Metformin for weight loss in children offered small improvements over short term

As childhood obesity in the US has increased in the past decade, researchers have looked for options to treat it. One such option is a medication called metformin.

A recent study found that meformin led to a small drop in children’s weight over the short – term.

Metformin is known by the brand names Glucophage, Fortamet, Glumetza and Riomet.

The decrease was evident when the medication was paired with lifestyle interventions, such as diet changes and exercise.

It did not appear that metformin was a significantly better option than other weight loss methods, though, the researchers wrote.

“ Discuss your child’s weight loss options with a pediatrician. ”

This study, led by Marian S. McDonagh, PharmD, looked at the effectiveness of the medication metformin for treating obesity in children.

The researchers looked for all clinical trials published on metformin in children that provided data on children’s body mass index at the end of the study. Body mass index (BMI) is a ratio of a person’s height to weight and is used to determine if a person is a healthy weight or not.

In adults, a BMI between 18.5 and 25 is considered healthy and normal. A BMI between 25 and 30 is overweight, while a BMI over 35 is obese.

However, these BMI categories do not always apply to children. In children, normal, overweight or obese BMI categories are determined based on a child’s age and height .

The researchers found 14 randomized clinical trials that met their requirements.

Together, these studies showed that non – diabetic children taking metformin lost an average 1.38 BMI points compared to children not taking metformin after six months.

Studies lasting shorter than six months also showed a small effect.

However, studies that lasted one year did not show a reduction in BMI points that was large enough to attribute to the medication (instead of possibly being due to chance differences).

When the researchers looked at children who started the study with a BMI below 35, they found a smaller drop in BMI, but it was not due to chance.

This same pattern was found among Hispanic children, older teens and children who had tried and failed at diet and exercise programs.

The researchers also looked at the safety of metformin for children.

They found that 26 percent of the children taking the medication experienced some kind of gastrointestinal problem, compared to 13 percent of children who did not take the medication.

No serious side effects were reported, and no more of the children taking metformin stopped taking the medications than children taking the placebos (fake medications).

The researchers therefore concluded that metformin did lead to a small drop in BMI in children when combined with lifestyle changes over a short – term period.

However, “In the context of other options for treating childhood obesity, metformin has not been shown to be clinically superior,” they wrote. Andre Hall, MD, an OBGYN at Birth and Women’s Care, PA in Fayetteville, NC, explained that metformin is most commonly used as an oral alternative to insulin in diabetic patients but has also been used in treating women with polycystic ovarian syndrome.

“Metformin helps decrease weight in these patients, thereby addressing the overall condition,” he said. “It makes sense, therefore, that this would be a safe alternative to treating childhood obesity.”

Dr. Hall emphasized the importance of treating obesity early on but recognizing what all aspects of that treatment should include.

“Obese children become obese adults and therefore it is important to address this problem when people are children and their lifestyles c an be readily influenced by the adults responsible for their care,” he said.

“Regardless of which medication is chosen to assist with the weight loss, the pillars of treatment must remain a healthy diet with reasonable caloric intakes along with regular exercise,” he said.

This study was published December 16 in the journal JAMA Pediatrics . Information on funding was not provided. The authors declared no conflicts of interest.

Vitamin D supplementation for pregnant women and infants improves overall levels

One of the goals of good prenatal care is to ensure babies get all the nutrients they need as they develop in the womb. Woman may take certain supplements to achieve this goal.

A recent study found that vitamin D supplements for pregnant women and their newborns ensured sufficient vitamin D levels in more of the children than those without supplements.

Vitamin D is currently added to some foods since it is harder than many other nutrients to get through diet alone.

Some women may need to take vitamin D supplements to ensure they and their children have sufficient levels.

However, this decision about supplements should be made with a doctor’s supervision since too much vitamin D can have negative side effects.

“Ask your OBGYN about vitamin D supplements”

The study, led by Cameron C. Grant, PhD, of the department of pediatrics at the University of Auckland in New Zealand, aimed to determine the best way to ensure babies have appropriate vitamin D levels.

The researchers divided 260 women who were 27 weeks pregnant into three groups. One group of 87 women received 1000 IU daily of vitamin D until they gave birth, and then their babies were given 400 IU daily of vitamin D until they were 6 months old.

The second group of 86 pregnant women received 2000 IU daily of vitamin D, and their babies were given 800 IU daily of vitamin D until 6 months old. The third group of 87 women received a placebo (fake vitamin) during the study, and then their children also received a placebo through 6 months old.

The researchers measured the vitamin D levels in the women at the start of the study and when they were 36 weeks pregnant.

The children’s vitamin D levels were measured at 2 months , 4 months, and 6 months old.

At the start of the study, 54 percent of the women who had received placebos had vitamin D levels of at least 20 ng/mL in their blood.

Having at least 20 ng/mL of vitamin D was determined in 2011 by the Institute of Medicine t o be sufficient vitamin D levels for at least 98 percent of children under 1 year old.

At 36 weeks of pregnancy, 50 percent of the placebo group had vitamin D levels of at least that much. Meanwhile, the other two groups saw significant increases in the percentage of women who had higher vitamin D levels after receiving supplements.

Among the group that had received 1000 IU a day of the vitamin, 64 percent had at least 20 ng/mL of vitamin D in their blood at the start of the study. At 36 weeks of pregnancy, 91 percent of that group had those levels of vitamin D.

While 55 percent of the group receiving 2000 IU a day had at least 20 ng/mL of vitamin D in their blood at the start of the study, 89 percent of the women in that group had those levels at 36 weeks o f pregnancy.

At birth, 22 percent of the newborns in the placebo group had cord blood levels of vitamin at 20 ng/mL or greater.

Meanwhile, 72 percent of the newborns whose mothers had received 1000 IU vitamin D daily, and 71 percent of the newborns whose mothers received 2000 IU daily had at last 20 ng/mL of vitamin D in their cord blood.

At 2 months old, 50 percent of the babies i n the placebo group, 82 percent of the babies in the 400 IU daily group, and 92 percent of the babies in the 800 IU daily group had vitamin D levels of at least 20 ng/mL.

At 4 months old, 66 percent of the babies in the placebo group, and 87 percent of the babies in both of the vitamin D supplement groups had at least 20 ng/mL of vitamin D in their blood.

By the time the babies were 6 months old, however, only the group receiving 800 IU of vitamin D daily had a significantly greater percentage of babies wit h the higher vitamin D levels.

At 6 months old, 74 percent of the placebo babies, 82 percent of the babies receiving 400 IU daily, and 89 percent of the babies receiving 800 IU daily had vitamin D levels of at least 20 ng/mL.

The researchers therefore concluded that vitamin D supplementation in pregnant women and their babies increased the percentage of infants that had appropriate vitamin D levels.

The researchers did not observe hypercalcemia in either group of women and children receiving vitamin D supplements.

Hypercalcemia is a condition in which a person has abnormally high levels of calcium in their body, which can be caused by too much vitamin D intake.

“If the objective of vitamin D supplementation is to achieve a serum 25(OH)D concentration >20 ng/ mL in 97.5 percent of infants, then it seems likely that this requires both maternal vitamin D supplementation during pregnancy and high compliance with daily dosing regimens,” the authors wrote.

However, this study’s findings do not mean that women or the ir children necessarily need to take vitamin D supplements, cautions Andre Hall, MD, an OBGYN at Birth and Women’s Care, PA in Fayetteville, NC.

“While I do not question that adding vitamin D supplementation above and beyond prenatal vitamins and diet will increase the levels in children, I do question whether it’s necessary or even potentially harmful,” Dr. Hall said.

“Pregnant women often do not eat diets that are sufficient to provide all the necessary nutrients for themselves and their developing child, ” he explained. “Hence, prenatal vitamins are prescribed and strongly recommended prior to conception and during the pregnancy.”

Dr. Hall said the many brands of prenatal vitamins are all required by the Food and Drug Administration to contain a certain amount of different vitamins and minerals.

“Therefore, in my opinion, regardless of cost, they are all equally adequate in providing the appropriate nutrients,” he said. “Therefore, I do not recommend adding additional supplements above and beyond what will be obtained from a regular diet and daily prenatal vitamin usage.”

The study was published December 16 in the journal Pediatrics .

The research was funded by the Health Research Council of New Zealand and Cure Kids. The study medication was prepared by the Ddrops Company. The authors declared no conflicts of interest.

Weight gain during pregnancy can influence risk for pregnancy complications
Author: Tara Haelle / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(dailyRx News) Nearly all women gain weight during their pregnancy. This is normal and expected since they’re growing a little human inside. But gaining too much or too little can present risks.

A recent study found that gaining too much weight during pregnancy can increase women’s odds of developing certain pregnancy complications.

Only about one in five women in the study gained the recommended amount of weight during pregnancy, based on 2009 guidelines from the Institute of Medicine.

Most women gained more than was recommended. These women were more likely to develop pre-eclampsia or other high blood pressure disorders during pregnancy.
“Discuss your weight gain with your OB/GYN.”

The study, led by Julie Johnson, MD, of the Department of Obstetrics and Gynecology at Brown University in Rhode Island, looked at how pregnant women fared based on the weight they gained during pregnancy.

The researchers specifically used the 2009 guidelines on pregnancy weight gain from the Institute of Medicine (IOM) to guide how they evaluated the participants in the study.

The researchers classified 8,293 pregnant women according to their pre-pregnancy weight using their body mass index (BMI).

BMI is a ratio of a person’s height to weight and is used to determine whether someone is a healthy weight or is under- or overweight.

Of the women in the study, 9.5 percent gained less weight than recommended by the IOM guidelines, and 17.5 percent of the women were within the guidelines.

The majority of the women — 73 percent — gained more weight than recommended by the IOM.

The researchers’ analysis of the women’s risk for various pregnancy complications was adjusted to account for differences in the women’s age, race/ethnicity, smoking status and treatment.

Women who exceeded the weight gain recommendations, regardless of their pre-pregnancy weight, were at higher risk for having high blood pressure disorders.

These disorders included pregnancy-induced hypertension and pre-eclampsia. Pre-eclampsia is a pregnancy complication involving high blood pressure and protein in a woman’s urine.

For example, the odds that women with a normal pre-pregnancy weight would develop gestational hypertension (high blood pressure during pregnancy) were 1.5 times greater if they gained more weight than recommended, compared to women gaining the recommended amount of weight.

Their odds of developing pre-eclampsia were 2.5 times greater if they gained more weight than recommended.

The risk for women who were overweight before pregnancy were even higher. These women had a risk four times greater for pre-eclampsia if they gained too much weight than if they had gained the recommended amount.

Obese women who gained too much weight during pregnancy were 1.9 times more likely to develop pre-eclampsia than if they stayed within the weight gain guidelines.

Women who were a normal weight or were overweight before becoming pregnant were at a higher risk for having a cesarean section (1.6 to 1.8 times greater odds) if they gained more weight than recommended during pregnancy.

Their odds of delivering a baby that was large for gestational age were 1.7 to 2.5 times greater if they gained more weight than recommended. Large for gestational age means that the baby had a higher birth weight than what is considered average for the pregnancy week when the baby was born.

These women were less likely than women who did not exceed the weight guidelines to have a baby that was small for gestational age, meaning a baby that had a lower birth weight than what is considered average for the pregnancy week when the baby was born.

The researchers were unable to identify consistent results regarding poor outcomes in women who did not gain enough weight based on the guidelines.

The IOM guidelines for weight gain include the following recommendations:

Underweight women (BMI below 18.5) should gain 28 to 40 pounds.
Normal weight women (BMI from 18.5 to 24.9) should gain about 25 to 35 pounds.
Overweight women (BMI from 25 to 29.9) should gain 15 to 25 pounds.
Obese women (BMI of 30 or higher) should gain 11 to 20 pounds.

“The guidelines and supporting recommendations are intended to be used in concert with good clinical judgment and should include a discussion between the woman and her care provider about diet and exercise,” the IOM noted in their 2009 report.

Andre Hall, an OBGYN at Birth and Women’s Care, PA in Fayetteville, NC, noted that weight gain has always been a sensitive subject, especially with women.

“The subject is no less sensitive when discussing it with women who are pregnant,” he said. “On average, women are expected to gain 27-32 pounds during the course of a pregnancy, depending on their pre-pregnancy weight.”

However, some women gain more than is appropriate.

“Unfortunately, many women use pregnancy as an excuse to ‘give in’ to cravings without the same proportion controls they use while not pregnant,” Dr. Hall said. “I’ve often heard comments like ‘I’m eating for two now.'”

Yet, Dr. Hall said that gaining too much weight during pregnancy can increase the risk of pregnancy-related complication, such as gestational diabetes and high blood pressure.

“These medical conditions may have significant adverse consequences for both mother and child,” he said. “It also leads to larger babies which are at increased risk of birth trauma due to their size. Judicious eating while pregnant, as in the non-pregnant state is an important facet of maintaining a healthy lifestyle.”

The study was published in the May issue of the journal Obstetrics and Gynecology.

The research was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Heart, Lung and Blood Institute and the National Center for Research Resources. The authors reported no conflicts of interest.

Contributing Expert – Andre F. Hall, MD
Dr. Hall is a Board Certified Obstetrician/Gynecologist with special interest in weight loss and fitness. He provides general OB/GYN services at Birth and Women’s Care in Fayetteville, NC.

Reviewed by: Robert Carlson, M.D, Beth Bolt, RPh
Citation: Obstetrics and Gynecology, “Pregnancy Outcomes With Weight Gain Above or Below the 2009 Institute of Medicine Guidelines” Institute of Medicine, “Weight Gain During Pregnancy: Reexamining the Guidelines” NICHD, “NICHD Research Weighs in on Weight Gain during Pregnancy”

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