Author Interviews, Biomarkers, OBGYNE, Rheumatology / 30.09.2015

Jane E. Salmon, MD Division of Rheumatology Hospital for Special Surgery, and Weill Cornell Medical College, New York, NY MedicalResearch.com Interview with: Jane E. Salmon, MD Division of Rheumatology Hospital for Special Surgery, and Weill Cornell Medical College, New York, NY  Medical Research: Background on lupus and antiphospholipid antibodies - what are they? Dr. Salmon: Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease that predominantly affects women and presents during their childbearing years. In SLE, the immune system which normally protects one from infection, turns reacts against the self and can cause damage of multiple organs. Antiphospholipid antibodies (APL) occur in some people with SLE and some without SLE. They are autoantibodies that can damage the placenta and cause arterial and venous thromboses. Patients with APL can have fetal deaths, miscarriages, preeclampsia and/or growth restricted babies. Pregnancy in patients with SLE, particularly those with antiphospholipid antibodies (APL), and in patients with APL alone, is associated with an increased risk for maternal and fetal morbidity due to preeclampsia (PE) and insufficient placental support of the developing fetus. PE and placental insufficiency are, in turn, associated with adverse pregnancy outcomes (APOs), including maternal complications of PE, intrauterine fetal death, and fetal growth restriction, as well as indicated preterm delivery. Given that APOs affect over one fifth of pregnancies in SLE and/or APL, the ability to identify patients early in pregnancy who are destined for poor outcomes would significantly impact care of this high risk population. Medical Research: Two bullets about your PROMISSE study: Dr. Salmon: The PROMISSE Study (Predictors of pRegnancy Outcome: bioMarker In antiphospholipid antibody Syndrome and Systemic lupus Erythematosus). PROMISSE is the largest multi-center, multi-ethnic and multi-racial study to prospectively assess the frequency of APO, clinical, laboratory and biomarker variables that predict APO, in women with SLE and/or APL with inactive or mild/ moderate activity at conception. Pregnant patients with SLE and/or APL were enrolled at <12 weeks gestation into PROMISSE between September 2003 and August 2013 at 7 sites (n=497) along with matched healthy controls (n=207) and followed every month of pregnancy.  (more…)
Alcohol, Author Interviews, CDC, OBGYNE / 25.09.2015

Cheryl H. Tan, M.P.H. Epidemiologist and lead author of the study National Center on Birth Defects and Developmental Disabilities CDCMedicalResearch.com Interview with: Cheryl H. Tan, M.P.H. Epidemiologist and lead author of the study National Center on Birth Defects and Developmental Disabilities CDC Medical Research: What is the background for this study? What are the main findings? Response: One in 10 pregnant women in the United States aged 18 to 44 years reports drinking alcohol in the past 30 days and 3.1 percent of pregnant women report binge drinking – defined as 4 or more alcoholic beverages on one occasion. That means about a third of pregnant women who consume alcohol engage in binge drinking. This is concerning because women who are pregnant or who might be pregnant should avoid drinking alcohol. Alcohol use during pregnancy is associated with an increased risk of birth defects and developmental disabilities in babies, as well as other pregnancy problems, such as miscarriage, stillbirth, and prematurity. Alcohol consumption during pregnancy causes Fetal alcohol spectrum disorders (FASDs), which are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. These conditions include physical problems, behavioral problems, and leaning disabilities. FASDs are completely preventable: if a woman does not drink alcohol during pregnancy, her child has zero risk of an FASD. (more…)
Author Interviews, Endocrinology, OBGYNE / 25.09.2015

Richard S. Legro, MD Vice Chair of Research and Professor of Obstetrics and Gynecology and Public Health Sciences Penn State College of MedicineMedicalResearch.com Interview with: Richard S. Legro, MD Vice Chair of Research and Professor of Obstetrics and Gynecology and Public Health Sciences Penn State College of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Legro: Weight loss is recommended for obese women with PCOS, but there are no randomized studies to show that it improves fertility outcomes. Both Lifestyle modification and oral contraceptives are also recommended for chronic treatment of women with PCOS so that this study has relevance to all obese women with PCOS. We designed this study to prospectively examine the effects of these common treatments on reproductive, metabolic and quality of life parameters, as well as on fertility in women seeking pregnancy. The main findings are summarized in the abstract and conclusion to the study.  I would repeat those here.  I would highlight that quality of life improved in all treatment groups, but the group that had both oral contraceptives and lifestyle modification had a significant improvement in their physical well-being compared to the oral contraceptive group. (more…)
AHA Journals, Author Interviews, Heart Disease, OBGYNE, Women's Heart Health / 22.09.2015

Barbara A. Cohn, PhD Director of the Child Health and Development Studies at the Public Health Institute. Berkeley, CaliforniaMedicalResearch.com Interview with: Barbara A. Cohn, PhD Director of the Child Health and Development Studies at the Public Health Institute. Berkeley, California Medical Research: What is the background for this study? Dr. Cohn: I guessed that pregnancy complications would be an early warning sign of cardiovascular problems because of the extraordinary demands that pregnancy places on a woman’s cardiovascular system. Medical Research: What data were used for this study? Dr. Cohn: The Child Health and Development Studies is a large pregnancy cohort that enrolled more than 20,000 pregnancies in the 1960’s. Women and their families have been followed now for more than 50 years. Information on pregnancy complications was captured from medical records as they occurred, long before cardiovascular disease developed. These data are the basis for the current study. Medical Research: Why hasn’t this study already been done? Dr. Cohn: Long-term, large studies of pregnancy are rare. I first tried to do this study forty years ago when I was in graduate school.   At that time, Dr. Bea van den Berg, the late, second director of the Child Health and Development Studies advised that the study mothers were still too young to observe their cardiovascular disease experience. Now 40 years later, my colleague Piera Cirillo and I have been able to test the idea that combinations of pregnancy complications are linked to cardiovascular disease death for women. (more…)
Author Interviews, Fertility, OBGYNE / 10.09.2015

Audrey J. Gaskins, Sc.D. Postdoctoral Fellow Department of Nutrition Harvard T.H. Chan School of Public Health Boston, MA 02115 MedicalResearch.com Interview with: Audrey J. Gaskins, Sc.D.  Postdoctoral Fellow Department  of Nutrition Harvard T.H. Chan School of Public Health Boston, MA 02115     Medical Research: What is the background for this study? What are the main findings? Dr. Gaskins: Infertility, defined as the inability to conceive after 12 months of unprotected intercourse, is a common reproductive disorder affecting ~15% of couples who attempt to become pregnant. Assisted reproductive technologies (ART), which include in vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI), have become the main treatment modalities for couples facing infertility. Pre-conceptional folate and vitamin B12 have been linked to many beneficial early pregnancy outcomes among couples undergoing assisted reproductive technologies treatment in Europe but mixed results have been found in regards to clinical pregnancy and live birth rates. Therefore, we sought to investigate whether higher levels of serum folate and vitamin B12 could increase reproductive success in a cohort of women undergoing assisted reproductive technologies at an academic medial center in the United States. We found that high concentrations of folate and vitamin B12 in serum are associated with increased chance of live birth following assisted reproduction. Moreover, women with higher concentrations of both serum folate and vitamin B12 had the greatest likelihood of reproductive success. Analysis of intermediate endpoints suggests that folate and vitamin B12 may exert their favorable effects on pregnancy maintenance following implantation. (more…)
Author Interviews, Infections, JAMA, OBGYNE / 08.09.2015

Dr. Martin N. Mwangi Researcher Division of Human Nutrition, Nutrition and Health over the lifecourse International Nutrition Unit Wageningen University The Netherlands MedicalResearch.com Interview with: Dr. Martin N. Mwangi Researcher Division of Human Nutrition, Nutrition and Health over the lifecourse International Nutrition Unit Wageningen University The Netherlands   Medical Research: What is the background for this study? Dr. Mwangi : Anemia in pregnancy is a moderate or severe health problem in more than 80 percent of countries worldwide, but particularly in Africa, where it affects 57 percent of pregnant women. Iron deficiency is the most common cause, but iron supplementation during pregnancy has uncertain health benefits. There is some evidence to suggest that iron supplementation may increase the risk of infectious diseases, including malaria. Our main objective was to measure the effect of antenatal iron supplementation on maternal Plasmodium infection risk, maternal iron status, and neonatal outcomes. We randomly assigned 470 pregnant Kenyan women living in a malaria endemic area to daily supplementation with 60 mg of iron (n = 237 women) or placebo (n = 233) until 1 month postpartum. All women received 5.7 mg iron/day through flour fortification during intervention and usual intermittent preventive treatment against malaria. Medical Research: What are the main findings? Dr. Mwangi : Overall, we found no effect of daily iron supplementation during pregnancy on risk of maternal Plasmodium infection. Iron supplementation resulted in an increased birth weight [5.3 ounces], gestational duration, and neonatal length; enhanced maternal and infant iron stores at 1 month after birth; and a decreased risk of low birth weight (by 58 percent) and prematurity. The effect on birth weight was influenced by initial maternal iron status. Correction of maternal iron deficiency led to an increase in birth weight by [8.4 ounces]. (more…)
Author Interviews, OBGYNE, Toxin Research / 04.09.2015

MedicalResearch.com Interview with: Dr. Jianying Hu Laboratory for Earth Surface Processes College of Urban and Environmental Sciences Peking University, Beijing People’s Republic of China  Medical Research: What is the background for this study? What are the main findings? Response: Early pregnancy loss or first-trimester miscarriage is the most common complication of human reproduction, and the miscarriage incidence is increasing around the world in the recent decades. Though there are many causes for miscarriage, approximately 40% of early pregnancy loss remains unexplained. Exposure to endocrine disrupting chemicals (EDCs) has been considering one of major risk factor to affect female reproduction. Of these EDCs related to reproductive toxicity, phthalates is of concern due to their wide usage and contamination in environment, and the reproductive toxicity in the female mouse. Our study found that the levels of phthalates in the women who underwent miscarriage were statistically significantly high, and the risk of clinical pregnancy loss was associated with urinary concentration of phthalate metabolites. (more…)
Author Interviews, JAMA, Multiple Sclerosis, OBGYNE / 01.09.2015

PD Dr. Kerstin Hellwig Neurologische Abteilung Universitätsklinikum St. Josef Hospital BochumMedicalResearch.com Interview with: PD Dr. Kerstin Hellwig Neurologische Abteilung Universitätsklinikum St. Josef Hospital Bochum Medical Research: What is the background for this study? What are the main findings? Dr. Hellwig: The relapse risk is elevated in women with Multiple Sclerosis after delivery. We found that women with Multiple Sclerosis who breastfed exclusively had a significant lower relapse risk, than women who did not breastfed at all or breastfed some but not exclusively. After the introduction of supplemental feedings, the relase risk was similar between both groups. (more…)
Author Interviews, OBGYNE, Pediatrics / 19.08.2015

Jennifer B. Kane PhD Assistant professor of Sociology University of California, Irvine MedicalResearch.com Interview with: Jennifer B. Kane PhD Assistant professor of Sociology University of California, Irvine Medical Research: What is the background for this study? Dr. Kane: We know that low-birth-weight babies are more susceptible to later physical and cognitive difficulties and that these difficulties can sharpen the social divide in the U.S. But knowing more about what causes low birth weight can help alleviate this intergenerational perpetuation of social inequality through poor infant health. This study was designed to expand our knowledge of these causes. Medical Research: What are the main findings? Dr. Kane: This study found that risk factors for low birth weight extend far beyond pregnancy—dating all the way back to women’s early life environment as well as to conditions dating back three generations. For example, a woman’s own weight at birth, as well as her education level and marital status pre-pregnancy can have repercussions for two generations, putting her children and grandchildren at higher risk of low birth weight. This study also discovered new pathways of risk that contribute to poor infant health. For example, intergenerational transmissions of maternal education, potentially reflecting parent-child socialization or role modeling, appear to have a long-term influence on birth outcomes of future generations. In addition, this study showed that intra-generational and inter-generational processes work in conjunction with one another to place some infants at higher risk of low birth weight. (more…)
Author Interviews, Baylor University Medical Center Dallas, OBGYNE, Pediatrics / 17.08.2015

Arpitha Chiruvolu MD FAAP Neonatologist Baylor University Medical Center Department of Neonatology Dallas, TX 75246 MedicalResearch.com Interview with: Arpitha Chiruvolu MD FAAP Neonatologist Baylor University Medical Center Department of Neonatology Dallas, TX 75246  MedicalResearch: What is the background and main findings of the study? Dr. Chiruvolu: There is growing evidence that delaying umbilical cord clamping (DCC) in very preterm infants may improve hemodynamic stability after birth and decrease the incidence of major neonatal morbidities such as intraventricular hemorrhage (IVH) and necrotizing enterocolitis. Recently, the American College of Obstetricians and Gynecologists (ACOG) published a committee opinion that supported delaying umbilical cord clamping in preterm infants, with the possibility for a nearly 50% reduction in IVH. However, the practice of DCC in preterm infants has not been widely adopted, mainly due to the concern of a delay in initiating resuscitation in this vulnerable population. Furthermore, there is uncertainty regarding the magnitude of published benefits in very preterm infants, since prior trials were limited by small sample sizes, wide variability in the technique and inconsistent reporting of factors that may have contributed to clinical outcomes. We recently implemented a delaying umbilical cord clamping quality improvement (QI) process in very preterm infants at a large delivery hospital. The objective of this cohort study was to evaluate the clinical consequences of a protocol-driven delayed umbilical cord clamping implementation in singleton infants born £ 32 weeks gestation. We hypothesized that DCC would not compromise initial resuscitation and would be associated with significant decrease in early red blood cell transfusions and IVH compared to a historic cohort. Delayed umbilical cord clamping was performed on all the 60 eligible infants. 88 infants were identified as historic controls. Gestational age, birth weight and other demographic variables were similar between both groups. There were no differences in Apgar scores or admission temperature, but significantly fewer infants in theDelayed umbilical cord clamping cohort were intubated in delivery room, had respiratory distress syndrome or received red blood cell transfusions in the first week of life compared to the historic cohort.  A significant reduction was noted in the incidence of IVH inDelayed umbilical cord clamping cohort compared to historic control group (18.3% versus 35.2%). After adjusting for gestational age, an association was found between the incidence of IVH and Delayed umbilical cord clamping with IVH significantly lower in the DCC cohort compared to historic cohort with odds ratio of 0.36 (95% CI 0.15 to 0.84, P <0.05). There were no significant differences in mortality and other major morbidities. (more…)
ADHD, Author Interviews, OBGYNE / 12.08.2015

Scott A. Adler, Ph.D. Associate Professor Coordinator Developmental Science Graduate Program Dept. of Psychology & Centre for Vision Research Visual and Cognitive Development Project York University Toronto, Ontario CanadaMedicalResearch.com Interview with: Scott A. Adler, Ph.D. Associate Professor Coordinator Developmental Science Graduate Program Dept. of Psychology & Centre for Vision Research Visual and Cognitive Development Project York University Toronto, Ontario Canada   Medical Research: What is the background for this study? Dr. Adler: Experiences that we have early in life clearly have an impact on our brain development and behavior as we get older.  Numerous studies have detailed these experiences, ranging from how we were fed as a baby to how many languages we hear to traumatic events.  These experiences have been shown to influence formation, maintenance, and pruning of the networks of synaptic connections in our brain's that impact all manner of thought and behavior.  Yet, the impact of one of the earliest experiences, that of being born, on brain and psychological behavior has not before been explored.  A recent study with rat pups has strongly suggested that the birth process has a definite impact on initial brain development.  If that is the case, what happens if the infant's birth is one in which she does not experience the natural birth process, such as occurs with caesarean section births? Medical Research: What are the main findings? Dr. Adler: There were two main findings from this study.  We measured the speed and timing of infants' saccadic eye movements, which are overt indicators of attention, relative to the onset of visual events on a computer monitor.  Moving attention and eye movements can occur through two general classes of processes.  The first is bottom-up mechanisms in which attention is moved reactively and automatically to the appearance or existence of unique and salient events in the world.  In this case, where attention goes is essentially controlled by the events in the world. The second is top-down mechanisms in which we move attention voluntarily to what we determine to be relevant event in the world based on our own cognitive biases and goals. This study found that 3-month-old infants born by caesarean section were significantly slower to move attention and make eye movements in reaction to the occurrence of visual events on the basis of bottom-up mechanisms than were infants born vaginally.  In contrast, there was difference between infants in moving attention and making eye movements in anticipation of the appearance of visual events on the basis of top-down mechanisms.  Additionally, maternal age, which has been shown to be related to the occurrence of caesarean sections, was found not to be related to the current effects. (more…)
Author Interviews, Hepatitis - Liver Disease, OBGYNE / 12.08.2015

Prof. Hanns-Ulrich Marschall Professor of clinical hepatology Wallenberg Laboratory Sahlgrenska Academy Göteborg, Sweden MedicalResearch.com Interview with: Prof. Hanns-Ulrich Marschall Professor of clinical hepatology Wallenberg Laboratory Sahlgrenska Academy Göteborg, Sweden Medical Research: What is the background for this study? Dr. Marschall: Intrahepatic cholestasis of pregnancy, or ICP, is the most common liver disease during pregnancy, affecting 1.5% of all pregnancies in Sweden. ICP is characterized by otherwise unexplained pruritus with elevated bile acids and/or transaminases in the late second and third trimester of pregnancy. It is well established that ICP is associated with risks for the unborn child, in particular preterm delivery, but also stillbirth. In contrast, for the mother, ICP has for a long time only been considered as an annoying but not serious condition that spontaneously resolves after delivery. However, ICP obviously is not such a benign condition for the mother: We have recently shown that women with ICP have a 3- to 5-times increased risk of hepatobiliary diseases, such as hepatitis C, cirrhosis and gallstones. Here we extended our study to investigate the association between ICP and later cancer, diabetes mellitus and other autoimmune-mediated diseases, and cardiovascular diseases.   Medical Research: What are the main findings? Dr. Marschall: Our study showed that women with ICP were at about 25% increased risk to be later diagnosed with immune-mediated diseases, in particular diabetes mellitus and Crohn’s disease but not ulcerative colitis. There was also a small increased risk of later cardiovascular disease, in particular if the woman with ICP also suffered from preeclampsia. Most important were the data on the risk of later malignancy: We found a 2.5-times higher risk for cancer in the biliary tree and even a 3.5-times increased risk of liver cancer. Even after adjusting for a diagnosis of hepatitis C, which is very strongly associated with liver cancer, more than 30-times, women with ICP were still at 2.5-times increased risk of later liver malignancy. (more…)
Author Interviews, Lancet, Nutrition, OBGYNE / 10.08.2015

Prof-Kate-JollyMedicalResearch.com Interview with: Prof. Kate Jolly Professor of Public Health and Primary Care Public Health Building School of Health & Population Sciences University of Birmingham Edgbaston Birmingham Medical Research: What is the background for this study? Response: The UK is amongst 32 countries worldwide with evidence of iodine deficiency. Severe iodine deficiency during pregnancy is associated with a lower intelligence quotient (IQ) and developmental abnormalities in the children; these are reversible by iodine supplementation during pregnancy. However, the effects of mild or moderate iodine deficiency during pregnancy are less clear as there are no high quality trials of supplementation that have reported the outcome of child IQ. However, in two studies in the UK and Australia, nine year old children of women who had a urinary iodine concentration suggestive of mild iodine deficiency during their pregnancy exhibited reduced educational outcomes and decreased IQ scores compared to children of iodine replete mothers. Recent research from the UK suggests that the country has become mildly iodine deficient. Many countries address their iodine deficiency by programmes of adding iodine to salt and some recommend that pregnant women take iodine supplements. Neither of these occur in the UK, although some commonly used pregnancy supplements already include iodine. Controversy about the need for supplementation in pregnancy, the ethics of undertaking a trial in which women would be randomly allocated to have iodine supplements, or not, and the high cost of following-up and assessing large numbers of children makes a trial unlikely. (more…)
Author Interviews, OBGYNE, Weight Research / 20.07.2015

Maya Tabet, MS Graduate Research Assistant Saint Louis University College for Public Health and Social Justice Department of Epidemiology St. Louis, MO 63104MedicalResearch.com Interview with: Maya Tabet, MS Graduate Research Assistant Saint Louis University College for Public Health and Social Justice Department of Epidemiology St. Louis, MO 63104 MedicalResearch: What is the background for this study? Response: The majority of women in the U.S. have an unhealthy weight before they start pregnancy, most of them being overweight or obese. It is well-known that having an unhealthy weight before pregnancy increases the likelihood of having adverse outcomes for the mother and baby. However, this study is the first to examine the likelihood of adverse outcomes in a second pregnancy among women who had an unhealthy weight before a first pregnancy that had no complications. MedicalResearch: What are the main findings? Response: Our study involved 121,049 women in Missouri who delivered their first 2 singleton pregnancies between 1989 and 2005. Findings revealed that women who were underweight before a first uncomplicated pregnancy had a 20% increased likelihood of having a shorter gestation and a 40% increased likelihood of having a small baby for gestational age in the second pregnancy, as compared to women who had a healthy weight before their first pregnancy. Also, women who were obese before a first uncomplicated pregnancy had a 55% increased likelihood of having a large baby for gestational age, a 156% increased likelihood of having preeclampsia, and an 85% increased likelihood of having a cesarean delivery. Babies born to these women also had a 37% increased likelihood of dying in the first 28 days of their life. (more…)
Author Interviews, Cost of Health Care, OBGYNE, Pharmacology / 14.07.2015

Nora V. Becker MD/PhD candidate Department of Health Care Management and Economics Wharton School, University of Pennsylvania, in Philadelphia. MedicalResearch.com Interview with: Nora V. Becker MD/PhD candidate Department of Health Care Management and Economics Wharton School, University of Pennsylvania, in Philadelphia. Medical Research: What is the background for this study? What are the main findings? Response: The Affordable Care Act mandates that private health insurance plans cover prescription contraceptives with no consumer cost sharing. The positive financial impact of this new provision on consumers who purchase contraceptives could be substantial, but it has not yet been estimated. Using a large administrative claims data set from a national insurer, we estimated out-of-pocket spending before and after the mandate. We found that mean and median per prescription out-of-pocket expenses have decreased for almost all reversible contraceptive methods on the market. The average percentages of out-of-pocket spending for oral contraceptive pill prescriptions and intrauterine device (IUD) insertions by women using those methods both dropped by 20 percentage points after implementation of the ACA mandate. We estimated average out-of-pocket savings per contraceptive user to be $248 for the IUD and $255 annually for the oral contraceptive pill. (more…)
Author Interviews, JAMA, OBGYNE / 13.07.2015

Diana W. Bianchi, M.D. Executive Director, Mother Infant Research Institute Vice Chair for Research and Academic Affairs, Department of Pediatrics Tufts Medical CenterMedicalResearch.com Interview with: Diana W. Bianchi, M.D. Executive Director, Mother Infant Research Institute Vice Chair for Research and Academic Affairs Department of Pediatrics Tufts Medical Center Medical Research: What is the background for this study? What are the main findings? Response: Noninvasive Prenatal Testing (NIPT) is the fastest growing genetic test. It has been available since late 2011. Over 2 million tests have been performed worldwide. Cancer in pregnancy is rare, and only occurs in 1 in 1,000 pregnant women. About 0.2 per cent of noninvasive prenatal tests that use sequencing of maternal plasma DNA have a so-called “false positive” result. In most cases this is not an error, but there is a biological explanation for the discrepancy between the abnormal noninvasive prenatal test result and a normal fetal chromosome result obtained from a diagnostic procedure, such as amniocentesis or chorionic villus sampling (CVS). We are very interested in the underlying biological explanations for the false positive cases, and it turns out that a clinically silent tumor in the mother is one of them. The mother’s tumor is shedding DNA into her blood that is detected by the prenatal test. In a large clinical dataset of over 125,000 pregnant women who had a DNA sequencing screen for fetal chromosome abnormalities there were 10 women who were subsequently found to have cancer. We retrospectively analyzed the DNA sequencing results in 8 of these women and found that they had abnormalities in multiple areas of the genome, suggesting that it was DNA from the tumor that was shed into the maternal blood and being detected by the prenatal screen. The noninvasive prenatal sequencing test result that was most suggestive of a cancer risk was the presence of more than one aneuploidy. This finding was present in 7 of the 10 women who had cancer. In three of the eight women we studied it was the abnormal prenatal test result that triggered a subsequent work-up that led to the diagnosis of cancer. (more…)
Author Interviews, Cost of Health Care, OBGYNE, Yale / 10.07.2015

Xiao Xu, Ph.D. Assistant Professor Department of Obstetrics, Gynecology & Reproductive Sciences Yale School of MedicineMedicalResearch.com Interview with: Xiao Xu, Ph.D. Assistant Professor Department of Obstetrics, Gynecology & Reproductive Sciences Yale School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Xiao Xu: While research has shown hospital variation in costs of care for other conditions, we know little about whether and how hospitals differ in costs of childbirth related care. With nearly 4 million births each year, childbirth is the most common reason for hospital admission in the U.S. Understanding the pattern and causes of variation in resource utilization during childbirth among hospitals can help inform strategies to reduce costs. Our study used data from 463 hospitals across the country and analyzed hospital costs of maternity care for low-risk births. We found that hospital varied widely in average facility costs per maternity stay. (more…)
Author Interviews, BMJ, CDC, OBGYNE / 10.07.2015

Jennita Reefhuis, PhD Epidemiologist with CDC National Center on Birth Defects and Developmental DisabilitiesMedicalResearch.com Interview with: Jennita Reefhuis, PhD Epidemiologist with CDC National Center on Birth Defects and Developmental Disabilities Medical Research: What is the background for this study? Dr. Reefhuis: There are previous reports on the link between birth defects and SSRIs. However, the results across some of these studies conflicted. It is not clear whether one SSRI might be safer than other SSRIs. Medical Research: What are the main findings? Dr. Reefhuis: Reassuringly, we found that the five earlier reported links between specific birth defects and sertraline were not found again. We did find that some birth defects occur two to three times more frequently among babies born to mothers who took paroxetine and fluoxetine in early pregnancy. (more…)
Author Interviews, Nature, OBGYNE / 08.07.2015

Shawn L. Chavez, Ph.D Assistant Scientist/Professor Oregon National Primate Research Center OHSU | Oregon Health & Science UniversityMedicalResearch.com Interview with: Shawn L. Chavez, Ph.D Assistant Scientist/Professor Oregon National Primate Research Center OHSU | Oregon Health & Science University Medical Research: What is the background for this study? Dr. Chavez: This study builds upon a previous study also published in Nature Communications in 2012, which demonstrated that chromosomally normal and abnormal 4-cell human embryos can be largely distinguished by combining the timing intervals of the first three cell divisions with the presence or absence of a dynamic process called cellular fragmentation. The current study further combines time-lapse imaging of embryo development and full chromosome analysis with high throughout single-cell gene expression profiling to assess the chromosomal status of human embryos up to the 8-cell stage. Medical Research: What are the main findings? Dr. Chavez: The key findings of this research were that by measuring the duration of the first cell division, one can identify which embryos are chromosomally normal versus abnormal even earlier in development. By examining gene expression at a single-cell level, we were able to correlate the chromosomal make-up of an embryo to a subset of 12 genes that are activated prior to the first cell division. These genes likely came from either the egg or sperm and can be used to predict whether an embryo will be chromosomally normal or abnormal within the first 30 hours of development. (more…)
Author Interviews, Cancer Research, JNCI, NIH, OBGYNE / 02.07.2015

MedicalResearch.com Interview with: Ashley S. Felix, PhD Bethesda, MD MedicalResearch: What is the background for this study? What are the main findings? Dr. Felix: Endometrial cancer prognosis is strongly affected by disease stage, or the extent of spread from the primary site. Endometrial cancers can spread via the lymph nodes, blood vessels, through the uterine wall, or through the fallopian tube into the peritoneal cavity. The last of these mechanisms is poorly understood, but appears to be a more common mode of spread for aggressive histologic subtypes of endometrial cancer. We hypothesized that women who previously underwent tubal ligation (TL) and later developed endometrial cancer would have lower stage disease, possibly by blocking passage of tumor cells along the fallopian tubes. Further, we hypothesized that TL would be associated with better prognosis, due to its relationship with lower stage. We found that women in our study who previously had tubal ligation were more likely to have lower stage endometrial cancer compared with women who did not report a previous tubal ligation. Specifically, tubal ligation was inversely associated with stage III and stage IV cancer across all subtypes of the disease, including aggressive histologic subtypes. Further, in statistical models of tubal ligation, tumor stage, and mortality, we observed no independent association with improved survival, suggesting that tubal ligation impacts mortality mainly through its effects on stage. (more…)
Author Interviews, OBGYNE / 29.06.2015

Frank Vandekerckhove, MD, PhD Clinical Head, Centre for Reproductive Medicine University Hospital Ghent BelgiumMedicalResearch.com Interview with: Frank Vandekerckhove, MD, PhD Clinical Head, Centre for Reproductive Medicine University Hospital Ghent Belgium Medical Research: What is the background for this study? What are the main findings? Dr. Vandekerckhove: Several retrospective studies have evaluated seasonal variations in the outcome of IVF treatment. Some also included weather conditions, mostly temperature and hours of daylight. The results were conflicting. We focused on individual variables provided as monthly results by our national meteorological institute. We shifted the results in IVF outcome to the weather results of one month earlier, as we supposed that the selection of good quality oocytes may start in the weeks before. Between January 2007 and December 2013, the IVF outcome of all Belgian patients treated in our university center was compared to the quarter of the year and monthly mean values of temperature, rain fall, rainy days and sunshine hours during the month when gonadotropins were started or the month before. 11494 patients started an IVF cycle and were included. Firstly bivariate correlation was performed by linear modelling between monthly weather conditions and IVF results. Secondly the same IVF outcome variables were plotted against the weather results stratified per quartile for each individual meteorological variable. There was no relationship between IVF outcome and the quarter of the year. When looking for a linear correlation between IVF results and the mean monthly values for the weather, the results were inconsistent. However, when the same analysis was repeated with the weather results of 1 month earlier, there was a clear trend towards better IVF outcome with higher temperature, less rain and more sunshine hours. The live birth rate per cycle was significantly different (p 0.019) between different groups (Q=quartile) of mean number of sunshine hours (Q1=60.75, Q2=136.00, Q3=174.50). (more…)
Author Interviews, Autism, JAMA, OBGYNE / 25.06.2015

MedicalResearch.com Interview with: Ali S. Khashan, Ph.D. Irish Centre for Fetal and Neonatal Translational Research (INFANT) Cork, Ireland Medical Research: What is the background for this study? What are the main findings? Dr. Khashan: The Caesarean section rate is increasing worldwide reaching 30% in some western countries and 50% in China and Brazil. As a result, it is becoming increasingly important to understand the long-term effects this procedure may have on both mother and child. Previously, our group conducted a systematic review and meta-analysis of published literature and found birth by Caesarean to be associated with approximately 20% increased risk of autism spectrum disorder (ASD), compared to birth by vaginal delivery. This means if the risk of ASD in children born by vaginal delivery were 1%, and the association was causal, the risk of autism spectrum disorder in children born by Caesarean section is 1.2% i.e. two additional ASD cases per 1000 births. However, studies were limited, and we were unable to determine what was driving this association. In our new study, now published in JAMA Psychiatry, we investigated this issue further with the largest study on this subject to date, including all children born in Sweden between 1982 and 2010. Our study included data on over 2.9 million people and accounted for variety of factors known to be associated with both Caesarean section and autism spectrum disorder. After controlling for known confounders, such as maternal age and psychiatric history as well as various other perinatal and socio-demographic factors, we confirmed our previous findings that birth by Caesarean was associated with approximately 20% increased risk of autism spectrum disorder, compared to birth by vaginal delivery. However, with this analysis it remained unclear whether the increased risk was due to the Caesarean section itself, or some genetic or environmental factor that we were unable to measure. To determine if it was birth by Caesarean section or another unknown factor which led to an increased risk of ASD, we compared children with autism spectrum disorder to their non-diagnosed brothers and sisters. In other words, we analysed pairs of siblings in which one was diagnosed with ASD and one was not, to determine if birth by Caesarean was associated with increased risk of ASD within families. In this way, we attempted to indirectly account for genetic and family environment factors that are shared by siblings but we were unable to measure in the general population. In this analysis, which included data on over 13,000 sibling pairs, there was no longer any association between birth by Caesarean section and ASD. Overall, these results indicate that though birth by Caesarean section may be associated with an increased risk of ASD, it is likely due to family factors such as genetics or environment, rather than the Caesarean section itself. These findings are more informative than many previous studies as we had the largest sample size on this topic to date and estimated the association between Caesarean section and the risk of autism spectrum disorder while comparing siblings born by different methods of delivery. This allowed us to control for many factors that other studies did not. (more…)
Allergies, Author Interviews, OBGYNE / 24.06.2015

MedicalResearch.com Interview with: Professor of Pediatrics Hans Bisgaard, MD, DMSc Copenhagen Prospective Studies on Asthma in Childhood Herlev and Gentofte Hospital, University of Copenhagen, Denmark Medical Research: What is the background for this study? Prof. Bisgaard: Programming of the immune response in perinatal life seems to contribute to the increased prevalence of immune-mediated diseases We hypothesized that initiation of labor could affect the developing newborn immune system. Medical Research: What are the main findings? Prof. Bisgaard: Pre-labor cesarean section is associated with a distinct and gestational age-related distribution of circulating immune cells in newborns suggesting that changes in specific immune compartments occur during the approach of labor. (more…)
Author Interviews, OBGYNE, Technology, University of Pennsylvania / 24.06.2015

Dan Dongeun Huh, Ph.D. Wilf Family Term Chair & Assistant Professor Department of Bioengineering University of Pennsylvania Philadelphia, PA 19104MedicalResearch.com Interview with: Dan Dongeun Huh, Ph.D. Wilf Family Term Chair & Assistant Professor Department of Bioengineering University of Pennsylvania Philadelphia, PA 19104 Medical Research: What is the background for this study? What are the main findings? Response: The placenta is a temporary organ central to pregnancy and serves as a major interface that tightly regulates transport of various endogenous and exogenous materials between mother and fetus.  The placental barrier consisting of the closely apposed trophoblast epithelium and fetal capillary endothelium is responsible for maintaining this critical physiological function, and its dysfunction leads to adverse pregnancy outcomes.  Despite its importance, barrier function of the placenta has been extremely challenging to study due to a lack of surrogate models that faithfully recapitulate the key features of the placental barrier in humans.  Our study aims to directly address this long-standing technical challenge by providing a microengineered in vitro system that replicates architecture, microenvironment, and physiological function of the human placenta barrier.  This “placenta-on-a-chip” device consists of microfabricated upper and lower cell culture chambers separated by a thin semipermeable membrane, and the placental barrier is generated by culturing human trophoblasts and fetal endothelial cells on either side of the membrane with steady flows of culture media in both chambers.  This microfluidic cell culture condition allowed the cells to form confluent monolayers on the membrane surface and to create a bi-layer tissue that resembled the placental barrier in vivo.  Moreover, the microengineered barrier enabled transport of glucose from the maternal chamber to the fetal compartment at physiological rates. (more…)
Author Interviews, Cancer Research, HPV, OBGYNE, Vaccine Studies / 18.06.2015

MedicalResearch.com Interview with: Ann Goding Sauer Epidemiologist, American Cancer Society, Inc. Atlanta, GA 30303 MedicalResearch: What is the background for this study? Response: Among US women, a positive association between Pap test uptake and HPV vaccination has been shown, though potential variation of the association by race/ethnicity had not been explored previously. The prevalence of some HPV types varies across different racial/ethnic groups so it is important to explore the association between Pap test uptake and HPV vaccination in detail. MedicalResearch: What are the main findings? Response: Pap test uptake was significantly lower among those who had not initiated HPV vaccination (81.0%) compared to women who had initiated vaccination (90.5%) (adjusted prevalence ratio = 0.93, 95% CI: 0.90–0.96). This result was seen across most of the sociodemographic factors examined, though not statistically significant for non-Hispanic blacks, Hispanics, those with lower levels of education, or those with higher levels of income. (more…)
Author Interviews, Cost of Health Care, Endocrinology, OBGYNE, Yale / 12.06.2015

Aileen Gariepy, MD, MPH Assistant Professor Section of Family Planning Department of Obstetrics, Gynecology, and Reproductive Sciences Yale School of Medicine New Haven, CT 06510MedicalResearch.com Interview with: Aileen Gariepy, MD, MPH Assistant Professor Section of Family Planning Department of Obstetrics, Gynecology, and Reproductive Sciences Yale School of Medicine New Haven, CT Medical Research: What is the background for this study? What are the main findings? Dr. Gariepy: Women who have just given birth are often highly motivated to prevent a rapid, repeat pregnancy.  For women who desire the contraceptive implant, a highly effective reversible form of contraception that is placed in the arm and can last for 3 years, new research shows that it is more cost-effective to place the implant while women are still in the hospital after giving birth, compared to delaying insertion to the postpartum visit 6-8 weeks later which is currently the most common practice. When the costs associated with the implant insertion and the costs of unintended pregnancy are compared in women who receive immediate contraceptive implant insertion (while still in the hospital after giving birth) to women who are asked to come back in 6-8 weeks for the implant insertion (delayed insertion), immediate insertion is expected to save $1,263 per patient.  Based on these estimates, for every 1,000 women using postpartum implant, immediate placement is expected to avert 191 unintended pregnancies and save $1,263,000 compared with delayed insertion in the first year. Cost savings would continue to increase for the second and third year after insertion. In fact, over half of U.S. pregnancies are unintended.  Maternal and infant care costs for unintended pregnancies amount to $11.1 billion annually for public insurance programs alone. The immediate postpartum period (after delivery but before discharge home) provides an ideal opportunity for initiating contraceptives as patients are motivated and timing is convenient. However, the majority of insurance company policies do not provide coverage for insertion of the contraceptive implant when the new mother is still in the hospital.  This lack of reimbursement is the most significant barrier to providing this highly effective contraceptive method for women who have just delivered a baby.  Surprisingly, the reason most insurance companies do not offer reimbursement for immediate insertion is due to an outdated insurance protocol, “the global obstetric fee” which precludes separate reimbursement of individual procedures (like inserting the implant). The main reason that immediate insertion results in cost savings is because more women will get the implant compared to a strategy of delayed insertion.  Women can get pregnant again within 4 weeks of delivering a baby.  Starting contraception as soon as possible after giving birth is important because most women will resume sexual activity before their postpartum office visit and therefore will be at risk of pregnancy. And approximately 35% of women do not return for a postpartum visit. Even for women who want another pregnancy soon, the implant has benefits.  When women conceive and deliver a baby within 2 years of last giving birth, there is a significantly higher risk of poor maternal and neonatal outcomes, including preterm birth, low birth weight, and even early neonatal and maternal death.  Birth spacing is better for moms and babies. (more…)
Author Interviews, OBGYNE, Weight Research / 12.06.2015

MedicalResearch.com Interview with: Theresa A Lawrie World Health Organization Department of Reproductive Health and Research Geneva, Switzerland MedicalResearch: What is the background for this study? Response: Excessive weight gain in pregnancy is associated with various undesirable outcomes in pregnancy. The aim of the review was to assess data from all relevant clinical trials in the field, to determine whether diet and/or exercise interventions during pregnancy were effective in reducing the chance of excessive weight gain in pregnancy. We also wanted to know whether these interventions could reduce the chance of having large babies (macrosomia), as this is associated with difficult labor, c/section, postpartum hemorrhage, birth injuries and other complications. MedicalResearch: What are the main findings? Response: Altogether 49 trials contributed data to the review. Approximately half the trials recruited women of any pre-pregnancy weight, the other half recruited women who were overweight or obese at the start of pregnancy. Most of the trials were conducted in high income countries. Interventions varied, some involved individual counseling, others group sessions, some were counseling interventions only, other programs were actively supervised by fitness trainers. Health outcomes for women receiving the intervention programs in addition to routine antenatal care (the intervention group) were compared with those of women receiving the routine antenatal care only (the control group). We found that diet or exercise or combined interventions led to an average 20% reduction in the number of women gaining excessive weight in pregnancy. This reduction was fairly consistent across the different types of interventions, although the largest effect was observed for combined diet and supervised exercise interventions. Overall findings suggested a small reduction in caesarean section (of about 5%) and in large babies (of about 7%).  However, a bigger reduction in large babies (in the region of a 19% reduction) was noted for exercise-only interventions, which were more likely to be supervised interventions. Other findings: We also found no difference in the risk of preterm birth between groups. Fewer women in the intervention group were assessed as having high blood pressure during pregnancy (although we assessed this as low quality evidence). Low quality evidence also suggested that women in the intervention group were likely to retain less weight at six months postpartum compared with the control group. Interestingly, data from two studies suggested that women receiving diet and exercise interventions were less likely to have babies with breathing difficulties at birth. These findings will hopefully be corroborated by other studies. A limitation of the review, is that we did not include gestational diabetes as an outcome as this is partly covered in a separate Cochrane review. Our exploratory analyses, however, suggested that there may be a reduction in gestational diabetes for certain types of interventions, and we hope to include these data in future review updates. In general, we did not find differences in outcomes for women according to pre-pregnancy weight or BMI. (more…)
Author Interviews, Cancer Research, JAMA, OBGYNE / 11.06.2015

MedicalResearch.com Interview with: Prof. Joris Vermeesch Hoofd Moleculaire Cytogenetica Coordinator Genomics Core University of Leuven, University Hospitals Leuven, Belgium Medical Research: What is the background for this study? What are the main findings? Dr. Vermeesch: We developed a novel analysis methodology for Noninvasive prenatal testing (NIPT), which not only interrogates the common trisomies, but looks at variations across all chromosomes.  We obtain a kind of genome wide copy number variation plot.  By applying this analysis method for Noninvasive prenatal testing, we have strict quality parameters.  If faulty, we ask for a second sample. In one pregnant woman, the second sample showed exactly the same aberrations as in the first sample.  We excluded this variation to be  caused by a maternal constitutional chromosomal rearrangement and also excluded this aberration to be from fetal origin.  This prompted us to assume a maternal cancer was the cause.  Three such cases were observed, all three women were referred to the oncology unit and all three were proven to show a cancer. (more…)
Author Interviews, Cognitive Issues, Endocrinology, OBGYNE / 03.06.2015

Dr.Carey Gleason Ph.D School of Medicine and Public Health, University of Wisconsin Geriatric Research, Education and Clinical Center William S. Middleton Memorial Veterans Hospital Wisconsin Alzheimer's Disease Research Center, Madison, WisconsinMedicalResearch.com Interview with: Dr.Carey Gleason Ph.D School of Medicine and Public Health, University of Wisconsin Geriatric Research, Education and Clinical Center William S. Middleton Memorial Veterans Hospital Wisconsin Alzheimer's Disease Research Center, Madison, Wisconsin Dr. Gleason: In this response I refer to hormone therapy (HT), which was formally called hormone "replacement" therapy. In particular, we examined menopausal HT, i.e., the use of HT during the menopausal transition to address menopausal symptoms. Medical Research: What is the background for this study? What are the main findings? Dr. Gleason: The WHI Memory Study (WHIMS) suggested that HT was associated with cognitive harm for women age 65 and older. In contrast, we found that the cognitive performance of women randomized to receive menopausal hormone therapy did not differ from that of women randomized to receive the placebo. On a measure of mood states, women treated with conjugated equine estrogens showed improvements compared to those on placebo. (more…)