An overlooked prenatal infection, thinking beyond obesity, & why U.S. health care is like a Jackson Pollock painting

"I'm baffled why people don't take it more seriously," said pediatrician Megan Pesch.

April 5, 2023 Check out STAT+

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By Elizabeth Cooney Reporter, Morning Rounds Writer

Good morning. If you're not familiar with the cytomegalovirus, you're not alone. Read about efforts to screen for the serious prenatal infections it can cause.

health An overlooked prenatal infection sparks debate about newborn screening  Courtesy Megan Pesch  It's about as common as flu, but while harmless to most people it infects for life, cytomegalovirus can be devastating for newborns. Not as well known as the much rarer Zika, CMV can infect neural stem cells, cause hearing loss, and increase the risk of stillbirth. But there's little public awareness of the virus, nor has there been much progress in treating or screening for CMV over the decades. That may be starting to change. In 2019, Ontario became the first region in the world to test every baby for CMV. Last month, Minnesota became the first state to screen all newborns for congenital CMV. ​​Connecticut has mandated targeted CMV screening since 2016. Still, "I'm baffled why people don't take it more seriously," said Megan Pesch (above, with her husband and their daughter, Odessa), a developmental and behavioral pediatrician at the University of Michigan. Her daughter Odessa was infected with CMV, uses braces to walk, and is deaf. STAT contributor Edward Chen has more. children's health  Thinking beyond mothers' BMI, study IDs other factors in child obesity  Researchers trying to pin down a mother's health factors that raise a child's risk for obesity have centered on BMI and diabetes. BMI is already under fire as a measure of health, and a new study in JAMA Network Open suggests that it is also not the best predictor of a child's obesity. The researchers looked at specific metabolic traits to assess risk and found that insulin resistance was a more powerful indicator than prepregnancy obesity (measured by BMI) and gestational diabetes.  The study also suggests some pregnant people who don't have traditional risk factors might have children with a higher risk of obesity. For example, in the group of women in the study who had insulin resistance, only 60% had prepregnancy obesity and just 15% of them had gestational diabetes. "I think we need studies like this one to help guide what we might want to measure in addition to BMI and glucose," study co-author Ellen Francis told STAT's Elaine Chen. Read more. cancer Enlisting oncology nurses to start end-of-life conversations led to more advance planning Talking about end-of-life planning is both difficult and valuable. Intended to ensure that patients' wishes are honored and the benefits of palliative care are available to them, these conversations often happen late or not at all. A new study in JNCCN, the Journal of the National Comprehensive Cancer Network, tested the impact of training oncology infusion nurses at community cancer clinics to start the process. Patients with advanced cancer were split into two groups: one prompted by nurses to consider advance care planning, and the other receiving standard care.  Of those patients who hadn't discussed the subject before, 45% in the experimental group later had that conversation compared to 18% in the control group. Results were similar for completing an advance directive: 43% in the experimental group did so vs. 18% in the control group. The study was small, so its findings might not be universal, but the researchers say the approach holds promise if nurses are given protected time to pursue it.

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Closer Look Opinion: A portrait of U.S. health care  Behrous Mehra/AFP via Getty Images What makes the American health care system like a Jackson Pollock painting? Start with the chaos of color surrounding white space, Chris Dodd, an internal medicine physician and clinical instructor at the University of Washington School of Public Health, writes in a STAT First Opinion. Those splashes are the health care venues and resources we have; the white space stands for gaps that keep people from finding what they need to improve their health. Some efforts to coordinate care delivery fill some of those gaps, but they often focus on one organ, one disease, one solution. Colorful metaphor aside, Dodd thinks there's a better way, and he sees it in a federally qualified community health center (to which he has no ties). Seattle-based Sea Mar Community Health Centers has built four pillars: access, trust, primary care, and value-based reimbursement. But much of that is more easily said than done. Read more.  reproductive health Birth outcomes for same-sex lesbian couples using ART better than for heterosexual couples Pregnancies achieved through assisted reproductive technologies carry the risk of worse outcomes compared to natural conception, but a new research letter in JAMA suggests the reason is infertility, not ART. The researchers analyzed birth records in Sweden, where since 2005, public funds have paid for same-sex lesbian couples to receive ART treatments with donated sperm. Looking at birth weight, gestational age, low birth weight, and preterm delivery, they found that same-sex lesbian couples undergoing ART had more favorable or similar birth outcomes compared to heterosexual couples who conceived naturally or underwent ART to conceive.  That implicates infertility-related factors rather than reproductive treatments in higher rates of adverse birth outcomes in ART pregnancies. Caveats: Infertility was not directly assessed in the study of medical records, and the number of same-sex couples in the study was small (868) compared to more than 23,000 heterosexual couples using ART and more than 450,000 conceiving naturally. legal J&J proposes paying $8.9 billion to settle Baby Powder lawsuits The long-running battle over Johnson & Johnson's widely used Baby Powder has taken another turn. Yesterday J&J agreed to pay $8.9 billion to settle tens of thousands of lawsuits alleging that talc in its Baby Powder and other products caused gynecological cancers and mesothelioma, Reuters reports. The agreement, which more than quadruples the company's original offer of $2 billion, follows a January appeals court ruling rejecting J&J's controversial "Texas two-step" bankruptcy maneuver. That legal move sought to switch the talc liability to a subsidiary, which would immediately file for Chapter 11. That subsidiary, LTL Management, filed for bankruptcy protection late yesterday for a second time and planned to submit a proposed settlement to which 60,000 talc claimants had agreed to the proposal. It said in a court document that the new filing would not run afoul of the January ruling because of different financing arrangements. J&J has repeatedly said that its talc-containing products are safe and do not cause cancer.

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Thanks for reading! More tomorrow,

elizabeth.cooney@statnews.com

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