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BackgroundTo evaluate the effect of magnesium (Mg) replacement on insulin resistance and cardiovascular risk factors in women with metabolic syndrome (MS) without diabetes.MethodsThis 12-week clinical randomized double-blind study compared the effects of 400 mg/day of Mg with those of a placebo (n = 72) on fasting glucose, insulin, HOMA-IR, lipid profile and CRP. Mg was measured in serum (SMg) and in mononuclear cells (MMg).ResultsHypomagnesemia (SMg < 1.7 mg/dL) was seen in 23.2% of patients and intracellular depletion in 36.1% of patients. The MMg means were lower in patients with obesity (0.94 ± 0.54 μg/mg vs. 1.19 ± 0.6 μg/mg, P = 0.04), and insulin resistance (0.84 ± 0.33 μg/mg vs. 1.14 ± 0.69 µg/mg, P < 0.05). Mg replacement did not alter SMg (1.82 ± 0.14 mg/dL vs. 1.81 ± 0.16 mg/dL, P = 0.877) and tended to increment MMg (0.90 ± 0.40 μg/mg vs. 1.21 ± 0.73 μg/mg, P = 0.089). HOMA-IR did not alter in interventions nor in placebo group (3.2 ± 2.0 to 2.8 ± 1.9, P = 0.368; 3.6 ± 1.9 to 3.2 ± 1.8, respectively), neither did other metabolic parameters.ConclusionSerum and intracellular Mg depletion is common in patients with MS; however, Mg replacement in recommended dosage did not increase significantly Mg levels, neither reduced insulin resistance or metabolic control.

Objective To evaluate whether a department policy changing the scheduling of the postpartum visit from 6 weeks to 2–3 weeks after delivery is associated with higher long-acting reversible contraception (LARC) initiation at the postpartum visit. Methods We conducted a quasi-experimental before–after study to evaluate LARC initiation, specifically an intrauterine device (IUD) or contraceptive implant, at the postpartum visit between women scheduled for follow-up at 6 weeks (before policy change) and 2–3 weeks after delivery (after policy change). Secondary outcomes included postpartum visit completion, overall contraception initiation at the postpartum visit, overall contraceptive use at 6 months after delivery, and repeat pregnancies by 6 months postpartum. We obtained delivery and postpartum information using the electronic medical record and contacted participants 3 and 6 months after delivery to assess contraception use and repeat pregnancies. Results We enrolled 586 participants between December 2014 and November 2015, of whom 512 women (256 in each cohort) continued to meet eligibility criteria after delivery. Long-acting reversible contraception initiation rates at the postpartum visit were lower in the 2–3 week (16.5%, 95%CI 12.2–21.8) compared to 6-week group (31.1%, 95%CI 25.2–37.7, p<0.01), primarily due to patient and health care provider preferences for delaying IUD insertion to a later visit. More women completed a scheduled 2–3 week postpartum visit (90.2%, 95%CI 86.0–93.3) compared to 6-week visit (81.6%, 95%CI 76.4–85.9, p<0.01). Deferral of any contraception initiation was higher in the 2–3 week group (27.3%, 95%CI: 21.9–33.4) compared to 6-week group (15.8%, 95%CI: 11.5–21.4, p<0.01), but there were no differences in overall contraceptive use patterns at 6 months postpartum. No IUD perforations or expulsions were observed in women who underwent insertion at 2–3 weeks postpartum. Five pregnancies were reported in each cohort by 6 months after delivery. Conclusions Scheduling a visit at 2–3 weeks after delivery was not associated with increased LARC initiation at this visit despite higher postpartum visit attendance.