Birth weight pre-eclampsia 'link' Women who were underweight when they were born are at greater risk of severe pre-eclampsia in pregnancy, a Swedish study involving 6,000 women suggests. The risk is particularly pronounced if their mothers had pre-eclampsia when pregnant with them, researchers say. Pre-eclampsia is a common condition which causes high blood pressure and can put the mother's life at risk. UK experts said doctors should use the findings, reported in BJOG, to identify women who need more careful monitoring. The researchers looked at more than 6,000 women under the age of 30 years who had been unusually small when they were born and who had given birth themselves.
Women who were underweight when born had a "markedly increased" risk for severe pre-eclampsia during their pregnancy, they said. If their mothers had also had pre-eclampsia, the risk was doubled. The research supports previous work suggesting that pre-eclampsia may run in families. Low birth weight is also believed to be related to other conditions associated with high blood pressure, such as heart disease. Prevention Spotting pre-eclampsia early on can be difficult, despite routine monitoring of blood pressure, and knowing who might be more at risk would be useful. Dr Karin Zetterstrom, study leader and gynaecologist and obstetrician at Orebro University Hospital in Sweden, said pre-eclampsia could be dangerous to a mother and baby in many ways. "Those who are born underweight also have high risk of heart disease and the severe form of pre-eclampsia might be part of that pathway. "It might be of value to ask a woman if she was born underweight or if her mother had pre-eclampsia because we know she is at high risk that her pre-eclampsia will turn out to be the severe form." Professor Andrew Shennan, professor of Obstetrics and Gynaecology at King's College London and spokesperson for the baby charity Tommy's, agreed with the researchers recommendations for identifying and monitoring those at increased risk. He said finding women at risk of the severe form of the condition was key. "One of the really important things is distinguishing between early (commonly severe) and late onset pre-eclampsia because early onset is where the problems lie. "But paradoxically we don't see people very often at that crucial time and that's the time we need increased surveillance." "This is quite new stuff and a lot of obstetricians may not even be thinking about it," he added. Professor Phil Steer, BJOG editor-in-chief, said: "What this research demonstrates is the need for careful and detailed history taking when a woman is first seen in pregnancy. "If we know that the likelihood of a woman developing severe pre-eclampsia is high, increased surveillance during pregnancy and early appropriate management will help to safeguard the health of both mother and baby." ************************* Hospital bug deaths on the rise The number of deaths linked to the hospital bug Clostridium difficile has outstripped those due to MRSA, latest figures show. Deaths involving Clostridium difficile rose by 69% to 3,800 from 2004-05, the Office for National Statistics said. In the same period, MRSA mentions on certificates increased by 39% to 1,629. The government said better recording had given a "more accurate picture", but accepted cutting deaths linked to both bugs was a "major challenge". Being mentioned on a certificate does not necessarily mean a hospital acquired infection was the cause of death, but it does mean it was considered a contributing factor. Most of the deaths from both C.difficile and MRSA were in the older age groups. The ONS figures also showed that between 2001 and 2005 MRSA was mentioned on one in every 500 death certificates in England and Wales. For C. difficile it was one in every 250. The ONS said greater awareness and high public profile of the disease may have contributed to an increase in the reporting of C. difficile on death certificates. Health Minister Lord Hunt agreed, saying: "We are now getting a far more accurate picture of the number of deaths from C. difficile and MRSA with vastly improved recording. "It is a major challenge for the NHS and a top priority for government." He said that tough hygiene targets meant the NHS was starting to see significant reductions in rates of MRSA infections. "We now want to see similar progress in relation to C. difficile," he said. Spores C. difficile is a bacterium found in the gut of up to 3% of healthy adults and 66% of infants, where it rarely causes problems. However, it can cause illness when its growth goes unchecked. For example, treatment with certain antibiotics can disturb the balance of "normal" bacteria in the gut, allowing C. difficile to thrive. And efforts to combat MRSA, such as alcohol hand-rubs, have had no impact on C. difficile. C. difficile forms spores which means it can survive for long periods in the environment, such as on floors and around toilets, and spread in the air. Rigorous cleaning with warm water and detergent is the most effective means of removing spores from the contaminated environment and the hands of staff, say experts. Shock figures Head of health at Unison, Karen Jennings, said: "These shocking figures show that MRSA and C difficile have a deadly grip on our NHS. Dirt is not cheap. "We need to wage war on these superbugs and cleaning and cleaners should be on the front line as an integral part of the infection control team. "No one wants to be treated in a dirty hospital but sadly the culture of cleaning was sold off at the same time as compulsory competitive tendering was brought in. "It's time for hospitals to set safe minimum staffing levels for their cleaning services - patients and staff deserve nothing less." A spokeswoman for the Patients Association said: "Our worry is that these figures will continue to rise as other priorities take precedence "The government promised to make infection control one of its top priorities. Yet its own announcement to further reduce waiting times by 'round the clock operations' will inevitably harm these efforts," she said.
