Author Interviews, Cancer Research, Lancet, Leukemia, OBGYNE, Pediatrics / 04.03.2016

MedicalResearch.com Interview with: Erin Marcotte, Ph.D. Assistant Professor Division of Epidemiology and Clinical Research Department of Pediatrics University of Minnesota MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Marcotte: Recently there have been several studies that indicate a higher risk of immune-related disorders, such as type-I diabetes, asthma, and allergies, among children born by cesarean delivery. Our analysis used pooled data from 13 independent studies of childhood leukemia that were conducted in 9 different countries. We used data on over 33,000 children to investigate the relationship between birth by cesarean delivery and risk of childhood leukemia. We did not find an association between cesarean delivery overall and childhood leukemia. However, when we looked at emergency cesarean deliveries and pre-labor (planned) cesarean deliveries separately, we found a 23% increase in risk of acute lymphoblastic leukemia among children born by pre-labor cesarean delivery. (more…)
Author Interviews, OBGYNE, Pain Research / 04.03.2016

MedicalResearch.com Interview with: Matthew S. Robbins, MD, FAHS Associate Professor of Clinical Neurology, Albert Einstein College of Medicine Chief of Neurology, Jack D. Weiler Hospital Montefiore Medical Center Director of Inpatient Services, Montefiore Headache Center Associate Program Director, Neurology Residency MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Robbins: It is now well-established that having a history of migraine increases the risk of having vascular and obstetrical complications for pregnant women.  What is not known is if having active migraine during pregnancy would increase complications later on in that very same pregnancy.  Having severe migraine attacks during pregnancy may indicate particularly severe and active disease.  We evaluated pregnant women who presented to the hospital setting with acute, severe migraine attacks, and then reviewed their records for what happened during the same pregnancy when they delivered.  We found that compared to local and national rates, pregnant women with severe migraine attacks presenting to the hospital have increased rates of preeclampsia, preterm delivery, and low birthweight.  This risk was particularly elevated in pregnant women age 35 years or older. (more…)
Alcohol, Author Interviews, Cognitive Issues, NYU, OBGYNE, Sleep Disorders / 27.02.2016

MedicalResearch.com Interview with: Donald A. Wilson, Ph.D. Professor, Departments of Child & Adolescent Psychiatry and Neuroscience & Physiology NYU Langone Medical Center Senior Research Scientist Nathan Kline Institute for Psychiatric Research Medical Research: What is the background for this study? What are the main findings? Dr. Wilson: Fetal alcohol spectrum disorder (FASD) is characterized by cognitive, emotional and behavioral problems that are life-long.  Generally, it is assumed that the initial trauma of alcohol exposure at a critical time in life is the cause of these problems.  In this study using an animal model of FASD, we find that developmental alcohol causes a life-long disturbance in sleep.  Given that sleep is important for memory and emotion, among other things, this suggests that developmental alcohol can produce a daily insult to the brain, far outlasting that initial exposure.  Each night, the brain is unable to store memories, adjust emotional circuits, remove waste products, in the way that it should, because FASD has disrupted sleep. (more…)
Author Interviews, JACC, Metabolic Syndrome, OBGYNE, Race/Ethnic Diversity, Women's Heart Health / 26.02.2016

MedicalResearch.com Interview with: Catherine J. Vladutiu, PhD, MPH Research Assistant Professor, Department of Obstetrics & Gynecology Adjunct Assistant Professor, Department of Epidemiology Chapel Hill, NC Medical Research: What is the background for this study? Dr. Vladutiu: During pregnancy, women experience physiological changes and are at risk of pregnancy-related complications, some of which are associated with a higher risk of cardiovascular health outcomes in later life.  Physiologic adaptations occurring across successive pregnancies may be associated with an even higher risk of adverse cardiovascular outcomes. Previous studies have found an association between higher parity (i.e., number of live births) and the metabolic syndrome (MetS). However, no studies have examined this association in a Hispanic/Latina population. Hispanic women have a higher prevalence of the MetS than non-Hispanic women.  Latinos are also the fastest growing minority population in the U.S. and Hispanic/Latina women report higher fertility and birth rates than their non-Hispanic counterparts. (more…)
Author Interviews, OBGYNE, Urology / 25.02.2016

MedicalResearch.com Interview with: Kari Aarne Olavi Tikkinen, M.D PHD Adjunct Professor Department of Urology Helsinki University Central Hospital and University of Helsinki Helsinki, Finland Medical Research: What is the background for this study? Dr. Tikkinen: ?Stress and urgency incontinence are the two most frequent and the most bothersome urinary symptoms among women. It has been estimated that about twelve percent of women report significant bother from stress incontinence and eight percent from urgency incontinence. Both stress urinary incontinence and urgency urinary incontinence are associated with substantial physical and psychological morbidity, and large societal costs. An extensive body of evidence suggests that delivering vaginally versus caesarean section increases rates of post-partum stress urinary incontinence. The magnitude of long term effects of different delivery modes on stress and urgency urinary incontinence remain, however, uncertain. ? (more…)
Author Interviews, BMJ, Cancer Research, OBGYNE / 24.02.2016

MedicalResearch.com Interview with: Jiangrong Wang PhD Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm, Sweden Medical Research: What is the background for this study? What are the main findings? Dr. Wang: Cervical screening has been proved to effectively suppress the occurrence of cervical cancer, since it detects not only cervical cancer at early stages, but also precursor lesions that can be treated before progressing to invasive cancers. However, cervical screening has mainly reduced the occurrence of squamous cell cervical cancer, the most common type of invasive cervical cancer, but not adenocarcinoma of the cervix which originates from glandular cells. Although there is a well-known connection between adenocarcinoma in situ and invasive adenocarcinoma, questions remain on the magnitude of the cancer risk after detection of the glandular intraepithelial lesion-atypical glandular cells (AGC). We also wanted to study whether the current clinical management after detection of glandular abnormalities reduced the cancer risk as much as the standard management for squamous intraepithelial lesions does. Our findings show that 2.6% of women with  intraepithelial lesion-atypical glandular cells as the first abnormality developed invasive cervical cancer after 15 years of follow up and 74% of the cancers were adenocarcinoma. A moderately high proportion of women with AGC had prevalent cancer (diagnosed within 6 months from AGC), while there was considerably high incidence of cervical cancer within 0.5-6.5 years after a detection of AGC. The incidence of cervical cancer following AGC was significantly higher than for high-grade squamous intraepithelial lesions, and this increased risk remained even after having histology assessment in the initial half year.

The high risk of cervical cancer associated with AGC implies that the current clinical management following AGC does not prevent cervical cancer as sufficiently as the management for squamous intraepithelial lesions does.

 

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Author Interviews, OBGYNE, Pediatrics, Pulmonary Disease, Tobacco Research / 24.02.2016

MedicalResearch.com Interview with: Dr. med. Julia Dratva, MD MPH          Medical Specialist Prevention and Public Health FMH  Scientific project leader MAS Versicherungsmedizin/Studienkoordinationleitung Dept. Epidemiology and Public Health Swiss Tropical and Public Health Institute Socinstrasse 57, P.O. Box, 4002 Basel, Switzerland Medical Research: What is the background for this study? What are the main findings? Dr. Dratva: Early childhood is a critical time window for subsequent health. Early life environment is known to be important for lung development and respiratory health. Little is known on the potential impact on lung ageing and the potential mechanisms responsible for the long-term impact. We investigated early childhood factors and their association with lung function decline, a common marker of lung aging, in two long-standing adult cohorts, SAPALDIA and ECRHS. As recently published in scientific journal PlosONE, maternal smoking, early respiratory infections or season of birth are associated with a faster decline in lung function decline, while less rapid decline was found in persons who had attended daycare. The early exposures may not only have an independent adverse effect on lung aging but also increase the respiratory vulnerability to other adult risk factors. Stronger effects were observed in in smokers exposed to the aforementioned adverse factors. (more…)
Abuse and Neglect, BMJ, Imperial College, Microbiome, OBGYNE / 23.02.2016

MedicalResearch.com Interview with: Dr. Aubrey Cunnington Faculty of Medicine, Department of Medicine Clinical Senior Lecturer Imperial College, London Medical Research: What is the background for this study? What are the main findings? Dr. Cunnington: We noticed that increasing numbers of women who were having Caesarean section deliveries at our hospitals were requesting for their vaginal fluid to be swabbed onto their babies after birth – a process often termed “vaginal seeding”. The idea behind this, is that it transfers all the natural bacteria (microbiota) from the mother’s vagina to the baby. We know that early on in life, babies born by Caesarean section have different bacteria living on their bodies and in their guts to those of babies born by vaginal delivery. Some people think these differences in the microbiota may be responsible for differences in long-term health, although a causal link is unproven. The hope is that vaginal seeding might reduce the risk of the baby developing some diseases like obesity and asthma in the future. Unfortunately we are a long way from having the evidence to show that this is possible, and we do not know whether vaginal seeding is really safe. Babies born by elective Caesarean section are at lower risk of transfer of some potentially harmful bacteria and viruses from the birth canal, but these harmful bacteria and viruses could be transferred to the baby on a swab and potentially cause a devastating infection. MedicalResearch.com Editor's note:  'Vaginal Seeding' is also known as "microbirthing",    (more…)
Author Interviews, Depression, Eating Disorders, Mental Health Research, Nutrition, OBGYNE, Pediatrics / 23.02.2016

MedicalResearch.com Interview with: Lisanne de Barse PhD Department of Epidemiology Erasmus Medical Center Rotterdam MedicalResearch: What is the background for this study? Dr. de Barse: Fussy (or “picky”) eating behaviour, which is characterised by consistent rejection of particular foods, is common in childhood and a source of concern for parents. It is not well understood what affects fussy eating. It is, however, well known that internalizing psychiatric problems of parents (i.e. anxiety and depression) have an impact on children’s health and development. Studies have also shown that mothers’ internalizing problems during the child’s preschool period was linked to child fussy eating. It was not clear whether the child’s eating problems causes stress and psychiatric symptoms in mothers or whether mothers’ symptoms predict child eating behaviour. Nor was it known what potential impact the dads’ state of mind have. The purpose of this study was to examine whether mothers’ and fathers’ internalizing problems during pregnancy and during the child’s life predicts child fussy eating. MedicalResearch: What are the main findings? Dr. de Barse: Our main findings indicate that mothers’ anxiety and depressive symptoms during pregnancy could have an influence on children’s fussy eating. This was irrespective of mothers’ internalizing symptoms at the child’s preschool period. We also found indications that fathers’ anxiety and depressive symptoms might influence children’s fussy eating behaviour. This was studied in Generation R, a study that has been tracking the health and wellbeing of children from conception onwards, conducted by the Erasmus Medical Centre, in Rotterdam, the Netherlands. (more…)
Author Interviews, Global Health, HIV, NEJM, OBGYNE / 22.02.2016

MedicalResearch.com Interview with: Jared Baeten, MD PhD Vice Chair, Department of Global Health Professor, Departments of Global Health, Medicine, and Epidemiology Co-Director, International Clinical Research Center University of Washington MedicalResearch.com: What is the background for this studies? Dr. Baeten: Women account for nearly 60 percent of adults with HIV in sub-Saharan Africa, where unprotected heterosexual sex is the primary driver of the epidemic. While several studies have shown that antiretroviral medications (ARVs) are highly effective in preventing HIV, other studies – such as VOICE and FACTS 001 – suggest that for young, at-risk women in Africa, ARVs delivered as a vaginal gel or as a tablet may not be acceptable. Products must be used to be effective, and that was not the case for most of the participants in previous studies. Medical Research: What was the aim of ASPIRE and The Ring Study? Dr. Baeten: As Phase III clinical trials, ASPIRE and The Ring Study were designed to determine whether a vaginal ring containing an antiretroviral (ARV) drug called dapivirine is safe and effective in protecting women against HIV when used for a month at a time. These trials also sought to determine whether women find the vaginal ring practical and easy to use. As sister studies, ASPIRE and The Ring Study were designed as the centerpiece of a broader licensure program to provide the strength of evidence to support potential licensure of the dapivirine vaginal ring for preventing HIV in women. Because at least two Phase III efficacy trials are usually needed for a product to be considered for regulatory approval, ASPIRE and The Ring Study were conducted in parallel to accelerate the timeline to the ring’s potential approval. (more…)
Author Interviews, Diabetes, OBGYNE, Pediatrics / 22.02.2016

MedicalResearch.com Interview with: Laurie A. Nommsen-Rivers, PhD, RD, IBCLC Assistant Professor, UC Department of Pediatrics Cincinnati Children's Hospital Medical Center  Medical Research: What is the background for this study? Dr. Nommsen-Rivers: Breastfeeding provides important benefits for mother and infant. Exclusive breastfeeding—that is, without any other food or fluids provided to the infant—is recommended for the first six months of life by multiple public health organizations. Some mothers, despite their best efforts, have difficulty establishing and sustaining sufficient milk production to support exclusive breastfeeding. Our previous research suggested that mothers with less optimal glucose tolerance are at risk for prolonged delays in time between birth and the establishment of copious milk production. We wanted to extend this finding by probing if mothers who had diabetes in pregnancy, as a sign of less optimal glucose tolerance, are at greater risk of sustained low milk production. “Glucose tolerance” refers to the body’s ability to metabolize glucose and maintain a healthy blood sugar level, which is orchestrated by the hormone insulin. For a long time, we did not consider insulin to play a role in milk production, but we are now learning that insulin plays an essential role in milk production. (more…)
Author Interviews, Blood Pressure - Hypertension, OBGYNE, Stroke / 19.02.2016

MedicalResearch.com Interview with: Dr. Adnan Qureshi MD Professor of Neurology, Neurosurgery and Radiology University of Minnesota  Medical Research: What is the background for this study? Dr. Quershi: Women who have the last pregnancy at advanced age (usually defined as pregnancy at age of 40 years or greater) have higher risk of developing hypertension, hypertension related disorders, and diabetes mellitus during pregnancy. There is some evidence that disproportionately higher rates of cardiovascular risk factors continue years after the pregnancy. Perhaps there are unknown medical conditions triggered during pregnancy at advanced age. These changes continue to progress without being clinically evident until years later manifesting as a cardiovascular event. Medical Research: What are the main findings? Dr. Quershi: We analyzed the data for 72,221 women aged 50-79 years who were enrolled in the observational arm of the Women's Health Initiative Study. We determined the effect of pregnancy in advanced age (last pregnancy at age≥40 year) on risk of ischemic stroke, hemorrhagic stroke, myocardial infarction, and cardiovascular death over a mean period  of 12 years. A total of 3306 (4.6%) of the 72,221 participants reported pregnancy in advanced age. Compared with pregnancy in normal age, the rate of ischemic stroke (2.4% versus 3.8%, p<0.0001), hemorrhagic stroke (0.5% versus 1.0%, p<0.0001), myocardial infarction (2.5% versus 3.0%, p<0.0001), and cardiovascular death (2.3% versus 3.9%, p<0.0001) was significantly higher among women with pregnancy in advanced age. In multivariate analysis, women with pregnancy in advanced age were 60% more likely to experience a hemorrhagic stroke even after adjusting for differences in age, race/ethnicity, congestive heart failure, systolic blood pressure, atrial fibrillation, alcohol use and cigarette smoking were adjusted. (more…)
Author Interviews, Diabetes, OBGYNE, Weight Research / 16.02.2016

MedicalResearch.com Interview with: Katherine Bowers, PhD, MPH Division of Biostatistics and Epidemiology Cincinnati Children's Hospital MedicalResearch.com: What is the background for this study? What are the main findings?  Dr. Bowers: Autism spectrum disorder (ASD) affects approximately 1 in 68 children and the prevalence continues to rise. Past studies have suggested that conditions experienced by women during pregnancy (for example, obesity and gestational diabetes mellitus (GDM)) may be associated with having a child with ASD. We collected medical record data from patients who resided in the Cincinnati Children’s Hospital Medical Center’s primary catchment area and linked those data to data from birth certificates to identify metabolic risk factors. Two comparison groups were analyzed; one with developmental disabilities; and the other, controls without a reported ASD or other developmental disability. Descriptive statistics and regression analyses evaluated differences. We found that maternal obesity and  gestational diabetes mellitus were associated with an increased risk of Autism spectrum disorder in the offspring; however, no difference in risk of Autism spectrum disorder according to BMI and GDM was seen when comparing to the group with other developmental disabilities. The strongest observed association was the joint effect of obesity and GDM (compared to neither obesity nor GDM) :OR=2.53 (95% CI: 1.72, 3.73). (more…)
Asthma, Author Interviews, OBGYNE, Pediatrics / 12.02.2016

MedicalResearch.com Interview with: Maria C. Magnus Norwegian Institute of Public Health Oslo Norway  Medical Research: What is the background for this study? What are the main findings? Response:  Researchers have found that developing asthma can be linked to pregnant women and infants being exposed to paracetamol, (acetaminophen) by testing that the association was not simply linked to the complaint for which the person is taking paracetamol. The findings were published in the International Journal of Epidemiology Using data from the Norwegian Mother and Child Cohort Study, researchers in Norway compared associations between several conditions during pregnancy (with and without the use of paracetamol) and asthma developing in the 114,500 children in the study. They examined asthma outcomes at ages three and seven and evaluated the likelihood of the association being as a result of the three most common uses of paracetamol in pregnancy: pain, fever, and influenza. The results showed that 5.7 per cent of the children had current asthma at age three, and 5.1 per cent had asthma at age seven. The research found that there was a strong link between children who had asthma at age three who had been exposed to paracetamol as during pregnancy or infancy. The strongest association was seen if the mother used paracetamol during pregnancy for more than one complaint with a child having asthma at three years old. (more…)
Author Interviews, CDC, Flu - Influenza, OBGYNE, Vaccine Studies / 04.02.2016

MedicalResearch.com Interview with: Ikwo Oboho, MD, ScMLCDR United States Public Health Service Medical Epidemiologist, Centers for Disease Control and PreventionPriority Populations Treatment Team| HIV Care & Treatment Branch | Division of Global HIV/TB Atlanta, GA 30333 MedicalResearch.com: What is the background for this study? Dr. Oboho: ·Pregnant women with flu are at high risk of serious illness and complications, including death. The study is based on data gathered from a nationwide flu surveillance network that includes 14 states. The analysis focused on pregnant women hospitalized with laboratory-confirmed flu over four recent flu seasons, from 2010 to 2014. MedicalResearch.com: What are the main findings?  Dr. Oboho: ·       During the study period, 865 pregnant women were hospitalized with flu. Sixty-three of these patients, or about 7 percent, had severe illness.
  • After adjusting for underlying medical conditions, vaccination status, and pregnancy trimester, we found that early treatment with the antiviral drug oseltamivir was associated with a shorter hospital stay.
  • Among pregnant women with severe flu illness who were treated early with oseltamivir — within two days of the start of symptoms — the median length of stay was about five days shorter compared to hospitalized pregnant women with severe flu illness who were treated later
  • Pregnant women who were hospitalized with severe cases of flu illness were half as likely to have been vaccinated as women with non-severe illness.
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Author Interviews, OBGYNE, Rheumatology, Stanford / 03.02.2016

MedicalResearch.com Interview with: Dr. Julia Fridman Simard ScD Assistant Professor Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden Division of Epidemiology, Department of Health Research & Policy Division of Immunology & Rheumatology, Department of Medicine Stanford School of MedicineDr. Julia Fridman Simard ScD Assistant Professor Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden Division of Epidemiology, Department of Health Research & Policy Division of Immunology & Rheumatology, Department of Medicine Stanford School of Medicine  Medical Research: What is the background for this study? What are the main findings? Dr. Simard: A number of studies have shown that women with lupus who get pregnant have more complications and adverse outcomes, although the methodologies across studies vary considerably. Using population-based data we were able compare the occurrence of these pregnancy complications in mothers with lupus to pregnancies from the general population. We were also interested in whether women in our data set who first presented with lupus up to five years post-partum had more pregnancy-related adverse events. Our descriptive study showed that preterm delivery, infant infection, and preeclampsia were more common in the first singleton pregnancies of women with lupus compared to the general population.  These outcomes were also observed more often among women who appeared to present with lupus up to five years post-partum. (more…)
Author Interviews, Blood Pressure - Hypertension, Kaiser Permanente, OBGYNE / 01.02.2016

MEDICALRESEARCH.COM INTERVIEW WITH: KRISTI REYNOLDS, PHD, MPH  KAISER PERMANENTE RESEARCH RESEARCH & EVALUATION PASADENA, CA 91101  Medical Research: What is the background for this study? Dr. Reynolds: Hypertensive disorders during pregnancy are common, affecting up to 10 percent of all pregnant women, and include gestational hypertension, preeclampsia (which is a combination of high blood pressure and protein in the urine), and eclampsia, which includes seizures in women with severe preeclampsia. Research has shown that hypertensive disorders in pregnancy are associated with long-term cardiovascular disease risk, but little is known about the effect of these conditions in the early years after delivery. As part of our study, we examined the electronic health records of 5,960 women who had prenatal care and delivered a baby at the Kaiser Permanente Southern California Bellflower Medical Center between 2005 and 2010. Women with high blood pressure before their pregnancy were excluded from the analysis. Medical Research: What are the main findings? Dr. Reynolds: We found that women who had a hypertensive disorder during pregnancy were 2.4 times more likely – and women with pre-eclampsia/eclampsia 2.5 times more likely – to develop pre-hypertension or hypertension in the year after delivery than those who maintained a normal blood pressure during their pregnancy, after controlling for differences between the groups. In comparison to women with normal blood pressure during pregnancy, women with pregnancy-related hypertension tended to be slightly younger and overweight or obese before pregnancy. In addition, they were more likely to have had one or more children previously and to gain excess weight and develop gestational diabetes during their pregnancy. (more…)
Author Interviews, Microbiome, Nature, NYU, OBGYNE / 01.02.2016

MedicalResearch.com Interview with: Maria Dominguez-Bello, PhD Associate Professor, Department of Medicine, Division of Translational Medicine NYU Langone Medical Center and Jose Clemente, PhD Assistant Professor, Departments of Genetics and Genomic Sciences, and Medicine Icahn School of Medicine at Mount Sinai       Medical Research: What is the background for this study? What are the main findings? Response: Humans and animals are a composite of their own cells and microbes. But where they get their microbes from?  For mammals, labor and birth are major exposures to maternal vaginal bacteria, and infants are born already with a microbiota acquired from the mother. Mom’s birth canal is heavily colonized by bacteria that are highly related to milk: some will use milk components and become dominant during early development, an important window for maturation of the immune system, the intestine and the brain. Thus, the maternal vaginal microbiota is thought to be of high adaptive value for newborn mammals. Indeed, studies in mice confirm that microbes acquired at birth are important to develop adequate immune and metabolic responses, and the mature adult microbiome will continue to modulate host metabolism and immunity. Humans are the only mammals that interrupt the exposure to maternal vaginal microbiota, by delivering babies by Cesarean section. C-sections save lives of babies and moms, and they are estimated necessary in 10-15% of the cases. But most Western countries have rates above 30%, with the notable exception of the Scandinavian countries, Holland and Japan, which have excellent health systems and low maternal-infant mortality rates. Previous work by us an others has shown that infants born by C-section acquire different microbiota at birth, and those differences are sustained over time, altering the normal age-dependent maturation of the microbiome. The fundamental questions are then, can we restore the microbiota of Cesarean delivered babies? And if we can, does that reduce the associated disease risks? In relation to the first question, we present here the results of a pilot study in which infants born by Cesarean delivery were exposed to maternal vaginal fluids at birth. A total of 18 infants were recruited for the study. Seven of them were vaginally delivered, the remaining 11 were born by scheduled C-section. Among the C-section infants, 4 were exposed to maternal vaginal fluids at birth and 7 were not. We sampled all infants and their mothers for the first month of life across different body sites (oral, skin, anal, maternal vagina) and determined the microbiome composition on a total of over 1,500 samples. (more…)
Asthma, Author Interviews, JAMA, OBGYNE, Vitamin D / 27.01.2016

More on Asthma on MedicalResearch.com MedicalResearch.com Interview with: Hans Bisgaard, MD, DMSc Professor of Pediatrics The Faculty of Health Sciences University of Copenhagen Head of the Copenhagen Prospective Studies on Asthma in Childhood University  of Copenhagen and Naestved Hospital MedicalResearch: What is the background for this study? What are the main findings? Dr. Bisgaard: Vitamin D deficiency has become a common health problem in westernized societies, possibly caused by a more sedentary indoor lifestyle and decreased intake of vitamin D containing foods. Vitamin D possesses a range of immune regulatory properties, and it has been speculated that vitamin D deficiency during pregnancy may affect fetal immune programming and contribute to asthma pathogenesis. Asthma often begins in early childhood and is the most common chronic childhood disorder. Observational studies have suggested that increased dietary vitamin D intake during pregnancy may protect against wheezing in the offspring, but the preventive effect of vitamin D supplementation to pregnant women is unknown. In our double-blind, single-center, randomized clinical trial conducted within the Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort we supplemented 2800 IU/d of vitamin D3 during the third trimester of pregnancy compared with 400 IU/d in the control group. Although the maternal supplementation did not result in a statistically significant reduction of risk of persistent wheeze in the offspring through age 3 years, the interpretation of the study is limited by a wide confidence interval that includes a clinically important protective effect. (more…)
Author Interviews, OBGYNE, Pediatrics / 25.01.2016

MedicalResearch.com Interview with: Jonathan Muraskas M.D. Professor of Pediatrics and OB/Gyne Neonatal and Maternal Fetal Medicine Director Neonatal-Perinatal Research Loyola University Stritch School of Medicine Loyola University Medical Center Medical Research: What is the background for this study? What are the main findings?  Dr. Muraskas: Multiple studies over the years have demonstrated that only 15% of cerebral palsy is due to the birthing process. In other words, a normal pregnancy is 7000 hours and lawyers frequently only focus on the last 2 hours. (more…)
Author Interviews, OBGYNE, Ovarian Cancer, Radiology / 22.01.2016

More on Ovarian Cancer on MedicalResearch.com MedicalResearch.com Interview with: Dirk Timmerman, MD PhD Department of Development and Regeneration Department of Obstetrics and Gynecology University Hospitals Leuven Leuven, Belgium Medical Research: What is the background for this study? What are the main findings? Dr. Timmerman: Ovarian cancer is the most aggressive and lethal gynecological malignant neoplasm. The prognosis of ovarian cancer is poor, with only about 40% of patients still alive five years after being diagnosed. The preoperative characterization of an adnexal tumor is fundamental for selecting the optimal management strategy. An accurate differentiation between benign and malignant masses can lead to optimal referral of patients with malignant diseases to gynecological oncology centers for further diagnostics and treatment, which positively influences the prognosis. On the other hand, it may help in safely selecting patients with benign ovarian masses for minimally invasive or fertility sparing surgery, and in some cases maybe even conservative follow-up. The International Ovarian Tumor Analysis (IOTA) study is the largest diagnostic accuracy study of its kind. Transvaginal ultrasound is a cheap and very accessible imaging technique. Using ultrasound features, which are easy to assess by a trained examiner, we proposed a model to define the individual risk of malignancy for each patient presenting with an adnexal tumor. This could considerably impact on the morbidity and mortality associated with adnexal pathology. (more…)
Author Interviews, Endocrinology, OBGYNE, Pediatrics / 19.01.2016

More on Obgyne on MedicalResearch.com MedicalResearch.com Interview with: Sandra Schulte (candidate Medicine) University Hospital Bonn Dept. Ped. Endocrinology and Diabetology MedicalResearch: What is the background for this study? What are the main  findings? Response: Low birth weight, unfavourable intrauterine conditions and post-natal catch-up-growth are associated with impaired growth, accelerated pubertal maturation and metabolic disturbances later in life. However, normally, study designs cannot rule out the influence of different genetic backgrounds and familiar environments between their subjects and control groups. Therefore, we recruited a very special study cohort, solely composed of monozygotic twins. These twins had significant differences in birthweight, due to twin-to-twin-transfusion-syndrome (TTTS). Because of irregular placental anastomoses, one twin, the recipient, receives more blood becoming hypertensive and polyuric, leading to polyhydramnios and ultimately congestive heart failure and hydrops fetalis. In contrast, the donor twin becomes hypovolemic, hypotensive and oliguric, leading to oligohydramnios and growth restriction. We followed 30 pairs of these twins regularly from birth up to this current follow-up at a mean age of 14.6 years, to examine the impact of a lower birthweight on auxologic development and pubertal maturation later in life. (more…)
Author Interviews, Cleveland Clinic, OBGYNE, Race/Ethnic Diversity / 15.01.2016

More on Racial Disparities in Health Care on MedicalResearch.com MedicalResearch.com Interview with: Emily A. DeFranco, D.O., M.S. Associate Professor Maternal-Fetal Medicine Center for Prevention of Preterm Birth, Perinatal Institute Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Department of Obstetrics and Gynecology Medical Sciences Building, Room 4553B Cincinnati, OH Medical Research: What is the background for this study? Dr. DeFranco: The Infant Mortality Rate in the state of Ohio is higher than many other states.  Additionally, there is a large disparity in the IMR with black infants impacted to a higher degree compared to white infants. For this reason, we are particularly interested in identifying factors that contribute to this disparity in order to identify potential areas where public health efforts can be focused. We know that preterm birth is a major contributor to infant mortality, and that all babies born alive prior to 23 weeks of gestational age, i.e. "previable", die after birth and contribute to the infant mortality rate.  In this study, we wanted to assess whether black women are more likely to have early preterm births at less than 23 weeks, and if so whether that may be part of the explanation of why black mothers are at higher risk of experiencing an infant mortality. Medical Research: What are the main findings? Dr. DeFranco: In this study, we found that black mothers were more likely to deliver than white mothers  at very early preterm gestational ages, less than 23 weeks.  We also found that the earlier the delivery, the larger the disparity with black mothers being at higher risk for the earliest deliveries compared to white mothers.  From this data, we estimated that in Ohio, 44% of all infant mortality in black mothers is caused by previable preterm birth, whereas only 28% of infant mortality in white mothers is attributed to the same cause.  We concluded that very early preterm birth in black mothers is a large contributor to the racial disparity observed in the infant mortality dilemma here in Ohio. (more…)
Author Interviews, BMJ, Diabetes, NIH, OBGYNE / 13.01.2016

MedicalResearch.com Interview with: Cuilin Zhang MD, PhD Senior Investigator, Epidemiology Branch Division of Intramural Population Health Research NICHD/National Institutes of Health Rockville, MD 20852  Medical Research: What is the background for this study? What are the main findings? Dr. Zhang: Potatoes are the third most commonly consumed food crop in the world. In the United States, about 35% of women of reproductive age consume potatoes daily, accounting for 8% of daily total energy intake.  Gestational diabetes mellitus (GDM) is a common complication of pregnancy characterized by glucose intolerance with onset or first recognition during pregnancy. GDM is at the center of a vicious circle of 'diabetes begets diabetes' across generations. Potato foods are typically higher in glycemic index and glycemic load, but data are lacking regarding whether potato consumption is associated with the risk of Gestational diabetes mellitus. Medical Research: What is the background for this study? What are the main findings? Dr. Zhang: Women who eat more potatoes before pregnancy may have higher risk of gestational diabetes—the form of diabetes that occurs or first diagnosed during pregnancy—compared to women who consume fewer potatoes. Substituting potatoes with other vegetables, legumes or whole grains may help lower gestational diabetes risk. (more…)
Author Interviews, JAMA, OBGYNE, Pediatrics / 11.01.2016

MedicalResearch.com Interview with: Annie Gatewood Hoen, PhD  Assistant Professor of Epidemiology and of Biomedical Data Science and Juliette Madan, MD, MS Associate Professor of Pediatrics The Geisel School of Medicine at Dartmouth Dartmouth-Hitchcock Medical Center Lebanon, NH 03756 Medical Research: What is the background for this study? What are the main findings? Response: When newborns are delivered they begin the process of acquiring vast numbers of bacteria that are critical for healthy nutrition and for immune training for a lifetime of health. Diseases such as obesity, heart disease, colitis, autism, and even cancer risk is associated with particular patterns in the gut microbiota; interestingly breast milk exposure is associated with decreased risk of many of these diseases. The intestinal microbiome plays a critical role in development, and delivery mode (cesarean section versus vaginal delivery) and feeding method (breast milk vs. formula) are important determinants of microbiome patterns.  We observed the intestinal microbiome in 6 week old infants and how it relates to delivery type and feeding. We were particularly interested in examining patterns in the microbiome in infants who received combination feeding of both breast milk and formula, an area that has been understudied. We prospectively studied 102 infants and, with gene sequencing of bacteria, identified important patterns in microbiome composition that differed greatly based upon delivery method and between feeding groups.  Babies who were combination fed (formula and breast milk) had an intestinal microbiome that was more similar to babies who were exclusively formula fed than breast fed babies. We identified individual bacteria that were differentially abundant between delivery mode and feeding groups. (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, OBGYNE, Pharmacology / 07.01.2016

MedicalResearch.com Interview with: Brittany M. Charlton, ScD Instructor Boston Children's Hospital and Harvard Medical School Researcher, Harvard Chan School Department of Epidemiology Boston, MA 02115   Medical Research: What is the background for this study? What are the main findings? Dr. Charlton: Even though oral contraceptives can be over 99% effective with perfect use, almost 10% of women become pregnant within their first year of use. Many more women will stop using oral contraceptives when planning a pregnancy and conceive within just a few months. In both of those examples, a woman may inadvertently expose her offspring during pregnancy to exogenous sex hormones. We conducted a nationwide cohort study in Denmark in order to investigate whether oral contraceptive use shortly before or during pregnancy was associated with an increased risk of major birth defects in the offspring. Our main finding was that there was no increased risk of having a birth defect associated with oral contraceptive exposure. These results were also consistent when we broke down the birth defects into different subgroups, like limb defects. (more…)
Author Interviews, Biomarkers, NEJM, OBGYNE / 06.01.2016

MedicalResearch.com Interview with: Stefan Verlohren, MD, PhD Consultant and Senior Lecturer Maternal-Fetal Medicine Klinik für Geburtsmedizin / Department of Obstetrics Charité Campus Mitte Berlin  Medical Research: What is the background for this study? What are the main findings? Dr. Verlohren: Preeclampsia affects 2–5% of pregnancies worldwide, and is a potentially life threatening syndrome for both mother and child. Treatment options for preeclampsia are very limited, with delivery being the only ‘cure’; however, early detection and monitoring are beneficial for improving maternal and fetal outcomes. Development of preeclampsia is very difficult to predict: its clinical presentation is variable and its signs and symptoms overlap with other conditions. There has been an unmet medical need for improved prediction of preeclampsia, i.e. predicting which women will develop preeclampsia and which will not. Women with suspected preeclampsia are often hospitalized until preeclampsia and related adverse outcomes are ruled out. Others who require hospitalization may be overlooked because their symptoms were nonspecific (e.g. headache). Preeclampsia has been linked with impaired function of the placenta. Placental development is highly dependent on blood vessel formation; before and during preeclampsia, levels of molecules involved in blood vessel inhibition or growth are altered in the maternal bloodstream. In particular, soluble fms-like tyrosine kinase-1 (sFlt-1) (a molecule that inhibits blood vessel growth) is increased and placental growth factor (PlGF) (a molecule that encourages blood vessel growth) is decreased. This study has established that the ratio of these two molecules (sFlt-1:PlGF) can be used to predict whether preeclampsia will develop or not. The sFlt-1:PlGF ratio can be calculated with a blood test (the Elecsys® sFlt-1 immunoassay and Elecsys® PlGF immunoassay). PROGNOSIS has validated the sFlt-1:PlGF ratio cutoff level of 38 for prediction of preeclampsia. For women with suspected preeclampsia, the Elecsys® immunoassay sFlt-1:PlGF ratio of 38 or below has a high negative predictive value to rule out preeclampsia or adverse fetal outcomes in the next week. A Elecsys® immunoassay sFlt-1:PlGF ratio of more than 38 indicates that preeclampsia or fetal adverse outcomes may develop in the next four weeks. In conjunction with other diagnostic and clinical information, the Elecsys® immunoassay sFlt-1:PlGF ratio can be used to guide patient management. (more…)
Author Interviews, Depression, OBGYNE, Pharmacology / 06.01.2016

MedicalResearch.com Interview with: Anick Bérard PhD FISPE Research chair FRQ-S on Medications and Pregnancy and Director, Réseau Québécois de recherche sur le médicament (RQRM) and Professor, Research Chair on Medications, Pregnancy and Lactation Faculty of Pharmacy University of Montreal and Director, Research Unit on Medications and Pregnancy Research Center CHU Ste-Justine  Medical Research: What is the background for this study? What are the main findings? Dr. Bérard: Paroxetine (one of the most used antidepressant during pregnancy) has been studied extensively over the past 10-12 years. In 2005, a black box warning was put on the Paxil label to caution against use during pregnancy due to the increased risk of cardiac defects. The ACOG 2010 guidelines also suggested switching to other antidepressants during pregnancy. Over the past decade, many studies, including meta-analyses, were performed on on paroxetine use during pregnancy and the risk of cardiac malformations - but results were sometimes statistically significant or not, although a consistent increased risk was observed. It was thought that these variations could be explained by different study designs, patient populations, and because maternal depression was not always taken into account correctly. Hence, we undertook another meta-analysis (the most recent and updated) to quantify the risk of cardiac defects overall as well as specific cardiac defects associated with paoxetine use during pregnancy and to assess the impact of study designs, maternal depression and patient population on the effect of the risk. We found that women using paroxetine during the first trimester of pregnancy (critical time-window for malformations) were 23% more at risk of having a child with malformations (15 studies combined) - baseline risk of malformation is 3-5% and thus a 23% increased risk is 3.69-6.15% absolute risk; women using paroxetine during the first trimester of pregnancy were 28% more at risk of having a child with cardiac malformations (18 studies combined) - baseline risk of cardiac malformation is 1% and thus a 28% increased risk is 1.28% absolute risk. We found that paroxetine was increasing the risk of many specific cardiac defects as well. Although the estimates varied depending on the comparator group, study design, and malformation detection period, a trend towards increased risk was observed. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Medicare, OBGYNE / 04.01.2016

MedicalResearch.com Interview with: Dr. Sarah Elizabeth Little, MD Obstetrics/Gynecology Department of Obstetrics and Gynecology Brigham and Women's Hospital Medical Research: What is the background for this study? What are the main findings? Dr. Little: This study investigates the variation in cesarean delivery rates across hospital services areas (a geographic unit designed by the Dartmouth Atlas to represent local markets for primarily hospital-based medical services). We looked at whether variation in cesarean delivery rates was related to broader variation in overall medical spending and utilization in that area, which we measured with Medicare spending and hospital use at the end-of-life. We found that an area’s cesarean delivery rate was correlated with these other measures; in other words, the hospital services areas that are doing the most cesarean deliveries are the same ones that are spending more and doing more to non-obstetric patients as well. (more…)
Author Interviews, OBGYNE, Surgical Research / 03.01.2016

MedicalResearch.com Interview with: Gabriele Saccone, MD Department of Neuroscience Reproductive Sciences and Dentistry School of Medicine University of Naples Federico II Naples, Italy Vincenzo Berghella, MD Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine Thomas Jefferson University Philadelphia, PA 19107, USA Medical Research: What is the background for this study? What are the main findings? Dr Saccone: Preterm birth (PTB) is the number one cause of perinatal mortality in many countries, including the US. The annual societal economic burden associated with Preterm birth in the US was at least $26.2 billion in 2006, or about $51,600 per infant born preterm. Defining risk factors for prediction of PTB is an important goal for several reasons.
  • First, identifying women at risk allows initiation of risk-specific treatment.
  • Second, it may define a population useful for studying particular interventions.
  • Finally, it may provide important insights into mechanisms leading to Preterm birth.Prior surgery on the cervix, such as cone biopsy and LEEP procedures, is associated with an increased risk of spontaneous PTB. History of uterine evacuation for abortion, by either induced termination of pregnancy (I-TOP) or treatment of spontaneous abortion (SAB) by suction dilation and curettage (D&C) or by dilation and evacuation (D&E), which may involve mechanical and/or osmotic dilatation of the cervix, has been associated with an increased risk of PTB in some studies, but not in others. Our systematic review and meta-analysis pooled data from 36 studies including 1,047,683 women with prior abortion. We found that history of surgical abortion is an independent risk factor for Preterm birth and also other obstetric complications including low birth weight and small for gestational age, while prior medical abortion with first-trimester mifepristone or mid-trimester misoprostol was not associated with an increased risk of PTB. The biological plausibility to explain our findings is not completely clear. However, three main hypotheses can be made.
  • The increased risk of Preterm birth could result from the overt or covert infection following surgically uterine evacuation,
  • as well as from mechanical trauma to the cervix leading to increased risk of cervical insufficiency.
  • Moreover, surgical procedures including curettage during D&E may result in scar tissue that may increase the probability of faulty placental implantation.
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