Health Rounds: Medication abortion is safe before 6 weeks of pregnancy
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By Nancy Lapid
Nov 7 (Reuters) -Hello Health Rounds Readers! While medication abortion has faced legal challenges in the U.S., it is considered safe and effective, and today we have a study that found this to be the case even before six weeks of pregnancy. We also feature a study that found increased use of type 2 diabetes medicines among those with type 1, and one on the risk of not removing filters used to prevent blood clots from entering the lungs.
Medication abortion before 6 weeks is safe, effective
Medication abortions can be safely performed as early as the fourth week of pregnancy, researchers reported on Wednesday in The New England Journal of Medicine.
Abortions induced by medications are generally not done until week five or six, when an ultrasound exam can confirm a pregnancy inside the uterus.
Before that, it is not possible to rule out the chance that the embryo is attached to a site outside the uterus. Such ectopic pregnancies are not terminated by a medication abortion and can be life-threatening.
The results of a large trial found that very early medical abortion was just as effective and safe to perform, even in cases of an undiagnosed ectopic pregnancy, study leader Dr. Kristina Gemzell-Danielsson of Karolinska University Hospital in Sweden said in a statement.
In some U.S. states, abortion is banned after the sixth week, coauthor Dr. Karin Brandell, also of Karolinska University Hospital, said in a statement.
“It was therefore important to show that early abortion is equivalent to current standard procedure at a later stage of pregnancy.”
The study included over 1,500 women at 26 clinics in nine countries who requested an abortion before ultrasound could confirm intrauterine pregnancy.
They either underwent a delayed medication abortion once pregnancy could be confirmed in the uterus in week 5 to 6, or an early abortion in weeks 4 to 6. Both groups received the standard two drugs used in medication abortion - mifepristone and misoprostol.
None of the participants had symptoms of ectopic pregnancy such as abdominal pain or bleeding, or risk factors for such a pregnancy, including becoming pregnant despite using an intrauterine device or having had previous ectopic pregnancies.
More than 95% of the women in both groups had a complete abortion. Women in the early group reported less pain and bleeding.
Rates of continued pregnancy were 3.0% in the early group and 0.1% in the standard group.
Ongoing pregnancy after medication abortion can be treated with a repeat dose of misoprostol or uterine aspiration, according to medical guidelines.
Surgical interventions for incomplete abortions were needed by 1.8% of the early group versus 4.5% of the standard group.
Use of type 2 diabetes drugs rising among those with type 1
Prescriptions for glucose-lowering medications that also have heart protective benefits and cause significant weight loss are on the rise among U.S. patients with type 1 diabetes, even though the drugs are only approved for the more common type 2 diabetes, according to a new study.
The medications include GLP-1 drugs such as Ozempic from Novo Nordisk NOVOb.CO and Trulicity from Eli Lilly LLY.N, and SGLT2 drugs such as Jardiance from Boehringer Ingelheim and Eli Lilly and Farxiga from AstraZeneca AZN.L.
Analyzing electronic health records on 943,456 individuals with type 1 diabetes across 50 states, researchers found the percentage of patients prescribed either GLP-1 or SGLT2 drugs rose from 0.7% in 2010 to 8.3% in 2023.
The percentage who were prescribed GLP-1 drugs rose from 0.3% to 6.6% during that period, while the percentage receiving SGLT2 drugs rose from 0.1% to 2.4%, researchers reported in JAMA.
The greatest increase in SGLT2 prescribing occurred in subgroups of patients with cardiovascular disease, while the biggest increase in GLP-1 prescribing was for those with obesity.
GLP-1 and SGLT2 drugs are not approved for type 1 diabetes in the United States and Europe due to safety concerns.
GLP-1s can increase the risk of dangerously low blood sugar levels and SGLT-2s can increase the risk of life-threatening diabetic ketoacidosis. People with type 1 diabetes are usually already taking insulin for the condition.
However, "use of these newer medications in type 1 diabetes may continue due to significant weight management and cardiorenal benefits,” the researchers said, referring to the heart and kidney protections they offer.
Until reliable studies can prove their efficacy and safety in individuals with type 1 diabetes, “caution should be exercised when prescribing these treatments,” they said.
Complications higher when clot filters not removed
Filters placed in the chest to prevent blood clots from traveling into the lungs should ideally not remain there forever, but very few of them are actually removed, a new study shows.
The filters are inserted into the inferior vena cava, the large vein that empties into the heart. Professional societies and the U.S. Food and Drug Administration recommend their removal as soon as the patient is no longer at high risk of pulmonary emboli, or blood clots in the lungs.
The longer the filters remain in place, the higher the risk of serious complications, and whether the benefits outweigh the risks has been controversial.
The study involved more than 270,000 U.S. adults over age 65 who had received an IVC filter between 2013 and 2021.
The annual volume of insertions fell sharply over time, from 44,680 in 2013 to 19,501 in 2021. Retrieval rates held steady, however, reaching 15.3% at a median of 1.2 years and 16.8% at a maximum follow-up of 9 years, the researchers reported in JAMA.
Among patients whose filters were not removed, 1.4% suffered filter-related complications during a median follow-up of 1.4 years.
Retrieval attempts were highly successful, with few complications, especially when done within the first few months after filter insertion, an editorial published with the study notes.
Given that the risk of many filter-related complications increases with time, "it is concerning that retrieval rates remained low throughout the study period,” the editorial said.
Reporting by Nancy Lapid; editing by Bill Berkrot
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