Women With PCOS Should Be Screened for Mental Health Issues

MedicalResearch.com Interview with:
Aled Rees, MD, PhD
Neuroscience and Mental Health Research Institute
Cardiff University School of Medicine, Health Park
Cardiff United Kingdom

MedicalResearch.com: What is the background for this study?  

Response: PCOS is a common condition, affecting 5-10% of women globally, in which elevated male hormone levels can cause a range of distressing and life-limiting symptoms, including reduced fertility, irregular periods, excessive facial and body hair, and acne. Previous studies have suggested a link between PCOS and poor mental health in women but the studies were small and did not adequately take other factors that can affect mental health into consideration. In addition, high levels of testosterone during pregnancy have been reported to increase the risk of neurodevelopmental disorders, such as ADHD and autism, in children.

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Prenatal Exposure to SSRIs May Be Linked to Changes in Infant Brain Development

MedicalResearch.com Interview with:

Jiook Cha, PhD Assistant Professor Division of Child and Adolescent Psychiatry  Columbia University Medical Center  New York, NY 10032

Dr. Jiook Cha

Jiook Cha, PhD
Assistant Professor
Division of Child and Adolescent Psychiatry
Columbia University Medical Center
New York, NY 10032

MedicalResearch.com: What did we already know about the connection between maternal SSRI use during pregnancy and infant brain development, and how do the current study findings add to our understanding? What’s new/surprising here and why does it matter for mothers and babies?

Response: Prior studies have shown mixed results in terms of the associations between maternal SRI use during pregnancy and offspring’s brain and cognitive development. Neurobiological studies with animal models suggest that SSRI use perturbs serotonin signaling and that this has important effects on cognitive development (a study conducted an author of this paper, Jay Gingrich, MD, PhD: Ansorge et al., 2004, Science). The human literature has been more mixed in terms of the associations of prenatal exposure to SSRI with brain and cognitive development.

In our study, we used neonatal brain imaging because this is a direct, non-invasive method to test associations between SSRI use and brain development at an early developmental stage, limiting the effects of the post-natal environment. In our study, we had two different control groups, that is, a non-depressed SSRI-free group (healthy controls), and depressed but SSRI-free (SSRI controls) group. Also, in our study we used rigorous imaging analytics that significantly improve the quantitative nature of MR-derived signals from the brain structure using two of the nation’s fastest supercomputers (Argonne National Laboratory and Texas Advanced Computing Center) and allows robust reconstruction of brain’s grey and white matter structure in the infants’ brains.

We report a significant association of prenatal exposure to SSRI with a volume increases within many brain areas, including the amygdala and insula cortex, and an increase in white matter connection strength between the amygdala and insular cortex. We were surprised by the magnitude of the effects (or the statistical effect size), compared with other brain imaging studies in psychiatry with children or adults’ brains. Importantly, it should be noted that our estimates of brain structure are still experimental and for research-purpose only. This means that our data need to be replicated and rigorously tested against confounders in order to make a firm conclusion. While our study suggests a “potential” association between prenatal exposure to SSRI and a change in fetal or infant brain development, we still need more research. 

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Prenatal SSRI Exposure Linked to Altered Infant Brain Development

MedicalResearch.com Interview with:

Claudia I. Lugo-Candelas, PhD Postdoctoral Research Fellow Columbia University Medical Center/ New York State Psychiatric Institute

Dr. Lugo-Candelas

Claudia I. Lugo-Candelas, PhD
Postdoctoral Research Fellow
Columbia University Medical Center/ New York State Psychiatric Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have seen, in the last decade, an increase in the amount of mothers being prescribed SSRIs during pregnancy. While we know that untreated prenatal maternal depression has adverse consequences for both the mother and child, it’s not really clear what, if any, are the consequences of prenatal SSRI exposure on infant’s brain development. There have been some studies finding increased depression and anxiety in children prenatally exposed to SSRIs, but not all studies find these associations.

We thus looked at 2-4 week old infants’ brains, using neuroimaging.  We found increased gray matter volume within the amygdala and insula, and increased white matter connectivity between these two structures in infants prenatally exposed to SSRIs. Of note, the statistical significance and the size of the effects we detected are quite large, even greater than the brain changes that we usually observe in our studies of children and adults with psychiatric disorders. Further, because these structures are involved in emotion processing, and alterations in volume and connectivity are sometimes seen in clinical populations, or in people at risk for anxiety, it important to learn more about what these volume and connectivity differences could mean for these infants.

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Two Genes Linked to Severe Nausea and Vomiting in Pregnancy

MedicalResearch.com Interview with:

Marlena Fejzo, PhD Aassociate researche David Geffen School of Medicine UCLA.

Dr. Fejzo

Marlena Fejzo, PhD
Aassociate researche
David Geffen School of Medicine
UCLA. 

MedicalResearch.com: What is the background for this study?

Response: Most women experience some nausea and vomiting of pregnancy, and the worst 2% are diagnosed with Hyperemesis Gravidarum which is associated with poor maternal and fetal outcomes. I had HG in 2 pregnancies. In my second pregnancy my HG was so severe that I could not move without vomiting and did not keep any food or water down for 10 weeks. I was put on a feeding tube, but ultimately lost the baby in the second trimester. I am a medical scientist by training so I looked into what was known about HG. At the time, very little was known, so I decided to study it. I partnered with the Hyperemesis Education and Research Foundation (HER) and we did a survey on family history of .Hyperemesis Gravidarum that provided evidence to support a role for genes. I collected saliva samples from HG patients and their unaffected acquaintances to do a DNA study. Then I partnered with the personal genetics company, 23andMe to do a genome scan and validation study, which identified 2 genes, GDF15 and IGFBP7, linked to HG.

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Estrogen Improved Disordered Eating Patterns in Young Women With Irregular Menses

MedicalResearch.com Interview with:

Madhusmita Misra, MD, MPH Division Chief, Pediatric Endocrinology Fritz Bradley Talbot and Nathan Bill Talbot Professor of Pediatrics, Harvard Medical School

Dr.Madhusmita Misra

Madhusmita Misra, MD, MPH
Division Chief, Pediatric Endocrinology
Fritz Bradley Talbot and Nathan Bill Talbot Professor of Pediatrics,
Harvard Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Disordered eating behavior is common in conditions of functional hypothalamic amenorrhea, such as anorexia nervosa and exercise-induced amenorrhea, which are also associated with anxiety and depression. In hypoestrogenic rodents, estrogen replacement reduces anxiety-related behavior. Similarly, physiologic estrogen replacement in adolescents with anorexia nervosa reduces anxiety and prevents the increased body dissatisfaction observed with increasing weightHowever, the impact of estrogen administration on disordered eating behavior and psychopathology in normal-weight young women with exercise-induced amenorrhea is unknown.

Adolescent and young adult normal-weight athletes 14-25 years old with irregular periods were randomized to receive (i) physiologic estrogen replacement using a transdermal patch with cyclic progesterone, or (ii) an oral estrogen-progesterone containing pill (an oral contraceptive pill), or (iii) no estrogen for 12-months. The Eating Disorder Inventory-2 (EDI-2) and Three-Factor Eating Questionnaire (TFEQ) were administered ag the beginning and the end of the study to assess disordered eating behavior and psychopathology.

We found that the group that did not receive estrogen had a worsening of disordered eating behavior and psychopathology over the 12-months duration of the study, but this was not observed in the group that received estrogen replacement. Further, body dissatisfaction scores improved over 12-months in the groups receiving estrogen replacement, with the transdermal estrogen group showing the strongest effect.

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Topical Estrogen No Better Than Moisturizer for Postmenopausal Vaginal Dryness

MedicalResearch.com Interview with:

Caroline Mitchell, MD, MPH Vincent Center for Reproductive Biology Assistant Professor, Obstetrics, Gynecology & Reproductive Biology

Dr. Caroline Mitchell

Caroline Mitchell, MD, MPH
Vincent Center for Reproductive Biology
Assistant Professor, Obstetrics, Gynecology & Reproductive Biology
http://massgeneral.link/MitchellLab

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In this study we compared two commonly recommended treatments for menopausal vaginal discomfort – low dose vaginal estradiol tablets and a vaginal moisturizer – to placebo, and found no difference in reduction of symptom severity; all three groups improved over 12 weeks of treatment.  This is great news for women, as it means that using any treatment regularly is likely to have benefit, whether it costs $20 or $200.

Symptoms of vaginal dryness, irritation and pain with sex, which occur in over half of postmenopausal women, cause a significant decrease in quality of life and negatively impact intimate relationships.  The significant impact of these symptoms is reflected in the fact that we enrolled all 302 participants in under a year, a faster enrollment than any of the four prior trials  conducted by the MsFlash research network that evaluated treatments for hot flashes.  Women were desperate for some kind of intervention for these symptoms. Continue reading

Can Probiotics and Fish Oil Supplements During Pregnancy Reduce Childhood Allergies?

MedicalResearch.com Interview with:
Dr Robert Boyle, 
Reader in Paediatric Allergy
Department of Medicine
Imperial College London

MedicalResearch.com: What is the background for this study?

Response: Diet in early life may influence whether or not an infant develops allergies or autoimmune disease. We undertook a project for the UK Food Standards Agency to evaluate the evidence for this.

MedicalResearch.com: What are the main findings? 

Response: We found that a probiotic supplement during the last 2-4 weeks of pregnancy and during breastfeeding may reduce an infant’s chances of developing eczema; and that omega-3 fatty acid supplements taken from the middle of pregnancy (20 weeks gestation) through the first few months of breastfeeding may reduce an infant’s chances of developing food allergy. We also found links between longer duration of breastfeeding and improved infant health, but for most other variations in diet during pregnancy or infancy we did not find evidence for a link with allergies or autoimmune disease.

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Pregnancy in Type 1 Diabetes: Glucose Control Can Reduce Fetal Overgrowth

MedicalResearch.com Interview with:

Rachel McGrath BSc (Hons), PhD Senior Research Fellow - Department of Endocrinology, RNSH Clinical Senior Lecturer - Northern Clinical School University of Sydney

Dr. Rachel McGrath

Rachel McGrath BSc (Hons), PhD
Senior Research Fellow – Department of Endocrinology, RNSH
Clinical Senior Lecturer – Northern Clinical School
University of Sydney 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Women with type 1 diabetes are significantly more likely to experience complications during pregnancy and to have infants with high birth weights. This can result in adverse outcomes at the time of delivery for both mother and baby, and can also predispose infants to obesity and chronic disease in later life.

The relationship between maternal blood glucose levels and foetal growth in type 1 diabetes in pregnancy has not been completely elucidated. Thus, we examined the association between maternal glycaemic control and foetal growth by examining serial ultrasound measurements and also by determining the relationship between HbA1c (a measure of circulating glucose exposure over a three month time period) and infant birth weight.

We found that maternal glucose levels were directly related to foetal abdominal circumference in the late second and third trimesters and also to birth weight. We also confirmed the results of previous studies to show that the optimal HbA1c during pregnancy to reduce the likelihood of large-for-gestational-age neonates is < 6%.  Continue reading

Relationship Status Helps Determine Contraception Choice

MedicalResearch.com Interview with:
“Birth control pills” by lookcatalog is licensed under CC BY 2.0Marie Harvey, DrPH MPH
Lisa P. Oakley, PhD MPH
College of Public Health and Human Sciences
Oregon State University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Because decisions about contraceptives are often made by young adults in the context of their relationships and specific partners, the characteristics of that relationship and feelings about that partner will likely influence how those decisions are made. Many studies have previously investigated individual factors that affect contraceptive choice and when examining partner influences have used questions that were not specific to a particular partner. Intuition, however, suggests that feelings for a specific partner would likely influence one’s perception of risk for disease acquisition, and thereby, their contraceptive choice. So, it was important to us to look at the influences of each specific partner and how the unique dynamics of each partnership influence contraceptive use.

In this study, we investigated how relationship qualities and dynamics (such as commitment and sexual decision-making) impact contraceptive choice above and beyond individual factors. We also used partner-specific questions.

We found that both individual and partner-specific relationship qualities and dynamics predicted contraceptive use, but these factors varied by contraceptive method. For example, young adults who reported greater exclusivity with a specific partner and more relationship commitment were less likely to use only condoms with that partner. Additionally, individuals who felt they played a strong role in making sexual decisions in their relationship were also more likely to only use condoms. Continue reading

How Much Genetic Information From Prenatal Testing Do Pregnant Women Want?

“Pregnancy 1” by operalynn is licensed under CC BY 2.0MedicalResearch.com Interview with:
Professor Jane Halliday, PhD
Group Leader, Public Health Genetics
Genetics
Murdoch Childrens Research Institute
The Royal Children’s Hospital
Parkville, Victoria  AUS 

MedicalResearch.com: What is the background for this study?

Response: The aim of the study was to examine the choice that pregnant women make about the amount of genetic information they want from their pregnancy. Women who underwent prenatal testing via chorionic villus sampling (CVS) or amniocentesis were recruited from across seven sites in Victoria.

Provision of this choice is not routinely offered but we thought it was important to look at this issue carefully, in a real-time setting, because, over the last five years, advances in technology have transformed how genetic abnormalities can be detected during a pregnancy.  Rather than examining genetic material (chromosomes) down the microscope, it is now possible to use a technique called ‘microarray’ which can do the analysis with 100 times greater depth than can be achieved using a microscope. The plus side is that the microarray technique can detect a far greater number of potentially important genetic differences; but a down side is that it can also detect many changes for which the impact on the health of the baby is unknown or uncertain.

Examples of genetic differences that carry certainty are major chromosome abnormalities such as the trisomies e.g. Down Syndrome, and deletions associated with severe intellectual disability in 100% of cases, e.g. 1p.36 deletion. Uncertain findings are the various small deletions and duplications that are known to only have an adverse outcome in 10-20% of people with them.

All participants were provided with a decision aid which described in detail the choice available in regards to the genetic information. The options were ‘targeted’, where only the information that would affect health of the baby was provided, or ‘extended’, where all information, even the uncertain aspects, was provided. Participants were asked to read the decision aid, complete a ten minute survey along with indicating their choice of genetic information.

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