June 30th, 2022

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A Note from the Editor-in-Chief
Authors:  Lawrence D. Devoe, M.D.
  Welcome to the November 2005 Editor-in-chief's page. In keeping with our approach to highlighting manuscripts of special interest, I have listed the following articles below.
In This Issue:
Pregnancy Weight Gain and Premenopausal Breast Cancer Risk. Hilakivi-Clarke L, Luoto R, Huttner T, Koskenvuo M. The obesity "epidemic" encountered in many societies has stimulated substantial interest in associated long-term health risks. Pregnancy provides a launching pad for excessive weight gain, which may initiate lifelong obesity for many women. While obesity appears to increase the risk of postmenopausal breast cancer, the authors of this case-control study looked at the risk of earlier development of breast cancer based on pregnancy weight gain. Their findings appear somewhat counterintuitive as risk for premenopausal breast cancer was significantly lower with weight gain exceeding 16 kg; this relationship also appeared independent of other factors that influence the risk of breast cancer. This is an interesting epidemiologic finding that may not be readily explicable on a biologically plausible basis. As the study population was slanted toward a younger group of patients, it will not be known for some time if the benefits of increased weight for reduction of premenopausal breast cancer will be balanced or "outweighed" in the future by an increased risk of postmenopausal breast cancer.
Maximal Urethral Closure Pressure <20 cm H2O: Does It Predict Intrinsic Sphincteric Deficiency? Krissi H, Pansky M, Halperin R, Langer R. Considering the importance of appropriate classification of bladder function prior to initiation of therapy, it would be worthwhile to consider the measurement tools themselves in a critical manner. Krissi and colleagues approached a fairly simple situation, patient positioning at the outset of urodynamic testing, by comparing maximal urethral closure pressure obtained in a seated vs. supine position. The important finding of their study suggests that a higher cutoff should be used for the latter testing position as this may improve patient selection for surgical therapy as well as the expectation for benefit from the procedure chosen.
Increasing Amniotic Fluid Magnesium Concentrations with Stable Maternal Serum Levels. Gortzak-Uzan L, Mezad D, Smolin A, Friger M, Huleihel M, Hallak M. Magnesium sulfate is the agent used most commonly for tocolysis in the majority of modern obstetric units. Although the benefits of delaying delivery to enable administration of pulmonary biochemical adjuvants are well recognized, fetuses who undergo prolonged exposure to magnesium may experience untoward metabolic/neurologic consequences. These are particularly significant if infants are delivered during or shortly after cessation of maternal magnesium therapy. The authors found that unlike the concentrations in the mother, whose magnesium levels stabilize within hours of therapy, the magnesium concentrations in amniotic fluid continue to rise, reflecting both increasing fetal serum levels and an increasing reservoir available for fetal swallowing. Eventually neonatal serum levels approach those of the mother. The dynamics of magnesium disposition in utero are supported by limited human evidence. Gortzak-Uzan et al now give us some indication that in this select population, amniotic fluid magnesium levels rise as long as magnesium is administered and do not apparently reach a plateau, as is the case for mothers. These findings should raise concern regarding the typical arbitrary and prolonged duration of magnesium therapy as currently implemented in most hospitals. Future studies that address modified therapeutic regimens, favoring shorter magnesium exposure for preterm neonates, would be most welcome.
Keywords:  Editorial; Lawrence D. Devoe, M.D.
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