Journals Watch - BP and postnatal depression

Not had time to catch up on the latest research? Let Dr Suzanne Hunter bring you up to date.

24-hour ambulatory BP monitoring was less effective than self-monitoring at home (Photograph: SPL)
24-hour ambulatory BP monitoring was less effective than self-monitoring at home (Photograph: SPL)

Home measurement of BP
Br J Gen Pract 2010; 60: 675-80

BP is labile. It can change from minute to minute and day to day, making it somewhat difficult to take an accurate measurement.

This study compared the variability of BP readings taken in the surgery (triple readings, using the second and third readings), readings taken on a 24-hour machine and self-monitored readings (performed morning and evening for at least six weeks).

The authors looked at the coefficient of variation (CV), which is how much the readings vary in individual patients. For systolic BP, readings taken in the surgery had a CV of 8.6 per cent, 24-hour ambulatory monitoring had a CV of 5.5 per cent and self-monitoring had a CV of 4.2 per cent. Equivalent values for diastolic BP were 8.6 per cent, 4.9 per cent and 3.9 per cent.

This paper points to the unreliability of surgery measurements in diagnosis of hypertension. It indicates that self-monitoring over a one-week period provides more accurate readings than 24-hour ambulatory monitoring.

Low-carbohydrate diets and mortality
Ann Intern Med 2010; 153: 289-98
Studies of low-carbohydrate diets have shown some adverse effects, including increased cardiovascular risk.

This study looked at effects on all-cause and cause-specific mortality of low-carbohydrate diets and then looked at the difference between animal-based low carbohydrate diets (animal fat and protein) and vegetable-based (vegetable fat and protein) diets.

The overall figures showed a modest increase in all-cause mortality, but when subdivided into vegetable and animal-based diets, a different picture emerged.

The animal based low carbohydrate diet showed an all- cause mortality hazard ratio (HR) of 1.23, while the vegetable based diet had a HR of 0.8. This was the same for cardiovascular mortality with HRs of 1.14 and 0.77 respectively.

These data suggest it would be sensible to recommend a vegetable fat and protein-based diet if a patient is considering a low-carbohydrate diet.

Adolescents with chronic conditions and risk of bullying
Arch Dis Child 2010; 95: 711-6

Bullying has adverse effects on a victim's physical and psychosocial well-being. This study aimed to look at whether adolescents with chronic disease or disability were more likely to be bullied.

The study included more than 7,000 adolescents, 10 per cent of whom had chronic conditions. The total bullying rate was 13.85 per cent. The bullying rate was significantly higher in adolescents with a chronic condition than controls; 18.61 per cent and 13.32 per cent respectively. Adolescents with chronic conditions were also more likely to be victims of two or three forms of bullying (adjusted odd ratio 1.92).

Bullying victims from both groups were more likely to have poor health perception, difficulty making friends, high levels of depression, to have experienced violence and have been sexually abused. The main differences were that those with chronic conditions were more likely to be socially excluded and experienced a higher intensity of bullying.

Perinatal risk factors for postnatal depression
BJOG 2010; 117: 1,390-8
The prevalence of postnatal depression is estimated at 10 per cent. Previous studies have identified low socioeconomic status, young age, ethnic minority, lack of social support, perfectionism, marital conflict and antenatal depression as risk factors. This Dutch study, using data from nearly 5,000 women, looked at whether complications during pregnancy or delivery increased the risk of postnatal depression.

The women were assessed two months post-delivery using the Edinburgh postnatal depression scale. They found certain perinatal complications were particularly associated with postnatal depression.

Pre-eclampsia had an odds ratio (OR) of 2.58, hospitalisation an OR of 2.25, emergency caesarean 1.53, suspicion of fetal distress 1.56 and a medically indicated delivery by an obstetrician 2.43.

Hospital admission of the baby had an OR of 1.45, whereas an unplanned pregnancy had no effect. It is important to consider these factors when assessing postnatal women.

Uterine rupture post-caesarean section
BJOG 2010; 117: 1,358-65
This Australian study set out to determine the risk of uterine rupture in second pregnancies after first caesarean. They included women who had a repeat caesarean without labour, spontaneous labour with no augmentation and combinations of induction with prostaglandins and/or oxytocin.

Over three years, they found 29,000 women who were eligible for the study, and of these 53 cases of uterine rupture were identified.

The baseline risk of rupture without labour was 0.01 per cent, and with spontaneous labour with no augmentation was 0.15 per cent. This increased to 1.91 per cent if there was augmentation with oxytocin.

The study found that the risk of rupture was 0.54 per cent with induction with oxytocin alone, 0.68 per cent with prostaglandin alone and 0.88 per cent in combination.

These figures point to a relative safety of vaginal delivery after a caesarean unless spontaneous labour is augmented.

CPD IMPACT: EARN MORE credits

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Review the practice's protocol of how BP is measured and whether a single surgery reading is a frequent way BP is assessed prior to medication commencement or alteration.
  • Organise a meeting with the health visitors and midwives to review the screening of postnatal depression.
  • Develop a protocol for assessing children with long-term conditions, which includes an assessment of depression, bullying and social exclusion.

Record all your learning with your free online CPD Organiser

Dr Hunter is a GP in Bishops Waltham, Hampshire, and a member of our team who regularly review the journals

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