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BMJ No 7103 Volume 315 This week in brief Saturday 2 August 1997 Diabetes during pregnancy is still a high risk state Calcium in pregnancy lowers risk of hypertension in offspring People in suicide pacts differ from solitary suicides Fundholding reduces waiting times Diabetes during pregnancy is still a high risk state Two studies in this week's issue show that the risk of perinatal death and congenital malformation remains high in infants born to mothers with pre-existing diabetes. The Mersey Diabetes in Pregnancy Group followed up all (462) pregnancies over five years in a geographically defined cohort of women with insulin dependent diabetes (p 275). Their infants had a fourfold increase in perinatal mortality and a 10-fold increase in risk of congenital malformations. Similarly, in their large population based study of insulin dependent and non-insulin dependent diabetic women in northern England, Hawthorne et al found that one in four women (113 pregnancies) had a poor outcome of pregnancy (p 279) Calcium in pregnancy lowers risk of hypertension in offspring Epidemiological studies have implicated perinatal nutritional factors in the development of hypertension later in life. In a randomised controlled trial Belizán et al (p 281) explored the effect of calcium supplementation during pregnancy on the blood pressure of the women's children. They found that children of a mean age of 7 years whose mothers had received 2 g a day of calcium had lower systolic blood pressure and a lower risk of high blood pressure. This is the first evidence from a randomised controlled trial of intrauterine programming of childhood blood pressure mediated by a nutritional intervention during pregnancy. People in suicide pacts differ from solitary suicides Death in a suicide pact is uncommon, accounting for less than 1% of all suicides each year. On p 286 Brown and Barraclough show that suicide pacts occur less often than 35 years ago, despite increasing interest in euthanasia. Pacts typically occur between partners who are usually of a high occupational social class, are either in a stable marriage or closely related, and who decide to die when serious illness threatens the continuation of the partnership. Rather than one being left alone, both elect to die together cooperatively and peacefully by poisoning with car exhaust fumes, analgesics, or sedatives. Pacts between young lovers are rare. People who die in suicide pacts have a different profile from those who die in solitary suicides. Fundholding reduces waiting times Using data from four NHS providers over four years, Dowling investigated the differences in waiting times for elective surgery between fundholding and non-fundholding general practices (p 290). He found that patients of fundholders on the waiting list for elective surgery had significantly shorter waiting times than patients of non-fundholding practices. Further analysis showed that the differences in waiting times did not become apparent until the year the practice joined the fundholding scheme, suggesting that shorter waiting times are a result of fundholding. Whether the shorter waiting times are due to fundholders being more effective purchasers of elective surgery or to overfunding of these practices requires further investigation. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline