WIC participation associated with improved birth outcomes, lower infant mortality

1. WIC participation associated with improved birth outcomes, lower infant mortality
Abstract: https://www.acpjournals.org/doi/10.7326/M22-0604
URLs go live when the embargo lifts
A systematic review of the most recently available evidence has found that participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is likely associated with improved birth outcomes and lower infant mortality. In addition, participation in WIC may increase receipt of child preventative services, such as vaccines. The review is published in Annals of Internal Medicine.

The WIC program provides supplemental foods, nutrition education and breastfeeding support, screening and referrals to medical and social services, and support for high-risk pregnancies to low-income women and children younger than five years of age. Because of its services and referrals, participation in WIC has potential to impact health of mothers and infants, and reduce economic, racial, or ethnic disparities in adverse outcomes. This latest review of the evidence focuses on maternal and child outcomes and whether they differ by enrollee characteristics or by duration of enrollment in the WIC program.

Researchers from Johns Hopkins University School of Medicine conducted a systematic review of studies of WIC-eligible mothers and children under the age of five, as part of an evidence report commissioned by the USDA to examine the most recent evidence. The authors report on the results of studies focused on maternal mortality, maternal morbidity, maternal pregnancy outcomes, maternal health behaviors, maternal health care utilization, birth and neonatal outcomes, and infant and child health outcomes. The review included 20 studies. The results showed that maternal WIC participation is likely to be associated with lower risk for preterm birth, low birthweight, and infant mortality. The authors also found that the risk of low birthweight or preterm birth was reduced, though they report that the risk reduction magnitude is more modest than previously reported. The strength of evidence was low or insufficient to determine outcomes by race or ethnicity of enrollees or duration of enrollment in WIC. No studies reported on the association of WIC participation with maternal mortality.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, S. Michelle Ogunwole, MD, PhD, please contact Michel Morris at melben1@jhmi.edu.
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2. Early rhythm control associated with lower risk of cardiovascular complications compared to rate control in most AF patients
Abstract: https://www.acpjournals.org/doi/10.7326/M21-4798
URL goes live when the embargo lifts
A cohort study of patients with atrial fibrillation (AF) and low risk for stroke has found that the use of early rhythm control therapy was associated with a lower risk of cardiovascular death, ischemic stroke, hospitalization for heart failure, or myocardial infarction compared to rate control therapy. The findings are published in Annals of Internal Medicine.

AF is associated with increased mortality and morbidity from stroke and congestive heart failure as well as impaired quality of life. Therapies like rate control are important to the management of AF and typically improves symptoms. Previous studies comparing rhythm and rate control have not demonstrated significant differences in effects on mortality and stroke, but the EAST-AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial) recently showed that rhythm control therapy was associated with lower risk for adverse cardiovascular outcomes compared with usual care among patients diagnosed with AF within the previous year.

Researchers from Yonsei and CHA University College of Medicine studied 54,216 patients with AF having early rhythm or rate control therapy that was initiated within the first year of diagnosis to investigate whether EAST-AFNET 4 results can be generalized to patients with low stroke risk. The authors report that almost 70 percent of study participants were eligible for EAST-AFNET 4. That data showed that the protective associations between early rhythm control and cardiovascular outcomes were similar for the eligible patients as well as ineligible low-risk patients who participated in the study. There were no significant differences in safety outcomes between rhythm control and rate control in either group, suggesting no need for tradeoffs sacrificing safety for better cardiovascular outcomes. These findings suggest that the effect of early rhythm control in improving outcomes was prominent in low-risk patients and supports initiatives for active consideration of rhythm control among all patients recently diagnosed with AF in clinical practice.
 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Boyoung Joung, MD, please email atropin5@cha.ac.kr.
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