BMJ medicine最新文献

{"title":"UK Household Longitudinal Study: cohort profile.","authors":"Michaela Benzeval, Meena Kumari","doi":"10.1136/bmjmed-2025-002121","DOIUrl":"10.1136/bmjmed-2025-002121","url":null,"abstract":"<p><p>Understanding societal change and the consequences for different population groups is fundamental to social science and population health research. The UK Household Longitudinal Study is an infrastructure resource, in which data have been collected annually since 2009 from a sample of about 30 000 households selected to be representative of the four UK nations. Data are collected from all household members of all ages, and covers a wide range of topics, including health, biomarker, genetic, and epigenetic data and is freely available to researchers. The study has oversampled the five main ethnic minority groups in the UK to enable a sufficient sample size for analysis, and periodically boosts samples to ensure sufficient sample size and representativeness. The study incorporates and builds on the British Household Panel Survey; thus, data for a subsample of households are available back to 1991. The UK Household Longitudinal Study also has a smaller innovation panel with the same design that provides a platform for methodological research and innovation. Detailed social science information combined with multi-omics data, health survey data, and linkages to health and socioeconomic administrative data, enables research on the interaction between health, social, and economic change relevant to policymakers. The UK Household Longitudinal Study is widely used across biological, health, and social sciences: the study findings have been used extensively to influence social policy developments and public health.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002121"},"PeriodicalIF":9.3,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting access and trust: cohort and data profiles in BMJ Medicine.","authors":"Tom Nolan, Neil Martin Davies, Katie Harron, Nazrul Islam, Sophie Cook","doi":"10.1136/bmjmed-2026-003139","DOIUrl":"10.1136/bmjmed-2026-003139","url":null,"abstract":"","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e003139"},"PeriodicalIF":9.3,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy and safety of glucagon-like peptide 1 based drugs for weight loss in adults with overweight or obesity without diabetes: network meta-analysis of randomised controlled trials.","authors":"Deshi Chen, Bing Ma, Hao Sun, Jing Zhang, Linlin Gong, Weiwei Wang, Zihan Liu, Hongying Zha, Shuaibo Du, Min Chen, Wenxin Sun, Qiqiang Guo, Yanli Cao, Yongze Li","doi":"10.1136/bmjmed-2026-003026","DOIUrl":"10.1136/bmjmed-2026-003026","url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficacy and safety of glucagon-like peptide 1 (GLP-1) based drug treatments for weight loss in adults with overweight or obesity without diabetes.</p><p><strong>Design: </strong>Network meta-analysis of randomised controlled trials.</p><p><strong>Data sources: </strong>Embase, PubMed (Medline), and Web of Science, 1 January 2000 to 6 March 2026.</p><p><strong>Eligibility criteria for selecting studies: </strong>Randomised controlled trials that enrolled adults with overweight or obesity, comparing GLP-1 receptor agonists or related co-agonists with placebo or active comparators, with a minimum intervention duration of 12 weeks. Excluded were trials that enrolled participants with diabetes, or where diabetes status could not be clearly determined.</p><p><strong>Results: </strong>58 trials of 24 214 participants were analysed. Compared with placebo, weight loss was greatest with retatrutide (-22.10%, 95% confidence interval -25.60% to -18.60%), followed by tirzepatide (-19.28%, -20.39% to -18.16%), and CagriSema (a combination of cagrilintide and semaglutide, -17.32%, -19.32% to -15.32%). Conventional GLP-1 receptor agonists showed more modest effects. Similar patterns were seen for waist circumference and lipid outcomes. Treatment rankings suggested a probabilistic hierarchy favouring next generation incretin based treatments, although confidence intervals overlapped for several comparisons. Low certainty evidence suggested higher rates for discontinuing treatment with danuglipron and retatrutide, whereas mazdutide showed better tolerability.</p><p><strong>Conclusions: </strong>In adults with overweight or obesity without diabetes, next generation incretin based treatments achieved greater weight loss than conventional GLP-1 receptor agonists. Differences in tolerability, limited head-to-head evidence, and residual uncertainty, however, should be considered when interpreting comparative treatment effects.</p><p><strong>Study registration: </strong>PROSPERO CRD420261279841.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e003026"},"PeriodicalIF":9.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical effectiveness of sodium-glucose cotransporter 2 inhibitors in heart failure with preserved ejection fraction: nationwide cohort study (REFINE-HFpEF).","authors":"Padmini Selvaganesan, Mohamad Karnib, Irfan Helmy, Yogesh N V Reddy, Mohammed Osman, Jayakumar Sahadevan, Rosita Zakeri, Varun Sundaram","doi":"10.1136/bmjmed-2025-002380","DOIUrl":"10.1136/bmjmed-2025-002380","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical effectiveness of sodium glucose cotransporter 2 (SGLT2) inhibitors in reducing the risk of hospital admission for heart failure and mortality in a contemporary nationwide cohort of patients with heart failure with preserved ejection fraction (HFpEF).</p><p><strong>Design: </strong>Nationwide cohort study (REFINE-HFpEF).</p><p><strong>Setting: </strong>170 veteran health medical centres across the US, 1 January 2014 to 31 December 2021.</p><p><strong>Participants: </strong>2177 patients with type 2 diabetes and HFpEF; 1129 patients were newly prescribed SGLT2 inhibitors and 1048 were newly prescribed dipeptidyl peptidase 4 (DPP4) inhibitors or sulfonylureas.</p><p><strong>Main outcome measures: </strong>The primary outcome was a composite of all cause mortality and hospital admission for heart failure. Secondary outcomes included all cause mortality only and serial changes in body weight. Hazard ratios were derived from Cox proportional hazards models, incorporating inverse probability of treatment weighting based on propensity scores to account for confounding.</p><p><strong>Results: </strong>From a validated cohort of 179 288 patients with type 2 diabetes and HFpEF, the study included 1129 new users of SGLT2 inhibitors (active treatment) and 1048 new users of DPP4 inhibitors or sulfonylureas (comparators). After a median follow-up of 2.63 years, 46.4% of the study population had at least one hospital admission for heart failure (n=1011) and the overall mortality rate was 45.9% (n=1000). Use of SGLT2 inhibitors was associated with a relative risk reduction in the primary composite outcome of 18% compared with the use of DPP4 inhibitors or sulfonylureas (hazard ratio 0.82, 95% confidence interval 0.70 to 0.96; P=0.01). The adjusted hazard ratio for all cause mortality only was 0.73 (0.60 to 0.89; P=0.002). Weight loss was similar in the two groups.</p><p><strong>Conclusions: </strong>In this large, contemporary, nationwide cohort of patients with HFpEF, type 2 diabetes, and high event rates, starting SGLT2 inhibitors was associated with a significantly lower risk of hospital admission for heart failure and all cause mortality compared with starting treatment with DPP4 inhibitors or sulfonylureas.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002380"},"PeriodicalIF":9.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biological treatments for asthma and chronic obstructive pulmonary disease.","authors":"Vickram Tejwani, Trishul Siddharthan, Uddalak Majumdar, Umur Hatipoğlu, Nicola A Hanania","doi":"10.1136/bmjmed-2025-002195","DOIUrl":"10.1136/bmjmed-2025-002195","url":null,"abstract":"<p><p>Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent heterogeneous airway diseases in which a subset of patients with severe disease have a disproportionate share of morbidity and mortality, largely through exacerbations. Major immunological advances have reframed both conditions around endotypes, with type 2 (inflammation driven by type 2 helper cells and group 2 innate lymphoid cells) and other inflammatory pathways defined and targeted with biological treatments. This review provides an overview of biological treatments in asthma and COPD. Biological treatments are engineered monoclonal antibodies targeting proteins (eg, IgE, interleukin (IL) 5 and IL5 receptor, IL4 and IL13, and upstream epithelial alarmins, such as thymic stromal lymphopoietin (TSLP) and IL33) that enable precision treatment. Biological treatments consistently reduce exacerbations and improve lung function and quality of life in biomarker defined populations. In asthma, short term biomarkers (blood eosinophils, fractional exhaled nitric oxide (FeNO), and sputum eosinophils) guide selection, whereas emerging longer term markers, including transcriptomic signatures and imaging endpoints, offer mechanistic readouts and raise the prospect of disease modification. In COPD, type 2 biological medicines have yielded benefits among patients with high levels of eosinophils and who are prone to exacerbations, and anti-IL33 and TSLP treatments show mixed but intriguing signals. Blood eosinophil counts (≥300 cells/µL) remain the most robust predictor of benefit; FeNO may provide complementary categorisation in select settings. Priorities for treatment are identifying treatable traits, supporting comprehensive self-management, and timely referral for patients with exacerbations despite optimised inhaled treatment. Key gaps include head-to-head comparisons, criteria for switching or stopping biological medicines, feasibility of de-escalation of inhaled treatment, and type 2 low strategies.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002195"},"PeriodicalIF":9.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High altitude pulmonary hypertension: overlap with other types of pulmonary hypertension and implications for treatment.","authors":"Lindsay M Forbes, Tim Lahm","doi":"10.1136/bmjmed-2025-001786","DOIUrl":"10.1136/bmjmed-2025-001786","url":null,"abstract":"<p><p>High altitude pulmonary hypertension occurs in a subset of the 80-140 million people who live at altitudes ≥2500 m. This type of pulmonary hypertension is generally defined by a mean pulmonary artery pressure >30 mm Hg and is associated with symptoms of exercise intolerance, with possible progression to right heart failure. High altitude pulmonary hypertension can be difficult to distinguish from other forms of pulmonary hypertension, including pulmonary arterial hypertension and pulmonary hypertension caused by lung disease. In theory, removal from high altitude effectively treats high altitude pulmonary hypertension but not pulmonary arterial hypertension and pulmonary hypertension caused by lung disease. In reality, mechanistic overlap between the diseases exists, and the clinical phenotypes may likewise overlap. Limited evidence exists for other treatments for high altitude pulmonary hypertension, with the greatest rationale currently for pulmonary vasodilators. Future research should revisit the diagnostic threshold for high altitude pulmonary hypertension and for other forms of pulmonary hypertension at high altitude. Also, more research is needed to better differentiate between patients living at high altitude with high altitude pulmonary hypertension and those with other forms of pulmonary hypertension, and to define which treatments can be extrapolated from other types of pulmonary hypertension to high altitude pulmonary hypertension.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001786"},"PeriodicalIF":9.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of gestational diabetes and inequalities in adverse pregnancy outcomes in England: contemporary, cross sectional observational study of 2.7 million births.","authors":"Carlos Sánchez-Soriano, Niamh-Maire McLennan, Sara L White, Nithya Sukumar, Ponnusamy Saravanan, Robert S Lindsay, Thomas Bolton, Fionna Chalmers, Laura A Magee, Rebecca M Reynolds","doi":"10.1136/bmjmed-2025-002412","DOIUrl":"10.1136/bmjmed-2025-002412","url":null,"abstract":"<p><strong>Objectives: </strong>To quantify the incidence of gestational diabetes mellitus in England, determine inequalities in diagnoses and pregnancy outcomes, and assess the indirect effects of the covid-19 pandemic.</p><p><strong>Design: </strong>Contemporary, cross sectional observational study.</p><p><strong>Setting: </strong>Primary and secondary care data from NHS England, based on the Hospital Episode Statistics Admitted Patient Care dataset, 1 January 2018 to 31 December 2022.</p><p><strong>Participants: </strong>2 314 365 women, aged 16-50 years, who gave birth to 2 758 170 babies in 184 hospitals.</p><p><strong>Main outcome measures: </strong>Rates of gestational diabetes, infants born small for gestational age or large for gestational age, and emergency caesarean births, summarised yearly and monthly, based on socioeconomic deprivation and ethnic group.</p><p><strong>Results: </strong>Diagnoses of gestational diabetes increased from about 8% in 2018 to >12% in 2022. The increase was greatest for individuals from non-white ethnic groups (23% for Asian women) or those living in deprivation (14%). Mothers from these backgrounds were also at greater risk of adverse pregnancy outcomes, such as emergency caesarean birth (odds ratio for black mothers 1.36, 95% confidence interval 1.34 to 1.38), preterm birth (odds ratio for deprived mothers 1.29, 1.27 to 1.31), or having an infant small for gestational age (odds ratio for Asian mothers 2.42, 2.39 to 2.45). Also, a diagnosis of gestational diabetes for these women was associated with an increase in the odds of preterm birth. Changes to screening methodology for gestational diabetes during the covid-19 pandemic had no significant effect on the number of diagnoses.</p><p><strong>Conclusions: </strong>The study found that one in eight mothers in England had a diagnosis of gestational diabetes, and that profound health inequalities exist in their outcomes. Strategies are urgently needed to provide and improve care for this high risk group, given the implications of gestational diabetes on the short and long term health outcomes for mothers and babies.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002412"},"PeriodicalIF":9.3,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Completion and outcomes of postmarketing requirements and commitments issued by the US Food and Drug Administration for new drugs, 2016-24: cross sectional evaluation of postmarketing studies.","authors":"Maximilian Siebert, Rylee McGonigle, Alba Gutiérrez-Sacristán, Huseyin Naci, Anita K Wagner, Florence T Bourgeois","doi":"10.1136/bmjmed-2025-002307","DOIUrl":"10.1136/bmjmed-2025-002307","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the use of postmarketing requirements under the FDA Amendments Act (FDAAA) and postmarketing commitments issued by the US Food and Drug Administration (FDA), for new drugs approved from 2016 to 2024, and to determine rates of study completion and changes in drug labelling resulting from these studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Cross sectional evaluation of postmarketing studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;All new drugs and their associated indications approved by the FDA's Center for Drug Evaluation and Research, 1 January 2016 to 31 December 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Population: &lt;/strong&gt;420 drugs approved by the FDA for 567 indications, associated with 913 FDAAA postmarketing requirements and 434 postmarketing commitments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Drug characteristics associated with issuance of FDAAA postmarketing requirements and issuance of postmarketing commitments, rates of study completion and on-time completion, and proportion of studies leading to changes in drug labelling.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;More than two thirds of drugs (n=287, 68.3%) had at least one FDAAA postmarketing requirement and 42.9% (n=180) had at least one postmarketing commitment. Indications with an orphan designation were more likely to have an FDAAA postmarketing requirement (63.3% &lt;i&gt;v&lt;/i&gt; 48.6%; absolute difference 14.7%, 95% confidence interval (CI) 6.7% to 22.8%), as were indications approved with an expedited programme (59.6% &lt;i&gt;v&lt;/i&gt; 48.1%; absolute difference 11.5%, 2.7% to 20.3%). Similarly, postmarketing commitments were more likely to be issued for indications with an orphan designation (47.0% &lt;i&gt;v&lt;/i&gt; 33.6%; absolute difference 13.4%, 5.4% to 21.4%) and those using expedited approval programmes (47.9% &lt;i&gt;v&lt;/i&gt; 23.8%; absolute difference 24.1%, 16.2% to 32.1%). Among studies due by the end of 2024, 73.4% (95% CI 69.2% to 77.3%; n=345) of FDAAA postmarketing requirements and 81.5% (76.3% to 86.1%; n=212) of postmarketing commitments were completed, although only 33.4% (29.1% to 37.9%) (n=157) and 36.2% (30.3% to 42.3%) (n=94), respectively, were completed on time. Of the 311 fulfilled FDAAA postmarketing requirement studies, 63.3% (n=197) resulted in at least one labelling change, most often in the section on use in specific populations and clinical pharmacology. Fewer postmarketing commitment studies (n=94, 49.7%) resulted in changes in drug labelling, with most changes found in the clinical pharmacology and clinical studies sections.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;FDAAA postmarketing requirements and postmarketing commitments are important regulatory tools for generating postapproval evidence, particularly for drugs approved with orphan designation or under expedited programmes. Although a large proportion of studies resulted in changes in drug labelling, delays in completion were common, highlighting the need to ensure effective oversight and timely study completion and re","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002307"},"PeriodicalIF":9.3,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13405232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gestational weight gain and maternal immediate perinatal and postpartum outcomes in low and middle income countries: individual participant data meta-analyses.","authors":"Uttara Partap, Janaína Calu Costa, Enju Liu, Ilana R Cliffer, Dongqing Wang, Molin Wang, Sudeer Kumar Nookala, Vishak Subramoney, Brittany Briggs, Ajibola Ibraheem Abioye, Manfred Accrombessi, Seth Adu-Afarwuah, Sheraz Ahmed, Hellen Akurut, Hasmot Ali, Asad Ali, Joao Guilherme Alves, Teddy Andra, Carla Adriane Leal de Araújo, Alemayehu Argaw, Shams Arifeen, Rinaldo Artes, Per Ashorn, Ulla Ashorn, Fereidoun Azizi, Bowen Banda, Ahmed Tijani Bawah, Nita Bhandari, Zulfiqar A Bhutta, Valerie Briand, Elvira Beatriz Calvo, Marly Augusto Cardoso, Marcia Caldas de Castro, Jose Guilherme Cecatti, Gabriela Chico-Barba, Ranadip Chowdhury, Parul Christian, Shalean Collins, Anthony Costello, Kathryn G Dewey, Titus H Divala, Jamille Gregório Dombrowski, Michele Drehmer, Christopher P Duggan, Pratibha Dwarkanath, Alison M Elliott, Davaasambuu Enkhmaa, Daniel Erchick, Guadalupe Estrada-Gutierrez, Frankie J Fair, Henrik Friis, Jimena Fritz, Samira Behboudi Gandevani, Davaasumbuu Ganmaa, Armando García-Guerra, Alison D Gernand, Exnevia Gomo, Austrida Gondwe, Isabel González-Ludlow, Rebecca Grais, Ousmane Guindo, Lotta Hallamaa, Davidson H Hamer, Giles Hanley-Cook, Alain Hien, Lieven Huybregts, Sheila Isanaka, Fyezah Jehan, Gilberto Kac, Richard Kajubi, Abel Kakuru, Margaret P Kasaro, Joanne Katz, Subarna K Khatry, Nancy F Krebs, Pratap Kumar, Anura V Kurpad, Carl Lachat, Tsering Pema Lama, Hector Lamadrid-Figueroa, Hermann Lanou, Anna Lartey, Miriam K Laufer, See Ling Loy, Nur Indrawaty Lipoeto, Laura Beatriz López, Liania Alves Luzia, Abdullah Mahmud, G Arun Maiya, Kenneth Maleta, Dharma S Manandhar, Mark J Manary, Charles Mangani, Claudio Romero Farias Marinho, Hugo Martínez-Rojano, Susana L Matias, Alicia Matijasevich, Elizabeth M McClure, Sotero S Mengue, Joshua D Miller, Sophie E Moore, Marhazlina Mohamad, Hamid Jan Jan Mohamed, Malay Kanti Mridha, Ferdinand M Mugusi, Ameer Muhammad, Alfa Muhihi, T Verenice Muñoz-Rocha, Wilbroad Mutale, Lynnette M Neufeld, Phuong Hong Nguyen, Maria Angélica Antunes Nunes, Maria Ome-Kaius, David Osrin, Noel Patson, Andrea B Pembe, Otilia Perichart-Perera, Karen E Peterson, Zul Premji, Andrew M Prentice, Amado D Quezada-Sánchez, Najeeb Rahman, Preetha Ramachandra, Usha Ramakrishnan, Arjumand Rizvi, Dominique Roberfroid, Patricia Lima Rodrigues, Stephen J Rogerson, Patricia Hc Rondó, Daniel E Roth, Reyna Sámano, Naomi M Saville, Maria Inês Schmidt, Katherine Ea Semrau, Yasir Shafiq, Saijuddin Shaikh, Bhim P Shrestha, José Roberto Da Silva, Hora Soltani, Sajid Soofi, Rodrigo Medeiros Martorano, Renato Teixeira Souza, Dan J Stein, Jeffrey Sa Stringer, Christopher R Sudfeld, Sunita Taneja, Fahimeh Ramezani Tehrani, Tinku Thomas, James M Tielsch, Laéticia Céline Toe, Holger W Unger, Willy Urassa, Juliana Dos Santos Vaz, Audêncio Victor, Emily L Webb, Keith P West, Elizabeth Widen, Lesley Workman, Robert O Wright, Lee Shu Fune Wu, Sera L Young, Heather Zar, Lingxia Zeng, Wafaie W Fawzi","doi":"10.1136/bmjmed-2025-001558","DOIUrl":"10.1136/bmjmed-2025-001558","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To estimate the associations between gestational weight gain and maternal immediate perinatal and postpartum outcomes by pooling data from low and middle income countries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Individual participant data meta-analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;PubMed, Embase, Web of Science, and Cochrane Library, based on three searches (Search 1: all prospective studies published from January 2000 to May 2021; Search 2: randomized controlled trials of balanced energy and protein supplementation published until June 2021; Search 3: randomized controlled trials of anti-infectious agents published until August 2021).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria for selecting studies: &lt;/strong&gt;Prospective studies (randomised controlled trials or observational cohort studies) with measured maternal weight during pregnancy and data available on maternal height, based in populations from low and middle income countries with no underlying conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The analyses included 156 300 women from 61 studies and 23 countries, with most participants based in South Asia (n=78 454, 50.2%) and sub-Saharan Africa (n=36 327, 23.2%). Compared with women with adequate (90-125%) gestational weight gain, women with excessive (&gt;125%) gestational weight gain had a higher risk of caesarean delivery (risk ratio 1.10, 95% confidence interval 1.06 to 1.13, τ&lt;sup&gt;2&lt;/sup&gt;=0.000) and emergency caesarean delivery (risk ratio 1.22, 1.03 to 1.43, τ&lt;sup&gt;2&lt;/sup&gt;=0.000). Women with moderately (70% to &lt;90%) or severely inadequate (&lt;70%) versus adequate gestational weight gain had lower risks for caesarean delivery (risk ratio in women with moderately inadequate gestational weight gain 0.88, 95% confidence interval 0.84 to 0.92, τ&lt;sup&gt;2&lt;/sup&gt;=0.004; risk ratio in women with severely inadequate gestational weight gain 0.82, 0.77 to 0.88, τ&lt;sup&gt;2&lt;/sup&gt;=0.010) and emergency caesarean delivery (risk ratio in moderately inadequate gestational weight gain 0.82, 0.71 to 0.95, τ&lt;sup&gt;2&lt;/sup&gt;=0.004; risk ratio in severely inadequate gestational weight gain 0.73, 0.56 to 0.96, τ&lt;sup&gt;2&lt;/sup&gt;=0.103). Excessive versus adequate gestational weight gain was associated with higher postpartum weight retained at any time point (mean difference 2.00 kg, 95% confidence interval 1.49 to 2.50, τ&lt;sup&gt;2&lt;/sup&gt;=1.317), whereas moderately and severely inadequate gestational weight gain were associated with lower retained weight compared with adequate gestational weight gain. Similar trends were found for postpartum body mass index. Severely inadequate gestational weight gain was associated with lower systolic and diastolic blood pressure at any time point post partum than adequate gestational weight gain. No associations were observed for other outcomes including postpartum depressive symptoms or breastfeeding. Evidence indicating an interaction between gestational weight gain and body mass index before pregnancy was found when examining the","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001558"},"PeriodicalIF":9.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehabilitation in preparation for surgery.","authors":"Daniel I McIsaac, Leandra Amado, Gurlavine Kidd, Christopher Wanczycki, Ianthe Boden, Emily Hladkowicz, Chelsia Gillis","doi":"10.1136/bmjmed-2025-001969","DOIUrl":"10.1136/bmjmed-2025-001969","url":null,"abstract":"<p><p>Prehabilitation transforms the preoperative waiting period into an opportunity for patients to actively improve their health before surgery. With surgical populations ageing and presenting with increasing frailty, patient prioritised outcomes, such as postoperative complications and disability, affect >20% of patients undergoing major surgery, resulting in substantial healthcare costs. This review combines the current evidence for prehabilitation components, including exercise, and respiratory, nutritional, cognitive, and psychosocial interventions. Although respiratory prehabilitation showed high certainty evidence for reducing postoperative pulmonary complications after major surgery, other components showed promising but lower certainty benefits. Multimodal prehabilitation, especially when exercise and nutrition are combined, seems to be most effective for improving clinical and patient centred outcomes. Significant knowledge gaps remain, however, about optimal programme design, delivery models, target populations, and strategies to maximise adherence. Patient perspectives emphasise the importance of individualised coaching or support from healthcare professionals, or both, home based accessibility, and collaborative care. Future research should include a focus on pragmatic multicentre trials with robust cost effectiveness analyses to support implementation in the health system of effective, scalable prehabilitation programmes that can meaningfully improve outcomes for surgical patients. Opportunities to enhance the effectiveness and reach of prehabilitation include exploiting existing and emerging technologies, as well as optimising participant support to maximise adherence.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001969"},"PeriodicalIF":9.3,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}