Author Interviews, OBGYNE, Science, Surgical Research / 05.08.2016

MedicalResearch.com Interview with: Dr David A MacIntyre MRC Career Development Fellow Lecturer in Reproductive Systems Medicine Institute of Reproductive and Developmental Biology Department of Surgery and Cancer Imperial College London UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: Preterm birth is the leading cause of death in children under 5 years of age. One of the first things that can happen to a women before suffering a preterm birth is early opening of the cervix, which is the neck of the womb. This also puts her and the baby at risk of infection. One of the few preventative treatments available for these women is a cervical cerclage. This is when a surgeon uses one of two types of suture thread to stitch the cervix closed. This provides mechanical support to the pregnancy and is thought to help prevent infections from ascending from the vaginal into the uterus. One type of suture thread used is thin, monofilament nylon, which appears similar to fishing line. The other is a thicker thread - around 5mm thick - that is comprised of smaller threads woven together like a shoe lace. The thicker woven thread - called multifilament - is used in around 80 per cent of procedures as surgeons believe it to be stronger, and more efficient at holding the cervix closed. In this study, we first looked at 671 women who had the procedure at five UK hospitals over the last ten years. Around half had the thinner 'fishing line' thread, while the other half had the thicker 'shoe lace' thread. The results revealed the thicker thread was associated with increased rate of intrauterine death compared to the thinner thread (15 per cent compared 5 per cent). The rate of intrauterine death in a normal pregnancy is around 0.5%. The thicker tape was also associated with an increased preterm birth rate compared to the thinner tape - 28 per cent compared to 17 per cent. The rate of preterm birth among the general population is around 7 per cent, but the cervical stitch procedure is only performed on women already deemed at high risk of premature birth. We then conducted a second study with 50 women who were due to have the cervical stitch procedure. Half received the thinner thread, while half received the thicker thread. We monitored the women at 4, 8 and 16 weeks after the procedure through ultrasound scans and analysis of bacteria in their reproductive tract. The results suggested that women who received the thicker thread had increased inflammation around the cervix. There was also increased blood flow, which is associated with the cervix opening before labour. Crucially, we also found that women who received the thicker thread had more potentially harmful bacteria in the vagina and around the cervix. (more…)
Author Interviews, CDC, OBGYNE, Zika / 04.08.2016

MedicalResearch.com Interview with: Charlan D. Kroelinger, PhD Division of Reproductive Health National Center for Chronic Disease Prevention and Health Promotion CDC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Zika virus infection during pregnancy can cause microcephaly and other severe fetal brain defects. Doctors have also found other problems in pregnancies and among infants infected with Zika virus before birth, such as absent or poorly developed brain structures, defects of the eye, hearing deficits, and impaired growth. Nearly half of all pregnancies in the United States are unintended. Increased access to birth control may lead to reductions in unintended pregnancies, which may result in fewer adverse pregnancy and birth outcomes in the context of a Zika virus outbreak. A new report from CDC estimates that use of highly effective, reversible forms of birth control, called long-acting reversible contraception (LARC), which includes intrauterine devices (IUDs) and implants, remains lower than use of moderate or less effective methods such as oral contraceptive pills and condoms, although contraception use varied across states and by age group and race/ethnicity. CDC scientists used data from four state-based surveillance systems to estimate contraception use for non-pregnant and postpartum women at risk for unintended pregnancy and sexually active female high school students who live in states with the potential for local Zika virus transmission. Less than one in four sexually active women of reproductive age and fewer than one in 10 sexually active female high school students reported using LARC. A higher percentage of postpartum women reported LARC use. Moderately effective and less effective contraceptive methods, including pills, patches, rings, injections, condoms and other barrier methods, were used more frequently than highly effective methods. These estimates are of concern because the most commonly used methods of contraception are not as effective at preventing unintended pregnancy. (more…)
Author Interviews, Global Health, Lancet, Methamphetamine, OBGYNE, STD / 29.07.2016

MedicalResearch.com Interview with: N. Saman Wijesooriya Public Health Advisor/Technical Advisor Centers for Disease Control and Prevention MedicalResearch.com: What is the background for this study? What are the main findings? Response: The article Global burden of maternal and congenital syphilis in 2008 and 2012: a health systems modeling study by Wijesooriya, et al published in the August 2016 issue of The Lancet Global Health (Open source - http://dx.doi.org/10.1016/S2214-109X(16)30135-8) estimates the incidence and prevalence of maternal and congenital syphilis for both time periods and identifies gaps antenatal care access and syphilis testing and treatment services to assess progress in the global elimination of congenital syphilis, or mother-to-child transmission of syphilis, as a public health problem. Untreated maternal syphilis is understood to be transmitted from mother-to-child in utero in 50% of cases resulting in tragic adverse pregnancy outcomes, or congenital syphilis infections, including early fetal death, stillbirth, preterm birth, low birthweight, neonatal death, and congenital infections in infants. Since most maternal syphilis infections are asymptomatic, it is recommended that screening for syphilis use a combination of serological tests for pregnant women and treatment of syphilis seropositive women with at least 2.4 million units of benzathine penicillin intramuscularly early in pregnancy to prevent most congenital syphilis infections. In 2007, the World Health Organization responded to estimates indicating 2 million maternal and 1.5 congenital syphilis infections would occur annually without treatment and launched the global initiative for the Elimination of Congenital Syphilis (ECS). The strategy includes reducing the prevalence of syphilis in pregnant women and mother-to-child transmission of syphilis. The objective is for countries to achieve high performing antenatal care systems providing access to antenatal care to more than 95% of pregnant women, syphilis testing for more than 95% of pregnant women, and treatment for more than 95% of seropositive women to attain a congenital syphilis rate of 50 or fewer cases per 100,000 live births. (more…)
Author Interviews, Biomarkers, Diabetes, Diabetologia, OBGYNE / 25.07.2016

MedicalResearch.com Interview with: Dr. Sandra Hummel and Dr. Daniela Much Institute of Diabetes Research Helmholtz Center Munich German Research Center for Environmental Health Munich MedicalResearch.com: What is the background for this study? What are the main findings? Response: Gestational diabetes mellitus is associated with a seven-fold increased risk of developing type 2 diabetes postpartum. In 2012, we published that type 2 diabetes risk was markedly reduced up to 15 years after delivery in women with gestational diabetes if they breastfed for more than 3 months. However the underlying biological mechanisms are still unclear to date. Aim of this biomarker study was to identify the mechanism underlying the protective effect of prolonged lactation. At our study site in Munich, we enrolled 197 women with previous gestational diabetes participating in a postpartum assessment of glucose tolerance at a median time of 3.6 years after delivery. By using a targeted metabolomics approach (including a broad spectrum of lipids and amino acids), we identified lactation-associated biochemical changes in maternal plasma samples. Most interestingly, these metabolite signatures have been described with decreased risk for type 2 diabetes previously. Our results indicate that lactation-associated alterations persisted up to 11 years post-lactation. (more…)
Author Interviews, Endocrinology, Hematology, OBGYNE, Thyroid Disease / 24.07.2016

MedicalResearch.com Interview with: Kris Poppe, MD, PhD Co-Head Endocrine Unit CHU St-Pierre UMC Université libre de Bruxelles MedicalResearch.com: What is the background for this study?  Response: Pregnant women are often referred by gynecologists to my endocrine practice, for altered thyroid function. At that occasion, I often noticed that the women also had low iron/ferritin levels (ferritin is the iron reserve). Searching in literature did not reveal many publications on the association between iron (deficiency) and thyroid function during pregnancy and so that was the background/aim to perform this study. (more…)
Alcohol, Author Interviews, Columbia, OBGYNE, Tobacco / 21.07.2016

MedicalResearch.com Interview with: Dr. Qiana L. Brown, PhD, MPH, LCSW Postdoctoral Research Fellow Columbia University Mailman School of Public Health Department of Epidemiology Substance Abuse Epidemiology Training Program MedicalResearch.com: What is the background for this study? Dr. Brown: Prenatal substance use is a major public health concern, and poses significant threats to maternal and child health. Tobacco and alcohol are the most commonly used substances among pregnant women and non-pregnant women of reproductive age, and are leading causes of preventable adverse health outcomes for both mother and baby. Women with health insurance have more prenatal visits, and present for prenatal care earlier than uninsured women, which may increase their exposure to health messaging around substance abuse prevention at prenatal visits. Additionally, treatment for substance use disorders and maternal and child health care are part of the Essential Health Benefits covered by the Affordable Care Act, which may encourage patients and providers to engage in discussions around alcohol and tobacco use prevention during pregnancy. Given these factors, we examined the relationship between health insurance coverage and both past month tobacco use and past month alcohol use among a nationally representative sample of reproductive age women in the United States. We sampled 97,788 women ages 12 to 44 years old who participated in the U.S. National Survey of Drug Use and Health in 2010 to 2014. Among these women, 3.28% (n=3,267) were pregnant. We specifically investigated whether the relationship between health insurance and alcohol or tobacco use differed between pregnant and non-pregnant women. (more…)
Author Interviews, Breast Cancer, Fertility, JAMA, OBGYNE / 20.07.2016

MedicalResearch.com Interview with: Alexandra W. van den Belt-Dusebout, PhD Department of Epidemiology The Netherlands Cancer Institute The Netherlands MedicalResearch.com: What is the background for this study? Response: In vitro fertilization (IVF) is commonly used, but because of the relatively recent use of IVF, long-term breast cancer risk is not yet known. Female sex hormones have been shown to affect breast cancer risk. Because sex hormone levels during hormonal stimulation of the ovaries for IVF are up to 10 times higher than in natural cycles, IVF was expected to increase breast cancer risk. (more…)
Author Interviews, Fertility, HPV, OBGYNE, STD / 12.07.2016

MedicalResearch.com Interview with: Dejan R. Nonato, MD, PhD Institute of Tropical Pathology and Public Health School of Medicine Federal University of Goiás Goiânia, GO, Brazil MedicalResearch.com: What is the background for this study? Response: Human papillomavirus (HPV) and Chlamydia trachomatis (CT) share the same route of sexual transmission and possess similar risk factors, indicating that co-infection may act synergistically in the induction of epithelial cell abnormalities. (more…)
Author Interviews, OBGYNE / 09.07.2016

MedicalResearch.com Interview with: Annefleur de Bruijn MD VU Medical Centre Department of Gynecology Amsterdam, The Netherlands MedicalResearch.com: What is the background for this study? Response: Since 1995 uterine artery embolization has been described in patients with symptomatic fibroids. Uterine artery embolization is a less invasive treatment option compared to hysterectomy. Studies including several randomized controlled trials established uterine artery embolization as a valuable treatment. Earlier these trials reported outcomes in terms of health related quality of life, clinical outcomes, efficacy and cost effectiveness after 1, 2 and 5 years of follow-up. In the randomized EMMY trial, we analyzed these results again, currently 10 years after treatment. (more…)
Author Interviews, Autism, OBGYNE / 04.07.2016

MedicalResearch.com Interview with: Dr-Claudia-Avella-GarcíaClaudia Avella-García MD, MPH, PhD ISGlobal - Institut de Salut Global Barcelona Unitat Docent de Medicina Preventiva i Salut Publica H.Mar-UPF-ASPB MedicalResearch.com: What is the background for this study? Response: Acetaminophen (paracetamol) is used by around half of all pregnant women in developed countries and is currently the recommended treatment for fever and pain during gestation. However, evidence linking exposure to this medication with negative changes in neurodevelopment has been coming to light, warranting further study. Therefore, our objective was to evaluate whether prenatal exposure to acetaminophen was adversely associated with child neurodevelopment at 1 and 5 years of age. For this reason, we evaluated 2644 mother-child pairs recruited during pregnancy as part of the INfancia y Medio Ambiente – Childhood and Environment (INMA) project, a Spanish general population-based cohort. We collected information on acetaminophen use prospectively up until week 32 of gestation. We evaluated neurodevelopment at 1 year of age using the Bayley Scales of Infant Development. At 5 years of age we applied a battery of tests evaluating different aspects of neurodevelopment including both cognitive and behavioural aspects. (more…)
Author Interviews, Dermatology, JAMA, OBGYNE, Sexual Health, Social Issues, UCSF / 29.06.2016

MedicalResearch.com Interview with: Tami Rowen MD MS Obstetrics, Gynecology and Reproductive Sciences UCSF MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study sought to answer the question of which women are engaging in genital grooming and understand their motivations. Prior studies have been limited by geography and age thus our goal was to provide a nationally representative sample of women. (more…)
Annals Internal Medicine, Author Interviews, Blood Pressure - Hypertension, Metabolic Syndrome, OBGYNE / 28.06.2016

MedicalResearch.com Interview with: Dr. Jian-Min Niu Department of Obstetrics Guangdong Women and Children Hospita Guangzhou , China MedicalResearch.com: What is the background for this study? Response: Physiological alteration leads to the question of whether the criteria for the diagnosis of gestational hypertension are suitable because the current criteria (systolic BP [SBP] ≥140 mm Hg and diastolic BP [DBP] ≥90 mm Hg) are derived from the non-pregnant population. The optimal blood pressure levels in pregnant women remain an open question. Recent studies have demonstrated associations between prehypertension before pregnancy and hypertensive disorders during pregnancy and gestational diabetes mellitus. To our knowledge, the association between prehypertension during pregnancy and postpartum cardiovascular risk has not been addressed. (more…)
Author Interviews, Diabetes, Diabetologia, OBGYNE, Pediatrics / 27.06.2016

MedicalResearch.com Interview with: Lu Qi, MD, PhD, FAHA HCA Regents Distinguished Chair and Professor Director, Tulane University Obesity Research Center Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans, LA 70112 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prenatal malnutrition and other stresses may cause small newborn babies, who are more likely develop type 2 diabetes and other chronic diseases during adulthood. However, whether such relation is causal remains to be determined. Genetic associations provide a new approach to provide evidence for such causality. (more…)
Author Interviews, NEJM, OBGYNE, University Texas, Zika / 26.06.2016

MedicalResearch.com Interview with: Abigail R.A. Aiken, MD, MPH, PhD Assistant Professor LBJ School of Public Affairs University of Texas at Austin Austin, TX, 78713 MedicalResearch.com: What is the background for this study? Response: As Zika began to emerge as an epidemic in Latin America and its links with microcephaly began to be realized, we were aware that women in the region who were already pregnant or who would become pregnant would have a very limited set of reproductive options. Research and media attention about the possible biological effects of Zika in pregnancy began to appear rapidly. But much less attention was been paid to the impacts of Zika on women. We followed the responses of governments and health organizations and when they began to issue advisories warning women to avoid pregnancy, we knew it would be important to investigate the impacts of those advisories. A country-wide policy that is impossible to follow if you are pregnant or cannot avoid pregnancy is an unusual and important public issue. Accurate data on abortion are very difficult to obtain in Latin America because in most countries, abortion is highly restricted. We wanted to provide a window on the issue of how women were responding to the risks of Zika and its associated advisories, so we worked with Women on Web (WoW), an online non-profit telemedicine initiative that provides safe medical abortion to women in countries where safe, legal abortion is not universally available. (more…)
Author Interviews, Hearing Loss, OBGYNE / 22.06.2016

MedicalResearch.com Interview with: Dr. Álex García-Faura Scientific Director of the Institut Marquès Spain MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our clinical research during the last three years has been focused on the effects of music during the early stages of life; in our preliminary studies, applying music to pregnant patients using abdominal speakers, we discovered that there was no fetal reaction to music and that the fetus would only be able to hear it as a distorted whisper because of the effects of the abdominal wall. We thought that it would be necessary to get the music closer to the fetus, and we decided to try to apply the music vaginally. It was a great decision. (more…)
Author Interviews, Cannabis, OBGYNE, Pediatrics / 21.06.2016

MedicalResearch.com Interview with: Dr. Hanan El Marroun, PhD Assistant Professor Department of Child and Adolescent Psychiatry, Department of Epidemiology The Generation R Study Erasmus, The Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for the study is that little is known about the potential long-term effects of cannabis exposure during pregnancy on child development. The main findings are the prenatal cannabis exposure was associated with differences in cortical thickness in childhood. MedicalResearch.com: What should readers take away from your report? Response: That our findings suggest an association between prenatal cannabis exposure and cortical thickness in children. However, the results must be carefully interpreted, as there may be other factors involved that we did not take into account. Therefore, further research is needed to explore the causal nature of this association. (more…)
Author Interviews, OBGYNE, Race/Ethnic Diversity / 17.06.2016

MedicalResearch.com Interview with: Luisa N. Borrell, DDS, PhD Professor Department of Epidemiology & Biostatistics Graduate School of Public Health & Health Policy City University of New York MedicalResearch.com: What is the background for this study? Dr. Borrell: Racial/ethnic disparities in birth outcomes in the United States are well documented, with non-Hispanic Black women exhibiting the worst outcomes. Several hypotheses have been proposed as explanation to this finding such as the weathering hypothesis and cumulative or chronic experiences of social inequality and racism. However, these hypotheses have only accounted for the stress burden associated with the mother’s race/ethnicity, as her race/ethnicity has been the sole information used to determine the child’s race/ethnicity, ignoring the possible stress associated with the father’s race/ethnicity. We used NYC birth- and death-linked data from 2000 to 2010 to examine the added effect of paternal race/ethnicity on adverse birth outcomes (low birth weight [LBW], small for gestational age [SGA], preterm births, and infant mortality [IM]) among NYC women. (more…)
Author Interviews, Depression, JAMA, OBGYNE, Pediatrics / 17.06.2016

MedicalResearch.com Interview with: Mari Videman Senior Consultant in Child Neurology BABA Center Children’s Hospital, Helsinki University Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Depression and anxiety are common during pregnancy, and up to 5% of all pregnant women are treated with serotonin uptake inhibitors (SRI). It is now known that SRIs do not cause major malformations in humans, however recent animal studies have suggested that fetal early SRI exposure may cause changes in brain microstructure and neuronal signaling. Prior human studies have shown that fetal SRI exposure leads to transient postnatal adaptation syndrome, as well as to an increased risk of developing childhood depression. We used electroencephalography (EEG) and advanced computational methods to assess both the local and global cortical function of the newborn brain. We found that several aspects of newborn brain activity are affected by exposuse to SRI during pregnancy. Most importantly, the communication between brain hemispheres, and the synchronization between cortical rhythms were weaker in the SRI-exposed newborns. These changes were most likely related to SRI exposure, because they did not correlate with the psychiatric symptoms of the mothers. (more…)
Author Interviews, OBGYNE, Pediatrics, Social Issues / 17.06.2016

MedicalResearch.com Interview with: Kelli A. Komro, MPH, PhD, Professor Director of Graduate Studies Behavioral Sciences and Health Education Jointly Appointed, Epidemiology Rollins School of Public Health Emory University Atlanta, GA 30322 MedicalResearch.com: What is the background for this study?  Dr. Komro: Epidemiologists have done a thorough job describing the income-health gradient, which shows a clear association between income and health. That is, as income increases, exposure to health risks and premature mortality decreases. Each step down on the income ladder decreases one’s health for many reasons related to material resources, physical environment exposures and social circumstances. The income to health association begins at birth, and more than one in four women giving birth in the U.S. are below the poverty level, putting nearly 1 million babies at risk each year. Low-income mothers are more likely to give birth prematurely, to have low birth weight babies, and to suffer the death of their infant during the post-neonatal period (28 to 364 days old). Given the importance of the income-health gradient, we set out to test the health effects of policies that are designed to increase economic security among low-income families. Our main question is: Do policies designed to reduce poverty and improve family economic security also improve health? One relevant policy is minimum wage laws. A federal minimum wage was first enacted in 1938. The real value (in 2015 dollars) of the federal minimum wage reached a high of $10.85 in 1968. The current federal rate is $7.25. Many cities and states have passed minimum wage laws that are higher than the federal rate, and currently there is a range of minimum wage increases under active public and policymaker discussion. Given that some states pass minimum wage standards and others do not, and that laws within states change over time, we took advantage of all the changes that have occurred to design a natural experiment. Our natural experiment examined the effects of state minimum wage laws on infant health. (more…)
Author Interviews, OBGYNE, Pediatrics, Vaccine Studies / 05.06.2016

MedicalResearch.com Interview with: Dr Paul T Heath MB BS, FRACP, FRCPCH Reader / Honorary Consultant Paediatric Infectious Diseases St George’s, University of London and Vaccine Institute London, United KingdomDr Paul T Heath MB BS, FRACP, FRCPCH Reader / Honorary Consultant Paediatric Infectious Diseases St George’s, University of London and Vaccine Institute London, United Kingdom MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Heath: Vaccinating pregnant women is an important and proven strategy for protecting young infants against tetanus, influenza and pertussis. Among the infants at highest risk for complications of these infections are infants born prematurely but it is generally believed that because antibody transfer from mother to baby is maximal in the 3rd trimester, babies born prematurely may miss out on the benefits of maternal vaccination. (more…)
Author Interviews, Lancet, OBGYNE, Schizophrenia, Smoking / 25.05.2016

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? Dr. Brown: Smoking during pregnancy is a risk factor for several pregnancy-related outcomes including low birthweight and preterm birth. Evidence for a link with schizophrenia is scant. We analyzed a maternal biomarker of smoking called cotinine, a nicotine metabolite, in mothers of nearly 1,000 schizophrenia cases and 1,000 controls in a national birth cohort in Finland. We found that heavy smoking in pregnancy was related to a 38% increase in schizophrenia risk in offspring and that as cotinine levels increased even in the more moderate smokers risk of schizophrenia also increased. (more…)
Author Interviews, Heart Disease, Nutrition, OBGYNE, Pediatrics, Weight Research / 25.05.2016

MedicalResearch.com Interview with: Dr. Brian Stansfield MD Neonatologist Children's Hospital of Georgia and the Medical College of Georgia Augusta University MedicalResearch.com: What is the background for this study? Dr. Stansfield: Since the mid-20th century, we have experimental evidence in animal models and human data demonstrating the influence of maternal nutrition on the offspring - both in the short term and long term. Low birth weight has been connected with higher incidence of cardiometabolic diseases including insulin resistance, coronary artery disease, and hypertension. Interestingly, low birth weight infants grow up to be relatively thin adults compared to their normal or high birth weight counterparts. Conversely, high birth weight infants tend to become heavier adults and obesity is directly linked with the same adult outcomes. So the association of cardiac and metabolic diseases with low birth weight is not linked to adult obesity in general. Thus, speculation as to why extremes of birth weight lead to adult onset cardiometabolic disease suggests different mechanisms and modifying factors. MedicalResearch.com: What are the main findings? Dr. Stansfield: The findings of our study shed considerable light on the relationship between birth weight and risk factors for insulin resistance and visceral adiposity. Using magnetic resonance imaging (MRI) to achieve precise measurements of visceral adipose content and biomarkers for insulin resistance, we show that both low and high birth weight are associated with increased visceral adiposity and insulin resistance in a healthy population of adolescents aged 13-17 years. This association persists when we account for several recognized confounders including age, sex, race, activity level, and socioeconomic status. The most interesting finding of our study is that when you account for each adolescent’s current body mass index, a measure of obesity, the relationship between increased visceral fat and insulin resistance and low birth weight is strengthened suggesting that these adolescents had relatively high visceral adipose content despite obesity rates that were similar to their normal birth weight counterparts. On the other hand, correction for adolescent BMI (obesity) reduced the relationship between these metabolic markers and high birth weight infants. Thus, low birth weight infants may develop insulin resistance and increased visceral fat, both significant risk factors for cardiovascular disease and metabolic disease, despite having a relatively normal body shape in adolescents. (more…)
Author Interviews, Cannabis, OBGYNE, Pediatrics, Toxin Research / 18.05.2016

MedicalResearch.com Interview with: Professor Claire Roberts PhD Robinson Research Institute Adelaide University MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Roberts: Our research aimed to identify novel risk factors for the four main complications of pregnancy;
  • preeclampsia where the mother gets high blood pressure and her kidneys don’t work properly,
  • preterm birth which is delivery before 37 weeks of gestation,
  • small for gestational age and
  • gestational diabetes. We have studied over 5500 pregnant women in 6 centres in 4 countries, Australia, New Zealand, the UK and Ireland. We have identified a number of factors that contribute to these major pregnancy complications. However, in this paper we have focused on well known risk factors for pregnancy complications including maternal cigarette smoking, BMI and socioeconomic status. To these we added maternal use of marijuana before pregnancy, in first trimester, at 15 weeks and at 20 weeks gestation. After adjusting the data for the other factors, we found that continued maternal marijuana use at 20 weeks gestation is strongly associated with spontaneous pre-term birth independent of maternal cigarette smoking. Women who continued to use marijuana at 20 weeks’ gestation were over 5 times more likely to deliver preterm than women who did not use marijuana. Previous studies have shown conflicting evidence but none have accounted for maternal cigarette smoking.
Importantly, not only did continued use of marijuana increase risk for preterm birth but it also made these births 5 weeks earlier on average with a greater number of women delivering very preterm. That is much more dangerous for the baby who inevitably would require admission to a neonatal intensive care unit (NICU). Earlier delivery would be expected to increase the baby’s risk for dying and having long term disabilities. (more…)
Author Interviews, Kaiser Permanente, OBGYNE, Pediatrics, Weight Research / 12.05.2016

MedicalResearch.com Interview with: Anny H. Xiang, PhD Kaiser Permanente Southern California Department of Research & Evaluation MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Xiang: Previous studies have identified a link between maternal obesity, diabetes and/or excessive gestational weight gain and long-term obesity risk in children. Our study examined the interplay among all four factors associated with childhood obesity: pre-pregnancy obesity, gestational weight gain, gestational diabetes and breastfeeding. To our knowledge, the interplay among these factors and their independent contributions to childhood obesity with data from a large and multi-ethnic cohort under current standard clinical care had not been previously studied. The study included 15,710 women who delivered babies at Kaiser Permanente medical facilities in Southern California in 2011. The key findings were:
  • A woman being obese (BMI of 30.0 or higher) prior to getting pregnant increased the odds of her child being overweight at age 2 by more than two-fold compared to women who had a normal pre-pregnancy weight (BMI between 18.5 and 25), after adjusting for weight gain during pregnancy, gestational diabetes and breastfeeding.
  • A woman being overweight (BMI between 25.0 and 29.9) prior to pregnancy was associated with 50 percent increased odds of her child being overweight at age 2.
  • Excessive weight gain during pregnancy was associated with 23 percent increased odds of a child being overweight at age 2 compared to women who had healthy weight gain during pregnancy after adjusting for pre-pregnancy weight, gestational diabetes and breastfeeding.
  • Breastfeeding for at least six months was associated with a 24 percent reduction for the odds of a child being overweight at age 2 regardless of a mother’s pre-pregnancy weight, gestational diabetes or excessive weight gain during pregnancy.
  • Gestational diabetes was not associated with the risk of a child being overweight at age 2. Women with gestational diabetes in this cohort were treated following standard clinical practice and had 40-49 percent lower rate of excessive weight gain during pregnancy and similar breastfeeding rates compared to women without gestational diabetes.
Excessive weight gain was defined according to Institute of Medicine guidelines, with normal-weight women gaining more than 35 pounds, overweight women gaining more than 25 pounds and obese women gaining more than 20 pounds during their pregnancy. Children were considered overweight at age 2 if their BMI was greater than the 85th percentile for their age and sex, based on growth charts from the Centers for Disease Control and Prevention. (more…)
Author Interviews, OBGYNE, Pharmacology, Science / 11.05.2016

MedicalResearch.com Interview with: Lynda Harris PhD Lecturer in Pharmaceutics University of Manchester Manchester Pharmacy School Maternal and Fetal Health Research Centre Manchester MedicalResearch.com: What is the background for this study? Dr. Harris: Pregnancy complications such as pre-eclampsia and fetal growth restriction remain a problem despite advances in antenatal care, and impact heavily on future health: small size at birth is associated with an increased risk of cardiovascular disease and diabetes in later life. Drugs to improve pregnancy outcome are severely lacking, as pregnant women are considered a high risk cohort by drug companies, who fear expensive lawsuits associated with side effects and teratogenicity. The majority of pregnancy complications are caused by a poorly growing or poorly functioning placenta. A number of potential drugs have been identified that enhance placental function in vitro, and improve fetal growth in animal models; however, there is currently no means of restricting their actions to the placenta, and systemic administration of these drugs to pregnant women is not feasible due to the risk of adverse effects in other tissues. To address this issue, we have identified a series of placental “homing peptides” which we have used to create nanocarriers for targeted delivery of drugs to the placenta. (more…)
Author Interviews, Depression, OBGYNE / 09.05.2016

MedicalResearch.com Interview with: Professor Robert H. Keefe PhD, LMSW, ACSW School of Social Work, University at Buffalo State University of New York, Buffalo, New York  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Keefe: The study focuses on recommendations mothers of color, who have histories of postpartum depression, would make to service providers that they believe would improve service effectiveness.  The study is timely inasmuch as the Patient Protection and Affordable Care Act mandates ongoing research to better understand and address differences in treatment needs among mothers from racial and ethnic groups and to develop culturally competent, evidence-based treatment approaches. We were concerned that the research on postpartum depression relies heavily on White mothers, who have access to care, ongoing relationships with service providers, are married or otherwise coupled, and from middle-class backgrounds.  While the limited research on mothers of color notes their rates of postpartum depression are markedly higher than White mothers, it does little to address how their treatment needs differ from White mothers. We undertook this study to get recommendations from the mothers and discovered that many of the issues that inhibit the mothers from accessing services are the very issues that lead mothers to have postpartum depression.  For example, many of the mothers report because they have poor-paying jobs, no health benefits, and limited transportation, they are unable to keep appointments despite wanting to do what is best for their newborn babies.  Furthermore, because they missed appointments, the service provider would terminate the mother from a service the mother needs, or worse contact Child Protective Services to report the mother for neglect.  The mothers were not at all neglectful.  They were all invested in their child’s wellbeing; but various life problems kept mounting up so that they and their babies were not receiving ongoing care. Consequently, the recommendations these mothers make have little to do with psychotherapy.  In fact, most of the mothers reported they had no time to be depressed and that psychotherapy was a luxury they could not afford. Instead, the mothers wanted service systems in place that would allow them to receive the care they need so that they and their new-born babies could live happy and health lives. (more…)
Author Interviews, Cost of Health Care, Fertility, OBGYNE / 09.05.2016

MedicalResearch.com Interview with: Dr. Scott Sills MD, PhD Medical Director at the Center for Advanced Genetics an IVF program based in Carlsbad, California  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Sills: Often regarded as a miracle procedure by many infertile couples, in vitro fertilization (IVF) can be financially difficult for those without insurance coverage for the treatment. This prohibitive cost leads many would-be parents who pursue IVF to transfer multiple embryos at once, to increase their chances of getting a baby and minimize the need for additional attempts. This new study now reports that the economic impact of IVF deserves a closer look. As corresponding author E. Scott Sills, MD PhD noted, rates of cesarean-section deliveries, premature births, and low birth weight of babies are all greater with two or more embryos transferred to the mother at once, compared to a lower risk, single-embryo pregnancy. The data derived from a comprehensive analysis of all IVF cases in Vermont (UVM) and was recently published in the journal Applied Health Economics & Health Policy. It is believed to be the first effort to calculate the difference in infant hospital costs based on the number of embryos transferred. Sills and his team had access to UVM Medical Center records of patients who conceived through IVF and delivered at least 20 weeks into their pregnancies between 2007 and 2011. (more…)
Author Interviews, Flu - Influenza, OBGYNE, Pediatrics, Vaccine Studies / 09.05.2016

MedicalResearch.com Interview with: Julie H. Shakib, DO, MS, MPH Assistant Professor of Pediatrics | University of Utah Medical Director | Well Baby and Intermediate Nursery Salt Lake City  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Shakib: Immunization against influenza in the first six months of life is ineffective  due to an immature immune response. Passive protection via maternal immunization offers an alternative but only a few studies have evaluated the efficacy of this immunization strategy. We found that in infants born to women immunized against influenza during pregnancy, the risk of laboratory-confirmed influenza and influenza-related hospitalization were reduced by 70% and 81% in their first 6 months of life, respectively.This large study provides more evidence that when women are immunized against influenza during pregnancy, their infants are much less likely to be diagnosed with influenza in their first 6 months. (more…)