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This Month in Archives of Pediatrics and Adolescent Medicine
March 2006

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2006;160(3):239. doi:10.1001/archpedi.160.3.239
A Randomized Placebo-Controlled Trial of Metformin for Adolescents With Polycystic Ovary Syndrome

Polycystic ovary syndrome is characterized by menstrual dysfunction and evidence of hyperandrogenism, and occurs in 5% to 10% of women between adolescence and menopause. Insulin resistance and hyperinsulinemia appear to play a key role in the pathophysiology of the disorder. This randomized controlled trial sought to determine if metformin would reduce serum testosterone levels in hyperandrogenic, hyperinsulinemic adolescents with the disorder. At 12 weeks of treatment, metformin lowered serum testosterone, increased the likelihood of menses 2.5-fold, and improved high-density lipoprotein cholesterol without affecting body weight. Longer follow-up studies are needed to determine the overall benefit of metformin treatment.

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Maternal Depressive Symptoms at 2 to 4 Months Post Partum and Early Parenting Practices

Increased attention has been paid to the effects of maternal depression on infants and young children because as many as a quarter of mothers of young children have depressive symptoms. McLearn and colleagues studied nearly 5000 mothers 2 to 4 months post partum. Mothers with depressive symptoms were 27% less likely to breastfeed, 30% less likely to play with their baby, and 26% less likely to talk with their infants than mothers without depressive symptoms. Maternal depressive symptoms appear to be common in the postpartum period and adversely affect parenting practices. This study emphasizes the need for links between adult and pediatric systems of care.

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Depressive Symptomatology as a Predictor of Exposure to Intimate Partner Violence Among US Female Adolescents and Young Adults

While many studies have shown that intimate partner violence increases the risk of subsequent depression, little is known about whether depressive symptoms are a risk factor for intimate partner violence in adolescents or adults. Lehrer and colleagues used data from the Add Health study to examine whether depressive symptomatology was associated with an increased risk of subsequent physical abuse. A total of 1659 adolescent women who were in a relationship with the opposite sex at a mean age of 15.9 years were observed for 5 years to a mean age of 21.3 years. Ten percent of women at baseline had high levels of depressive symptoms; their risk of subsequent moderate to severe intimate partner violence was nearly double that of women with the lowest level of depressive symptoms. Each 1-point increase in depressive symptomatology was associated with a 3% increase in the odds of violence.

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Estimated Cost-effectiveness of Growth Hormone for Idiopathic Short Stature

In July 2003, the US Food and Drug Administration approved the use of recombinant growth hormone for the long-term treatment of idiopathic short stature. With this indication, it is estimated that 400 000 children in the United States now qualify for growth hormone treatment. The authors sought to estimate the cost-effectiveness of growth hormone therapy for idiopathic short stature based on the efficacy data used by the Food and Drug Administration for approval of this indication. The estimated incremental cost-effectiveness ratio of growth hormone therapy for idiopathic short stature, compared with no therapy, is $52 634 per inch or $100 000 per child, which reflects an incremental growth of 1.9 in. Alternate treatment strategies such as increased duration of growth hormone therapy and high pubertal dosing of growth hormone did not substantially improve the cost-effectiveness ratio. The significance of a cost of more than $50 000 per inch gained is difficult to judge without a better understanding of the benefits associated with height gain after growth hormone treatment.

Figure.
Estimated incremental cost per inch of growth (dashed line) based on the drug price of growth hormone (GH). The solid line represents the current range of GH prices.

Estimated incremental cost per inch of growth (dashed line) based on the drug price of growth hormone (GH). The solid line represents the current range of GH prices.

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