OBGYNE
27 Sep C-section carries a 4-fold increased risk of blood clots, compared with vaginal deliveries
Posted at 11:23h
in Author Interviews, Blood Clots, CHEST, OBGYNE, Surgical Research, Thromboembolism
MedicalResearch.com Interview with:
Marc Blondon, MD
Division of Angiology and Hemostasis, Department of Specialties of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, WA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Venous thromboembolism, a condition including deep vein thrombosis (blood clots) and pulmonary embolism, is more common in older than younger patients. However, pregnancy and particularly the postpartum period are times at greater risk of blood clots in women. It is important to understand the risk and the risk factors for thrombosis in the postpartum period to guide the use of preventive measures such as heparin, an anticoagulant treatment, or leg compression devices.
Our study summarizes the evidence on the link between C-sections and blood clots from the past 35 years.
Our meta-analysis demonstrates that:
- C-section carries a 4-fold increased risk of blood clots in the postpartum period, compared with vaginal deliveries ;
- that this risk is most prominent but not restricted to emergency C-section ;
- and that women who undergo elective C-section are also at higher risk than women who have a vaginal delivery.
- Importantly, we estimated an absolute risk of blood clots after a C-section of 2-4 per 1000 pregnancies: on average, 3 out of 1000 women after C-section will develop a blood clot.
26 Sep Nausea and Vomiting During Pregnancy May Signal Less Risk of Pregnancy Loss
MedicalResearch.com Interview with: Stefanie N. Hinkle, Ph.D. Staff Scientist | Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: Thank you for the interest in our research. Nausea and vomiting are very common early in pregnancy and these symptoms can be difficult for women. Before we began this study there was very limited high-quality data on the implications of these difficult symptoms in pregnancy. Our study is unique because we asked women to report their symptoms continuously throughout their pregnancy before they may or may not have gone on to have a loss. We found that among women with 1 or 2 prior pregnancy losses, women who have nausea, and particularly nausea with vomiting, were less likely to have a pregnancy loss.21 Sep Bidirectional Link Between Depression and Risk of Gestational Diabetes
MedicalResearch.com Interview with: [caption id="attachment_28228" align="alignleft" width="158"]
Dr. Cuilin Zhang[/caption]
Cuilin Zhang MD, PhD
Senior Investigator
NICHD, National Institutes of Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Pregnant women are at high risk of developing depressive symptoms; at least 10% US women suffering from depression during pregnancy. Gestational diabetes is a common pregnancy complication, affecting 4-7% of pregnancies in the U.S.. Gestational diabetes has adverse health implications on both women and their children. Depression and glucose intolerance commonly co-occur among non-pregnant individuals; however, the temporal relationship between gestational diabetes and depression during pregnancy and the postpartum period is less understood.
19 Sep Pregnancy May Be a Time of Heightened Homicide Risk, Particularly For Young Black Women
[caption id="attachment_28111" align="alignleft" width="133"]
Dr. Pauline Mendola[/caption]
MedicalResearch.com Interview with:
Pauline Mendola, PhD
Investigator, Epidemiology Branch
Division of Intramural Population Health Research
Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH
Bethesda, MD 20892
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Efforts to monitor and reduce maternal mortality during and around the time of pregnancy largely focus on causes physiologically related to the pregnancy, despite the fact that increasing evidence suggests violent death – including homicide and suicide – are leading causes.
In this study, we analyzed US death certificates from 2005-2010 from states that include pregnancy information on the death record in order to estimate rates of pregnancy-associated homicide and suicide, and to determine if risk of violent death was increased for women during pregnancy and postpartum. Given the large proportion of death records with unknown pregnancy status, we adjusted for a range of possible misclassification and found that pregnancy-associated homicide risk ranged from 2.2-6.2 per 100,000 live births, while pregnancy-associated suicide risk ranged from 1.6-4.5 per 100,000 live births. Overall, homicide risk was 1.8 times higher among pregnant/postpartum women compared to non-pregnant women in the population. The risk of suicide was 38% lower among pregnant/postpartum women than the general population.
19 Sep Rates of Gestational Diabetes Higher in Summer
MedicalResearch.com Interview with: Anastasia Katsarou PhD LUND University MedicalResearch.com: What is the background for this study? What are the main findings? Response: The study is using data from the Mamma study which screened pregnant women during 2003-2005. During this period, we gathered results from the oral glucose tolerance tests that the women underwent at the 28th week of pregnancy. We used data on the 2hour blood glucose levels from these tests and the frequency of women who were diagnosed with gestational diabetes and grouped them into months and seasons. We gathered also data on the mean monthly temperatures from the Swedish Meteorological and Hydrological Institute. We observed that the 2hour glucose levels and the frequency of women diagnosed with gestational diabetes were statistically significantly higher during the summer months.17 Sep Almost 5 Million Unnecessary Pap Smears Done Annually In Women With Hysterectomy
Posted at 20:58h
in Author Interviews, Cost of Health Care, OBGYNE, Outcomes & Safety, University Texas
MedicalResearch.com Interview with:
[caption id="attachment_28034" align="alignleft" width="200"]
Dr. Fangjian Guo[/caption]
Fangjian Guo, MD, PhD
Assistant Professor
BIRCWH Scholar
Department of Obstetrics & Gynecology
Center for Interdisciplinary Research in Women’s Health
The University of Texas Medical Branch
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: National guidelines consistently recommend against cervical cancer screening among women with a history of a total hysterectomy for a benign condition. These women are unlikely to develop high-grade cervical lesions. The goal of our study was to assess whether these guidelines are being followed. We examined the use of Pap testing among US adult women with a history of total hysterectomy for a benign condition and the roles of health care providers and patients in the initiation of Pap test use.
We found that in 2013, 32% of women who have had a hysterectomy received an unnecessary recommendation for cervical cancer screening from a health care provider in the past year; 22.1% of women with hysterectomy received unnecessary Pap testing. Although the majority of Pap tests were performed at a clinician’s recommendation, approximately one fourth were initiated by patients without clinician recommendations. According to standard 2010 US Census population figures, about 4.9 million unnecessary Pap tests are performed annually among women who have had a total hysterectomy for a benign condition. At approximately $30 per test, $150 million in direct medical costs could be saved annually if screening guidelines were followed for these women.
16 Sep Cause and Preventative Treatment of Most Preterm Births Remains Unknown
MedicalResearch.com Interview with: [caption id="attachment_27981" align="alignleft" width="104"]
Dr. Joseph Leigh Simpson[/caption]
Joseph Leigh Simpson, MD FACOG, FACMG
President at International Federation of Fertility Societies
March of Dimes Foundation
White Plains, NY
MedicalResearch.com: What is the background for this study?
Response: Preterm birth (PTB) is the most common single cause of perinatal and infant mortality, affecting 15 million infants worldwide each year with global rates increasing. A total of 1.1 million infants die each year. Preterm births and their complications are the leading cause of deaths in children under age 5.
The biological basis of preterm birth remains poorly understood, and for that reason, preventive interventions are often empiric and have only limited benefit. Large differences exist in preterm birth rates across high income countries: 5.5 percent in Sweden and at present 9.6 percent in the U.S. The International Federation of Gynecologists and Obstetricians (FIGO)/March of Dimes Working Group on Preterm Birth Prevention hypothesized that identifying the risk factors underlying these wide variations could lead to interventions that reduce preterm birth in countries having high rates.
14 Sep Adolescent Girls Not Adequately Screened For Pregnancy Before Chemo or CT Scans
MedicalResearch.com Interview with: [caption id="attachment_27794" align="alignleft" width="144"]
Dr. Pooja Rao[/caption]
Pooja Rao, MD, MSCE
Assistant Professor
Division of Pediatric Hematology/Oncology
Milton S. Hershey Medical Center
Penn State College of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Although many chemotherapy drugs can cause birth defects, no standardized guidelines exist for pregnancy screening in adolescent female patients with cancer. Additionally, little is known about how often they are screened prior to receiving treatment.
Our study found that adolescent girls are not adequately screened for pregnancy prior to receiving chemotherapy or CT scans that could potentially harm a developing fetus. Adolescents with acute lymphoblastic leukemia, the most common childhood cancer, had the lowest pregnancy screening rates of the patients studied.
13 Sep In Utero Exposure to Ethinyl Estradiol Linked to Tamoxifen Resistance and Breast Cancer Recurrence
MedicalResearch.com Interview with: [caption id="attachment_27856" align="alignleft" width="120"]
Dr. Leena Hilakivi-Clarke[/caption]
Leena Hilakivi-Clarke, PhD
Professor of Oncology
Georgetown University
Washington, DC 20057
MedicalResearch.com: What is the background for this study?
Response: About 70% of women who develop breast cancer express estrogen receptors in their cancer. These patients are treated with endocrine therapies that target estrogen receptors. Endocrine therapies are effective in half of the patients, but the other half are resistant to the treatment and recur. Prior to the start of endocrine therapy, there is no way to predict who will respond to it and who will have recurrence of breast cancer. Therefore, it is not known which patients might benefit from an additional therapy to prevent recurrence, and what that additional therapy would entail. We wondered if resistance to endocrine therapy (we used tamoxifen) is pre-programmed by maternal exposure to the estrogenic endocrine disrupting chemical ethinyl estradiol (EE2). Previously, we and others have found that EE2 and other estrogenic compounds, when given during pregnancy, increase breast cancer risk in the female offspring in animal studies and among humans. The current study was done using a preclinical animal model that was used 50 years ago to discover that tamoxifen is an effective endocrine therapy for estrogen receptor positive breast cancer patients.
06 Sep Origins of Childhood Asthma Can Be Traced To Very Early in Pregnancy
MedicalResearch.com Interview with: [caption id="attachment_27674" align="alignleft" width="132"]
Dr. Stephen Turner[/caption]
Dr Steve Turner MD MBBS
Lead investigator of the study team and
Respiratory paediatrician
Royal Aberdeen Children’s Hospital
MedicalResearch.com: What is the background for this study?
Response: For almost thirty years there has been evidence that we are all born with a certain predisposition to what are called non communicable diseases (NCD) such as high blood pressure, type II diabetes and heart disease.
The evidence comes from studies which have linked reduced birth weight with increased risk for these NCDs in later life. The question which arises, and which has been more difficult to answer, is “when during pregnancy is the predisposition to for NCDs first seen?”
This is important to any attempt to reduce the unborn baby’s risk for NCD. We and other researchers have used fetal ultrasound data to link size before birth to non communicable diseases outcomes. In childhood, NCDs include asthma.
06 Sep Uncertainty Persists About Benefits of Delayed Cord Clamping In Extremely Premature Infants
MedicalResearch.com Interview with: [caption id="attachment_27700" align="alignleft" width="138"]
Dr. David Osborn[/caption]
David Osborn MB BS MM PhD FRACP
Clinical Associate Professor, University of Sydney
Senior Neonatologist, Royal Prince Alfred Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In an analysis of trials of placental transfusion at delivery by either delayed umbilical cord clamping or cord milking in infants born before 30 weeks gestation, placental transfusion was associated with short term benefits including increased hemoglobin, fewer blood transfusions, improved blood pressure and reduced late onset sepsis, with no significant effect on other outcomes. There were insufficient data regarding effects of placental transfusion on survival and long term disability.
The Australian Placental Transfusion Study (APTS) is a randomised controlled trial that aims to determine if delayed cord clamping (≥ 60 seconds) compared to early cord clamping (≤10 seconds) in 1600 infants born before 30 weeks gestation results in improved newborn outcomes and disability free survival.
In this echocardiographic sub study, the aim was to determine the effect of placental transfusion on systemic blood flow in the first day after birth in 266 infants randomly allocated to delayed versus early cord clamping (133 infants in each group). The primary outcome was superior vena cava (SVC) flow (cardiac input) which overcomes the problem of shunts across the adapting heart which affect the usefulness of measuring ventricular outputs in the first days after birth.
In infants born <30 weeks gestation, delayed cord clamping had no effect on the principle measure of systemic blood flow (SVC flow) during the first 24 hours compared to immediate cord clamping. However, right ventricular output (RVO) was lower in the delayed cord clamping group. This was not predicted and may be a chance finding. Further analysis suggests the effect of cord clamping on RVO could be mediated by its effect on hemoglobin. This may be a positive or negative adaptive change. There was no evidence of an increase in right to left ductal shunting suggestive of high pulmonary blood pressure to explain the difference in RVO. Delayed cord clamping resulted in a 8.9g/L greater increase in hemoglobin to 6 hours but had no effect on ductus arteriosus size, shunt direction or treatment, no effect on blood pressure or its treatment, and no effect on blood gas parameters and other cardiovascular variables in the first 24 hours.
01 Sep Persistent Postpartum Pain Linked To Higher Risk of Depression
MedicalResearch.com Interview with: MS WEI DU, First author Third Year Medical Student DUKE-NUS Medical School and DR BAN LEONG SNG, Senior Author Senior Consultant Department of Women’s Anesthesia KK Women’s and Children’s Hospital MedicalResearch.com: What is the background for this study? What are the main findings? MS WEI DU: We performed a cohort study involving 200 healthy women...
29 Aug Association Between Regular Exercise and Decreased Risk of Cesarean Delivery
MedicalResearch.com Interview with: [caption id="attachment_18222" align="alignleft" width="180"]
Dr. Katrine Owe[/caption]
Katrine M. Owe, PhD
Domain for Mental and Physical Health
Norwegian Institute of Public Health
OSLO, Norway
Norwegian National Advisory Unit on Women's Health
Oslo University Hospital, Rikshospitalet
Oso, Norway
MedicalResearch.com: What is the background for this study?
Response: The rising cesarean delivery rates in developed countries are of great concern. Given the many adverse consequences of repeated cesarean deliveries for both mother and child, identifying factors associated with the decision to perform the first cesarean is important.
Growing evidence show that regular exercise during pregnancy is associated with a lower risk of gestational diabetes, preeclampsia and excessive birth weight, all of which are highly correlated with having a cesarean delivery.
Results from previous studies examining the relationship between pregnancy exercise and mode of delivery, are inconsistent. Small sample size, not population-based, reporting crude estimates, and not powered to study cesarean delivery, are common methodological limitations in previous studies.
23 Aug Step Closer To Treating Mitochondrial Diseases by Understanding How Embryos Digest Sperm
MedicalResearch.com Interview with: [caption id="attachment_27272" align="alignleft" width="150"]
Dr. Peter Sutovsky[/caption]
Peter Sutovsky PhD
Professor of Animal Science in the College of Agriculture, Food and Natural Resources
University of Missouri
Professor of Obstetrics, Gynecology and Women’s Health at the School of Medicine
University of Missouri Health System
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Strictly maternal inheritance of mitochondria, the cellular power stations, and mitochondrial genes that mitochondria harbor, is a major biological paradigm in mammals. Propagation of paternal, sperm-contributed mitochondrial genes, resulting in a condition called heteroplasmy, is seldom observed in mammals, due to post-fertilization elimination sperm mitochondria, referred to as “sperm mitophagy.” Our and others’ recent results suggest that this process is mediated by the synergy of ubiquitin–proteasome system (UPS) pathway that recycles outlived cellular proteins one molecule at a time, and autophagic pathway capable of engulfing and digesting an entire mitochondrion.
Here we demonstrate that the co-inhibition of the ubiquitin-binding autophagy receptor proteins SQSTM1, GABARAP, and UPS, and the UPS protein VCP dependent pathways delayed the digestion of sperm mitochondria inside the fertilized pig egg. By manipulating said proteins, we created heteroplasmic pig embryos with both the paternal and maternal mitochondrial genes. Such animal embryos that could be used as a biomedical model to research and alleviate certain forms of mitochondrial disease.
19 Aug Maternal Gestational Diabetes Increased Risk of Childhood Obesity
MedicalResearch.com Interview with: [caption id="attachment_26918" align="alignleft" width="200"]
Dr. Gang Hu[/caption]
Dr. Gang Hu, Associate Professor
LSU’s Pennington Biomedical Research Center & Director
Chronic Disease Epidemiology Lab
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Some studies have found that maternal gestational diabetes mellitus (GDM) places offspring at increased risk of long-term adverse outcomes, including obesity. However, most of studies are from high income countries, with limited data from low to middle income countries. The present study, conducted at urban and suburban sites in 12 countries, found that the increased risk for children of GDM mothers compared with non-gestational diabetes mellitus mothers was 53% for obesity, 73% for central obesity, and 42% for high body fat.
19 Aug Closed-Loop Insulin Delivery During Pregnancy Improves Glucose Control
MedicalResearch.com Interview with: Professor Helen Murphy and Dr Zoe Stewart Institute of Metabolic Science University of Cambridge MedicalResearch.com: What is the background for this study? Response: Controlling blood glucose levels is a daily challenge for people with Type 1 diabetes and is particularly crucial during pregnancy. Previous research shows that women with type 1 diabetes spend only 12 hours per day within the recommended glucose target levels, leading to increased rates of complications including preterm delivery and large for gestational age infants. National surveys show that one in two babies suffer complications related to type 1 diabetes in the mother. The hormonal changes that occur in pregnancy make it difficult for women to predict the best insulin doses for every meal and overnight. Too much insulin causes low glucose levels harmful for the mother and too little causes problems for the developing baby. The artificial pancreas automates the insulin delivery giving better glucose control than we can achieve with currently available treatments. Previous studies show that the closed-loop system also known as artificial pancreas can be used safely in children and adults and our study aimed to investigate whether or not it was helpful for women with type1 diabetes during pregnancy.19 Aug Most Antipsychotics Found To Not Raise Risk of Congenital Malformations
Posted at 00:05h
in Author Interviews, Brigham & Women's - Harvard, JAMA, Mental Health Research, OBGYNE
MedicalResearch.com Interview with:
[caption id="attachment_27170" align="alignleft" width="179"]
Dr. Krista Huybrechts[/caption]
Krista F. Huybrechts, M.S., Ph.D.
Assistant Professor of Medicine
Harvard Medical School
Epidemiologist
Division of Pharmacoepidemiology and Pharmacoeconomics
Brigham and Women’s Hospital
Boston, MA 02120
MedicalResearch.com: What is the background for this study?
Response: The use of antipsychotic medications during pregnancy has doubled in the last decade. Yet, information on the safety of antipsychotic medication use during pregnancy for the developing fetus is very limited: existing studies tend to be small (the largest study available to date includes 570 exposed women) and findings have been inconsistent. Concerns have been raised about a potential association with congenital malformations.
The objective of our study was to examine the risk of congenital malformations overall, as well as cardiac malformations given findings from earlier studies, in a large cohort of pregnant women. We used a nationwide sample of 1.3 mln pregnant women insured through Medicaid between 2000-2010, of which 9,258 used an atypical antipsychotic and 733 used a typical antipsychotic during the first trimester, the etiologically relevant period for organogenesis. We also examined the risks associated with the most commonly used individual medications.
18 Aug Douching May Be Associated With Increased Risk of Ovarian Cancer
MedicalResearch.com Interview with: [caption id="attachment_27098" align="alignleft" width="133"]
Dr. Clarice Weinberg[/caption]
Clarice Weinberg, Ph.D.
Deputy Branch Chief
Biostatistics and Computational Biology Branch
National Institute of Environmental Health Sciences
National Institutes of Health
Research Triangle Park, NC 27709
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: A number of studies have reported a link between genital use of talc powders and ovarian cancer. We wondered whether the practice of douching could contribute to that risk by moving fibers and chemicals into and up the reproductive tract. We are carrying out the Sister Study, a large cohort study that enrolled more than 50,000 women who each had a sister diagnosed with breast cancer and who are consequently at increased risk of ovarian cancer. During the Sister Study enrollment interview, we asked each of them about their douching and use of talc in the previous 12 months. During approximately 6 years of follow up, 154 participants developed ovarian cancer. Our statistical analyses did not show any relationship between talc use and risk of ovarian cancer, but we estimated that women who had said they douched had almost double the risk for ovarian cancer compared to women who did not douche.
17 Aug Prenatal Expanded Carrier Screening Could Identify Many More Serious Defects
MedicalResearch.com Interview with: [caption id="attachment_27104" align="alignleft" width="200"]
Gabriel Lazarin[/caption]
Gabriel Lazarin MS
Vice President,Counsyl
Medical Science Liaisons
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The study finds there is a significant opportunity to identify more pregnancies affected by serious conditions, across all ethnicities, through the clinical use of expanded carrier screening (ECS). We found that compared to current prenatal genetic testing guidelines, expanded carrier screening for 94 genetically inherited conditions better addresses the risk of having a pregnancy affected with a serious condition.
Certain physicians have been offering ECS since 2010. However, in order for it to come into routine use, a group of major medical organizations last year stated a need for further data regarding the frequency of previously unscreened genetic variants. This study uses real test results from approximately 350,000 people to provide that data.
09 Aug Preconception Counselling Resource Improves Pregnancy Care in Women With Diabetes
MedicalResearch.com Interview with: [caption id="attachment_26855" align="alignleft" width="174"]
Dr. Valerie Holmes[/caption]
Dr Valerie Holmes
Senior Lecturer
Centre for Public Health
School of Medicine, Dentistry and Biomedical Science
Queen's University Belfast
Belfast
MedicalResearch.com: What is the background for this study?
Response: Women with diabetes, type 1 diabetes and type 2 diabetes, are advised to plan for pregnancy as there are higher risks of complications for both the mother and baby when compared to the general maternity population. Careful planning in partnership with diabetes care teams, especially in relation to achieving optimum blood glucose control and taking folic acid can significantly reduce the risks. However, while most women know that they should plan for pregnancy, they are unaware as to why this is important or how to engage with the process, and thus the majority of women (up to two thirds of women) enter pregnancy unprepared. This study describes the implementation of a regional preconception counsellng resource, in the format of a DVD, into routine care in Northern Ireland to raise awareness of pregnancy planning. The authors assessed if the introduction of this resource improved pregnancy planning among women with diabetes in the region.
05 Aug Early Hysterectomy With Preserved Ovaries Doubles Risk of Hot Flashes and Night Sweats
MedicalResearch.com Interview with: [caption id="attachment_26763" align="alignleft" width="208"]
Louise Wilson[/caption]
Louise Wilson PhD Candidate
The University of Queensland
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Hysterectomy remains one of the most common gynecological procedures worldwide, with rates highest among women aged between 40 and 50. Between 30 and 40% of women aged in their 40s and 50s experience hot flushes and night sweats (vasomotor symptoms) that can greatly impact upon their overall quality of life. There is consistent evidence that women who have a hysterectomy and both ovaries removed are more likely to report more frequent or severe vasomotor symptoms, probably due to the abrupt decline in estrogen levels post-surgery.
For women who have a hysterectomy with ovaries retained, the evidence is less clear. We wanted to increase our understanding of the symptom experiences of these women. We examined 17 years of data from more than 6,000 women in the Australian Longitudinal Study on Women’s Health. Approximately one in five of the women had a hysterectomy with ovarian conservation before the age of 50.
We found that a third of these women experienced hot flushes that persisted in the long term, and around one in five were afflicted by constant night sweats. These rates were double those of women who did not have a hysterectomy over the 17-year study period, and could not be explained by differences in lifestyle or socio-economic factors.
05 Aug Suturing With Thicker Thread To Prevent Preterm Delivery Increases Risk of Miscarriage
MedicalResearch.com Interview with: [caption id="attachment_26708" align="alignleft" width="149"]
Dr. David Macintyre[/caption]
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.
04 Aug CDC Urges Wider Availability of Contraceptives In Regions Affected by Zika
MedicalResearch.com Interview with: [caption id="attachment_26696" align="alignleft" width="158"]
Dr. Charlan Kroelinger[/caption]
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.
29 Jul Almost A Million Cases of Maternal Syphilis Globally Per year
MedicalResearch.com Interview with: [caption id="attachment_26580" align="alignleft" width="200"]
N. Saman Wijesooriya[/caption]
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.
25 Jul Breastfeeding May Correct Metabolic Abnormalities Linked To Diabetes
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.24 Jul Iron Levels Should Be Checked During Pregnancy
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.21 Jul Large Proportion of Pregnant Women Use Alcohol and Tobacco in First Trimester
MedicalResearch.com Interview with: [caption id="attachment_26340" align="alignleft" width="131"]
Dr. Qiana Brown[/caption]
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.
20 Jul Is There an Increased Risk of Breast Cancer in Women Who Have IVF?
MedicalResearch.com Interview with: [caption id="attachment_26343" align="alignleft" width="174"]
Dr. Alexandra van den Belt-Dusebout[/caption]
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.
12 Jul Co-infection with HPV and Chlamydia Can Be Asymptomatic and Lead to Infertility
MedicalResearch.com Interview with: [caption id="attachment_26136" align="alignleft" width="149"]
Dr. Dejan Nonato[/caption]
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.