Pregnancy
Physicians neglecting preventive care for women with diabetes, study finds

Women with diabetes are less likely to get preventive care than those without the condition, a UCLA-led study suggests.
The findings are based on an analysis of more than 40 studies from several countries.
They highlight how physicians largely overlook the importance of these routine services for women who have diabetes mellitus, or DM, putting them at risk of preventable medical conditions such as pregnancy complications.
Lauren Wisk is associate professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA and senior author on the study.
She said: “These findings are important because they identify that women with diabetes are not receiving recommended well-woman care, which is essential to support both managing their diabetes and their overall health.
“Providers need to be aware that they should not forget to provide these essential services for women with diabetes.”
The researchers sifted through thousands of studies, focusing on the concepts of women, diabetes and women’s health services, and settled on 44 that addressed treatment services for women aged 15 to 49 with type 1 or type 2 diabetes, excluding those with diabetes insipidus or gestational diabetes.
They looked at four preventive health service categories: contraceptive counselling and use, breast and cervical cancer screening, pre-conception counselling, and screening for sexually transmitted infections.
One study found that 48 per cent of women with diabetes received contraceptive services compared with 62 per cent of women without the disease.
Nine papers showed cervical cancer screening rates ranging from 38 to 79 per cent for women with diabetes compared with 46 to 86 per cent for those without diabetes.
Four studies found that breast cancer screening rates for women with diabetes ranged between 38 and 69 per cent compared with 54 and 82 per cent for those without diabetes.
Fourteen studies found pre-conception counselling rates of just over 1 per cent compared with 46 per cent for women with diabetes who are planning to get pregnant.
The researchers did not identify any studies on screening for sexually transmitted infections, which they said represents “a substantial gap in the literature.”
The researchers wrote: “One of the more striking findings of this review is the importance of robust coordinated care teams in ensuring access to appropriate services for women with DM.
“Several of the identified studies provide support that a co-management model, or the concept of involving endocrinology, primary care, and other specialty care providers in the care of individuals with DM, as recommended by the American Diabetes Association, is associated with greater receipt of services.”
Within the time constraints of an office visit, primary care physicians are expected to address preventative health needs as well as chronic disease management, said Dr Lisa Kransdorf, an associate clinical professor of medicine at the Geffen School and a study co-author.
She said chronic disease management will often take priority.
“In cases where the patient has other providers such as specialists and clinical pharmacists actively involved in their chronic disease management, there is opportunity for primary care physicians to attend to preventative care gaps,” the researcher added:
There are some limitations to the findings.
The search yielded only 44 studies, many of which relied on patient recall, which can be unreliable, highlighting the need for further research.
In addition, most of the studies analysed had small sample sizes or were conducted at a single site, limiting how applicable the findings might be in other settings.
Pregnancy
Ultrasound Direct extends Trice Imaging partnership

Ultrasound Direct has extended its Trice Imaging partnership for three years, adding a reporting tool across its 70-clinic UK network.
The private ultrasound provider will continue using the Tricefy platform for secure image storage and patient engagement, alongside TriceIQ for efficiency and productivity analytics.
It will also introduce Trice Workspace Reporting across its network. The companies say the tool will help standardise ultrasound reporting templates and workflows and reduce variation between clinics.
Ultrasound Direct carries out an estimated 120,000 patient scans each year across services including pregnancy, fertility, women’s health, men’s health and other diagnostic pathways.
Its network uses a large pool of sonographers working across different ultrasound systems and serves referral routes including self-referring patients, GPs and commercial partners.
Mike Steward, founding director at Ultrasound Direct, said: “Having worked with Trice Imaging since 2018, we first partnered to replace manual methods of providing scan images to expectant parents with Trice’s secure electronic image-sharing platform. Today, every study performed across the Ultrasound Direct Network is recorded and stored on Tricefy, while our clinical services have expanded considerably beyond pregnancy into fertility, women’s health, men’s health and other diagnostic pathways.”
He added: “To continue futureproofing our image management strategy across a network of 70 clinics, a large team of sonographers, varying ultrasound systems and a growing number of referral partners with different needs, we decided to extend with Trice Imaging. This includes the introduction of the new Trice Workspace Reporting module to help us scale and standardise our ultrasound reporting templates and workflow, reducing variability between clinics.”
The partnership began in 2018, initially focusing on replacing manual methods of sharing pregnancy scan images with expectant parents.
Johanna Wollert Melin, founder and chief executive of Trice Imaging Europe, said: “Ultrasound Direct has been a valued partner in the UK for 8 years.”
She added: “At the heart of the relationship is a willingness to explore new ideas, test new tools and the spirit to solve real challenges across a large and complex clinical network.”
Mark A. Samii, chief revenue officer at Trice Imaging, said: “We are delighted to retain and extend our relationship with Ultrasound Direct.”
He added: “The addition of Trice Workspace Reporting addresses a challenge we hear from multi-site providers globally – keeping reporting quality consistent across many users, systems, referral or payer relationships.”
Steward said Ultrasound Direct continues to see growing demand for private diagnostics alongside NHS care from self-referring patients and an increasingly diverse range of professional and commercial referral partners.
He added: “As that development continues, scalable digital infrastructure becomes increasingly important. Our focus is on ensuring that a growing national network can support consistent clinical workflows, different referral pathways and the technology requirements of the future, while continuing to provide patients with accessible diagnostic services.”
Fertility
Paracetamol use may impact future fertility, studies suggest

Paracetamol use in pregnancy was not linked to autism or ADHD, while separate research found reproductive differences in girls exposed before birth.
One study analysed health records from more than 120,000 children and found no increased risk of autism following prenatal paracetamol exposure.
A separate analysis of nearly 100,000 children also found no increased risk of ADHD among those born to mothers who used the painkiller during pregnancy.
Researchers from the Hong Kong Hospital Authority examined electronic health records covering pregnancies between January 2001 and December 2023.
The autism analysis included 124,333 children, who were nine years old on average and split almost evenly between males and females. There were 3,445 autism diagnoses, representing 2.8 per cent of the group.
The ADHD analysis involved 97,285 children, who were seven years old on average and also split evenly between males and females. There were 5,168 ADHD diagnoses, representing 5.3 per cent.
Women prescribed paracetamol during pregnancy were more likely to be older and have pre-existing conditions including psychiatric disorders, as well as reasons for taking the drug such as infection, fever or chronic pain.
No association was found between prenatal paracetamol exposure and either autism or ADHD.
The findings did not differ according to the trimester in which paracetamol was taken or whether use was intermittent or daily. Advanced maternal age, defined as pregnancy in women over 35, did not alter the findings.
The researchers wrote: “Paracetamol remains a safe and essential analgesic [pain reliever] and antipyretic [fever reducer] during pregnancy, whereas alternatives, such as NSAIDs and opioids carry well-documented risks.
“Unwarranted reluctance to use paracetamol could lead to undertreatment of pain and fever, or the use of more harmful alternatives, both posing risks to the pregnancy and developing fetus.”
The authors said women should assess paracetamol use with guidance from their doctor.
A separate study involving 685 pregnant women without pre-existing conditions and 302 infant daughters found associations between prenatal paracetamol exposure and differences in reproductive organs and hormone levels.
Researchers from Copenhagen University Hospital enrolled the women during their first trimester and assessed them during the first trimester, third trimester and again when their babies were three months old.
At around three months, infants experience a temporary rise in reproductive hormones sometimes called mini-puberty.
Pregnant participants completed questionnaires every two weeks about their use of pain medicines including paracetamol. Infant girls underwent ultrasound scans of their reproductive organs and blood tests to measure hormone levels.
Researchers also examined a separate group of 1,210 girls followed from infancy to adolescence whose mothers reported paracetamol use during the third trimester.
Three-month-old girls exposed to paracetamol before birth had an average 40 per cent smaller ovarian volume, 13 per cent smaller uterine volume and 23 per cent fewer ovarian follicles.
Girls exposed during the first trimester also had lower levels of Anti-Müllerian hormone, a marker of ovarian function.
Among the older girls, those exposed before birth were more likely to have smaller uteruses at puberty and smaller ovaries during their teenage years.
Dr Margit Bistrup Fischer, lead study author and postdoctoral researcher in the Department of Growth and Reproduction at Rigshospitalet hospital in Denmark, said: “Animal studies have demonstrated that impaired formation of ovarian follicles can lead to reduced fertility and earlier reproductive aging.
“Whether the differences observed in our study have implications for fertility and age at menopause in humans remains unknown and will require long-term follow-up of the girls in our cohort.”
She cautioned that women who had used paracetamol during pregnancy “should not be alarmed by our findings”, as the study found associations rather than direct causation and outcomes for individual women and children are unclear.
“Importantly, our study does not evaluate whether [acetaminophen] causes reproductive problems, nor does it provide evidence that prenatal exposure affects future fertility or age at menopause,” she said.
“Although we observed similar associations in an independent cohort, long-term follow-up is needed to determine whether these early-life differences have any clinical significance later in life.”
Pregnancy
Pregnant women prioritised as NHS rolls out flu vaccine

Pregnant women are among the first groups offered the NHS flu vaccine this winter, which has been updated to better match the subclade K strain.
Schoolchildren are also being prioritised and, like pregnant women, can receive the vaccine from September because they can catch and spread flu easily.
Protecting them also helps others, including younger siblings and grandparents.
Other eligible groups, including people aged 65 and over, will be able to receive a free NHS flu vaccine from October and should receive an invitation by phone or post.
Dr Amanda Doyle from NHS England said: “Last year’s flu season came early and was made worse by a new variant, which had a major impact for patients and put enormous pressure on urgent and emergency care services across the country.
“With the NHS experiencing its busiest summer on record, staff have started preparing for this winter earlier than ever – and with services already under significant pressure, it is vital that everyone offered the vaccine comes forward.”
Last winter’s flu season began more than a month earlier than usual as a new mutated strain circulated.
The strain was sometimes referred to as “Super flu”, although this is not a medical term and does not mean the virus is harder to treat. The name reflected that people had yet to build up immunity against it.
Flu vaccines are updated each year to better match the influenza viruses expected to circulate. These viruses continually mutate, so experts must predict how they are likely to change.
This winter’s vaccine includes changes intended to provide a better match for subclade K.
It remains unclear when flu will begin circulating widely this winter or how severe the season will be. Experts often look at flu activity in southern hemisphere countries such as Australia and New Zealand for indications of how the UK season could develop.
Their flu season peaks in July or August. Australia has recorded fewer cases than last year, while New Zealand has experienced high numbers.
Everyone is at risk of catching flu, regardless of age or how fit and healthy they are.
Doyle said: “Flu can really knock you for six, and for some children and pregnant women it can mean becoming seriously ill or ending up in hospital.”
The flu vaccine cannot give you flu. Instead, it helps the body know how to fight the virus.
Children aged two and over receive a nasal spray version, while adults receive an injection. One dose is needed ahead of winter.
Free NHS flu vaccines are available through pharmacies, GPs and schools. People who are not eligible for a free vaccination can pay around £10 to £20.
Schoolchildren and pregnant women can receive a free NHS flu vaccine from September onwards.
From October, free vaccination will also be available to children aged two or older who have not yet started school, people aged 65 and over, those with certain long-term health conditions, care home residents and carers of older or disabled people, including those receiving a carer’s allowance.
It will also be available to people living with someone who has a weakened immune system and those experiencing homelessness or staying in a homeless hostel or night shelter.
More adults will also be offered vaccination against respiratory syncytial virus (RSV), a virus that attacks the lungs, this winter.
From September, adults with certain pre-existing health conditions, such as chronic lung disease, will be invited for the RSV vaccine when they turn 65 rather than waiting until 75.
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