Author Interviews, Cleveland Clinic, OBGYNE, Race/Ethnic Diversity / 15.01.2016

More on Racial Disparities in Health Care on Interview with: Emily A. DeFranco, D.O., M.S. Associate Professor Maternal-Fetal Medicine Center for Prevention of Preterm Birth, Perinatal Institute Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Department of Obstetrics and Gynecology Medical Sciences Building, Room 4553B Cincinnati, OH Medical Research: What is the background for this study? Dr. DeFranco: The Infant Mortality Rate in the state of Ohio is higher than many other states.  Additionally, there is a large disparity in the IMR with black infants impacted to a higher degree compared to white infants. For this reason, we are particularly interested in identifying factors that contribute to this disparity in order to identify potential areas where public health efforts can be focused. We know that preterm birth is a major contributor to infant mortality, and that all babies born alive prior to 23 weeks of gestational age, i.e. "previable", die after birth and contribute to the infant mortality rate.  In this study, we wanted to assess whether black women are more likely to have early preterm births at less than 23 weeks, and if so whether that may be part of the explanation of why black mothers are at higher risk of experiencing an infant mortality. Medical Research: What are the main findings? Dr. DeFranco: In this study, we found that black mothers were more likely to deliver than white mothers  at very early preterm gestational ages, less than 23 weeks.  We also found that the earlier the delivery, the larger the disparity with black mothers being at higher risk for the earliest deliveries compared to white mothers.  From this data, we estimated that in Ohio, 44% of all infant mortality in black mothers is caused by previable preterm birth, whereas only 28% of infant mortality in white mothers is attributed to the same cause.  We concluded that very early preterm birth in black mothers is a large contributor to the racial disparity observed in the infant mortality dilemma here in Ohio. (more…)
Author Interviews, BMJ, Diabetes, NIH, OBGYNE / 13.01.2016 Interview with: Cuilin Zhang MD, PhD Senior Investigator, Epidemiology Branch Division of Intramural Population Health Research NICHD/National Institutes of Health Rockville, MD 20852  Medical Research: What is the background for this study? What are the main findings? Dr. Zhang: Potatoes are the third most commonly consumed food crop in the world. In the United States, about 35% of women of reproductive age consume potatoes daily, accounting for 8% of daily total energy intake.  Gestational diabetes mellitus (GDM) is a common complication of pregnancy characterized by glucose intolerance with onset or first recognition during pregnancy. GDM is at the center of a vicious circle of 'diabetes begets diabetes' across generations. Potato foods are typically higher in glycemic index and glycemic load, but data are lacking regarding whether potato consumption is associated with the risk of Gestational diabetes mellitus. Medical Research: What is the background for this study? What are the main findings? Dr. Zhang: Women who eat more potatoes before pregnancy may have higher risk of gestational diabetes—the form of diabetes that occurs or first diagnosed during pregnancy—compared to women who consume fewer potatoes. Substituting potatoes with other vegetables, legumes or whole grains may help lower gestational diabetes risk. (more…)
Author Interviews, JAMA, OBGYNE, Pediatrics / 11.01.2016 Interview with: Annie Gatewood Hoen, PhD  Assistant Professor of Epidemiology and of Biomedical Data Science and Juliette Madan, MD, MS Associate Professor of Pediatrics The Geisel School of Medicine at Dartmouth Dartmouth-Hitchcock Medical Center Lebanon, NH 03756 Medical Research: What is the background for this study? What are the main findings? Response: When newborns are delivered they begin the process of acquiring vast numbers of bacteria that are critical for healthy nutrition and for immune training for a lifetime of health. Diseases such as obesity, heart disease, colitis, autism, and even cancer risk is associated with particular patterns in the gut microbiota; interestingly breast milk exposure is associated with decreased risk of many of these diseases. The intestinal microbiome plays a critical role in development, and delivery mode (cesarean section versus vaginal delivery) and feeding method (breast milk vs. formula) are important determinants of microbiome patterns.  We observed the intestinal microbiome in 6 week old infants and how it relates to delivery type and feeding. We were particularly interested in examining patterns in the microbiome in infants who received combination feeding of both breast milk and formula, an area that has been understudied. We prospectively studied 102 infants and, with gene sequencing of bacteria, identified important patterns in microbiome composition that differed greatly based upon delivery method and between feeding groups.  Babies who were combination fed (formula and breast milk) had an intestinal microbiome that was more similar to babies who were exclusively formula fed than breast fed babies. We identified individual bacteria that were differentially abundant between delivery mode and feeding groups. (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, OBGYNE, Pharmacology / 07.01.2016 Interview with: Brittany M. Charlton, ScD Instructor Boston Children's Hospital and Harvard Medical School Researcher, Harvard Chan School Department of Epidemiology Boston, MA 02115   Medical Research: What is the background for this study? What are the main findings? Dr. Charlton: Even though oral contraceptives can be over 99% effective with perfect use, almost 10% of women become pregnant within their first year of use. Many more women will stop using oral contraceptives when planning a pregnancy and conceive within just a few months. In both of those examples, a woman may inadvertently expose her offspring during pregnancy to exogenous sex hormones. We conducted a nationwide cohort study in Denmark in order to investigate whether oral contraceptive use shortly before or during pregnancy was associated with an increased risk of major birth defects in the offspring. Our main finding was that there was no increased risk of having a birth defect associated with oral contraceptive exposure. These results were also consistent when we broke down the birth defects into different subgroups, like limb defects. (more…)
Author Interviews, Biomarkers, NEJM, OBGYNE / 06.01.2016 Interview with: Stefan Verlohren, MD, PhD Consultant and Senior Lecturer Maternal-Fetal Medicine Klinik für Geburtsmedizin / Department of Obstetrics Charité Campus Mitte Berlin  Medical Research: What is the background for this study? What are the main findings? Dr. Verlohren: Preeclampsia affects 2–5% of pregnancies worldwide, and is a potentially life threatening syndrome for both mother and child. Treatment options for preeclampsia are very limited, with delivery being the only ‘cure’; however, early detection and monitoring are beneficial for improving maternal and fetal outcomes. Development of preeclampsia is very difficult to predict: its clinical presentation is variable and its signs and symptoms overlap with other conditions. There has been an unmet medical need for improved prediction of preeclampsia, i.e. predicting which women will develop preeclampsia and which will not. Women with suspected preeclampsia are often hospitalized until preeclampsia and related adverse outcomes are ruled out. Others who require hospitalization may be overlooked because their symptoms were nonspecific (e.g. headache). Preeclampsia has been linked with impaired function of the placenta. Placental development is highly dependent on blood vessel formation; before and during preeclampsia, levels of molecules involved in blood vessel inhibition or growth are altered in the maternal bloodstream. In particular, soluble fms-like tyrosine kinase-1 (sFlt-1) (a molecule that inhibits blood vessel growth) is increased and placental growth factor (PlGF) (a molecule that encourages blood vessel growth) is decreased. This study has established that the ratio of these two molecules (sFlt-1:PlGF) can be used to predict whether preeclampsia will develop or not. The sFlt-1:PlGF ratio can be calculated with a blood test (the Elecsys® sFlt-1 immunoassay and Elecsys® PlGF immunoassay). PROGNOSIS has validated the sFlt-1:PlGF ratio cutoff level of 38 for prediction of preeclampsia. For women with suspected preeclampsia, the Elecsys® immunoassay sFlt-1:PlGF ratio of 38 or below has a high negative predictive value to rule out preeclampsia or adverse fetal outcomes in the next week. A Elecsys® immunoassay sFlt-1:PlGF ratio of more than 38 indicates that preeclampsia or fetal adverse outcomes may develop in the next four weeks. In conjunction with other diagnostic and clinical information, the Elecsys® immunoassay sFlt-1:PlGF ratio can be used to guide patient management. (more…)
Author Interviews, Depression, OBGYNE, Pharmacology / 06.01.2016 Interview with: Anick Bérard PhD FISPE Research chair FRQ-S on Medications and Pregnancy and Director, Réseau Québécois de recherche sur le médicament (RQRM) and Professor, Research Chair on Medications, Pregnancy and Lactation Faculty of Pharmacy University of Montreal and Director, Research Unit on Medications and Pregnancy Research Center CHU Ste-Justine  Medical Research: What is the background for this study? What are the main findings? Dr. Bérard: Paroxetine (one of the most used antidepressant during pregnancy) has been studied extensively over the past 10-12 years. In 2005, a black box warning was put on the Paxil label to caution against use during pregnancy due to the increased risk of cardiac defects. The ACOG 2010 guidelines also suggested switching to other antidepressants during pregnancy. Over the past decade, many studies, including meta-analyses, were performed on on paroxetine use during pregnancy and the risk of cardiac malformations - but results were sometimes statistically significant or not, although a consistent increased risk was observed. It was thought that these variations could be explained by different study designs, patient populations, and because maternal depression was not always taken into account correctly. Hence, we undertook another meta-analysis (the most recent and updated) to quantify the risk of cardiac defects overall as well as specific cardiac defects associated with paoxetine use during pregnancy and to assess the impact of study designs, maternal depression and patient population on the effect of the risk. We found that women using paroxetine during the first trimester of pregnancy (critical time-window for malformations) were 23% more at risk of having a child with malformations (15 studies combined) - baseline risk of malformation is 3-5% and thus a 23% increased risk is 3.69-6.15% absolute risk; women using paroxetine during the first trimester of pregnancy were 28% more at risk of having a child with cardiac malformations (18 studies combined) - baseline risk of cardiac malformation is 1% and thus a 28% increased risk is 1.28% absolute risk. We found that paroxetine was increasing the risk of many specific cardiac defects as well. Although the estimates varied depending on the comparator group, study design, and malformation detection period, a trend towards increased risk was observed. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Medicare, OBGYNE / 04.01.2016 Interview with: Dr. Sarah Elizabeth Little, MD Obstetrics/Gynecology Department of Obstetrics and Gynecology Brigham and Women's Hospital Medical Research: What is the background for this study? What are the main findings? Dr. Little: This study investigates the variation in cesarean delivery rates across hospital services areas (a geographic unit designed by the Dartmouth Atlas to represent local markets for primarily hospital-based medical services). We looked at whether variation in cesarean delivery rates was related to broader variation in overall medical spending and utilization in that area, which we measured with Medicare spending and hospital use at the end-of-life. We found that an area’s cesarean delivery rate was correlated with these other measures; in other words, the hospital services areas that are doing the most cesarean deliveries are the same ones that are spending more and doing more to non-obstetric patients as well. (more…)
Author Interviews, OBGYNE, Surgical Research / 03.01.2016 Interview with: Gabriele Saccone, MD Department of Neuroscience Reproductive Sciences and Dentistry School of Medicine University of Naples Federico II Naples, Italy Vincenzo Berghella, MD Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine Thomas Jefferson University Philadelphia, PA 19107, USA Medical Research: What is the background for this study? What are the main findings? Dr Saccone: Preterm birth (PTB) is the number one cause of perinatal mortality in many countries, including the US. The annual societal economic burden associated with Preterm birth in the US was at least $26.2 billion in 2006, or about $51,600 per infant born preterm. Defining risk factors for prediction of PTB is an important goal for several reasons.
  • First, identifying women at risk allows initiation of risk-specific treatment.
  • Second, it may define a population useful for studying particular interventions.
  • Finally, it may provide important insights into mechanisms leading to Preterm birth.Prior surgery on the cervix, such as cone biopsy and LEEP procedures, is associated with an increased risk of spontaneous PTB. History of uterine evacuation for abortion, by either induced termination of pregnancy (I-TOP) or treatment of spontaneous abortion (SAB) by suction dilation and curettage (D&C) or by dilation and evacuation (D&E), which may involve mechanical and/or osmotic dilatation of the cervix, has been associated with an increased risk of PTB in some studies, but not in others. Our systematic review and meta-analysis pooled data from 36 studies including 1,047,683 women with prior abortion. We found that history of surgical abortion is an independent risk factor for Preterm birth and also other obstetric complications including low birth weight and small for gestational age, while prior medical abortion with first-trimester mifepristone or mid-trimester misoprostol was not associated with an increased risk of PTB. The biological plausibility to explain our findings is not completely clear. However, three main hypotheses can be made.
  • The increased risk of Preterm birth could result from the overt or covert infection following surgically uterine evacuation,
  • as well as from mechanical trauma to the cervix leading to increased risk of cervical insufficiency.
  • Moreover, surgical procedures including curettage during D&E may result in scar tissue that may increase the probability of faulty placental implantation.
Author Interviews, Hospital Acquired, Infections, OBGYNE, Outcomes & Safety / 30.12.2015 Interview with: Muhammad A. Halwani, MSc, PhD Faculty of Medicine, Al Baha University Al Baha, Saudi Arabia.  Medical Research: What is the background for this study? What are the main findings? Response: The study idea was based on examining the current rate of post cesarean section infections that were detected in the hospital at the time. It was hypothesized that the detected infections were actually less than the real number identified. Therefore, we challenged the traditional surveillance method that was applied in the hospital with a new enhanced methodology which is telephone follow-ups for patients who under go C-section operations. Our main finding proved that this new applied method was able to detect more cases than the traditional one. Using phone calls as a gold standard, the sensitivity of the standard methodology to capture SSI after cesarean increased to 73.3% with the new methodology identifying an extra five cases. These patients represented 26.3% (5 of 19) of all the patients who developed SSI. In other words, for every 100 C-section procedures there were 2.6% missed cases which the new method was able to detect. The duration of the calls ranged from 1 to 5 minutes and were well received by the patients. (more…)
Author Interviews, Diabetes, Diabetes Care, OBGYNE / 23.12.2015 Interview with: Dr. Janet Rowan Obstetric Physician National Women's Health, Auckland Medical Research: What is the background for this study? Dr. Rowan: Clinicians are interested in screening during early pregnancy to identify women with previously unrecognised diabetes, as these women have increased risks of adverse pregnancy outcomes. HbA1c is a simple and reproducible measure of glucose elevations, but its usefulness as an early pregnancy screening test is not clear. The aim of this study was to examine whether pregnant women with an HbA1c of 41-49mmol/mol (5.9-6.6%) are a high risk subgroup and whether treating these women from early pregnancy improves outcomes compared with identifying them during routine screening for gestational diabetes (GDM) from 24 weeks’ gestation. This observational study compared women referred to the diabetes clinic <24 weeks’ who had an early pregnancy HbA1c of 41-49mmol/mol (5.9-6.6%) with women who, at the time of diagnosis of GDM ≥24 weeks’ (typically by 75gOGTT), had an HbA1c of 41-49mmol/mol (5.9-6.6%). Both groups were compared with women diagnosed with GDM who had a lower HbA1c at diagnosis. (more…)
Abuse and Neglect, Author Interviews, JAMA, OBGYNE / 04.12.2015 Interview with: Alex Haynes, MD, MPH Assistant Professor of Surgery, Harvard Medical School Assistant in Surgery, Massachusetts General Hospital Division of Surgical Oncology Associate Program Director, Safe Surgery, Ariadne Labs Research Associate Harvard School of Public Health and George Molina, MD, MPH Surgical Research Resident Massachusetts General Hospital  Medical Research: What is the background for this study? What are the main findings? Response: We have previously done work looking at the global volume of operations, and in particular the surgical volume at a country level. This work was based on the hypothesis that a certain level of surgical care is necessary for healthy populations. In doing this work, we found that cesarean delivery makes up a large proportion of all operations that happen globally. In the mid-1980’s, based on existing data the World Health Organization made the recommendation that at a country-level, the cesarean delivery rate should not exceed 10 to 15 per 100 live births. We wanted to see if this recommendation was still applicable using current data. In order to answer this question, we used multiple imputation to estimate country-level cesarean delivery rates for all 194 countries in the world in 2012 to investigate the association between country-level cesarean delivery rates and maternal and neonatal mortality. We found that at a population level, as the cesarean delivery rate increased up to about 19 per 100 live births, there was a decrease in country-level maternal and neonatal mortality. However, as country-level cesarean delivery rates rose above this level there were no associated changes in maternal or neonatal mortality. (more…)
Author Interviews, Karolinski Institute, Lancet, OBGYNE, Weight Research / 03.12.2015 Interview with: Professor Sven Cnattingius Professor in reproductive epidemiology Clinical Epidemiology Unit, Department of Medicine Karolinska University Hospital Karolinska Institutet, Stockholm, Sweden  Medical Research: What is the background for this study? Prof. Cnattingius: Maternal overweight and obesity are associated with increased risks of stillbirth and infant mortality. Weight gain between pregnancies increases risks of other obesity-related complications, including preeclampsia, gestational diabetes, and preterm birth. Weight gain appear to increase these risks especially in women who start off with normal weight. As these complications increases risks of stillbirth and infant mortality, we wanted to study the associations between weight change between successive pregnancies and risks of stillbirth and infant mortality (deaths during the first year of life). Medical Research: What are the main findings? Prof. Cnattingius: The main findings include:
  • Weight gain increases risk of stillbirth in a dose-response manner.
  • In women starting off with normal weight (BMI <25), weight gain  increases risk of infant mortality in a dose-response manner.
  • In women starting off with overweight or obesity (BMI >25), weight loss reduces the risk of neonatal mortality (deaths during the first four weeks of life).
Asthma, Author Interviews, JAMA, OBGYNE, Pediatrics / 01.12.2015 Interview with: Dr Mairead Black MBChB, MRCOG, MSc Research Fellow, Wellcome Trust Clinical Lecturer, Obstetrics and Gynaecology School of Medicine and Dentistry, Division of Applied Health Sciences University of Aberdeen Aberdeen Maternity Hospital, Cornhill Road Aberdeen AB25 2ZD  Medical Research: What is the background for this study? Dr. Black: The current thinking is, if a baby is exposed to labour, then it is also exposed to ‘good bacteria’ that mothers pass on during the birth, and they are also exposed to a degree of natural stress at the time of birth that might make them more resistant to developing future illnesses. The World Health Organisation formerly recommended that no more than 15 percent of deliveries should be C-sections. However rates in some countries have soared – China and Brazil have rates in excess of 50%, whilst in the UK the figure is 26% with almost half of these being planned in advance. The main purpose of this study was to explore whether health outcomes in children up to very early adulthood differ according to how they are delivered and whether avoiding labour entirely, i.e. via a planned C-section, could put children at a disadvantage compared to those delivered vaginally or by emergency C-section, where most will have been exposed to labour. The study analysed data from over 300,000 births between 1993 and 2007 across Scotland, using routinely collected data from seven linked databases. (more…)
Author Interviews, OBGYNE, Race/Ethnic Diversity / 30.11.2015

Medical Interview with: Rada K. Dagher, Ph.D. Assistant Professor University of Maryland School of Public Health Department of Health Services Administration College Park, MD 20742 MedicalResearch: What is the background for this study? Dr. Dagher: In the United States, 51% of all pregnancies are unintended, and these happen disproportionately among racial and ethnic minorities. For example, in 2008, rates of unintended pregnancies were 69% among African American women, 56% among Hispanic women, and 40% among White women. Our study utilized 2006-2010 data from a nationally representative dataset, the National Survey of Family Growth, to investigate the reasons behind these racial/ethnic disparities. MedicalResearch: What are the main findings of this study? Dr. Dagher: The main findings of this study are as follows. Age and marital status differences explained both racial and ethnic disparities, where being single and younger than 20 years old at the time of conception contributed to the differences in unintended pregnancy between African American and White women, and between Hispanic and White women. However, there were also unique factors explaining the differences in unintended pregnancy between African Americans and Whites (respondent’s mother’s age at first birth, income, and insurance status) and the differences between Hispanics and Whites (U.S. born status and educational level). These findings provide support for culturally-tailored public health interventions that target at-risk groups of women such as younger, unmarried, lower income, lower educated, non-U.S. born women and those with public insurance, in order to reduce racial/ethnic disparities in unintended pregnancy. MedicalResearch: What should clinicians and patients take away from your report? Dr. Dagher: Our findings suggest that interventions to reduce racial and ethnic differences in unintended pregnancy should take into account multiple factors at multiple levels of influence. For example, at the policy level, the Affordable Care Act has mandated that health plans cover women’s preventative health care, including contraceptives, without cost sharing. Thus, primary care providers could educate their patients about these new policy provisions and encourage them to take advantage of them, especially patients at higher risk of unintended pregnancy such as women who are younger than 20, unmarried, non-U.S. born, have lower income, and those with public insurance. (more…)
Author Interviews, Lancet, OBGYNE / 29.11.2015 Interview with: Gordon C S Smith, MD PhD DSc FMedSci Professor & Head of Department, Obstetrics and Gynaecology, Cambridge University Cambridge UK Medical Research: What were the key findings of the study? Dr. Smith: We demonstrated that using ultrasound to scan all women in the last 3 months of pregnancy increased the detection of small babies. Our routine approach to antenatal care identified 1 in 5 small babies. Our research approach on the same patients, where all women were scanned in the last third of pregnancy, resulted in 3 in 5 small babies being detected. We also found that, when we identified small babies, there was a scan measurement which helped us to distinguish which of those small babies were at increased risk of complications. Medical Research: What's the problem with small babies? Dr. Smith: We have known for many years that small babies are at increased risk of subsequent complications, both in the short term and long term. For example, they are more likely than normal sized babies to have difficulties during labour due to shortage of oxygen. We assume that this is because their growth has been restricted. This leads to them being less well prepared to face the stress of labour. We think that the poor growth usually occurs because of a problem in the way the placenta functions. The placenta, also known as the afterbirth, is the organ which allows the transfer of nutrients and oxygen to the baby. If the placenta isn’t functioning properly it is likely to impair the growth of the baby in the womb. If we suspect during a pregnancy that the baby is small, it influences a number of aspects of the care of the mother. For example, we might deliver the baby earlier, we might recommend delivery in a high risk unit. It might also influence decisions about whether a mother has a caesarean delivery, or how the baby is monitored during labour. (more…)
Addiction, Alcohol, Author Interviews, Cannabis, OBGYNE, Ophthalmology, Pediatrics / 28.11.2015 Interview with: Professor Benjamin Thompson PhD School of Optometry and Vision Science Faculty of Science, University of Waterloo Waterloo, Ontario Canada Medical Research: What is the background for this study? Dr. Thompson: Our investigation was part of the longitudinal Infant Development and Environment and Lifestyle (IDEAL) study that was designed to investigate the effect of prenatal methamphetamine exposure on neurodevelopment. Although the negative impact of prenatal drug exposure on a wide range of neurodevelopmental outcomes such cognitive and motor function is established, the effect on vision is not well understood. To address this issue, vision testing was conducted when children in the New Zealand arm of the IDEAL study turned four and half years of age. Although the primary focus of the IDEAL study was the impact of methamphetamine on neurodevelopment, the majority of children enrolled in the study were exposed to a range of different drugs prenatally including marijuana, nicotine and alcohol. Many children were exposed to multiple drugs. This allowed us to investigate the impact of individual drugs and their combination on the children’s visual development. Alongside standard clinical vision tests such as visual acuity (the ‘sharpness’ of vision) and stereopsis (3D vision), we also tested the children’s ability to process complex moving patterns. This test, known as global motion perception, targets a specific network of higher-level visual areas in the brain that are thought to be particularly vulnerable to neurodevelopmental risk factors. (more…)
Author Interviews, NEJM, OBGYNE / 26.11.2015 Interview with: Arri Coomarasamy, MBChB, MD, FRCOG Professor of Gynaecology and Reproductive Medicine University of Birmingham Medical Research: What is the background for this study? What are the main findings? Professor Coomarasamy: Progesterone is a natural hormone that is essential to maintain a healthy pregnancy, and more than 60 years ago clinicians and researchers began to ask if progesterone supplementation in the first trimester of pregnancy could help to reduce the risk of miscarriage for women with a history of recurrent miscarriage. The evidence achieved in some small controlled clinical trials conducted before the PROMISE (progesterone in recurrent miscarriage) trial suggested a benefit from progesterone therapy, but without sufficient certainty to usefully guide clinical practice. Five years after it began, the PROMISE trial has provided a definitive result. It is clear, it is important, and it is not the result that many anticipated. Our study of more than 800 women with a history of unexplained recurrent miscarriage has shown that those who received progesterone treatment in early pregnancy were no less likely to miscarry than those who received a placebo (or dummy treatment). This was true whatever their age, ethnicity, and medical history. (more…)
Author Interviews, OBGYNE, Outcomes & Safety / 25.11.2015 Interview with: Dr William L Palmer Honorary research fellow Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London, London Medical Research: What is the background for this study? Dr. Palmer: For the majority of women and their newborns, their care will be safe and result in good outcomes. However, previous research has suggested that outcomes across a range of healthcare areas might be worse at weekends. We therefore undertook to investigate whether there was an association between day of delivery and complications, using a range of different outcomes: perinatal mortality and - for both women and neonate - injury, infection and emergency readmission rates. Our analysis was based on every delivery to public health services in the NHS in England across a two-year period so accounting for some 1.3 million births. To account for possible differences in case-mix and maternal characteristics we controlled for a range of factors including gestational age, delivery type, maternal age, birth-weight, and pre-existing diabetes or hypertension.  (more…)
Author Interviews, Kaiser Permanente, OBGYNE, Pediatrics / 24.11.2015 Interview with: Erica P. Gunderson, PhD, MPH, MS, RD Senior Research Scientist, Division of Research, Cardiovascular and Metabolic Conditions Section Kaiser Permanente Northern California Oakland, CA 94612 Medical Research: What is the background for this study? Dr. Gunderson: Gestational diabetes mellitus (GDM) is a disorder of glucose tolerance affecting 5-9 percent of all U.S. pregnancies (approximately 250,000 annually), with a 7-fold higher risk of progression to type 2 diabetes. Strategies during the postpartum period for prevention of diabetes focus on modification of lifestyle behaviors, including dietary intake and physical activity to promote weight loss. Lactation is a modifiable postpartum behavior that improves glucose and lipid metabolism, and increases insulin sensitivity, with favorable metabolic effects that persist post-weaning. Despite these metabolic benefits, evidence that lactation prevents type 2 diabetes remains inconclusive, particularly among women with gestational diabetes mellitus (GDM). Among women with GDM, evidence that lactation prevents diabetes is based on only two studies with conflicting findings. The Study of Women, Infant Feeding and Type 2 Diabetes after GDM Pregnancy, also known as the SWIFT Study, is the first to measure breastfeeding on a monthly basis during the first year after delivery and the first to enroll a statistically significant number of women with gestational diabetes, and to evaluate social, behavioral and prenatal risk factors that influence development of type 2 diabetes, as well as breastfeeding initiation and success. (more…)
Author Interviews, Coffee, OBGYNE, Pediatrics / 20.11.2015 Interview with: Mark A. Klebanoff, MD Center for Perinatal Research The Research Institute Nationwide Children's Hospital Medical Research: What is the background for this study? What are the main findings? Dr. Klebanoff: Caffeine is among the substances most commonly consumed by pregnant women.  There are numerous sources of caffeine in the diet—regular (non-decaf) coffee, regular tea, many soft drinks, energy drinks, and some power bars. Even chocolate contains some caffeine.  It’s also included in some over the counter pain relievers, and in over the counter ‘keep awake’ pills such as No-Doz.  As a result of its wide availability, most pregnant women consume at least some caffeine.  In spite of over 30 years of research, whether moderate amounts of caffeine (up to 200 milligrams, the amount contained in about 2 normal-sized cups of coffee, per day) during pregnancy are harmful is uncertain.  However almost all previous research has been about events related to pregnancy, such as difficulty becoming pregnant, miscarriage, birth defects, and the size of the newborn.  Whether maternal caffeine use during pregnancy has an impact on things later in childhood, such as obesity and neurologic development, has hardly been studied. We used a biomarker, measured in the mother’s blood during pregnancy, for caffeine use, and found that more caffeine use was not associated with the child’s body mass index at either 4 or 7 years of age, and that at blood levels of the marker that we saw in the vast majority, caffeine was not associated with the child’s IQ, nor with behavioral abnormalities at those ages. (more…)
Author Interviews, Cancer Research, Fertility, OBGYNE, Technology / 19.11.2015 Interview with: Kutluk Oktay, MD, PhD. Professor of Obstetrics & Gynecology, Medicine, and Cell Biology & Anatomy Director, Division of Reproductive Medicine & Institute for Fertility Preservation Innovation Institute for Fertility and In Vitro Fertilization New York Medical College, Valhalla, NY Medical Research: What is the background for this study? What are the main findings? Dr. Oktay: Cancer treatments cause infertility and early menopause in a growing number of young women around the world and US. One of the strategies to preserve fertility, which was developed by our team, is to cryopreserve ovarian tissue before chemotherapy and later transplant it back to the patient when they are cured of the cancer and ready to have children. However, success of ovarian transplantation has been limited due to limitation in blood flow to grafts. In this study we described a new approach which seems to improve graft function. The utility of an extracellular tissue matrix and robotic surgery seems to enhance graft function. With this approach both patients conceived with frozen embryos to spare and one has already delivered. (more…)
Author Interviews, CDC, Infections, OBGYNE, STD / 13.11.2015 Interview with: Dr. Virginia Bowen PhD Epidemic Intelligence Service Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention,CDC  Medical Research: What is the background for this study? What are the main findings? Dr. Bowen: Congenital syphilis (CS) occurs when a mother infected with syphilis transmits the infection to her child during the course of pregnancy. Our study looked at recent trends in CS between 2008 and 2014. After four years of decline, Congenital syphilis rates increased by 38% from 2012 to 2014. The findings from this report show we are missing opportunities to screen and treat pregnant women for STDs. Syphilis in pregnant women can cause miscarriages, premature births, stillbirths, or death of newborn babies. We have effective tests and treatment for syphilis – there’s no excuse for allowing it to resurge. Every case of CS is one too many. (more…)
Author Interviews, OBGYNE, Pediatrics, Toxin Research, Weight Research / 13.11.2015 Interview with: Joseph M. Braun PhD Assistant Professor Department of Epidemiology in the Program in Public Health Brown University Medical Research: What is the background for this study? Dr. Braun:  Perfluoroalkyl substances are a class of chemicals used to produce stain/water repellent textiles, fire fighting foams, and non-stick coatings. Virtually all people in the US have measurable levels of several different perfluoroalkyl substances in their blood. There is concern that early life exposure to these chemicals can increase the risk of obesity by reducing fetal growth or promoting adipogenesis. What are the main findings? Dr. Braun:  Pregnant women in our study had perfluorooctanoic acid (PFOA) concentrations in their blood that were over 2-fold higher than pregnant women in the United States (median: 5.3 vs. 2.3 ng/mL) during the same time period (2003-2006). Children born to women with higher serum PFOA concentrations during pregnancy had a higher body mass index, greater waist circumference, and more body fat at 8 years of age compared to children born to women with lower serum PFOA concentrations. In addition, children born to women with higher serum PFOA concentrations during pregnancy gained more fat mass between 2 and 8 years of age than children born to women with lower PFOA concentrations. (more…)
Author Interviews, OBGYNE, Pediatrics, UCLA / 10.11.2015 Interview with: Edward R. B. McCabe, MD, PhD Senior Vice President and Chief Medical Officer Professor Adjunct of Pediatrics Yale University School of Medicine Distinguished Professor Emeritus, Department of Pediatrics & Inaugural Mattel Executive Endowed Chair of Pediatrics, UCLA School of Medicine Inaugural Physician-in-Chief, Mattel Children's Hospital Chief Medical Officer March of Dimes Medical Research: What is the background for this study? What are the main findings? Dr. McCabe: The March of Dimes Prematurity Campaign was launched in 2003. The goal of the campaign is to lower the rate of premature birth to 8.1 percent of live births by 2020 and to 5.5 percent by 2030. Premature birth is the leading cause of death for newborns, and a major cause of childhood disabilities. Worldwide, 15 million babies are born preterm, and nearly one million die due to complications of an early birth. The U.S. preterm birth rate ranks among the worst of high-resource nations. Babies who survive an early birth often face serious and lifelong health problems, including breathing problems, jaundice, vision loss, cerebral palsy and intellectual delays. The US earned a “C” on the 8th annual March of Dimes Premature Birth Report Card which revealed persistent racial, ethnic and geographic disparities within states. The report card provided preterm rates and grades for each state and the largest cities. The report card showed that although some progress is being made in reducing preterm births, not all families are sharing in the success. State specific information is available at Portland, Oregon has the best preterm birth rate of the top 100 cities with the most births nationwide, while Shreveport, Louisiana has the worst, according to the 2015 Report Card. The U.S. preterm birth rate was 9.6 percent in 2014. The report card shows more than 380,000 babies were born too soon last year. (more…)
Author Interviews, Melanoma, OBGYNE / 06.11.2015 Interview with: Pedram Gerami, MD Department of Dermatology Northwestern University Chicago, IL Medical Research: What is the background for this study? What are the main findings?   Dr. Gerami: The influence of pregnancy on the prognosis of melanoma has been debated for decades. Even in the last ten years, population-based and cohort studies have given us mixed results, with some suggesting no adverse influence of pregnancy, and others reporting poorer outcomes and increased cause-specific mortality. The conflicting data leave many clinicians uncertain of how to advise patients to proceed with family planning after a diagnosis of melanoma. Since one-third of all new cases of melanoma diagnosed in women will occur during childbearing age, this represents a fairly common clinical dilemma for physicians and their patients. We suspected that the different results from different investigators maybe related to the melanoma stage of the patients being studied. We investigated the impact of pregnancy on tumor proliferation in women with primarily early stage melanoma. In comparing melanomas from a group of women with pregnancy-associated melanoma (PAM) and a non-PAM group, we found that women with pregnancy-associated melanoma  actually had a significantly greater proportion of in situ disease, and for cases of invasive melanoma there was no significant difference in proliferative activity, as assessed by mitotic count or two immunohistochemical markers of cell proliferation. In a comparison of additional prognostic features such as Breslow depth and ulceration, we found no significant differences between groups to suggest more aggressive tumor behavior in association with pregnancy. (more…)
Author Interviews, Fertility, OBGYNE / 04.11.2015 Interview with Dr. Norbert Gleicher, MD, FACOG, FACS Founder, Center for Human Reproduction Background: What’s My Fertility and the Center for Human Reproduction in New York, have announced the first screening for Premature Ovarian Aging (POA) in young women, based on new research that the FMR1 gene can be predictive of POA. Medical Research:   What is Premature Ovarian Aging (POA)? How does POA differ from Premature Ovarian Failure? Dr. Gleicher: Premature Ovarian Aging (POA) is a condition that causes a young woman’s ovaries to age faster than normal. It affects roughly 10% of all women, regardless of race or ethnic background. POA typically causes no symptoms until the ovarian reserve is already very low. Women are born with all their egg cells (called oocytes). Scientists refer to this as a woman’s original “ovarian reserve.” From birth on, significant numbers of these eggs are constantly lost until menopause. As women age, their ovarian reserve, therefore, depletes and fertility declines. In most women, fertility begins to decline around age 35 – but for women at risk for POA, fertility declines can begin as early as in their teens or 20s. POA in early stages typically has no symptoms. Most women until now, therefore, are usually only diagnosed after troubles conceiving become apparent, which brings them to a fertility specialist. At that point, most require stressful and costly infertility treatment to have children. Premature Ovarian Failure (POF), sometimes also called premature menopause of primary ovarian insufficiency (POI) is the end stage of POA, when women reach menopause under age 40. Fortunately, this happens only to 10% of the 10% of women with Premature Ovarian Aging, - which means to 1% of the total female population. In those unfortunate few, even routine IVF can usually no longer help, and most of these women will only conceive with use of young donor eggs.  (more…)
Author Interviews, OBGYNE, Social Issues / 03.11.2015 Interview with: Susan Cha, PhD Division of Epidemiology Department of Family Medicine and Population Health School of Medicine Virginia Commonwealth University Richmond, VA  Medical Research: What is the background for this study? What are the main findings? Dr. Cha: We used data from the 2006-2010 National Survey of Family Growth to evaluate the association between couple pregnancy intentions and rapid repeat pregnancy (RRP) in women. Results indicated that the odds of RRP was primarily influenced by paternal rather than maternal desire for pregnancy. For instance, couples where the father intended the pregnancy but not the mother were 2.5 times as likely to have rapid repeat pregnancy than couples who both intended their pregnancy. Furthermore, more than 85% of women in the study reported no contraceptive use between pregnancies. (more…)
Author Interviews, OBGYNE / 01.11.2015

Anick Bérard PhD FISPE Research chair FRQ-S on Medications and Pregnancy Director, Réseau Québécois de recherche sur le médicament (RQRM) Professor, Research Chair on Medications, Pregnancy and Lactation Faculty of Pharmacy, University of Montreal Director, Research Unit on Medications and Pregnancy Research Center CHU Interview with: Anick Bérard PhD FISPE Research chair FRQ-S on Medications and Pregnancy Director, Réseau Québécois de recherche sur le médicament (RQRM) Professor, Research Chair on Medications, Pregnancy and Lactation Faculty of Pharmacy, University of Montreal Director, Research Unit on Medications and Pregnancy Research Center CHU Ste-Justine Medical Research:  Should we have any reservations about prescribing these macrolides during pregnancy? Dr. Bérard: With penicillin, macrolides are amongst the most used medications in the general population and in pregnancy. However, debate remained on whether it is the infections or in fact the macrolides used to treat them that put women and their unborn child at greater risk of adverse pregnancy outcomes, including birth defects. Our study was performed within the Quebec Pregnancy Cohort, one of the largest pregnancy cohorts in the World, and did not find a statistically significant association between macrolide use (a widely used class of antibiotics) during pregnancy and the risk of malformations. When looking at specific types of macrolides, no association was found between azithromycin, clarithromycin or erythromycin use during the first trimester of pregnancy and the risk of major malformations or cardiac malformations. This is reassuring when treating infections during pregnancy. (more…)
Author Interviews, Emergency Care, OBGYNE, Primary Care / 30.10.2015 Interview with: Alfred Sacchetti, M.D. Department of Emergency Medicine Our Lady of Lourdes Medical Center, Camden, NJ Thomas Jefferson University, Philadelphia, PA Medical Research: What is the background for this study? Dr. Sacchetti: Much of the value of the "Affordable Care Act" is based on the concept that a primary care provider will limit the need for Emergency Department visits.  Unfortunately, this has never been proven, particularly for women's health issues. The purpose of our study was to determine if a relationship with a primary care provider did limit the need to access Emergency Department services. Medical Research: What are the main findings? Dr. Sacchetti: What our results demonstrated was that patients with a primary care Obstetrical / Gynecologic provider utilized the emergency department to the same extent as patients without a documented primary OB/GYN relationship.   Patients with women's health issues still required the services of the ED, even with an established primary care provider.  What was very interesting was that Emergency Department use was not restricted to off hours in the evenings and on weekends.  In fact the use of the ED occurred as much during the 9-5 hours on the weekdays as it did during other times.  The majority of the ED visits were for ambulatory complaints, with most patients being discharged to home after their care. (more…)
Author Interviews, Columbia, OBGYNE, Weight Research / 26.10.2015

Elizabeth M. Widen, PhD, RD Postdoctoral Fellow in the Department of Medicine, Institute of Human Nutrition & Department of Epidemiology Columbia University Mailman School of Public Health New York, NY Interview with: Elizabeth M. Widen, PhD, RD Postdoctoral Fellow in the Department of Medicine, Institute of Human Nutrition & Department of Epidemiology Columbia University Mailman School of Public Health New York, NY 10032 Medical Research: What is the background for this study? What are the main findings? Dr. Widen: The Columbia Center for Children’s Environmental Health Mothers and Newborns Study was started in 1998 and is based in Northern Manhattan and the South Bronx. Pregnant African American and Dominican mothers were enrolled from 1998 to 2006, and mothers and their children have been followed since this time. Pregnancy weight gain and maternal size and body fat was measured at seven years postpartum, allowing us to examine the role of nutrition in pregnancy on long-term maternal health. We found that high pregnancy weight gain, above the Institute of Medicine 2009 guidelines, was associated with long-term weight retention and higher body fat at seven years postpartum among women who began pregnancy with underweight, normal weight and modest overweight body mass index (BMI). These findings suggest that prepregnancy BMI and high pregnancy weight gain have long-term implications for maternal weight-related health, especially among mothers who begin pregnancy with lower prepregnancy BMI values. (more…)