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Medscape
33 minutes ago
- Medscape
TNF Inhibitor Use in Pregnancy Shows a Growing Trend in US
TOPLINE: TNF inhibitors were used by 64% of pregnant women with inflammatory diseases through all trimesters. Those with continuous use through all trimesters had reduced use of corticosteroids postpartum. METHODOLOGY: Researchers analyzed prescriptions of TNF inhibitors in pregnant women with chronic inflammatory diseases in the MarketScan US commercial claims database, focusing on usage patterns and discontinuation compared with those who continued using them throughout pregnancy. They included live birth pregnancies among women aged 15-45 years with rheumatoid arthritis, radiographic axial spondyloarthritis, psoriatic arthritis, psoriasis, and/or inflammatory bowel disease who were hospitalized between 2011 and 2021. A total of 3711 pregnancies were exposed to TNF inhibitors during gestation, with use of TNF inhibitors defined as having at least one filled prescription or infusion during the preconception, gestation, or postpartum periods. The time of exposure during pregnancy was categorized by trimesters, with a grace period of five half-lives added to account for biologic activity. TNF inhibitors were classified by high or low placental transfer ability, using national drug and procedure codes. The use of systemic corticosteroids and nonbiologic disease-modifying antirheumatic drugs was also assessed. TAKEAWAY: Overall, 64% of pregnancies were exposed to TNF inhibitors throughout all trimesters, whereas 17% were exposed during a single trimester and 18% during two trimesters. Additionally, 89% had preconception exposure, and 68% had postpartum exposure. Among pregnant women with inflammatory bowel disease, 84% continued using TNF inhibitors throughout all trimesters. A higher proportion of pregnant women with rheumatoid arthritis, psoriatic arthritis, and radiographic axial spondyloarthritis/psoriasis discontinued TNF inhibitors before the third trimester than those with inflammatory bowel disease. The proportion of pregnancies exposed to TNF inhibitors throughout all trimesters increased from 55% in 2011-2013 to 73% in 2020-2021 (P for trend < .001). Pregnancies with continuous use of TNF inhibitors had lower use of corticosteroids during pregnancy and postpartum than those with limited exposure. Exposure to TNF inhibitors with a high placental transfer ability was seen in 73% of pregnancies, whereas exposure to low-transfer agents was seen in 27%; switching from high- to low-transfer TNF inhibitors occurred in 1.4% of pregnancies, with 0.2% switching from low- to high-transfer agents. IN PRACTICE: 'Our findings suggest a trend toward increased TNFi [inhibitor] continuation throughout gestation. As TNFi continue to be widely used, ongoing evaluation of their safety and long-term outcomes during pregnancy will be critical, notably related to immunization response in offspring. This information will inform future guidelines and help optimize the health of mothers with chronic inflammatory disease and their children,' the authors of the study concluded. SOURCE: This study was led by Leah K. Flatman, PhD, McGill University, Montreal, Quebec, Canada. It was published online on June 15, 2025, in The Journal of Rheumatology. LIMITATIONS: The study's retrospective design may lead to residual confounding because it relied on administrative data. The lack of detailed clinical information, such as disease activity levels and reasons for stopping TNF inhibitors, limited the understanding of treatment decisions. Potential misclassification of TNF inhibitor exposure and gestational timing exists owing to reliance on claims data. The exclusion of stillbirths limits the generalizability of findings, and the focus on commercially insured women may not reflect broader populations. DISCLOSURES: This study was funded by the Canadian Institutes of Health Research (CIHR) project grant and the Arthritis Society Stars Career Development Award to an author who also reported receiving senior salary support from the Fonds de Recherche du Québec — Santé. Another author received support from a CIHR Canada Graduate Scholarships Doctoral Award. No relevant conflicts of interest were disclosed by the authors. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
an hour ago
- Medscape
Phone Support Lowers BMI in Preschool Kids
TOPLINE: A 2-year telephone-based intervention providing nurse-led support calls and short message service (SMS) to mothers was associated with a reduced BMI in children aged up to 5 years, with the greatest benefit seen in those from lower-income families. METHODOLOGY: Telehealth became crucial during the COVID pandemic when face-to-face health programs were suspended; however, evidence on the effectiveness of telephone- and SMS-based obesity interventions for preschool-aged children and their caregivers has been lacking. Researchers conducted an extension study of a clinical trial to evaluate the effectiveness of a 2-year telephone-based intervention in reducing BMI and improving health behaviors among preschool-aged children. Originally, 662 mother-child pairs (children aged 2-3 years) were randomly assigned to receive either a five-stage, telephone-based support program, which included nurse-led calls, SMS, and a mailed booklet on healthy behaviors (intervention group), or mailouts with information unrelated to the intervention (control group). After the first year, the intervention group continued for a second year (when children were 3-4 years old), followed by a 1-year follow-up period (when children were 4-5 years old); the original group allocations were maintained throughout. The primary outcome was child BMI, measured at 3, 4, and 5 years of age. Secondary outcomes included child dietary behaviors, active playtime, screen time, and sleep duration. TAKEAWAY: The intervention group had a significantly lower mean BMI than the control group for children aged 3-5 years (15.90 vs 16.20; mean difference [MD], -0.30; P = .039). The effect of the intervention group was more pronounced among lower-income families (MD, -0.57; P = .018). The intervention group was also associated with greater odds of meeting four or more dietary recommendations (adjusted odds ratio [aOR], 1.70; P = .02), not eating in front of the television (aOR, 2.65; P < .0001), and not eating fast food (aOR, 1.67; P = .047) than the control group for children aged 3-5 years. IN PRACTICE: 'Our study demonstrates the potential for telehealth in a preventive framework to improve obesity risk outcomes of preschool-aged children, particularly low-income children,' the authors wrote. SOURCE: This study was led by Li Ming Wen, Population Health Research & Evaluation Hub, Sydney Local Health District, Camperdown, Australia. It was published online in the International Journal of Obesity. LIMITATIONS: The generalizability of the findings was limited by the study location and participant demographics. Due to the COVID pandemic, the trial intervention and data collection were conducted pragmatically rather than ideally, which may have affected outcomes. Additionally, secondary outcomes were limited by mothers' self-reporting. DISCLOSURES: This study was funded by a National Health and Medical Research Council Partnership grant. The authors declared having no competing interests. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Forbes
an hour ago
- Forbes
When First-Year College Students Struggle With Separation Anxiety
Student unpacking things in dormitory, looking at family photos getty The start of the academic year is often a peak time for many student counseling centers. Not surprisingly, many first-year/incoming students seek counseling due to anxiety about moving away from home and being in a new environment. A 2024 report on discussed the importance of understanding homesickness in college students. As indicated in this report, homesickness is a natural and expected reaction to being away from established attachments while experiencing significant changes. Homesickness can even serve as a sign of secure relationships and meaningful lives that were enjoyed prior to starting college. However, the concept of separation anxiety is vastly different from homesickness. As explained in a 2007 study in the Journal of Psychology , there was a time when symptoms of separation anxiety were rarely considered for college students. However, this study found that 21% of first semester college students reported such symptoms. According to a 2025 report on a defining characteristic of separation anxiety in adults are emotions that are developmentally inappropriate for being away from home or attachment figures. The term developmentally inappropriate is used to describe emotional responses that are significantly more intense than expected given the student's age. A formal diagnosis of adult separation anxiety also requires that the symptoms endure more than six months and negatively affect social functioning and responsibilities. Even without a formal diagnosis, intense separation anxiety and/or excessive homesickness among incoming college students can be detrimental. Refusing to attend classes, frequent panic attacks, and having nightmares about leaving home are commonly reported by students with these struggles. It's also important to note what separation anxiety is not. These struggles do not equate to hating the school, not having friends, or being weak. Students with these struggles are in real distress, and this distress is not a matter of personal choice. Coping with and reducing separation anxiety is possible, but it's essential that students don't personalize their symptoms or become self-critical. Counseling methods that are effective in treating general anxiety also tend to be effective with reducing separation anxiety. A 2024 report by Pacific Neurocounseling discussed the effectiveness of treatments, such as cognitive-behavioral therapy, and provided other ways to help overcome adult separation anxiety. It's often helpful to view separation anxiety in college students as a matter of distress tolerance. According to a 2024 report on distress tolerance refers to a person's ability to manage actual or perceived emotional distress. Students with high levels of separation anxiety often have low levels of distress tolerance. Fortunately, the ability to tolerate distress can be improved upon. The first aspect of improving distress tolerance is learning how to minimize distress, which is a vital coping skill that's often established during the traditional college-aged years. According to the report on , healthy distractions and positive mood boosters are ways to avoid a sense of dread for students who are missing home. The second aspect of improving distress tolerance is learning how to increase tolerance. It's important for many students with separation anxiety to accept when they're experiencing distress and intentionally respond to this distress. As stated, separation anxiety is not predicated on a specific campus, meaning that these struggles are likely to occur whenever student leaves home. Though incoming students might feel embarrassed by their struggles with separation anxiety, many counseling centers have services designed to reduce these struggles. Seeking help to reduce separation anxiety can result in many students staying in school as well as better enjoying their college experiences.
