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Glucose Regulation in Young Adults With Very Low Birth Weight
Glucose Regulation in Young Adults With Very Low Birth Weight
acute bipolar depression for short periods with trials, STEP-BD enrolled a large number of patients
antidepressants alone could result in higher re- with bipolar disorder who were seeking treatment.
sponse rates than the use of antidepressants in However, the relatively low percentage of de-
combination with mood stabilizers. However, a pressed patients who underwent randomization
blinded maintenance study1 reported lower re- reflected the large number of patients who were
sponse rates when patients with bipolar disorder ineligible owing to previous treatment with both
who were receiving placebo under double-blind bupropion and paroxetine, an unwillingness to
conditions became depressed and received adjunc- accept treatment with approved mood stabilizers,
tive antidepressants, as compared with the re- or an unwillingness to taper the dose of a current
sponse rates observed when the antidepressants antidepressant medication. However, we acknowl-
were added to mood stabilizers in a blinded fash- edge that results from our study may not apply to
ion. To our knowledge, no published study has all antidepressants, since our study examined only
had design features that directly address Dr. El- bupropion and paroxetine.
Mallakh’s supposition, which requires that pa- Gary S. Sachs, M.D.
tients be randomly assigned to receive antidepres- Harvard Medical School
sants in combination with a mood stabilizer or Boston, MA 02115
as monotherapy. Since evidence-based treatment Charles Bowden, M.D.
guidelines consistently recommend the concurrent University of Texas Health Science Center
use of a mood stabilizer, it is likely that ethical San Antonio, TX 78229-3900
concerns, as well as concerns about practical com- Michael E. Thase, M.D.
plexities and study costs, account for the lack of University of Pennsylvania
such initiatives. Philadelphia, PA 19104
Dr. Belmaker’s concern about limited gener-
1. Gyulai L, Bowden CL, McElroy SL, et al. Maintenance effi-
alizability and low recruitment rates in our study cacy of divalproex in the prevention of bipolar depression. Neu-
requires some clarification. Unlike most clinical ropsychopharmacology 2003;28:1374-82.
The authors reply: Manzoni et al. raise the im- for preeclampsia. Also, when we excluded subjects
portant issue of maternal preeclampsia, which is with a history of maternal preeclampsia, the ef-
a frequent reason for prematurity. Previous reports fects of very low birth weight remained similar
suggest that offspring of mothers with preeclamp- and statistically significant. Therefore, we con-
sia have higher-than-normal blood pressure in clude that maternal preeclampsia did not explain
childhood1 and impaired glucose regulation in the association of very low birth weight with
adulthood.2 In our study, we decided not to pre impaired glucose regulation and higher blood
sent results adjusted for preeclampsia because pressure.
such an adjustment would not have altered the Petteri Hovi, M.D.
results. We here present numerical data to sup- National Public Health Institute
port this decision. FI-00300 Helsinki, Finland
Young adults born to mothers with preeclamp- Sture Andersson, M.D., Ph.D.
sia had glucose and insulin concentrations simi- Hospital for Children and Adolescents
lar to those of the rest of the subjects. However, FI-00029 HUS Helsinki, Finland
their systolic blood pressure was increased by Eero Kajantie, M.D., Ph.D.
3.8 mm Hg (95% CI, 0.2 to 7.4). After adjustment National Public Health Institute
for preeclampsia, very low birth weight was associ- FI-00300 Helsinki, Finland
ated with an increase in the fasting insulin level
1. Tenhola S, Rahiala E, Martikainen A, Halonen P, Voutilainen
of 16.7% (95% CI, 4.2 to 30.6), an increase in the R. Blood pressure, serum lipids, fasting insulin, and adrenal
2-hour glucose level of 6.4% (95% CI, 0.3 to 12.7), hormones in 12-year-old children born with maternal pre-
and an increase in systolic blood pressure of 4.4 eclampsia. J Clin Endocrinol Metab 2003;88:1217-22.
2. Thomas C, Hyppönen E, Power C. Prenatal exposures and
mm Hg (95% CI, 1.7 to 7.1). These estimates are glucose metabolism in adulthood: are effects mediated through
similar to those we reported without adjustment birth weight and adiposity? Diabetes Care 2007;30:918-24.