of the high correlation among the three methods and because of the overlapping intervals, all methods seem to be equally adequate to estimate changes in maternal body fat during pregnancy and the year thereafter.

The effect of a counselling intervention on weight changes during and after pregnancy: a randomised trial.

OBJECTIVES: To evaluate the effects of a counselling intervention on excessive weight gain during pregnancy and postpartum weight retention. DESIGN: The New Life(style) study was a randomised trial with a control group (n = 113) and an intervention group (n = 106). SETTING: Midwife practices in the Netherlands. POPULATION: Women with a healthy pregnancy, expecting their first baby. METHODS: The intervention consisted of four face-to-face counselling sessions about weight, physical activity and diet during pregnancy, and one session by telephone after delivery. MAIN OUTCOME MEASURES: Weight was objectively assessed at 15, 25 and 35 weeks of gestation, and again at 8, 26 and 52 weeks postpartum. In regression models, the intervention effect on gestational weight gain and postpartum weight retention was assessed. RESULTS: Women gained on average 11.3 kg (SD 3.7 kg) from early to late pregnancy. Women were 1.0 kg (SD 5.3 kg) lighter at 52 weeks postpartum compared with early pregnancy. The intervention had no effect on gestational weight gain (B = -0.05; 95% CI -1.10 to 1.00) or postpartum weight (B = 0.94; 95% CI -2.41 to 0.53) in the total study group. In a subgroup of overweight and obese women (n = 47), a favourable trend on all outcomes was observed, but none of the differences were statistically significant. CONCLUSION: The lifestyle counselling intervention evaluated in this study did not have an effect on excessive weight gain or postpartum weight retention. Our findings for overweight and obese women need to be confirmed in a larger, well-designed randomised trial.

[New recommendations as regards forgetting to take the contraceptive pill]. / Nieuwe adviezen bij het vergeten van de anticonceptiepil.

Guidelines from the Dutch College of General Practitioners (NHG), the Scientific Institute of Dutch Pharmacists (WINAp), the Dutch Association for Obstetrics & Gynaecology (NVOG) and the Dutch Expert Centre on Sexuality (Rutgers Nisso Groep) all gave different recommendations on the use of the morning after pill in the event of the contraceptive pill being missed. This is an undesirable situation. Using the 2004 WHO-recommendations on missed pills as a starting point, new Dutch guidelines were drawn up. The consensus is that in the case of only one pill being missed, no extra precautions are necessary. This is by far the most frequent situation. The forgotten pill should be taken as soon as possible. Forgetting to take the pill more than once is a rare occurrence. Iftwo or more pills have been missed, advice will be given in accordance with the existing NHG guideline. The WHO has been requested to initiate research in order to establish if its current recommendations on forgetting more than one contraceptive pill can be supported by better data. The new recommendations will be implemented into harmonized guidelines thus enabling women to be given the same simple advice at every advisory centre.

[Randomized clinical trials in the Nederlands Tijdschrift voor Geneeskunde]. / Gerandomiseerde klinische trials in het Nederlands Tijdschrift voor Geneeskunde.

OBJECTIVE: To collect all randomized clinical trials (RCT) published in the Nederlands Tijdschrift voor Geneeskunde (Ned Tijdschr Geneeskd) in order to present them to the Cochrane Centre, Oxford, United Kingdom, to be included in the international database of RCT's, which will be used to perform meta-analyses. DESIGN: Retrospective bibliometric study. SETTING: Editorial office of Ned Tijdschr Geneeskd. METHOD: All original papers (OP), published between the May 1st, 1948 and May 1st, 1993 were studied. Papers were selected that met the criteria for RCT: randomization or the similar assignment of patients to different treatment groups. RESULTS: Of 6820 OP 259 (3.8%) were selected. In 69 (26.6%) randomization seemed to be performed correctly and in 20 (7.7%) randomization was not correct; in 170 (65.6%) there was no randomization. In the period May 1st, 1948 till May 1st, 1968 24 RCT's were published, in the period May 1st, 1973 till May 1st, 1993 60. Most RCT's (78%) describe the effects of pharmaceutical treatment. CONCLUSION: RCT's as such were difficult to recognize in Ned Tijdschr Geneeskd. Over the years there was an increase in the number of published RCT's. The problems we found with the design of RCT's and randomization are still current. An international register of published and/or planned RCT's, as envisaged by the Cochrane Centre, will make it easier to carry out meta-analyses.