OBGYNE
24 Mar Dual and Concordant Vaginal and Oral HPV Infections in Women
MedicalResearch.com Interview with: [caption id="attachment_22854" align="alignleft" width="200"]
Dr. Ryan Orosco[/caption]
Ryan K. Orosco, MD
Division of Head and Neck Surgery
Department of Surgery
University of California, San Diego
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Orosco: Our group at UC San Diego is interested in HPV as it relates to diseases of the head and neck. HPV is a well-publicized cause of cervical cancer, and awareness about its link to throat (oropharynx) cancer is rapidly increasing.
Less well-known, is the relationship between HPV and benign (non-cancerous) diseases such as genital warts and papilloma of the throat. As we strive to understand how to best care for patients with HPV-related disorders, it is important to understand the entire process of disease progression, which begins with HPV infection. Our group wanted to explore the relationship between HPV infection in the two most commonly infected body sites: oral and vaginal.
24 Mar Miscarriage Risk Reduced by Daily Multivitamins Before and After Conception
MedicalResearch.com Interview with: [caption id="attachment_22845" align="alignleft" width="133"]
Dr-Germaine M. Buck-Louis[/caption]
Germaine M. Buck Louis, Ph.D., M.S.
Office of the Director
Division of Intramural Population Health Research
Eunice Kennedy Shriver National Institute of Child Health and Human Development
Rockville, Maryland 20852.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: To understand the association between couples’ lifestyles and risk of pregnancy loss. Couples were recruited upon discontinuing contraception to try for pregnancy and followed daily for up to one year of trying or until pregnancy. Pregnant women were followed daily for 7 weeks following conception then monthly.
16 Mar Study Examines Adverse Childhood Health After Planned Repeat C-Section
MedicalResearch.com Interview with: [caption id="attachment_22696" align="alignleft" width="150"]
Dr. Mairead Black[/caption]
Dr Mairead Black MBChB, MRCOG, MSc
Clinical Lecturer, Obstetrics and Gynaecology
School of Medicine and Dentistry, Division of Applied Health Sciences
University of Aberdeen
Aberdeen Maternity Hospital, Cornhill Road
Aberdeen
MedicalResearch.com: What is the background for this study?
Dr. Black: The commonest reason for performing a planned Cesarean Section (CS) in high-income countries is a history of a previous CS. However, there is very little information available on childhood health outcomes of birth after a previous .
MedicalResearch.com: Why might vaginal birth be beneficial?
Dr. Black: If a baby is born naturally, it is exposed to various processes of labour and birth which may help their immunity and ability to avoid or fight future illness.
14 Mar Hypertensive Disorders in Pregnancy Linked To Later Risk of Cardiomyopathy
MedicalResearch.com Interview with: Ida Behrens, MD and Heather Boyd PhD Department of Epidemiology Research Statens Serum Institut Copenhagen, Denmark MedicalResearch.com: What is the background for this study? Response: Over the past decade, we have begun to realize that a woman’s pregnancy experiences can be a predictor of her future health. Miscarriages, stillbirths and preterm deliveries have all been linked with an increased risk of later cardiovascular disease, as have hypertensive disorders of pregnancy (preeclampsia and gestational hypertension). Women with preeclampsia also have an increased risk of peripartum cardiomyopathy, a rare but serious condition that severely compromises heart function at the end of pregnancy or shortly after delivery. We were interested to find out whether women with preeclampsia or gestational hypertension during one or more pregnancies also had an increased risk of cardiomyopathy later in life. MedicalResearch.com: What are the main findings? Response: Using Danish national registers, we followed more than 1 million women with pregnancies between 1978 and 2011 – with an average follow-up of almost 18 years per woman – to see whether women with hypertensive disorders of pregnancy had increased rates of cardiomyopathy later in life, compared with women who only had normotensive pregnancies. We found that the women with hypertensive disorders of pregnancy had a two-fold increased risk of cardiomyopathy later in life. Interestingly, only half of this increase in risk could be linked to chronic hypertension, which is common among women who have previously had a hypertensive disorder of pregnancy. The remaining 50% was not associated with hypertension and could potentially be directly attributable to the woman’s pregnancy experience (or to an underlying cause common to both hypertensive disorders of pregnancy and cardiomyopathy).14 Mar Bacterial Infections in Pregnancy May Lead To Brain Changes in Baby
MedicalResearch.com Interview with: [caption id="attachment_22601" align="alignleft" width="200"]
Dr. Elaine Tuomanen[/caption]
Elaine Tuomanen, MD
Chair and Full Member
Dept of Infectious Diseases
St Jude Children’s Research Hospital
262 Danny Thomas Place
Memphis, TN 38105
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Tuomanen: While investigating mechanisms of brain repair during infection in a mouse model system, we found that components from the surfaces of bacteria could traffic from the mother to the fetus. The bacterial components moved across the placenta and into the fetal brain. To our surprise, the fetal brain did not respond with neuronal death like we see in children with meningitis. Rather, fetal neurons proliferated. This response involved the innate immune system (TLR2) inducing the neuronal transcription factor, FoxG1, which is known to drive proliferation. The newly born neurons migrated appropriately to the cortical plate, the area on the surface of the fetal brain that forms the cortex, a major part of the adult brain. Although the neurons moved to the right place in the brain, there were too many and they crowded together in the cortex, changing the architecture of the brain. At birth, affected mice seemed to have no abnormalities. However, when we tested if this change in architecture would affect brain function after birth, mice were shown to progressively develop defects in learning, memory and other cognitive functions. This indicates there is a window during pregnancy where components of bacteria from the mother can change fetal brain architecture and subsequent postnatal behavior
11 Mar Vaginal Progesterone Did Not Prevent Preterm Death or Delivery
MedicalResearch.com Interview with: [caption id="attachment_22576" align="alignleft" width="146"]
Dr. Charles Lockwood[/caption]
Charles J. Lockwood, MD
Member of of the March of Dimes Board of Trustees
Dean at Morsani College of Medicine
Senior Vice President, USF Health and Professor of Obstetrics & Gynecology, and Public Health The University of South Florida
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Lockwood: There remain questions about the utility of vaginal progesterone therapy in asymptomatic women with singleton gestations at risk for preterm birth. The OPPTIMUM study investigators conducted a double-blind, randomized, placebo-controlled trial of vaginal progesterone delivered via a pessary releasing 200 mg per day (n=618) vs. placebo (n=610) from around 22 to 34 weeks gestation among women at high risk for prematurity on the basis of a characteristic history and/or the presence of cervicovaginal fetal fibronectin or a cervical length less than 25 mm in length on transvaginal ultrasound. The primary endpoints were fetal death or preterm birth before 34 weeks (obstetrical outcome), or a composite of neonatal mortality or morbidities (neonatal outcome). The authors found that progesterone had no significant impact on either primary endpoint, with an adjusted OR of 0·86, 95% CI: 0·61-1·22 for obstetrical outcomes and an OR of 0·62, 95% CI:0·38-1·03 for neonatal outcomes.
08 Mar Pre-Abortion Informed Consents May Contain Inaccurate Information
MedicalResearch.com Interview with: [caption id="attachment_22482" align="alignleft" width="200"]
Dr. Cynthia Daniels[/caption]
Cynthia R. Daniels PhD
Professor, Political Science Department.
Rutgers University
New Brunswick, N.J. 08901
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Daniels: The study found that over 30% of information regarding embryological and fetal development is medically misleading in the informed consent materials states require women see before receiving an abortion. Nearly half of the information provided about the 1st trimester of pregnancy, when most women have abortions, was medically inaccurate, meaning either 'false' or 'misleading.'
07 Mar Dengue During Pregnancy Linked to Adverse Fetal Outcomes
MedicalResearch.com Interview with: Mrs Enny S Paixão London School of Hygiene & Tropical Medicine London UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: Dengue is a vector borne disease endemic in more than 100 countries (mainly in South America and southeast Asia) and is spreading to new areas, with outbreaks of increasing magnitude and severity. It is estimated that each year, 390 million people are infected with dengue and 96 million develop clinical symptoms. Despite of the importance of this disease, the effects of disease during pregnancy on fetal outcomes remain unclear. Using the published scientific literature, we investigated the risk of stillbirth, miscarriage, preterm birth, and low birth weight for women who had dengue infection during pregnancy. This study showed some evidence that dengue infection alone, in the absence of clinical symptoms, does not affect the outcome of pregnancy, but also that clinical dengue during pregnancy seems to increase the frequency of stillbirth, prematurity, and low birthweight.04 Mar Cesarean Section May Increase Risk of Childhood Leukemia
MedicalResearch.com Interview with: [caption id="attachment_22359" align="alignleft" width="180"]
Dr. Erin Marcotte[/caption]
Erin Marcotte, Ph.D.
Assistant Professor
Division of Epidemiology and Clinical Research
Department of Pediatrics
University of Minnesota
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Marcotte: Recently there have been several studies that indicate a higher risk of immune-related disorders, such as type-I diabetes, asthma, and allergies, among children born by cesarean delivery. Our analysis used pooled data from 13 independent studies of childhood leukemia that were conducted in 9 different countries. We used data on over 33,000 children to investigate the relationship between birth by cesarean delivery and risk of childhood leukemia. We did not find an association between cesarean delivery overall and childhood leukemia. However, when we looked at emergency cesarean deliveries and pre-labor (planned) cesarean deliveries separately, we found a 23% increase in risk of acute lymphoblastic leukemia among children born by pre-labor cesarean delivery.
04 Mar Pregnant Women With Severe Migraine Should Be Considered High Risk
MedicalResearch.com Interview with: [caption id="attachment_22355" align="alignleft" width="120"]
Dr. Matthew Robbins[/caption]
Matthew S. Robbins, MD, FAHS
Associate Professor of Clinical Neurology, Albert Einstein College of Medicine
Chief of Neurology, Jack D. Weiler Hospital
Montefiore Medical Center
Director of Inpatient Services, Montefiore Headache Center
Associate Program Director, Neurology Residency
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Robbins: It is now well-established that having a history of migraine increases the risk of having vascular and obstetrical complications for pregnant women. What is not known is if having active migraine during pregnancy would increase complications later on in that very same pregnancy. Having severe migraine attacks during pregnancy may indicate particularly severe and active disease. We evaluated pregnant women who presented to the hospital setting with acute, severe migraine attacks, and then reviewed their records for what happened during the same pregnancy when they delivered. We found that compared to local and national rates, pregnant women with severe migraine attacks presenting to the hospital have increased rates of preeclampsia, preterm delivery, and low birthweight. This risk was particularly elevated in pregnant women age 35 years or older.
27 Feb Poor Sleep Linked to Cognitive Issues in Fetal Alcohol Syndrome
MedicalResearch.com Interview with: [caption id="attachment_22137" align="alignleft" width="200"]
Dr. Donald Wilson[/caption]
Donald A. Wilson, Ph.D.
Professor, Departments of Child & Adolescent Psychiatry and Neuroscience & Physiology
NYU Langone Medical Center
Senior Research Scientist
Nathan Kline Institute for Psychiatric Research
Medical Research: What is the background for this study? What are the main findings?
Dr. Wilson: Fetal alcohol spectrum disorder (FASD) is characterized by cognitive, emotional and behavioral problems that are life-long. Generally, it is assumed that the initial trauma of alcohol exposure at a critical time in life is the cause of these problems. In this study using an animal model of FASD, we find that developmental alcohol causes a life-long disturbance in sleep. Given that sleep is important for memory and emotion, among other things, this suggests that developmental alcohol can produce a daily insult to the brain, far outlasting that initial exposure. Each night, the brain is unable to store memories, adjust emotional circuits, remove waste products, in the way that it should, because FASD has disrupted sleep.
26 Feb Multiple Pregnancies May Raise Metabolic Syndrome Risk in Latina Women
Posted at 16:29h
in Author Interviews, JACC, Metabolic Syndrome, OBGYNE, Race/Ethnic Diversity, Women's Heart Health
MedicalResearch.com Interview with:
[caption id="attachment_21829" align="alignleft" width="150"]
Dr. Catherine Vladutiu[/caption]
Catherine J. Vladutiu, PhD, MPH
Research Assistant Professor, Department of Obstetrics & Gynecology
Adjunct Assistant Professor, Department of Epidemiology
Chapel Hill, NC
Medical Research: What is the background for this study?
Dr. Vladutiu: During pregnancy, women experience physiological changes and are at risk of pregnancy-related complications, some of which are associated with a higher risk of cardiovascular health outcomes in later life. Physiologic adaptations occurring across successive pregnancies may be associated with an even higher risk of adverse cardiovascular outcomes. Previous studies have found an association between higher parity (i.e., number of live births) and the metabolic syndrome (MetS). However, no studies have examined this association in a Hispanic/Latina population. Hispanic women have a higher prevalence of the MetS than non-Hispanic women. Latinos are also the fastest growing minority population in the U.S. and Hispanic/Latina women report higher fertility and birth rates than their non-Hispanic counterparts.
25 Feb More Long Term Stress Incontinence With Vaginal Delivery vs C-Section
MedicalResearch.com Interview with: [caption id="attachment_22027" align="alignleft" width="165"]
Dr. Kari Tikkinen[/caption]
Kari Aarne Olavi Tikkinen, M.D PHD
Adjunct Professor
Department of Urology
Helsinki University Central Hospital and University of Helsinki
Helsinki, Finland
Medical Research: What is the background for this study?
Dr. Tikkinen: ?Stress and urgency incontinence are the two most frequent and the most bothersome urinary symptoms among women. It has been estimated that about twelve percent of women report significant bother from stress incontinence and eight percent from urgency incontinence. Both stress urinary incontinence and urgency urinary incontinence are associated with substantial physical and psychological morbidity, and large societal costs.
An extensive body of evidence suggests that delivering vaginally versus caesarean section increases rates of post-partum stress urinary incontinence. The magnitude of long term effects of different delivery modes on stress and urgency urinary incontinence remain, however, uncertain. ?
24 Feb Risk of Invasive Cervical Cancer After Glandular Atypia on PAP Smear
MedicalResearch.com Interview with: [caption id="attachment_21992" align="alignleft" width="150"]
Dr. Jianrong Wang[/caption]
Jiangrong Wang PhD
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet
Stockholm, Sweden
Medical Research: What is the background for this study? What are the main findings?
Dr. Wang: Cervical screening has been proved to effectively suppress the occurrence of cervical cancer, since it detects not only cervical cancer at early stages, but also precursor lesions that can be treated before progressing to invasive cancers. However, cervical screening has mainly reduced the occurrence of squamous cell cervical cancer, the most common type of invasive cervical cancer, but not adenocarcinoma of the cervix which originates from glandular cells. Although there is a well-known connection between adenocarcinoma in situ and invasive adenocarcinoma, questions remain on the magnitude of the cancer risk after detection of the glandular intraepithelial lesion-atypical glandular cells (AGC). We also wanted to study whether the current clinical management after detection of glandular abnormalities reduced the cancer risk as much as the standard management for squamous intraepithelial lesions does.
Our findings show that 2.6% of women with intraepithelial lesion-atypical glandular cells as the first abnormality developed invasive cervical cancer after 15 years of follow up and 74% of the cancers were adenocarcinoma. A moderately high proportion of women with AGC had prevalent cancer (diagnosed within 6 months from AGC), while there was considerably high incidence of cervical cancer within 0.5-6.5 years after a detection of AGC. The incidence of cervical cancer following AGC was significantly higher than for high-grade squamous intraepithelial lesions, and this increased risk remained even after having histology assessment in the initial half year.
The high risk of cervical cancer associated with AGC implies that the current clinical management following AGC does not prevent cervical cancer as sufficiently as the management for squamous intraepithelial lesions does.
24 Feb Being Born in Winter, or To A Smoker, Worsens Children’s Lung Health
MedicalResearch.com Interview with: [caption id="attachment_21974" align="alignleft" width="135"]
Dr. Julia Dratva[/caption]
Dr. med. Julia Dratva, MD MPH
Medical Specialist Prevention and Public Health
FMH Scientific project
leader
MAS Versicherungsmedizin/Studienkoordinationleitung
Dept. Epidemiology and Public Health
Swiss Tropical and Public Health Institute
Socinstrasse 57, P.O. Box, 4002 Basel,
Switzerland
Medical Research: What is the background for this study? What are the main findings?
Dr. Dratva: Early childhood is a critical time window for subsequent health. Early life environment is known to be important for lung development and respiratory health. Little is known on the potential impact on lung ageing and the potential mechanisms responsible for the long-term impact. We investigated early childhood factors and their association with lung function decline, a common marker of lung aging, in two long-standing adult cohorts, SAPALDIA and ECRHS. As recently published in scientific journal PlosONE, maternal smoking, early respiratory infections or season of birth are associated with a faster decline in lung function decline, while less rapid decline was found in persons who had attended daycare. The early exposures may not only have an independent adverse effect on lung aging but also increase the respiratory vulnerability to other adult risk factors. Stronger effects were observed in in smokers exposed to the aforementioned adverse factors.
23 Feb Vaginal Seeding After C-Section Can Transfer Harmful Germs To Baby
MedicalResearch.com Interview with: [caption id="attachment_21901" align="alignleft" width="214"]
Dr. Aubrey Cunnington[/caption]
Dr. Aubrey Cunnington
Faculty of Medicine, Department of Medicine
Clinical Senior Lecturer
Imperial College, London
Medical Research: What is the background for this study? What are the main findings?
Dr. Cunnington: We noticed that increasing numbers of women who were having Caesarean section deliveries at our hospitals were requesting for their vaginal fluid to be swabbed onto their babies after birth – a process often termed “vaginal seeding”. The idea behind this, is that it transfers all the natural bacteria (microbiota) from the mother’s vagina to the baby. We know that early on in life, babies born by Caesarean section have different bacteria living on their bodies and in their guts to those of babies born by vaginal delivery. Some people think these differences in the microbiota may be responsible for differences in long-term health, although a causal link is unproven. The hope is that vaginal seeding might reduce the risk of the baby developing some diseases like obesity and asthma in the future. Unfortunately we are a long way from having the evidence to show that this is possible, and we do not know whether vaginal seeding is really safe. Babies born by elective Caesarean section are at lower risk of transfer of some potentially harmful bacteria and viruses from the birth canal, but these harmful bacteria and viruses could be transferred to the baby on a swab and potentially cause a devastating infection.
MedicalResearch.com Editor's note: 'Vaginal Seeding' is also known as "microbirthing",
23 Feb Does Mom’s Anxiety During Pregnancy Make Her Child A Fussy Eater?
Posted at 23:11h
in Author Interviews, Depression, Eating Disorders, Mental Health Research, Nutrition, OBGYNE, Pediatrics
MedicalResearch.com Interview with:
[caption id="attachment_21832" align="alignleft" width="200"]
Dr. Lisanne De Barse[/caption]
Lisanne de Barse PhD
Department of Epidemiology
Erasmus Medical Center Rotterdam
MedicalResearch: What is the background for this study?
Dr. de Barse: Fussy (or “picky”) eating behaviour, which is characterised by consistent rejection of particular foods, is common in childhood and a source of concern for parents. It is not well understood what affects fussy eating. It is, however, well known that internalizing psychiatric problems of parents (i.e. anxiety and depression) have an impact on children’s health and development. Studies have also shown that mothers’ internalizing problems during the child’s preschool period was linked to child fussy eating. It was not clear whether the child’s eating problems causes stress and psychiatric symptoms in mothers or whether mothers’ symptoms predict child eating behaviour. Nor was it known what potential impact the dads’ state of mind have. The purpose of this study was to examine whether mothers’ and fathers’ internalizing problems during pregnancy and during the child’s life predicts child fussy eating.
MedicalResearch: What are the main findings?
Dr. de Barse: Our main findings indicate that mothers’ anxiety and depressive symptoms during pregnancy could have an influence on children’s fussy eating. This was irrespective of mothers’ internalizing symptoms at the child’s preschool period. We also found indications that fathers’ anxiety and depressive symptoms might influence children’s fussy eating behaviour. This was studied in Generation R, a study that has been tracking the health and wellbeing of children from conception onwards, conducted by the Erasmus Medical Centre, in Rotterdam, the Netherlands.
22 Feb Antiretroviral Vaginal Ring May Become HIV Prevention Tool For Women
MedicalResearch.com Interview with: [caption id="attachment_21920" align="alignleft" width="200"]
Dr. Jaret Baeten[/caption]
Jared Baeten, MD PhD
Vice Chair, Department of Global Health
Professor, Departments of Global Health, Medicine, and Epidemiology
Co-Director, International Clinical Research Center
University of Washington
MedicalResearch.com: What is the background for this studies?
Dr. Baeten: Women account for nearly 60 percent of adults with HIV in sub-Saharan Africa, where unprotected heterosexual sex is the primary driver of the epidemic. While several studies have shown that antiretroviral medications (ARVs) are highly effective in preventing HIV, other studies – such as VOICE and FACTS 001 – suggest that for young, at-risk women in Africa, ARVs delivered as a vaginal gel or as a tablet may not be acceptable. Products must be used to be effective, and that was not the case for most of the participants in previous studies.
Medical Research: What was the aim of ASPIRE and The Ring Study?
Dr. Baeten: As Phase III clinical trials, ASPIRE and The Ring Study were designed to determine whether a vaginal ring containing an antiretroviral (ARV) drug called dapivirine is safe and effective in protecting women against HIV when used for a month at a time. These trials also sought to determine whether women find the vaginal ring practical and easy to use. As sister studies, ASPIRE and The Ring Study were designed as the centerpiece of a broader licensure program to provide the strength of evidence to support potential licensure of the dapivirine vaginal ring for preventing HIV in women. Because at least two Phase III efficacy trials are usually needed for a product to be considered for regulatory approval, ASPIRE and The Ring Study were conducted in parallel to accelerate the timeline to the ring’s potential approval.
22 Feb Gestational Diabetes Raises Risk of Low Milk Supply in Breastfeeding Moms
MedicalResearch.com Interview with: [caption id="attachment_21895" align="alignleft" width="200"]
Dr. Laurie Nommsen-Rivers[/caption]
Laurie A. Nommsen-Rivers, PhD, RD, IBCLC
Assistant Professor, UC Department of Pediatrics
Cincinnati Children's Hospital Medical Center
Medical Research: What is the background for this study?
Dr. Nommsen-Rivers: Breastfeeding provides important benefits for mother and infant. Exclusive breastfeeding—that is, without any other food or fluids provided to the infant—is recommended for the first six months of life by multiple public health organizations. Some mothers, despite their best efforts, have difficulty establishing and sustaining sufficient milk production to support exclusive breastfeeding. Our previous research suggested that mothers with less optimal glucose tolerance are at risk for prolonged delays in time between birth and the establishment of copious milk production. We wanted to extend this finding by probing if mothers who had diabetes in pregnancy, as a sign of less optimal glucose tolerance, are at greater risk of sustained low milk production. “Glucose tolerance” refers to the body’s ability to metabolize glucose and maintain a healthy blood sugar level, which is orchestrated by the hormone insulin. For a long time, we did not consider insulin to play a role in milk production, but we are now learning that insulin plays an essential role in milk production.
19 Feb Post Menopausal Stroke Risk Raised In Women With Later Life Pregnancy
MedicalResearch.com Interview with: [caption id="attachment_21777" align="alignleft" width="80"]
Dr. Adnan Qureshi[/caption]
Dr. Adnan Qureshi MD
Professor of Neurology, Neurosurgery and Radiology
University of Minnesota
Medical Research: What is the background for this study?
Dr. Quershi: Women who have the last pregnancy at advanced age (usually defined as pregnancy at age of 40 years or greater) have higher risk of developing hypertension, hypertension related disorders, and diabetes mellitus during pregnancy. There is some evidence that disproportionately higher rates of cardiovascular risk factors continue years after the pregnancy. Perhaps there are unknown medical conditions triggered during pregnancy at advanced age. These changes continue to progress without being clinically evident until years later manifesting as a cardiovascular event.
Medical Research: What are the main findings?
Dr. Quershi: We analyzed the data for 72,221 women aged 50-79 years who were enrolled in the observational arm of the Women's Health Initiative Study. We determined the effect of pregnancy in advanced age (last pregnancy at age≥40 year) on risk of ischemic stroke, hemorrhagic stroke, myocardial infarction, and cardiovascular death over a mean period of 12 years. A total of 3306 (4.6%) of the 72,221 participants reported pregnancy in advanced age. Compared with pregnancy in normal age, the rate of ischemic stroke (2.4% versus 3.8%, p<0.0001), hemorrhagic stroke (0.5% versus 1.0%, p<0.0001), myocardial infarction (2.5% versus 3.0%, p<0.0001), and cardiovascular death (2.3% versus 3.9%, p<0.0001) was significantly higher among women with pregnancy in advanced age. In multivariate analysis, women with pregnancy in advanced age were 60% more likely to experience a hemorrhagic stroke even after adjusting for differences in age, race/ethnicity, congestive heart failure, systolic blood pressure, atrial fibrillation, alcohol use and cigarette smoking were adjusted.
16 Feb Maternal Obesity and Gestational Diabetes May Raise Risk of Autism
MedicalResearch.com Interview with: [caption id="attachment_21640" align="alignleft" width="200"]
Dr. Katherine Bowers[/caption]
Katherine Bowers, PhD, MPH
Division of Biostatistics and Epidemiology
Cincinnati Children's Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Bowers: Autism spectrum disorder (ASD) affects approximately 1 in 68 children and the prevalence continues to rise. Past studies have suggested that conditions experienced by women during pregnancy (for example, obesity and gestational diabetes mellitus (GDM)) may be associated with having a child with ASD. We collected medical record data from patients who resided in the Cincinnati Children’s Hospital Medical Center’s primary catchment area and linked those data to data from birth certificates to identify metabolic risk factors. Two comparison groups were analyzed; one with developmental disabilities; and the other, controls without a reported ASD or other developmental disability. Descriptive statistics and regression analyses evaluated differences.
We found that maternal obesity and gestational diabetes mellitus were associated with an increased risk of Autism spectrum disorder in the offspring; however, no difference in risk of Autism spectrum disorder according to BMI and GDM was seen when comparing to the group with other developmental disabilities. The strongest observed association was the joint effect of obesity and GDM (compared to neither obesity nor GDM) :OR=2.53 (95% CI: 1.72, 3.73).
12 Feb Acetaminophen During Pregnancy Linked To Childhood Asthma
MedicalResearch.com Interview with: [caption id="attachment_21542" align="alignleft" width="133"]
Maria C. Magnus[/caption]
Maria C. Magnus
Norwegian Institute of Public Health
Oslo Norway
Medical Research: What is the background for this study? What are the main findings?
Response: Researchers have found that developing asthma can be linked to pregnant women and infants being exposed to paracetamol, (acetaminophen) by testing that the association was not simply linked to the complaint for which the person is taking paracetamol. The findings were published in the International Journal of Epidemiology
Using data from the Norwegian Mother and Child Cohort Study, researchers in Norway compared associations between several conditions during pregnancy (with and without the use of paracetamol) and asthma developing in the 114,500 children in the study. They examined asthma outcomes at ages three and seven and evaluated the likelihood of the association being as a result of the three most common uses of paracetamol in pregnancy: pain, fever, and influenza.
The results showed that 5.7 per cent of the children had current asthma at age three, and 5.1 per cent had asthma at age seven. The research found that there was a strong link between children who had asthma at age three who had been exposed to paracetamol as during pregnancy or infancy. The strongest association was seen if the mother used paracetamol during pregnancy for more than one complaint with a child having asthma at three years old.
04 Feb Pregnant Women With Flu At High Risk of Serious Illness and Complications
[caption id="attachment_21281" align="alignleft" width="145"]
Dr. Ikwo Oboho[/caption]
MedicalResearch.com Interview with:
Ikwo Oboho, MD, ScMLCDR
United States Public Health Service
Medical Epidemiologist, Centers for Disease Control and PreventionPriority Populations Treatment Team| HIV Care & Treatment Branch | Division of Global HIV/TB
Atlanta, GA 30333
MedicalResearch.com: What is the background for this study?
Dr. Oboho: ·Pregnant women with flu are at high risk of serious illness and complications, including death.
The study is based on data gathered from a nationwide flu surveillance network that includes 14 states. The analysis focused on pregnant women hospitalized with laboratory-confirmed flu over four recent flu seasons, from 2010 to 2014.
MedicalResearch.com: What are the main findings?
Dr. Oboho: · During the study period, 865 pregnant women were hospitalized with flu. Sixty-three of these patients, or about 7 percent, had severe illness.
- After adjusting for underlying medical conditions, vaccination status, and pregnancy trimester, we found that early treatment with the antiviral drug oseltamivir was associated with a shorter hospital stay.
- Among pregnant women with severe flu illness who were treated early with oseltamivir — within two days of the start of symptoms — the median length of stay was about five days shorter compared to hospitalized pregnant women with severe flu illness who were treated later
- Pregnant women who were hospitalized with severe cases of flu illness were half as likely to have been vaccinated as women with non-severe illness.
03 Feb Lupus Linked To Higher Risk of Pregnancy and Neonatal Complications
MedicalResearch.com Interview with:
Dr. Julia Fridman Simard ScD
Assistant Professor
Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
Division of Epidemiology, Department of Health Research & Policy
Division of Immunology & Rheumatology, Department of Medicine
Stanford School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Simard: A number of studies have shown that women with lupus who get pregnant have more complications and adverse outcomes, although the methodologies across studies vary considerably. Using population-based data we were able compare the occurrence of these pregnancy complications in mothers with lupus to pregnancies from the general population. We were also interested in whether women in our data set who first presented with lupus up to five years post-partum had more pregnancy-related adverse events. Our descriptive study showed that preterm delivery, infant infection, and preeclampsia were more common in the first singleton pregnancies of women with lupus compared to the general population. These outcomes were also observed more often among women who appeared to present with lupus up to five years post-partum.
01 Feb Postpartum Screening Important For Women With Hypertension During Pregnancy
MEDICALRESEARCH.COM INTERVIEW WITH: KRISTI REYNOLDS, PHD, MPH [caption id="attachment_21205" align="alignleft" width="146"]
Dr. Kristi Reynolds[/caption]
KAISER PERMANENTE RESEARCH
RESEARCH & EVALUATION
PASADENA, CA 91101
Medical Research: What is the background for this study?
Dr. Reynolds: Hypertensive disorders during pregnancy are common, affecting up to 10 percent of all pregnant women, and include gestational hypertension, preeclampsia (which is a combination of high blood pressure and protein in the urine), and eclampsia, which includes seizures in women with severe preeclampsia. Research has shown that hypertensive disorders in pregnancy are associated with long-term cardiovascular disease risk, but little is known about the effect of these conditions in the early years after delivery.
As part of our study, we examined the electronic health records of 5,960 women who had prenatal care and delivered a baby at the Kaiser Permanente Southern California Bellflower Medical Center between 2005 and 2010. Women with high blood pressure before their pregnancy were excluded from the analysis.
Medical Research: What are the main findings?
Dr. Reynolds: We found that women who had a hypertensive disorder during pregnancy were 2.4 times more likely – and women with pre-eclampsia/eclampsia 2.5 times more likely – to develop pre-hypertension or hypertension in the year after delivery than those who maintained a normal blood pressure during their pregnancy, after controlling for differences between the groups.
In comparison to women with normal blood pressure during pregnancy, women with pregnancy-related hypertension tended to be slightly younger and overweight or obese before pregnancy. In addition, they were more likely to have had one or more children previously and to gain excess weight and develop gestational diabetes during their pregnancy.
01 Feb Microbiome Can Be Partially Restored in C-Section Delivered Babies
MedicalResearch.com Interview with: [caption id="attachment_21187" align="alignleft" width="150"]
Dr. Dominguez-Bello[/caption]
Maria Dominguez-Bello, PhD
Associate Professor, Department of Medicine, Division of Translational Medicine
NYU Langone Medical Center and
[caption id="attachment_21188" align="alignleft" width="150"]
Dr. Jose Clemente[/caption]
Jose Clemente, PhD
Assistant Professor, Departments of Genetics and Genomic Sciences, and Medicine
Icahn School of Medicine at Mount Sinai
Medical Research: What is the background for this study? What are the main findings?
Response: Humans and animals are a composite of their own cells and microbes.
But where they get their microbes from? For mammals, labor and birth are major exposures to maternal vaginal bacteria, and infants are born already with a microbiota acquired from the mother.
Mom’s birth canal is heavily colonized by bacteria that are highly related to milk: some will use milk components and become dominant during early development, an important window for maturation of the immune system, the intestine and the brain. Thus, the maternal vaginal microbiota is thought to be of high adaptive value for newborn mammals. Indeed, studies in mice confirm that microbes acquired at birth are important to develop adequate immune and metabolic responses, and the mature adult microbiome will continue to modulate host metabolism and immunity.
Humans are the only mammals that interrupt the exposure to maternal vaginal microbiota, by delivering babies by Cesarean section. C-sections save lives of babies and moms, and they are estimated necessary in 10-15% of the cases. But most Western countries have rates above 30%, with the notable exception of the Scandinavian countries, Holland and Japan, which have excellent health systems and low maternal-infant mortality rates.
Previous work by us an others has shown that infants born by C-section acquire different microbiota at birth, and those differences are sustained over time, altering the normal age-dependent maturation of the microbiome. The fundamental questions are then, can we restore the microbiota of Cesarean delivered babies? And if we can, does that reduce the associated disease risks? In relation to the first question, we present here the results of a pilot study in which infants born by Cesarean delivery were exposed to maternal vaginal fluids at birth.
A total of 18 infants were recruited for the study. Seven of them were vaginally delivered, the remaining 11 were born by scheduled C-section. Among the C-section infants, 4 were exposed to maternal vaginal fluids at birth and 7 were not. We sampled all infants and their mothers for the first month of life across different body sites (oral, skin, anal, maternal vagina) and determined the microbiome composition on a total of over 1,500 samples.
27 Jan Trial Tests Effect of Vitamin D Supplementation During Pregnancy On Wheezing in Children
More on Asthma on MedicalResearch.com [caption id="attachment_19464" align="alignleft" width="133"]
Prof. Bisgaard[/caption]
MedicalResearch.com Interview with:
Hans Bisgaard, MD, DMSc
Professor of Pediatrics
The Faculty of Health Sciences
University of Copenhagen
Head of the Copenhagen Prospective Studies on Asthma in Childhood
University of Copenhagen and Naestved Hospital
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Bisgaard: Vitamin D deficiency has become a common health problem in westernized societies, possibly caused by a more sedentary indoor lifestyle and decreased intake of vitamin D containing foods. Vitamin D possesses a range of immune regulatory properties, and it has been speculated that vitamin D deficiency during pregnancy may affect fetal immune programming and contribute to asthma pathogenesis. Asthma often begins in early childhood and is the most common chronic childhood disorder. Observational studies have suggested that increased dietary vitamin D intake during pregnancy may protect against wheezing in the offspring, but the preventive effect of vitamin D supplementation to pregnant women is unknown. In our double-blind, single-center, randomized clinical trial conducted within the Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort we supplemented 2800 IU/d of vitamin D3 during the third trimester of pregnancy compared with 400 IU/d in the control group. Although the maternal supplementation did not result in a statistically significant reduction of risk of persistent wheeze in the offspring through age 3 years, the interpretation of the study is limited by a wide confidence interval that includes a clinically important protective effect.
25 Jan Most Cerebral Palsy Not Due To Poor Delivery Technique
[caption id="attachment_20937" align="alignleft" width="165"]
Dr. Muraskas[/caption]
MedicalResearch.com Interview with:
Jonathan Muraskas M.D.
Professor of Pediatrics and OB/Gyne
Neonatal and Maternal Fetal Medicine
Director Neonatal-Perinatal Research
Loyola University Stritch School of Medicine
Loyola University Medical Center
Medical Research: What is the background for this study? What are the main findings?
Dr. Muraskas: Multiple studies over the years have demonstrated that only 15% of cerebral palsy is due to the birthing process.
In other words, a normal pregnancy is 7000 hours and lawyers frequently only focus on the last 2 hours.
22 Jan Proposed Model Clarifies Ovarian Risk Assessment By Ultrasound
[caption id="attachment_20871" align="alignleft" width="200"]
Dr. Dirk Timmerman[/caption]
More on Ovarian Cancer on MedicalResearch.com
MedicalResearch.com Interview with:
Dirk Timmerman, MD PhD
Department of Development and Regeneration
Department of Obstetrics and Gynecology
University Hospitals Leuven
Leuven, Belgium
Medical Research: What is the background for this study? What are the main findings?
Dr. Timmerman: Ovarian cancer is the most aggressive and lethal gynecological malignant neoplasm. The prognosis of ovarian cancer is poor, with only about 40% of patients still alive five years after being diagnosed. The preoperative characterization of an adnexal tumor is fundamental for selecting the optimal management strategy. An accurate differentiation between benign and malignant masses can lead to optimal referral of patients with malignant diseases to gynecological oncology centers for further diagnostics and treatment, which positively influences the prognosis. On the other hand, it may help in safely selecting patients with benign ovarian masses for minimally invasive or fertility sparing surgery, and in some cases maybe even conservative follow-up. The International Ovarian Tumor Analysis (IOTA) study is the largest diagnostic accuracy study of its kind. Transvaginal ultrasound is a cheap and very accessible imaging technique. Using ultrasound features, which are easy to assess by a trained examiner, we proposed a model to define the individual risk of malignancy for each patient presenting with an adnexal tumor. This could considerably impact on the morbidity and mortality associated with adnexal pathology.