Journals watch: impact of increasing BMI, contraception and domestic violence among pregnant women

Too busy to read all of the journals? Dr Gwen Lewis selects the latest papers of interest to GPs.

Prevalence of multimorbidity rose with increasing BMI, researchers found
Prevalence of multimorbidity rose with increasing BMI, researchers found

The impact of increasing BMI on the prevalence of multimorbidity

Fam Pract 2014; 21(1): 38-43

It is well recognised that obesity is associated with increased risk of long-term conditions, including type 2 diabetes, depression and osteoarthritis.

Multimorbidity is the presence of multiple long-term conditions and in this study, it was defined as the co-occurrence of two or more of 11 conditions affecting seven organ systems.

The electronic care records of 300,006 adults aged 30 years or over were studied, of whom 223,089 had their BMI recorded. In men of normal weight, the standardised prevalence of multimorbidity was 23%, rising to 27% in those who were overweight and rising with increasing BMI to 44% in the most obese.

In women, the rates were even more marked, at 28% in those of normal weight, rising to 51% in the most obese. In analysis, 32% of multimorbidity was directly attributable to overweight and obesity. This highlights the need for targeted prevention in primary care.

Continuing contraception for women on EHC from pharmacists

J Fam Plann Reprod Health Care 2014; doi: 10.1136/jfprhc-2013-100730

In the UK, access to emergency hormonal contraception (EHC) from pharmacists and doctors continues to play an important part in helping to reduce the numbers of terminations of pregnancy carried out.

Increasingly, women are choosing to obtain EHC from pharmacists. However, at present, pharmacists do not provide effective continuing contraception.

In this study from Edinburgh, questionnaires were given to women obtaining EHC, specifically asking if they would be in favour of being given a temporary supply of a progesterone-only pill (POP) in conjunction with the EHC.

Out of a total of 211 respondents, 64% were positive about the idea, agreeing this would be helpful.

Clinicians working in sexual health clinics were also asked for their opinion and 92% responded favourably about a pharmacist supplying a POP at the time of EHC supply.

This would appear to be a popular move that could help to reduce unwanted pregnancies.

Guidance on the management of low-lying IUDs and IUSs

J Fam Plann Reprod Health Care 2014 doi: 10.1136/jfprhc-2012-100384

NICE is encouraging the use of long-acting reversible contraception. However, sometimes on an ultrasound scan, the IUD is found to be lying low in the uterus, or to be malpositioned.

There appears to be a lack of consensus, with little published guidance available on management.

In this study, an email questionnaire was sent to senior medical staff working in contraceptive services. Results confirmed the variation in views and management of a low-lying or malpositioned IUD or intrauterine system (IUS).

Almost all of the clinicians questioned would replace an IUD positioned totally or partially within the cervical canal, while the nearer the device was to the fundus, the less likely it was that the clinicians would opt for it to be replaced.

Clinicians were generally less concerned about a malpositioned levonorgestrel IUS than a copper IUD, presumably because of the hormonal effect. If there was abnormal bleeding, most clinicians appeared to look for other causal links, rather than assuming it was related to the device.

It was felt that accurate evidence-based guidance was required to assist in these cases.

Prevalence of domestic violence among pregnant women

BJOG 2014; doi:111/1471-0528.12609

This study looked at the prevalence of domestic violence in pregnant women attending termination of pregnancy and antenatal clinics.

Women were screened for domestic violence using a modified version of the Abuse Assessment Screen.

Approximately 500 women completed the survey. Results showed that women attending for termination of pregnancy were six times more likely to experience physical abuse in their current relationship and five times more likely to undergo emotional abuse than those women attending antenatal clinics.

However, only 10 women out of 274 attending for termination of pregnancy mentioned domestic violence as a contributing factor for their request for termination.

It would appear that women requesting terminations are at increased risk of domestic violence and GPs should be aware of this.

  • Dr Lewis is a GP in Windsor, Berkshire, and a member of our team who regularly review the journals

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

  • Perform an audit of very overweight patients to assess the level of multimorbidity and ways to help in weight reduction.
  • Arrange a practice meeting to discuss how to improve provision of emergency contraception and to make sure that women requiring it are also provided with continuing contraception.
  • Conduct a search of notes of women who have had an IUD fitted, to assess low-lying and malpositioned devices.

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

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