Author Interviews, Brigham & Women's - Harvard, OBGYNE, Pediatrics / 18.11.2016

MedicalResearch.com Interview with: Melissa C. Bartick, MD, MSc Department of Medicine Cambridge Health Alliance Harvard Medical School Cambridge, MA MedicalResearch.com: What is the background for this study? Response: This is the first study ever to combine maternal and pediatric health outcomes from breastfeeding into a single model. We had published a cost analysis of suboptimal breastfeeding for pediatric disease in 2010, which found that suboptimal breastfeeding cost the US $13 billion in costs of premature death costs and medical expenses, and 911 excess deaths. We followed that up with a maternal cost analysis which found about $18 billion in premature death costs and medical expenses. In both these studies, most of the costs were from premature death. We were unable to combine the results of these two studies because their methodologies were different, and both of them, especially the pediatric portion needed to be updated. (more…)
Author Interviews, JAMA, OBGYNE, Surgical Research, Weight Research / 15.11.2016

MedicalResearch.com Interview with: Brodie Parent, MD MS General Surgery R4 University of Washington MedicalResearch.com: What is the background for this study? What are the main findings? Response: We already knew that women with a history of bariatric surgery are a high risk group when it comes to childbirth. Our study has confirmed prior data which show that infants from these women are at a higher risk for being premature, low birth-weight, or requiring ICU admission. However, this is some of the first data which looks at their risk over time after recovery from the operation. Data from this study show that risks to the infant are highest in the first 3 years after an operation, and diminish over time. This suggests that women should wait a minimum of three years after an operation before attempting conception. (more…)
Author Interviews, OBGYNE, Pediatrics / 10.11.2016

MedicalResearch.com Interview with: Jason Bentley, MBiostat Doctoral Fellow Menzies Centre for Health Policy University of Sydney MedicalResearch.com: What is the background for this study? Response: Planned birth (labor induction or pre-labor caesarean section) is a decision to intervene and so determines a gestational age at birth that would have otherwise been later if pregnancy had progressed through to spontaneous labor. Significant changes in clinical practice have seen an increase in planned births before 39-40 completed week’s gestation from an increased use of primary and repeat cesarean section and a greater use of labor induction. At a population level this has resulted in a decrease in modal gestational age with planned birth accounting for almost half of births before 39-40 weeks. Clinical research has indicated that the threshold for planned birth and the gestational age for intervening has reduced. Numerous reasons have been given as justification for this including litigation, patient and provider perception of safety versus risk, reduced perinatal mortality, increased fetal monitoring, maternal age, obesity and convenience. There has also been the clinical perception that birth just before the optimal date carries little significant morbidity, with a focus on short-term risks to mother or baby only rather than longer-term outcomes. It is of paramount importance to ensure there are no unintended harms from such a significant shift in clinical practice. This study investigated whether the timing of planned birth was associated with poorer developmental outcomes at school age. (more…)
Author Interviews, JAMA, OBGYNE, Pediatrics / 09.11.2016

MedicalResearch.com Interview with: Dr. Sharon Unger BSc, MD, FRCP Staff Neonatologist at Mount Sinai Hospital Associate Staff Neonatologist at The Hospital for Sick Children (SickKids) Associate Professor in the Department of Paediatrics at the University of Toronto. Medical Director of the Rogers Hixon Ontario Human Milk Bank and Dr. Deborah L. O’Connor PhD, RD Senior Associate Scientist in Physiology & Experimental Medicine SickKids and Professor Department of Nutritional Sciences at the University of Toronto MedicalResearch.com: What is the background for this study? What are the main findings? Response: Babies who are born very early (before 32 weeks’ gestation) and/or at very low weights (less than 1,500 grams) are among the most fragile of all paediatric patients, typically facing serious medical issues and requiring care in a Neonatal Intensive Care Unit (NICU). In addition to underdeveloped organs and risk of neurodevelopmental issues, preterm and very low birth weight babies are at risk of a severe bowel emergency called necrotizing enterocolitis, which involves the damage and potential destruction of the intestinal tissue. This disease affects approximately six per cent of very low birth weight infants each year, making it one of the most common causes of death and long-term complications in this population. As a neonatologist and a PhD-trained dietitian, we have spent our careers working to improve outcomes for babies and supporting breastfeeding. While there is already strong evidence to suggest that breastfeeding is associated with a variety of benefits including reduced risk of childhood infections and may play a role in the prevention of overweight and diabetes, in healthy, full-term infants, we launched a research program a decade ago to figure out how to ensure the same advantage could be provided to vulnerable hospitalized infants, specifically very low birth weight infants. Breastfeeding initiation rates in Canada are now at all-time high for healthy newborns, but for many reasons related to preterm birth, up to two thirds of mothers of very low birth weight infants are unable to provide a sufficient volume of breast milk to their infant. A variety of factors may limit breast milk production in these cases, including immaturity of the breast cells that make milk, maternal illness, breast pump dependency, and stress. In addition to the health benefits attributed to mother’s milk for full-term, healthy infants, previous studies have shown that use of mother’s milk in very low birth weight infants is associated with a reduction in necrotizing enterocolitis. It is also associated with a reduction in severe infection, improved feeding tolerance and more rapid hospital discharge. Ten years ago, along with our inter-professional colleagues at 21 NICUs in the Greater Toronto and Hamilton areas, we began to examine whether using donor breast milk as a supplement to mother’s milk would improve health outcomes of very low birth weight infants when mother’s milk was not available. (more…)
Anemia, Author Interviews, OBGYNE / 07.11.2016

MedicalResearch.com Interview with: Daniel C Benyshek, PhD Professor, Department of Anthropology Adjunct Professor, UNLV School of Medicine Co-Director, Metabolism, Anthropometry and Nutrition Lab University of Nevada, Las Vegas MedicalResearch.com: What is the background for this study? What are the main findings? Response: Maternal placentophagy is ubiquitous among nearly all terrestrial mammals, but is rare to non-existent among humans in the historic and cross-cultural records. Recently, however, human maternal placentophagy has emerged as a popular trend among a small but growing number of women in many industrialized countries. Most women engaging in the practice today consume their processed placenta in capsule form, taken daily, over several weeks postpartum. While human maternal placentophagy advocates claim many maternal health benefits from the practice, including improved postpartum mood, increased breast-milk production, and improved energy, among others, no carefully designed, placebo-controlled studies have evaluated these claims. Our randomized, double-blind, placebo-controlled pilot study (N=23) investigated some of these claims. Our study found that the postpartum iron status of participants who consumed their own encapsulated placenta (based on the three week daily intake recommendation of one prominent placenta encapsulation service), was no different from those women who consumed the same amount of beef placebo. (more…)
Author Interviews, CDC, OBGYNE / 04.11.2016

MedicalResearch.com Interview with: Cynthia Ferre MA PhD Division of Reproductive Health National Center for Chronic Disease Prevention and Health Promotion CDC MedicalResearch.com: What is the background for this study? Response: Reductions in births to teens and preterm birth rates are two recent public health successes in the United States. To date, however, we haven’t had data to indicate whether these two declines are associated. So, we used age-specific data on trends in births overall and in preterm births to determine the effects of changes in maternal age on preterm birth. (more…)
Author Interviews, Columbia, Genetic Research, OBGYNE / 03.11.2016

MedicalResearch.com Interview with: Sarah Horvath, MD Paula M. Castaño, MD, MPH Anne R. Davis, MD, MPH Columbia University Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Approximately 3% of pregnant women in the United States will receive a prenatal diagnosis of fetal aneuploidy (such as trisomy 21) or fetal structural abnormality (such as cardiac or CNS malformations). Many of these women will undergo abortion. Advances in screening over the past few decades have allowed earlier diagnosis of aneuploidy, but most structural abnormalities cannot be diagnosed until the anatomy ultrasound at 18-20 weeks gestational age because of fixed patterns of fetal development. Our analysis examines gestational age at time of abortion for these two types of fetal diagnosis from 2004-2014. Our main finding was that median gestational age at time of abortion for fetal aneuploidy decreased from 19 weeks to 14 weeks. However, over the same 11 year period, median gestational age at time of abortion for fetal structural abnormalities remained unchanged and at or above 20 weeks gestation. (more…)
Author Interviews, JAMA, OBGYNE, Pediatrics, Vaccine Studies / 02.11.2016

MedicalResearch.com Interview with: Malini B. DeSilva, MD, MPH Clinician Investigator HealthPartners Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: This is a retrospective study of more than 324,000 live births at seven Vaccine Safety Datalink sites between 2007 and 2013 which showed that the Tdap vaccine in pregnant mothers was not associated with increased risk for microcephaly or other major birth defects in their offspring. (more…)
Author Interviews, OBGYNE, Pediatrics, Primary Care, Yale / 26.10.2016

MedicalResearch.com Interview with: Ann Kurth, Ph.D., C.N.M., R.N. USPSTF Task Force member Dean of the Yale School of Nursing MedicalResearch.com: What is the background for this study? What are the main findings? Response: Breastfeeding is beneficial for both mothers and their babies, with the evidence showing that babies who are breastfed are less likely to get infections such as ear infections, or to develop chronic conditions such as asthma, obesity, and diabetes. For mothers, breastfeeding is associated with a lower risk for breast and ovarian cancer and type 2 diabetes. While breastfeeding rates have been rising in recent decades—with 80 percent of women starting to breastfeed and just over half still doing so at six months—they are still lower than the Healthy People 2020 targets and the Task Force wanted to review the latest evidence around how clinicians can best support breastfeeding.” After balancing the potential benefits and harms, the Task Force found sufficient evidence to continue to recommend interventions during pregnancy and after birth to support breastfeeding. This recommendation includes the same types of interventions the Task Force recommended in 2008, such as education about the benefits of breastfeeding, guidance and encouragement, and practical help for how to breastfeed. (more…)
Author Interviews, Columbia, JAMA, OBGYNE, Stroke / 24.10.2016

MedicalResearch.com Interview with: Eliza Miller, M.D. Vascular Neurology Fellow New York-Presbyterian Hospital/Columbia University Medical Center We collaborated with researchers at the Massachusetts General Hospital and with the New York State Department of Health. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prior research has found that older women of childbearing age are at higher risk of stroke during pregnancy and postpartum than younger women. We hypothesized that their increased stroke risk might not be due to pregnancy-related factors, but just due to the fact that stroke risk increases with age for all people. We used billing data from New York State hospitals to calculate incidence risk ratios for four age groups: 12-24, 25-34, 35-44 and 45-55. In each age group, we compared the incidence of stroke in women who were pregnant or postpartum to the incidence of stroke in women of the same age who were not pregnant. As in prior studies, we found that the incidence of pregnancy-associated stroke was higher in older women compared to younger women (about 47/100,000 deliveries in the oldest group, versus 14/100,000 deliveries in the youngest group). However, the incidence ratios showed that pregnancy increased stroke risk significantly in women under 35, but did not appear to increase stroke risk in women over 35. In the youngest group (age 12-24), pregnancy more than doubled the risk of stroke, and in the 25-34 age group, pregnancy increased stroke risk by 60%. In women aged 35 and older, pregnancy did not increase stroke risk. Women who had pregnancy-related strokes tended to have fewer traditional vascular risk factors like hypertension and diabetes, compared to same-aged women with non-pregnancy related strokes. (more…)
Author Interviews, Endocrinology, Fertility, OBGYNE / 21.10.2016

MedicalResearch.com Interview with: Kavita Vedhara FAcSS Professor of Health Psychology Division of Primary Care School of Medicine University Park,Nottingham MedicalResearch.com: What is the background for this study? What are the main findings? Response: There has been a longstanding interest in the role of the hormone cortisol in fertility, because of its potential to affect the functioning of the biological systems that influence both conception and pregnancy. This interest has extended to IVF, with researchers exploring the relationship between levels of the hormone and pregnancy since the advent of the treatment in the late 1970s. However, a recent review showed that the relationship between cortisol and pregnancy in IVF was unclear. A number of reasons were highlighted for this, including that all of the studies to date had relied on short-term measures of the hormone measured in blood, saliva, urine and sometimes follicular fluid. Such measures can only capture hormone levels over a matter of minutes and hours. Such ‘snapshots’ are unable to give us an accurate picture of the levels of hormone over longer periods of time. This is important because any clinically relevant effects of cortisol on fertility are only likely to occur in the context of long-term changes in the hormone. In recent years it has become possible to measure long-term levels of cortisol in hair. Cortisol is deposited in the hair shaft and because human hair grows, on average, 1cm per month, a 3cm sample of hair closest to the scalp can tell us about levels of cortisol in the previous 3 months. We used the development of this technique to examine whether long term levels of cortisol (as measured in hair), or short term levels of cortisol (as measured in saliva) could predict whether or not women going through IVF would become pregnant. If you are trying to obtain a perfect cortisol balance, I use this product that helps to do just that. (more…)
Author Interviews, Endocrinology, OBGYNE, Pharmacology / 19.10.2016

MedicalResearch.com Interview with: Hugh S. Taylor, MD Anita O'Keeffe Young Professor of Obstetrics, Gynecology, and Reproductive Sciences and Professor of Molecular, Cellular, and Developmental Biology; Chair of Obstetrics Gynecology, and Reproductive Sciences, Yale School of Medicine Chief of Obstetrics and Gynecology Yale-New Haven Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: The abstract presented at ASRM featured results from two replicate pivotal Phase 3 clinical trials evaluating the efficacy and safety of Elagolix in premenopausal women who suffer from endometriosis. Elagolix is an investigational, orally administered, gonadotropin-releasing hormone (GnRH) receptor antagonist that blocks endogenous GnRH signaling by binding competitively to GnRH receptors in the pituitary gland. Administration results in rapid, reversible, dose-dependent inhibition of luteinizing hormone and follicle-stimulating hormone secretion, leading to reduced ovarian production of the sex hormones, estradiol and progesterone, while on therapy. The data demonstrated dose-dependent superiority in reducing daily menstrual and non-menstrual pelvic pain associated with endometriosis compared to placebo. At month three and month six, patients treated with Elagolix reported statistically significant reductions in scores for menstrual pain (dysmenorrhea) and non-menstrual pelvic pain associated with endometriosis as measured by the Daily Assessment of Endometriosis Pain scale. The safety profile of Elagolix was consistent across both Phase 3 trials and also consistent with prior Elagolix studies. (more…)
Author Interviews, Heart Disease, OBGYNE, Pediatrics / 14.10.2016

MedicalResearch.com Interview with: Prof. Chung-Yi Li Department of Public Health College of Medicine National Cheng Kung University Tainan Taiwan MedicalResearch.com: What is the background for this study? What are the main findings? Response: Congenital heart disease is the leading congenital malformation that causes perinatal and infant deaths. However, little information is available about the risk factors, especially modifiable environmental and behavioral factors that may have posed adverse effects on fetal cardiac development. We conducted a nationwide population-based study in Taiwan to further evaluate the potential role of maternal chronic diseases in the risk of developing congenital heart disease in offspring. We found that children of women with several kinds of chronic disease were at elevated risk for congenital heart disease; these diseases included type 1 and type 2 diabetes, hypertension, congenital heart defects, anemia, connective tissue disorders, epilepsy, and mood disorders. (more…)
Author Interviews, Columbia, JAMA, Mental Health Research, OBGYNE, Pediatrics / 13.10.2016

MedicalResearch.com Interview with: Alan S. Brown, M.D., M.P.H. Professor of Psychiatry and Epidemiology Columbia University Medical Center Director, Program in Birth Cohort Studies, Division of Epidemiology New York State Psychiatric Institute  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Maternal use of antidepressants during pregnancy has been increasing.  A previous study from a team that I led in a national birth cohort in Finland showed that mother’s use of a serotonin reuptake inhibitor antidepressant is related to an increased risk of depression in offspring.  We sought to evaluate whether these medications also increased risk of speech/language, scholastic, and motor outcomes in offspring.  We found an increased risk (37% higher risk) of speech/language disorders in offspring of mothers exposed to SSRIs in pregnancy compared to mothers who were depressed during pregnancy but did not take an SSRI during pregnancy. (more…)
Author Interviews, Exercise - Fitness, OBGYNE / 12.10.2016

MedicalResearch.com Interview with: Prof. Kari Bø PhD Norwegian School of Sport Sciences Oslo, Norway MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background is that more and more female elite athletes continue to exercise into their 30s and beyond and more want to become pregnant and some to continue to compete at the same level after giving birth. MedicalResearch.com: What should readers take away from your report? Response: To date there is little scientific knowledge on elite athletes and others who perform strenuous exercise (eg women in the military) during pregnancy and after childbirth and we therefore have to be cautious when recommending intensity levels of both endurance and strength training exercise. However, given the knowledge we have now.
  • Elite athletes planning pregnancy may consider reducing high impact training routines in the week after ovulation and refraining from repetitive heavy lifting regimens during the first trimester as some evidence suggests increased miscarriage risk.
  • There is little risk of abnormal fetal heart rate response when elite athletes exercise at <90% of their maximal heart rates in the second and third trimesters.
  • Baby birthweights of exercising women are less likely to be excessively large (>4000g) and not at increased risk of being excessively small (<2500g).
  • Exercise does not increase the risk of preterm birth.
  • Exercise during pregnancy does not increase the risk of induction of labour, epidural anesthesia, episiotomy or perineal tears, forceps or vacuum deliveries.
  • There is some encouraging evidence that the first stage of labour (before full dilatation) is shorter in exercising women.
  • There is also some encouraging evidence that exercise throughout pregnancy may reduce the need for caesarean section.
(more…)
Author Interviews, OBGYNE, Pediatrics, Vaccine Studies / 09.10.2016

MedicalResearch.com Interview with: Ameae M. Walker Vice Provost for Academic Personnel Distinguished Teaching Professor Biomedical Sciences School of Medicine University of California, Riverside MedicalResearch.com: What is the background for this study? What are the main findings? Response: There has previously been some evidence that immune cells in breast milk could pass through the wall of the immature gut, but if active they, like antibodies in milk, were considered likely a form of passive immunity. We now show that in addition to some maternal cells being active in the newborn (i.e. that they do contribute to passive cellular immunity), there are, more importantly, others that go to the thymus where they participate in selection of the neonate’s T cells. In this fashion, the neonate develops cells that recognize antigens against which the mother has been vaccinated – a process we have dubbed maternal educational immunity. (more…)
Author Interviews, Heart Disease, OBGYNE, Pediatrics, Women's Heart Health / 30.09.2016

MedicalResearch.com Interview with: Melissa C. Bartick, M.D. Assistant Professor of Medicine Department of Medicine, Cambridge Health Alliance, Cambridge Harvard Medical School, Boston Massachusetts MedicalResearch.com: What is the background for this study? Response: There has never been a study that combined maternal and pediatric health outcomes and costs into a single model. My colleague Arnold Reinhold and I had published a pediatric study in 2010, which was widely publicized but needed to be updated. My colleagues and I published a maternal study in 2013. But the two studies had different methodologies, and so the total costs could not be simply added together. Here, we wanted to get a picture of the impact of breastfeeding in the US public health as whole, by creating a single model that combined maternal and pediatric outcomes. That had never been done before. (more…)
Author Interviews, Dermatology, OBGYNE, Pediatrics / 28.09.2016

MedicalResearch.com Interview with: Dr Sarah El-Heis MBBS, MRCP (London) Clinical Research Fellow MRC Lifecourse Epidemiology Unit University of Southampton Southampton General Hospital Southampton MedicalResearch.com: What is the background for this study? What are the main findings? Response: Atopic eczema is a common, multifactorial and potentially distressing skin condition. Evidence that it partly originates in utero is increasing with some studies suggesting links with aspects of maternal diet during pregnancy. Nicotinamide is a naturally occurring nutrient that is maintained through the dietary intakes of vitamin B3 and tryptophan. As a topical treatment it has been used in the management of some skin conditions including atopic eczema, and has been shown to have anti-inflammatory effects, to stabilise mast cells and to alter lipids in the outer layers of the skin. The objective of our study was to examine the link between maternal serum concentrations of nicotinamide and related tryptophan metabolites to the risk of atopic eczema in the offspring. We found that maternal late pregnancy concentrations of nicotinamide and related metabolite concentrations were not associated with offspring atopic eczema at age 6 months. Higher maternal serum concentrations of nicotinamide and anthranilic acid were, however, associated with a 30% lower risk of eczema at age 12 months. (more…)
Author Interviews, Blood Clots, CHEST, OBGYNE, Surgical Research, Thromboembolism / 27.09.2016

MedicalResearch.com Interview with: Marc Blondon, MD Division of Angiology and Hemostasis, Department of Specialties of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, WA MedicalResearch.com: What is the background for this study? What are the main findings? Response: Venous thromboembolism, a condition including deep vein thrombosis (blood clots) and pulmonary embolism, is more common in older than younger patients. However, pregnancy and particularly the postpartum period are times at greater risk of blood clots in women. It is important to understand the risk and the risk factors for thrombosis in the postpartum period to guide the use of preventive measures such as heparin, an anticoagulant treatment, or leg compression devices. Our study summarizes the evidence on the link between C-sections and blood clots from the past 35 years. Our meta-analysis demonstrates that:
  • C-section carries a 4-fold increased risk of blood clots in the postpartum period, compared with vaginal deliveries ;
  • that this risk is most prominent but not restricted to emergency C-section ;
  • and that women who undergo elective C-section are also at higher risk than women who have a vaginal delivery.
  • Importantly, we estimated an absolute risk of blood clots after a C-section of 2-4 per 1000 pregnancies: on average, 3 out of 1000 women after C-section will develop a blood clot.
(more…)
Author Interviews, JAMA, NIH, OBGYNE / 26.09.2016

MedicalResearch.com Interview with: Stefanie N. Hinkle, Ph.D. Staff Scientist | Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: Thank you for the interest in our research. Nausea and vomiting are very common early in pregnancy and these symptoms can be difficult for women. Before we began this study there was very limited high-quality data on the implications of these difficult symptoms in pregnancy. Our study is unique because we asked women to report their symptoms continuously throughout their pregnancy before they may or may not have gone on to have a loss. We found that among women with 1 or 2 prior pregnancy losses, women who have nausea, and particularly nausea with vomiting, were less likely to have a pregnancy loss. (more…)
Author Interviews, Diabetes, Diabetologia, NIH, OBGYNE / 21.09.2016

MedicalResearch.com Interview with: Cuilin Zhang MD, PhD Senior Investigator NICHD, National Institutes of Health  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Pregnant women are at high risk of developing depressive symptoms; at least 10% US women suffering from depression during pregnancy. Gestational diabetes is a common pregnancy complication, affecting 4-7% of pregnancies in the U.S..  Gestational diabetes has  adverse health implications on both women and their children.   Depression and glucose intolerance commonly co-occur among non-pregnant individuals; however, the temporal relationship between gestational diabetes and depression during pregnancy and the postpartum period is less understood. (more…)
Accidents & Violence, Author Interviews, NIH, OBGYNE / 19.09.2016

MedicalResearch.com Interview with: Pauline Mendola, PhD Investigator, Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH Bethesda, MD 20892 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Efforts to monitor and reduce maternal mortality during and around the time of pregnancy largely focus on causes physiologically related to the pregnancy, despite the fact that increasing evidence suggests violent death – including homicide and suicide – are leading causes. In this study, we analyzed US death certificates from 2005-2010 from states that include pregnancy information on the death record in order to estimate rates of pregnancy-associated homicide and suicide, and to determine if risk of violent death was increased for women during pregnancy and postpartum. Given the large proportion of death records with unknown pregnancy status, we adjusted for a range of possible misclassification and found that pregnancy-associated homicide risk ranged from 2.2-6.2 per 100,000 live births, while pregnancy-associated suicide risk ranged from 1.6-4.5 per 100,000 live births. Overall, homicide risk was 1.8 times higher among pregnant/postpartum women compared to non-pregnant women in the population. The risk of suicide was 38% lower among pregnant/postpartum women than the general population. (more…)
Author Interviews, Diabetes, OBGYNE / 19.09.2016

MedicalResearch.com Interview with: Anastasia Katsarou PhD LUND University MedicalResearch.com: What is the background for this study? What are the main findings? Response: The study is using data from the Mamma study which screened pregnant women during 2003-2005. During this period, we gathered results from the oral glucose tolerance tests that the women underwent at the 28th week of pregnancy. We used data on the 2hour blood glucose levels from these tests and the frequency of women who were diagnosed with gestational diabetes and grouped them into months and seasons. We gathered also data on the mean monthly temperatures from the Swedish Meteorological and Hydrological Institute. We observed that the 2hour glucose levels and the frequency of women diagnosed with gestational diabetes were statistically significantly higher during the summer months. (more…)
Author Interviews, Cost of Health Care, OBGYNE, Outcomes & Safety, University Texas / 17.09.2016

MedicalResearch.com Interview with: Fangjian Guo, MD, PhD Assistant Professor BIRCWH Scholar Department of Obstetrics & Gynecology Center for Interdisciplinary Research in Women’s Health The University of Texas Medical Branch MedicalResearch.com: What is the background for this study? What are the main findings? Response: National guidelines consistently recommend against cervical cancer screening among women with a history of a total hysterectomy for a benign condition. These women are unlikely to develop high-grade cervical lesions. The goal of our study was to assess whether these guidelines are being followed. We examined the use of Pap testing among US adult women with a history of total hysterectomy for a benign condition and the roles of health care providers and patients in the initiation of Pap test use. We found that in 2013, 32% of women who have had a hysterectomy received an unnecessary recommendation for cervical cancer screening from a health care provider in the past year; 22.1% of women with hysterectomy received unnecessary Pap testing. Although the majority of Pap tests were performed at a clinician’s recommendation, approximately one fourth were initiated by patients without clinician recommendations. According to standard 2010 US Census population figures, about 4.9 million unnecessary Pap tests are performed annually among women who have had a total hysterectomy for a benign condition. At approximately $30 per test, $150 million in direct medical costs could be saved annually if screening guidelines were followed for these women. (more…)
Author Interviews, OBGYNE, Pediatrics, PLoS / 16.09.2016

MedicalResearch.com Interview with: Joseph Leigh Simpson, MD FACOG, FACMG President at International Federation of Fertility Societies March of Dimes Foundation White Plains, NY MedicalResearch.com: What is the background for this study? Response: Preterm birth (PTB) is the most common single cause of perinatal and infant mortality, affecting 15 million infants worldwide each year with global rates increasing. A total of 1.1 million infants die each year. Preterm births and their complications are the leading cause of deaths in children under age 5. The biological basis of preterm birth remains poorly understood, and for that reason, preventive interventions are often empiric and have only limited benefit. Large differences exist in preterm birth rates across high income countries: 5.5 percent in Sweden and at present 9.6 percent in the U.S. The International Federation of Gynecologists and Obstetricians (FIGO)/March of Dimes Working Group on Preterm Birth Prevention hypothesized that identifying the risk factors underlying these wide variations could lead to interventions that reduce preterm birth in countries having high rates. (more…)
Author Interviews, Cancer, Cancer Research, OBGYNE, Pediatrics / 14.09.2016

MedicalResearch.com Interview with: Pooja Rao, MD, MSCE Assistant Professor Division of Pediatric Hematology/Oncology Milton S. Hershey Medical Center Penn State College of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although many chemotherapy drugs can cause birth defects, no standardized guidelines exist for pregnancy screening in adolescent female patients with cancer. Additionally, little is known about how often they are screened prior to receiving treatment. Our study found that adolescent girls are not adequately screened for pregnancy prior to receiving chemotherapy or CT scans that could potentially harm a developing fetus. Adolescents with acute lymphoblastic leukemia, the most common childhood cancer, had the lowest pregnancy screening rates of the patients studied. (more…)
Author Interviews, Breast Cancer, Endocrinology, OBGYNE / 13.09.2016

MedicalResearch.com Interview with: Leena Hilakivi-Clarke, PhD Professor of Oncology Georgetown University Washington, DC 20057 MedicalResearch.com: What is the background for this study? Response: About 70% of women who develop breast cancer express estrogen receptors in their cancer. These patients are treated with endocrine therapies that target estrogen receptors. Endocrine therapies are effective in half of the patients, but the other half are resistant to the treatment and recur. Prior to the start of endocrine therapy, there is no way to predict who will respond to it and who will have recurrence of breast cancer. Therefore, it is not known which patients might benefit from an additional therapy to prevent recurrence, and what that additional therapy would entail. We wondered if resistance to endocrine therapy (we used tamoxifen) is pre-programmed by maternal exposure to the estrogenic endocrine disrupting chemical ethinyl estradiol (EE2). Previously, we and others have found that EE2 and other estrogenic compounds, when given during pregnancy, increase breast cancer risk in the female offspring in animal studies and among humans. The current study was done using a preclinical animal model that was used 50 years ago to discover that tamoxifen is an effective endocrine therapy for estrogen receptor positive breast cancer patients. (more…)
Asthma, Author Interviews, OBGYNE, Pediatrics / 06.09.2016

MedicalResearch.com Interview with: Dr Steve Turner MD MBBS Lead investigator of the study team and Respiratory paediatrician Royal Aberdeen Children’s Hospital MedicalResearch.com: What is the background for this study? Response: For almost thirty years there has been evidence that we are all born with a certain predisposition to what are called non communicable diseases (NCD) such as high blood pressure, type II diabetes and heart disease. The evidence comes from studies which have linked reduced birth weight with increased risk for these NCDs in later life. The question which arises, and which has been more difficult to answer, is “when during pregnancy is the predisposition to for NCDs first seen?” This is important to any attempt to reduce the unborn baby’s risk for NCD. We and other researchers have used fetal ultrasound data to link size before birth to non communicable diseases outcomes. In childhood, NCDs include asthma. (more…)
Author Interviews, OBGYNE, Pediatrics / 06.09.2016

MedicalResearch.com Interview with: David Osborn MB BS MM PhD FRACP Clinical Associate Professor, University of Sydney Senior Neonatologist, Royal Prince Alfred Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: In an analysis of trials of placental transfusion at delivery by either delayed umbilical cord clamping or cord milking in infants born before 30 weeks gestation, placental transfusion was associated with short term benefits including increased hemoglobin, fewer blood transfusions, improved blood pressure and reduced late onset sepsis, with no significant effect on other outcomes. There were insufficient data regarding effects of placental transfusion on survival and long term disability. The Australian Placental Transfusion Study (APTS) is a randomised controlled trial that aims to determine if delayed cord clamping (≥ 60 seconds) compared to early cord clamping (≤10 seconds) in 1600 infants born before 30 weeks gestation results in improved newborn outcomes and disability free survival. In this echocardiographic sub study, the aim was to determine the effect of placental transfusion on systemic blood flow in the first day after birth in 266 infants randomly allocated to delayed versus early cord clamping (133 infants in each group). The primary outcome was superior vena cava (SVC) flow (cardiac input) which overcomes the problem of shunts across the adapting heart which affect the usefulness of measuring ventricular outputs in the first days after birth. In infants born <30 weeks gestation, delayed cord clamping had no effect on the principle measure of systemic blood flow (SVC flow) during the first 24 hours compared to immediate cord clamping. However, right ventricular output (RVO) was lower in the delayed cord clamping group. This was not predicted and may be a chance finding. Further analysis suggests the effect of cord clamping on RVO could be mediated by its effect on hemoglobin. This may be a positive or negative adaptive change. There was no evidence of an increase in right to left ductal shunting suggestive of high pulmonary blood pressure to explain the difference in RVO. Delayed cord clamping resulted in a 8.9g/L greater increase in hemoglobin to 6 hours but had no effect on ductus arteriosus size, shunt direction or treatment, no effect on blood pressure or its treatment, and no effect on blood gas parameters and other cardiovascular variables in the first 24 hours. (more…)