Author Interviews, Fertility, OBGYNE, Pediatrics / 15.04.2016

MedicalResearch.com Interview with: Dr. Kieron Barclay PhD Department of Social Policy London School of Economics MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Barclay: Mean age at childbearing has been increasing in most countries in the OECD since the early 1970s. A wealth of research has shown that childbearing at advanced ages is associated with greater difficulty in terms of getting pregnant, higher rates of miscarriage, stillbirth, and increased risk of poor peri-natal outcomes such as pre-term birth and low birth weight. Studies also indicate that the offspring of older mothers have a greater risk of Alzheimer’s disease, diabetes, and mortality in adulthood. However, from the perspective of any individual woman, delaying childbearing to an older age necessarily also means that she will give birth in a later birth year. The last 40 to 50 years have seen substantial improvements in educational opportunities, and better public health conditions and medical knowledge. As a result, these positive secular trends may outweigh or counterbalance the negative effects of reproductive aging for the child. (more…)
Author Interviews, CMAJ, Fertility, OBGYNE / 12.04.2016

MedicalResearch.com Interview with: Marcelo L. Urquia PhD PhD, MSc, Mg Public Health, BA Scientist, Li Ka Shing Knowledge Institute St. Michael’s Hospital Assistant Professor, Dalla Lana School of Public Health, University of Toronto MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Urquia: In most populations the sex ratio at birth, that is, ratio of male newborns to female newborns, is about 103 to 107 males per 100 females. This is well established and does not substantially vary according to whether a woman had one or two previous children of the same sex, as each pregnancy is an independent event. However, it is known that several parts of Asia characterize for having son-biased sex ratios at birth. As countries from Asia, such as India and China are the top contributors of births to immigrant women in Canada, we wanted to verify whether son-biased sex ratios were present in Canada. Since induced abortion following prenatal sex determination using ultrasonography has been hypothesized to be a major mechanism that may explain the distorted sex ratios observed in Asia, we also studied the connection between the probability of having boys after induced abortions. In our first study entitled “Sex ratios after induced abortion” published in CMAJ (http://www.cmaj.ca/lookup/doi/10.1503/cmaj.151074), which used Ontario health care records, we found that sex ratios among Canadian-born women in Ontario were within the expected, irrespective of birth order. The sex ratio among immigrant women from India with two prior girls was 196 males per 100 females for the third live birth. Among Indian immigrant women with two prior daughters the sex ratio increased to 326 males per 100 females if they have had induced abortions preceding the third birth, to 409 males per 100 females if they have had more than one induced abortion since the last newborn child, and to 663 males per 100 females if they have had at least one preceding abortion after 14 weeks of gestation (when the sex of the fetus can be accurately estimated by ultrasonography). These findings suggest that among Indian immigrants to Ontario induced abortions of female fetuses are much more common than induced abortions of male fetuses, which helps explain the deficit in the expected number of female newborns. In our companion paper entitled “Variations in male-female infant ratios among births toCanadian- and Indian-born mothers, 1990-2011: a population-based register study” and published in CMAJ Open (insert URL), we used national birth certificate data and verified that the patterns observed in Ontario are very likely to apply to all Canadian provinces. Moreover, son-biased sex ratios at birth among Indian immigrants have existed in Canada since the early 1990’s. The deficit in the expected number of girls to Indian immigrants over the last two decades in Canada is in between 3211 to 5921. (more…)
Author Interviews, OBGYNE, Weight Research / 12.04.2016

MedicalResearch.com Interview with: Laura Mullaney School of Biological Sciences Dublin Institute of Technology Dublin Ireland. MedicalResearch.com: What is the background for this study? What are the main findings? Response: There are gaps in our knowledge regarding postpartum changes in weight. There continues to be a dramatic increase in adult obesity and the postpartum period is a vulnerable life-stage for weight gain in women. Maternal obesity matters because it is associated with an increase in both fetal and maternal complications, it is technically challenging, it is economically costly and it carries potential lifelong health consequences for the woman and her offspring. Thus, our aim was to compare trajectories in maternal weight and BMI between early pregnancy and four months postpartum and nine months postpartum, and to analyse these trajectories by BMI category. Of the 328 women who attended all appointments, mean weight at the first antenatal visit was 69.3 ±14.3 kg, mean Body Mass Index (BMI) was 25.3 ±5.0 kg/m2 and 14.4% were obese. At four months postpartum, the mean change in weight from the first antenatal visit was +1.6 ±4.2 kg, the mean change in BMI was +0.6 ±1.5 kg/m2 and 19.2% were obese. At nine months postpartum, the mean change in weight was +0.2 ±4.7 kg, the mean BMI change was -0.06 ±1.8 kg/m2 and 16.8% were obese. Of women who had an ideal BMI in early pregnancy, 16.6% and 11.1% were overweight at four and nine months postpartum respectively. Of women who were overweight in early pregnancy, 20.3%and 14.3% had become obese at four and nine months postpartum respectively. Ninety percent of women who were obese in early pregnancy remained obese at four and nine months postpartum. Women who had gained weight between early pregnancy and four months postpartum had a lower early pregnancy BMI and were less likely to be obese in early pregnancy. However women who gained weight between four and nine months postpartum were more likely to be obese in early pregnancy. (more…)
Author Interviews, BMJ, Cannabis, OBGYNE, Pediatrics / 06.04.2016

MedicalResearch.com Interview with: Cara Christ, M.D., M.S. Director of the Arizona Department of Health Services MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Christ: This study was a systematic review. The purpose of a systematic review is to critically assess and summarize the best available research evidence on a specific issue. This usually involves a critical synthesis of the results of several high quality studies on the issue under review. Overall, this review found that infants exposed to cannabis during pregnancy had a 77% higher likelihood of being underweight (<2500grams) at birth, compared to infants whose mothers did not use cannabis. Also, if the mother used cannabis during pregnancy, the likelihood of her infant needing to be placed in a neonatal intensive care unit was two times higher compared to those infants whose mothers did not use cannabis during pregnancy. (more…)
Author Interviews, CDC, Fertility, OBGYNE, Pediatrics / 06.04.2016

MedicalResearch.com Interview with: Sheree L. Boulet, DrPH, MPH Division of Reproductive Health Centers for Disease Control and Prevention Atlanta, Georgia MedicalResearch.com: What is the background for this study? Dr. Boulet: Findings from some studies have suggested that children conceived with assisted reproductive technology (ART) have increased risks of birth defects compared with spontaneously conceived children. Many of these studies were limited by a small sample size and were unable to assess risks associated with specific ART procedures. MedicalResearch.com: What are the main findings? Dr. Boulet: We found that singleton infants conceived using assisted reproductive technology were 1.4 times more likely to have a non-chromosomal birth defect compared with other infants, and the risks were highest for gastrointestinal and musculoskeletal defects. However, when our study was restricted to only ART-conceived infants, no single procedure substantially increased the risk for birth defects. This suggests that the higher risk of birth defects may be due to underlying issues related to infertility, rather than to ART itself. (more…)
Allergies, Asthma, Author Interviews, OBGYNE, Pulmonary Disease / 05.04.2016

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 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Intranasal corticosteroid (Nasacort) use during pregnancy for the treatment of seasonal allergies has increased over the past decade. Nasacort is now available over the counter since October 2013 in the US and January 2015 in Canada. Given that seasonal allergies are prevalent during pregnancy and that a medication available over-the-counter is likely to be used frequently, we aimed to study the risk of using Nasacort during gestation. Furthermore, given the potential public health impact, the objectives of our study were to assess the safety of intranasal triamcinolone exposure during pregnancy on the occurrence of major congenital malformations, small-for-gestational-age (SGA) newborn, and spontaneous abortions. Use of intranasal triamcinolone during the first trimester of pregnancy was not significantly associated with the risk of overall congenital malformations (OR 0.88, 95%CI 0.60-1.28; 31 exposed cases) compared to non-exposure; it was however associated with the risk of respiratory defects (OR 2.71, 95%CI 1.11-6.64; 5 exposed cases). This is important given that a medication given for the treatment of respiratory diseases is associated with respiratory defects in newborns. Pregnancy exposure to intranasal triamcinolone was not significantly associated with the risk of spontaneous abortions (OR 1.04, 95%CI 0.76-1.43; 50 exposed cases). No association was found between 2nd or 3rd trimester exposure to intranasal triamcinolone and the risk of SGA (OR 1.06, 95%CI 0.79-1.43; 50 exposed cases). (more…)
Asthma, Author Interviews, OBGYNE / 02.04.2016

MedicalResearch.com Interview with: Dr Anju Joham (MBBS (Hons), FRACP, PhD) Endocrinologist, Monash Health Post doctoral Research Fellow Monash Centre for Health Research and Implementation – MCHRI School of Public Health and Preventive Medicine Monash University – in partnership with Monash Healtj MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Johan: Polycystic Ovary Syndrome (PCOS) is a common condition affecting reproductive-aged women. Recent research suggests that asthma may be more commonly seen in women with PCOS; however, there are very limited studies that have examined this relationship. It will be helpful to understand if there is a relationship with PCOS and asthma. Women were randomly selected from the national health insurance database (Medicare) in Australia. Data was available for 8612 women. We found that in women aged 28 to 33 years, PCOS prevalence was 5.8% (95% CI: 5.3%-6.4%). The prevalence of asthma was 15.2% in women reporting PCOS and 10.6% in women not reporting PCOS respectively. PCOS was associated with 34% increased odds of asthma after adjusting for weight. In addition, weight in the overweight and obese range were associated with increased odds of asthma. (more…)
Author Interviews, Diabetes, Mental Health Research, OBGYNE / 30.03.2016

MedicalResearch.com Interview with: Eyal Sheiner, MD,PhD Department of Obstetrics and Gynecology Soroka University Medical Center Beer-Sheva Israel MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Sheiner: The reported rates of gestational diabetes mellitus (GDM) are constantly escalating and little is known about the long term complications in the offspring. Evidence from the field of epigenetics strongly advocated the need for research on the neuropsychiatric impact of being exposed prenatally to GDM. In our study, in utero exposure to gestational diabetes mellitus was found to be an independent risk factor for long term neuropsychiatric morbidity of the offspring. (more…)
Author Interviews, HPV, OBGYNE / 29.03.2016

MedicalResearch.com Interview with: Andrew Combs MD Alan Fishman MD Obstetrix Medical Group San Jose, California MedicalResearch.com: What is the background for this study? Response: Vaginal ultrasound is a common procedure in gynecology and obstetrics. To perform vaginal ultrasound, an ultrasound probe is placed in the vagina in order to get a close-up view of a woman’s pelvic organs. In non-pregnant women, this is the preferred method for ultrasound of the uterus and ovaries. In early pregnancy, vaginal ultrasound often yields better images of the developing embryo than abdominal ultrasound. In later pregnancy, vaginal ultrasound gives more accurate pictures of the cervix and placenta than abdominal ultrasound. In order to prevent transmission of disease from patient to patient, it is mandatory to clean and disinfect the probe after each vaginal exam. The FDA has a list of “high level” disinfectants that neutralize or kill a variety of bacteria and viruses. Several manufacturers make disinfectant systems that are approved for disinfection of ultrasound probes. It is also mandatory to cover the probe with a barrier during each exam. Various companies manufacture ultrasound probe covers intended to be barriers against infection. MedicalResearch.com: What are the main findings? Response: Recent studies found that two widely-used disinfectants (glutaraldehyde and ortho-ophthalaldehyde) do not neutralize human papilloma virus (HPV) even though they are on the FDA list of high level disinfectants. HPV is the most common sexually transmitted infection in the USA, affecting over 8 million women of reproductive age. HPV is responsible for 60% of cervical cancer worldwide. Clearly, it is critical to neutralize this virus on vaginal ultrasound probes. A different high-level disinfectant system, sonicated hydrogen peroxide, was found to be highly effective at neutralizing HPV. Other studies show that commercial ultrasound probe covers have a high rate of leakage, 8-81%. Condoms are safer probe covers, with leakage rates of 0.9 to 2%. (more…)
Author Interviews, HPV, JAMA, OBGYNE, Sexual Health, UCSD / 24.03.2016

MedicalResearch.com Interview with: Ryan K. Orosco, MD Division of Head and Neck Surgery Department of Surgery University of California, San Diego MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Orosco: Our group at UC San Diego is interested in HPV as it relates to diseases of the head and neck. HPV is a well-publicized cause of cervical cancer, and awareness about its link to throat (oropharynx) cancer is rapidly increasing. Less well-known, is the relationship between HPV and benign (non-cancerous) diseases such as genital warts and papilloma of the throat. As we strive to understand how to best care for patients with HPV-related disorders, it is important to understand the entire process of disease progression, which begins with HPV infection. Our group wanted to explore the relationship between HPV infection in the two most commonly infected body sites: oral and vaginal. (more…)
Author Interviews, Coffee, Fertility, Lifestyle & Health, NIH, OBGYNE / 24.03.2016

MedicalResearch.com Interview with: Germaine M. Buck Louis, Ph.D., M.S. Office of the Director Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development Rockville, Maryland 20852. MedicalResearch.com: What is the background for this study? What are the main findings? Response: To understand the association between couples’ lifestyles and risk of pregnancy loss. Couples were recruited upon discontinuing contraception to try for pregnancy and followed daily for up to one year of trying or until pregnancy. Pregnant women were followed daily for 7 weeks following conception then monthly. (more…)
Author Interviews, OBGYNE, Pediatrics, PLoS, Surgical Research / 16.03.2016

MedicalResearch.com Interview with: Dr Mairead Black MBChB, MRCOG, MSc Clinical Lecturer, Obstetrics and Gynaecology School of Medicine and Dentistry, Division of Applied Health Sciences University of Aberdeen Aberdeen Maternity Hospital, Cornhill Road Aberdeen MedicalResearch.com: What is the background for this study? Dr. Black: The commonest reason for performing a planned Cesarean Section (CS) in high-income countries is a history of a previous CS. However, there is very little information available on childhood health outcomes of birth after a previous . MedicalResearch.com: Why might vaginal birth be beneficial? Dr. Black: If a baby is born naturally, it is exposed to various processes of labour and birth which may help their immunity and ability to avoid or fight future illness. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA, OBGYNE / 14.03.2016

MedicalResearch.com Interview with: Ida Behrens, MD and Heather Boyd PhD Department of Epidemiology Research Statens Serum Institut Copenhagen, Denmark MedicalResearch.com: What is the background for this study? Response: Over the past decade, we have begun to realize that a woman’s pregnancy experiences can be a predictor of her future health. Miscarriages, stillbirths and preterm deliveries have all been linked with an increased risk of later cardiovascular disease, as have hypertensive disorders of pregnancy (preeclampsia and gestational hypertension). Women with preeclampsia also have an increased risk of peripartum cardiomyopathy, a rare but serious condition that severely compromises heart function at the end of pregnancy or shortly after delivery. We were interested to find out whether women with preeclampsia or gestational hypertension during one or more pregnancies also had an increased risk of cardiomyopathy later in life. MedicalResearch.com: What are the main findings? Response: Using Danish national registers, we followed more than 1 million women with pregnancies between 1978 and 2011 – with an average follow-up of almost 18 years per woman – to see whether women with hypertensive disorders of pregnancy had increased rates of cardiomyopathy later in life, compared with women who only had normotensive pregnancies. We found that the women with hypertensive disorders of pregnancy had a two-fold increased risk of cardiomyopathy later in life. Interestingly, only half of this increase in risk could be linked to chronic hypertension, which is common among women who have previously had a hypertensive disorder of pregnancy. The remaining 50% was not associated with hypertension and could potentially be directly attributable to the woman’s pregnancy experience (or to an underlying cause common to both hypertensive disorders of pregnancy and cardiomyopathy). (more…)
Author Interviews, Infections, OBGYNE, Pediatrics / 14.03.2016

MedicalResearch.com Interview with: Elaine Tuomanen, MD Chair and Full Member Dept of Infectious Diseases St Jude Children’s Research Hospital 262 Danny Thomas Place Memphis, TN 38105 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Tuomanen: While investigating mechanisms of brain repair during infection in a mouse model system, we found that components from the surfaces of bacteria could traffic from the mother to the fetus. The bacterial components moved across the placenta and into the fetal brain. To our surprise, the fetal brain did not respond with neuronal death like we see in children with meningitis. Rather, fetal neurons proliferated. This response involved the innate immune system (TLR2) inducing the neuronal transcription factor, FoxG1, which is known to drive proliferation. The newly born neurons migrated appropriately to the cortical plate, the area on the surface of the fetal brain that forms the cortex, a major part of the adult brain. Although the neurons moved to the right place in the brain, there were too many and they crowded together in the cortex, changing the architecture of the brain. At birth, affected mice seemed to have no abnormalities. However, when we tested if this change in architecture would affect brain function after birth, mice were shown to progressively develop defects in learning, memory and other cognitive functions. This indicates there is a window during pregnancy where components of bacteria from the mother can change fetal brain architecture and subsequent postnatal behavior (more…)
Author Interviews, Lancet, OBGYNE / 11.03.2016

MedicalResearch.com Interview with: Charles J. Lockwood, MD Member of of the March of Dimes Board of Trustees Dean at Morsani College of Medicine Senior Vice President, USF Health and Professor of Obstetrics & Gynecology, and Public Health The University of South Florida MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Lockwood: There remain questions about the utility of vaginal progesterone therapy in asymptomatic women with singleton gestations at risk for preterm birth. The OPPTIMUM study investigators conducted a double-blind, randomized, placebo-controlled trial of vaginal progesterone delivered via a pessary releasing 200 mg per day (n=618) vs. placebo (n=610) from around 22 to 34 weeks gestation among women at high risk for prematurity on the basis of a characteristic history and/or the presence of cervicovaginal fetal fibronectin or a cervical length less than 25 mm in length on transvaginal ultrasound. The primary endpoints were fetal death or preterm birth before 34 weeks (obstetrical outcome), or a composite of neonatal mortality or morbidities (neonatal outcome). The authors found that progesterone had no significant impact on either primary endpoint, with an adjusted OR of 0·86, 95% CI: 0·61-1·22 for obstetrical outcomes and an OR of 0·62, 95% CI:0·38-1·03 for neonatal outcomes. (more…)
Author Interviews, Education, OBGYNE / 08.03.2016

MedicalResearch.com Interview with: Cynthia R. Daniels PhD Professor, Political Science Department. Rutgers University New Brunswick, N.J. 08901 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Daniels: The study found that over 30% of information regarding embryological and fetal development is medically misleading in the informed consent materials states require women see before receiving an abortion. Nearly half of the information provided about the 1st trimester of pregnancy, when most women have abortions, was medically inaccurate, meaning either 'false' or 'misleading.' (more…)
Author Interviews, Dengue, Lancet, OBGYNE / 07.03.2016

MedicalResearch.com Interview with: Mrs Enny S Paixão London School of Hygiene & Tropical Medicine London UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: Dengue is a vector borne disease endemic in more than 100 countries (mainly in South America and southeast Asia) and is spreading to new areas, with outbreaks of increasing magnitude and severity. It is estimated that each year, 390 million people are infected with dengue and 96 million develop clinical symptoms. Despite of the importance of this disease, the effects of disease during pregnancy on fetal outcomes remain unclear. Using the published scientific literature, we investigated the risk of stillbirth, miscarriage, preterm birth, and low birth weight for women who had dengue infection during pregnancy. This study showed some evidence that dengue infection alone, in the absence of clinical symptoms, does not affect the outcome of pregnancy, but also that clinical dengue during pregnancy seems to increase the frequency of stillbirth, prematurity, and low birthweight. (more…)
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…)