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.
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MedicalResearch.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.
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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.
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MedicalResearch.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.
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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.
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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.
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MedicalResearch.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.
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MedicalResearch.com Interview with:
Prof. Michael Breakspear MB BS, Ba(Hons), Bsc(Med), PhD
QIMR Berghofer Medical Research Institute
Royal Brisbane Hospital
Medical Research: What is the background for this study? What are the main findings?
Prof. Breakspear: The first 72 hours following complicated full-term or premature delivery of a newborn represents a critical window in which survival and long term brain development hangs in the balance. During this window of time, there does not currently exist a reliable, non-invasive, real-time measure of neuropathology that provides neurologists and neonatologists prognostic indicators of clinical outcome. We developed a tool that draws on techniques in physics used to characterize naturally occurring phenomena, such as earthquakes and avalanches, to analyze brain activity recordings of preterm infants. Our tool allows early identification of preterm infants at significant risk of developing poor long-term neurodevelopmental outcomes, such as cerebral palsy and learning difficulties at two years of age.
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MedicalResearch.com Interview with: Yana Vinogradova, Research Fellow
Division of Primary Care
School of Medicine
University of NottinghamMedical Research: What is the background for this study? What are the main findings?
Response: Combined oral contraceptives are an effective method of birth control but do have measurable side effects. One – common to all combined contraceptives and sometimes fatal – is an increased risk of venous thromboembolism (VTE). A number of earlier studies investigated VTE risks for different types of hormonal contraceptives, but all were performed some years ago or had insufficient data to analyse newer preparations, while some included only healthy users and others did not adequately control for lifestyle and health issues. The data used for this study were representative of the UK population and covered all currently prescribed drugs, with results adjusted for the widest possible range of available relevant factors.
We found that the venous thromboembolism risks of combined oral contraceptives appear to fall into two distinct groups. Newer drugs containing gestodene, desogestrel, drospirenone or cyproterone were associated with risks of VTE between 1.5 and 1.8 times higher than both the older compositions containing norethisterone or levonorgestrel and the relatively newer norgestimate. While our findings are statistical associations between different compositions and venous thromboembolism risks, they do represent more comprehensive and reliable information for doctors making evidence-based prescribing decisions. (more…)
MedicalResearch.com Interview with:
Katherine Jones, M.A.
Research Associate, Department of Research
The American College of Obstetricians and Gynecologists
Department of Psychology, American University
Medical Research: What is the background for this study? What are the main findings?
Response: It is well evidenced that breastfeeding is highly advantageous for the mother, child, and society. Benefits to breastfeeding may be significantly larger for minority women as they are disproportionately affected by numerous adverse health outcomes. The benefits of breastfeeding may help mitigate some of these negative health consequences, and thus, also bridge larger gaps in racial and ethnic health disparities. This article aimed to review the literature on racial and ethnic disparities in breastfeeding rates and practices, conduct a systematic review of breastfeeding interventions, address barriers to breastfeeding among minority women, and provide obstetrician-gynecologists (ob-gyns) with recommendations on how they can help improve rates among minority women.
Overall, racial and ethnic minority women continue to have lower breastfeeding rates than white women in the United States, with African American women having the lowest rates of breastfeeding initiation and continuation among to all women. Minority women report several unique barriers to breastfeeding, including lack of access to information that promotes and supports breastfeeding, lack of work and cultural acceptance and support, language and literacy barriers, acculturation, and historical, sociopolitical, and economic challenges. Results from the systematic review of breastfeeding interventions among minority women indicated that breastfeeding-specific clinic appointments, enhanced breastfeeding programs, group prenatal education, peer counseling, and hospital policy changes significantly improve breastfeeding initiation, duration, and exclusivity. (more…)
MedicalResearch.com Interview with:
Dr. Nina Kaminen-Ahola Ph.D.
Department of Medical Genetics
Faculty of Medicine
University of Helsinki
Helsinki, Finland
Medical Research: What is the background for this study?Dr. Kaminen-Ahola: The beginning of embryonic development is vulnerable to the effects of external influences and disruption of these processes can have
long-term effects on development. Our previous study demonstrated, for
the first time, that alcohol exposure in early pregnancy can cause
permanent changes to the epigenetic regulation, gene function and the
appearance of mouse offspring. We discovered increased
DNA-methylation, transcriptional silencing of an epigenetically
sensitive allele Agouti viable yellow (Avy) and darker coat colour in
the offspring. In this study we wanted to see whether alcohol consumed
in early pregnancy causes long-term changes to the epigenome and gene
expression in hippocampus.
According to previous studies the phenotype of offspring in this mouse
model is highly variable, but reminiscent of human FAS with growth
restriction, similar structural changes to corresponding areas of the
face and skull, and hyperactivity. In this study we wanted to
determine the impact of alcohol on the structures of the central
nervous system.
Medical Research: What are the main findings?Dr. Kaminen-Ahola: We observed that early exposure to alcohol caused subtle changes in the epigenome and altered the function of several genes in the
hippocampi of adolescent mice. We also detected alcohol-induced
alterations in the brain structure of adult offspring.
Interestingly, we also found out that in addition to hippocampus,
alcohol caused similar changes to gene function in two different
tissues of the infant mouse, bone marrow and the olfactory epithelium
of the snout.
These results support our hypothesis that early gestational ethanol
exposure alters the epigenetic reprogramming of the embryo, which
leads to alterations in gene regulation and embryonic development, and
causes life-long changes in brain structure, function, and behaviour.
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MedicalResearch.com Interview with:
Robert A. Meguid, MD MPH FACS
Assistant Professor Section of General Thoracic Surgery
Division of Cardiothoracic Surgery Department of Surgery
University of Colorado Denver | Anschutz Medical Campus
Aurora, CO 80045
Medical Research: What is the background for this study? What are the main findings?
Dr. Meguid: The surgical literature on adverse outcomes after surgery on pregnant patients is conflicting. We know that the majority of surgery performed on pregnant patients is not elective (and just over 50% of it in the database studied was emergency surgery). We expected to find an increased rate of adverse outcomes in those pregnant patients. However, when we matched the pregnant and non-pregnant women who underwent surgery in the database, with excellent matching on all available preoperative characteristics and on the actual operation performed, we found similar, low rates of 30-day postoperative death and complication. In this study, pregnant patients had undergone a broad spectrum of different types of operations, including general, vascular, thoracic, head and neck, non-obstetric gynecologic and urologic, orthopedic, reconstructive, and neuro-surgery. Given the concern that we as surgeons have over operating on pregnant patients, both for the well-being of the patient and her child, our findings are reassuring. This suggests that we as a medical profession are diligent in minimizing risk to pregnant women who need surgery that cannot be delayed until after the child's birth. Again, this study faces the limitations of being unable to assess any short term harm done to the fetus and the subsequent long term outcome of the child.
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MedicalResearch.com Interview with:
Dmitry Kissin, MD
Health scientist
CDC Division of Reproductive Health
Medical Research: What is the background for this study?
Dr. Kissin: Due to the frequent transfer of more than one embryo during assisted reproductive technology (ART) treatments, such as in vitro fertilization (IVF), many ART-conceived children are born as multiples (twins, triplets and higher order). Multiple births, even twins, carry increased risk for both mothers and children. In the U.S., the practice guidelines published by the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) provide recommendations on how many embryos to transfer in order to balance safety with the effectiveness of assisted reproductive technology. In an effort to reduce multiple births and associated complications, it is important to evaluate embryo transfer practices that contribute to these outcomes.
Medical Research: What are the main findings?
Dr. Kissin: Using data from the CDC’s National ART Surveillance System (NASS), we found that the majority of ART-related multiple births in the U.S. resulted from assisted reproductive technology cycles practiced in accordance with ASRM/SART guidelines and involved the transfer of two embryos. Almost half of ART-related multiple births resulted from transferring two fresh blastocysts (embryos cultured for 5/6 days) to favorable- or average-prognosis patients less than 35 years and donor-egg recipients, or two frozen/thawed embryos to patients less than 35 years.
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MedicalResearch.com Interview with:Dr Jonathan McGuane PhD.
Robinson Research Institute and Discipline of Obstetrics and Gynaecology
School of Paediatrics and Reproductive Health
University of Adelaide, Adelaide, South Australia, Australia
Medical Research: What is the background for this study?
Dr. McGuane: Epidemiological studies suggest that endometriosis is present more often in women who report having intercourse during menstruation compared to those who don’t (Filer and Wu, J Reprod Med 1989:887-890). The idea for this study came from our research showing that seminal plasma induces marked changes in the immunology of the female reproductive tract, which are essential for optimal implantation of an embryo and subsequent fetal development. However, some of these immunological changes could increase the likelihood of endometrial tissue developing into an endometriotic lesion if it subsequently ends up in the peritoneum via retrograde menstruation (a la Sampson's hypothesis). This could help to explain the epidemiological findings cited above. Our study was designed to explore "proof-of-principle" of this concept by exposing human endometrial tissue directly to seminal plasma or control medium in vitro, and transplanting it under the skin of receptive mice.
Medical Research: What are the main findings?
Dr. McGuane: After two weeks, endometrial tissue exposed to seminal plasma was significantly larger than control tissue. This appeared to be the result of increased cell proliferation and tissue survival. Although we hypothesised that an immune-mediated mechanism would underlie the changes induced by seminal plasma, we did not find much evidence to support this idea; however, more work needs to be done on this aspect of the research.
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MedicalResearch.com Interview with:
Anita L. Nelson, MDProfessor, Department of Obstetrics and Gynecology at Harbor-UCLA Medical Center
Los Angeles BioMedical Research Institute
Harbor-UCLA Medical Center
Torrance, California
Medical Research: What is the background for this study? What are the main findings?
Dr. Nelson: The clinical impact heavy menstrual bleeding has often been expressed in terms of quality of life issues, but many women have heavy and prolonged bleeding that can lead to serious medical problems. The frequency with which women were treated at Harbor-UCLA Medical Center with profoundly low hemoglobin levels prompted us to do a comprehensive review of such women during a recent five year period to remind readers that even in the 21st century, this is not an uncommon problem. Overall 149 woman were treated 168 times for severe anemia (hemoglobin < 5.0 g/dL); 40% had previously been transfused (but not effectively treated). Over a quarter had reactive thrombocytosis which placed them at high risk for thrombosis (DVT, PE, and stroke). Over a third were discharged without therapy to prevent recurrence.
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MedicalResearch.com Interview with:
Joanna Kitlinska, PhD
Assistant Professor
Georgetown University Medical Center
Department of Biochemistry and Molecular & Cellular Biology
Washington, DC 20057
MedicalResearch: What is the background for this study? What are the main findings?Dr. Kitlinska: Neuroblastoma is a pediatric tumor which arises due to defects in normal fetal neuronal development. Although the disease is associated with genetic changes, there are also clinical and experimental data implicating non-genetic factors in its etiology. We hypothesized that maternal stress during pregnancy can be one such factor, as it leads to fetal hypoxia and elevated cortisol levels – the two factors known to alter normal neuronal development and increase aggressiveness of neuroblastoma. Indeed, using an animal model of neuroblastoma, we have found that offspring of mothers which have been subjected to stress during pregnancy develop tumors twice as frequently as those from intact pregnancies. Moreover, tumors developing in prenatally-stressed mice were spreading more often to distant organs.
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MedicalResearch.com Interview with:
Alexandre Faisal-Cury, MD, PhD
Departamento de Medicina Preventiva, Faculdade de Medicina
Universidade de São Paulo
São Paulo, Brazil
Medical Research: What is...
MedicalResearch.com Interview with:Jeanne M. Meck, PhDFACMG
Director, Prenatal Diagnosis & Cytogenomic
GeneDx
Gaithersburg, MD 20877
Medical Research: What is the background for this study?
Dr. Meck: Non-invasive prenatal screening (NIPS) for fetal aneuploidy is a new test which requires only a blood sample from the pregnant mother to provide a risk estimate of whether or not her fetus has a chromosomal aneuploidy such as trisomy 21 (Down syndrome), trisomies 13 or 18, or a sex chromosome abnormality. This testing relies on the fact that circulating maternal blood contains cell free fetal DNA. Published studies have reported very high specificities and sensitivities. However, the more important question is what is the positive predictive value (PPV= #true positive results/#true positive + false positive results) since it answers the question of interest to physicians and patients: “Given an Non-invasive prenatal screening result that shows a high risk for a given fetal aneuploidy, what is the chance that the fetus is affected?” We attempted to answer this question by looking at the results of fetal chromosome analyses on chorionic villus samples (CVS) or amniotic fluid that were referred to our cytogenetics laboratories after Non-invasive prenatal screening in order to see if NIPS correctly predicted the fetal karyotype.
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MedicalResearch.com Interview with:
Dr. Mala Sachdeva MD
North Shore University Hospital, Long Island Jewish Medical Center
Assistant Professor, Nephrology, Internal Medicine
Hofstra North Shore-LIJ School of Medicine
Medical Research: What is the background for this study?
Dr. Sachdeva: The last study examining pregnancy and dialysis outcomes in the United States was performed more than 15 years ago. Our study was conducted to evaluate practice patterns and to trend maternal and fetal outcomes in the pregnant dialysis female over the past five years. We did a surveymonkey-based survey of American nephrologists on their knowledge of managing pregnancy patients on dialysis.
Medical Research: What are the main findings?Dr. Sachdeva: Over the past five years, more than 59 pregnancies have been reported. During this time period, almost half of the American nephrologist respondents (43%) have cared for pregnant females on hemodialysis. Hence, we can see that more nephrologists are now faced with taking care of the pregnant dialysis patient. Although a good number of patients initiated dialysis during pregnancy (32%), the majority (58%) of pregnancies occurred within the first five years of being on maintenance dialysis.
Pregnancy outcomes can improve. Of the reported pregnancies 23% did not result in live births. 50% of the pregnancies were complicated by preeclampsia. There were no maternal deaths.
Most nephrologists prescribe 4 to 4.5 hours of hemodialysis. 64% of respondents provide dialysis for six days per week. Only 21% aimed for a target predialysis BUN of less than 20 mg/dL while 66% of nephrologists targeted a BUN less than 50mg/dL. 75% of respondents do not have access to fetal monitoring during dialysis for their pregnant patient.
There are approximately 32% of American nephrologists who are somewhat to very uncomfortable caring for a pregnant woman on hemodialysis. 51% of American nephrologists or a member of their staff counsel their female dialysis patients about contraception.
So in summary, while majority of the US based nephrologists are trying to dialyze pregnant ESRD patients with more intense prescriptions, there are still some gaps with comfort and knowledge.
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MedicalResearch.com Interview with:
Dr. Jean-Luc Margot PhD
Professor, Department of Earth, Planetary, and Space Sciences and Department of Physics and Astronomy,
University of California, Los Angeles
Medical Research: What is the background for this study? What are the main findings?
Dr. Margot: Some professionals who work in emergency rooms or maternity wards believe that the number of hospital admissions or human births is larger during the full moon than at other times. This belief is incorrect. Analysis of the data shows conclusively that the moon does not influence the timing of hospital admissions or human births.
Results of a new analysis have been published online in the journal Nursing Research. The Nursing Research article addresses some of the methodological errors and cognitive biases that can explain the human tendency of perceiving a lunar effect where there is none. It reviews basic standards of evidence and, using an example from the published literature, illustrates how disregarding these standards can lead to erroneous conclusions. (more…)
MedicalResearch.com Interview with:
Dr. Bradley S. Peterson, M.D
Director of the Institute for the Developing Mind
The Saban Research Institute of Children’s Hospital
Los Angeles Children’s Hospital Los Angeles
Medical Research: What is the background for this study?
Dr. Peterson: Neurotoxic PAH (polycyclic aromatic hydrocarbons) are ubiquitous in the environment, in the home and in the workplace. Emissions from motor vehicles, oil and coal burning for home heating or power generation, wildfires and agricultural burning, hazardous waste sites, tobacco smoke and charred foods are all sources of exposure. PAH readily crosses the placenta and affects an unborn child’s brain; earlier animal studies showed that prenatal exposure impaired the development of behavior, learning and memory. Our group previously reported that exposure to airborne PAH during gestation was associated with multiple neurodevelopmental disturbances, including development delay by age 3, reduced verbal IQ at age 5, and symptoms of anxiety and depression at age 7.
Medical Research: What are the main findings?
Dr. Peterson: Together with Virginia Rauh, ScD and Frederica Perera, DrPH, PhD of Columbia University’s Mailman School of Public Health, we conducted a brain imaging study to test the effects on brain structure of PAH exposure during the final trimester of pregnancy. We used magnetic resonance imaging (MRI) to measure the brains of 40 children from a cohort of more than 600 mother-baby pairs from minority communities in New York City. These 40 children were carefully selected to have no other exposures that would affect brain development. Our findings showed that prenatal PAH exposure led to reductions in nearly the entire white matter surface of the brain’s left hemisphere – losses that were associated with slower processing of information during intelligence testing and more severe behavioral problems, including ADHD and aggression. Postnatal PAH exposure – measured at age 5 – was found to contribute to additional disturbances in development of white matter in the dorsal prefrontal region of the brain, a portion of the brain that supports concentration, reasoning, judgment, and problem-solving ability. (more…)
MedicalResearch.com Interview with:
Elizabeth Burns, MPH
Rollins School of Public Health
Emory University
MedicalResearch: What is the background for this study? What are the main findings?Response: Epidemiologic studies suggest that prenatal stress is associated with preterm birth, low birth weight and peripartum anxiety and depressive symptoms. The most recent population-based study on the prevalence of stress among pregnant women, which used data from 1990-1995, reported that 64% of women experience stressful life events (SLEs) in the year before their infant’s birth. More recent estimates of prevalence and trends of prenatal stressful life events are useful for clinicians in order to understand the risk profile of their patients.
The Pregnancy Risk Assessment Monitoring System (PRAMS) collects self-reported information on maternal experiences and behaviors before, during, and after pregnancy among women who delivered a live infant. PRAMS includes 13 questions about maternal SLEs experienced in the year preceding the birth of the child. Based on previous research, SLEs were grouped into four dichotomous constructs:
1) emotional stressors (family member was ill and hospitalized or someone very close died);
2) financial stressors (moved to a new address, lost job, partner lost job, or unable to pay bills);
3) partner-associated stressors (separated/divorced, argued more than usual with partner/husband, or husband/partner said he did not want pregnancy); and
4) traumatic stressors (homeless, involved in a physical fight, partner or self-went to jail, or someone very close had a problem with drinking or drugs).
The prevalence of self-reported stressful life events decreased modestly but significantly during 2000–2010. Despite this, 70.2% of women reported ≥1 SLEs in 2010. Prevalence of stressful life events vary by state and maternal demographic characteristics and are especially prevalent among younger women, women with ≤12 years of education (75.6%), unmarried women (79.6%), and women that were covered by Medicaid for prenatal care or delivery of their child (78.7%).
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MedicalResearch.com Interview with:
Elizabeth M. Widen, PhD, RD
Postdoctoral Fellow in the Institute of Human Nutrition & Department of Epidemiology
Columbia University
Mailman School...
MedicalResearch.com Interview with:
Dr. Jennifer Lind PharmD, MPH
Division of Birth Defects and Developmental Disabilities,
CDC
Medical Research: What is the background for this study? Dr. Lind: CDC and Florida investigators published a new report describing the characteristics of infants with neonatal abstinence syndrome (NAS) and their mothers. NAS is a group of signs exhibited by newborns exposed to addictive drugs taken by a mother during pregnancy. Infants with neonatal abstinence syndrome have prolonged hospital stays, experience serious medical complications, and are very costly to treat.
Medical Research: What are the main findings?
Dr. Lind: In this investigation, 242 infants with neonatal abstinence syndrome were identified in three Florida hospitals during a 2-year period (2010–2011). Nearly all of the infants with NAS were exposed to opioid painkillers during pregnancy (99.6%) and experienced serious medical complications, with more than 97% being admitted to an intensive care unit, where the average length of stay was 26 days. Despite a high prevalence of positive urine toxicology tests during the birth hospitalization, only a small proportion of mothers had documentation of referrals for drug counseling or rehabilitation.
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MedicalResearch.com Interview with:
Dr. Jennifer Adibi, MPH ScD
University of Pittsburgh, Public HealthAssistant Professor, Epidemiology
Assistant Professor, Department of Obstetrics/Gynecology and Reproductive Sciences
Affiliate, Dept. of ObGYN and Reproductive Sciences
University of California, San Francisco
Medical Research: What is the background for this study?
Dr. Adibi: Prenatal exposure to phthalates in rodents can cause defects in male sexual development including a shorter distance between the anus and the genitalia (anogenital distance or AGD). Human studies have shown a correlation between higher prenatal phthalate urinary concentrations in the mother and shorter AGD in males. AGD in males is related to fertility and reproductive health over the lifetime. In females, AGD was associated with numbers of ovarian follicles. The role of the placenta has not been considered in these studies. A placental hormone called human chorionic gonadotropin (hCG) is essential for normal male development. Our previous research has shown that hCG expression by human placental cells is disrupted by phthalate concentrations equal to what we measured in maternal urine. The placenta secretes molecules early in pregnancy that might provide an opportunity to detect these effects in humans.
Medical Research: What are the main findings?Dr. Adibi: In 350 pregnancies, we measured a significant association of maternal urinary concentrations of mono-n-butyl phthalate (MnBP) and monobenzyl phthalate (MBzP) with hCG in maternal blood in the first trimester. Higher phthalate concentrations were associated with higher hCG if the mother was carrying a female fetus, and lower concentrations if she was carrying a male fetus. In a high/low MnBP comparison, hCG was 15-fold higher in the higher exposed female fetuses. We also observed a relationship between maternal levels of hCG in the first trimester and anogenital distance in the newborns. The correlation was positive in female newborns, and inverse in male newborns. Similar to the parent study, we observed associations of higher first trimester MnBP and mono-2-ethyl hexyl phthalate (MEHP) with lower male anogenital distance. If we combined these findings into a mediation analysis, we estimated that approximately 20-30% of the phthalate-induced effect on anogenital distance was due to the phthalate disruption of hCG.
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MedicalResearch.com Interview with:
Amy Branum M.S.P.H., Ph.D andJo Jones Ph.D
Center for Health Statistics
Division of Vital Statistics, Reproductive Statistics BranchMedical Research: What is the background for this study?
Response: This data brief was based on multiple years of the National Survey of Family Growth (NSFG). The NSFG, first conducted in 1973, is administered by NCHS in response to a legal mandate that says that NCHS “shall collect statistics on …family formation, growth, and dissolution.” (PHS Act, Sec 306). Up through the 2002 NSFG, the survey was conducted periodically; with the 2006-2010 data collection, the NSFG is a continuous survey with interviews conducted over multiple years. We felt it was important to examine long-term trends in Long-acting Reversible Contraception use due to fluctuations over time in IUD and implant acceptability and availability as contraception methods, especially in light of recent efforts to promote LARC use to prevent unintended pregnancies and for birth spacing.
Medical Research: What are the main findings?
Response: We found that Long-acting Reversible Contraception use declined between 1982 and 1988, remained stable through 2002 and then increased almost five-fold between 2002 and 2011-2013 (from 1.5% to 7.2). Long-acting Reversible Contraception use has, and continues to be, generally highest among women aged 25-34 but has increased the most among women 15-24 since 2002. Hispanic women used Long-acting Reversible Contraception at higher rates in 1982 compared to non-Hispanic white and non-Hispanic black women but patterns of use diverged after 1995 so that by 2011-2013, patterns of use were more similar by race and Hispanic origin. Women who have at least one previous live birth have used, and continue to use, LARCs at a higher rate compared to women with no previous births. (more…)
MedicalResearch.com Interview with:
Kari Johansson, PhD
Department of Medicine Solna, Karolinska Institutet
Clinical Epidemiology
Karolinska University Hospital
Stockholm, Sweden
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Johannson: The number of women who are obese in early pregnancy has increased dramatically over the last decades. Consequently, there has been a dramatic rise in the number of women becoming pregnant after bariatric surgery. In Sweden the number of births of women with a history of bariatric surgery has increased from 150 (≈0.15%) to more than 500 (0.5%) per year between 2006 and 2011. The positive effects of bariatric surgery on health outcomes, such as diabetes and cardiovascular disease, are reasonably well-studied, but less is known about the effects on pregnancy and perinatal outcomes. We therefore conducted a population-based study, using data from nationwide Swedish registers.
The main findings are that women who had a history of bariatric surgery were much less likely to develop gestational diabetes (2% compared to 7%; P<0.001) and give birth to large-for-gestational age babies (9% vs 22%; P<0.001). On the other hand, the operated women were twice as likely to give birth to babies who were small for gestational age (16% vs 8%), and have pregnancies of shorter duration (273 vs 277.5; P<0.001). (more…)
MedicalResearch.com Interview with:
Ekaterina Maslova PhD
Doctor of Science in Nutrition and Epidemiology
Center for Fetal Programming
Copenhagen, Denmark
Medical Research: What is the background for this study? What are the main findings?
Response: From prior studies we know that excessive gestational weight gain (GWG) in pregnancy is associated with complications for both the mother and the child, including gestational diabetes, hypertension, and high birth weight. Understanding the factors that determine gestational weight gain would allow for interventions early on to improve pregnancy outcomes. Dietary intake has been found to influence gestational weight gain in other studies, but evidence is conflicting and still quite limited. In non-pregnant populations a high-protein diet was shown to decrease weight and improve weight maintenance. We therefore hypothesized that a similar relation may exist for gestational weight gain in pregnant women.
In this study we had data on dietary intake of more than 45,000 Danish women who were pregnant between 1996 and 2002. We examined the relation between their intake of protein and carbohydrates and the rate of gestational weight gain (in grams per week). We found that women who consumed a high protein-to-carbohydrate (PC) ratio gained less gestational weight gain compared to women with a lower PC ratio in their diet. The results was stronger in women who started their pregnancy already overweight compared to normal weight women.
Since a high PC ratio may result from either a high protein intake or low carbohydrate intake, we decided to focus on a component of carbohydrates that may increase gestational weight gain: added sugar. We found that pregnant women with higher intake of sugar gained more weight in pregnancy compared to those who consumed less added sugar. This averaged out to about 1.4 kg (or 7%) higher weight gain across the entire pregnancy.
(more…)
MedicalResearch.com Interview with:
Virender K. Rehan, MD
LA BioMed Lead Researcher
Medical Research: What are the main findings?Dr. Rehan: A new study holds hope for reversing asthma caused by smoking during
pregnancy. The study, published online by the American Journal of Physiology
- Lung Cellular and Molecular Physiology, reported that a medication that
stimulates certain proteins in the body reversed airway damage in disease
models of asthma caused by prenatal exposure to nicotine.
This is the first study to indicate that the damage caused by exposure to
nicotine during pregnancy could actually be reversed. Earlier studies found
this medication could prevent nicotine-induced asthma when given during
pregnancy. Researchers at Los Angeles Biomedical Research Institute (LA
BioMed) conducted the study to determine if the lung and airway damage
caused by nicotine could be reversed and found it could be.
(more…)
MedicalResearch.com Interview with:
Jonetta L. Johnson, PhD, MPH
Epidemiologist
Division of Reproductive Health, CDC.
Medical Research: What is the background for this study?
Dr. Johnson: Achieving adequate gestational weight gain (GWG) is important for optimal health of the infant and mother. Women who gain below or above Institute of Medicine (IOM) recommendations are more likely to experience maternal complications and negative infant birth outcomes. Realizing the importance of gestational weight gain to maternal and infant health, the IOM established recommendations for gestational weight gain based on a woman’s prepregnancy body mass index (BMI) in 1990 and updated them in 2009. Trends in GWG are particularly of interest since prepregnancy BMI has increased over time in the U.S and little data was available on how gestational weight gain has changed over time.
Medical Research: What are the main findings?
Dr. Johnson: Our findings show that from 2000-2009, the majority of women did not gain weight within IOM GWG recommendations and that women were more likely to gain outside recommendations in more recent years. In fact, from 2000–2009, there was a gradual decrease (1.0 percentage point every 2 years) in women gaining within IOM gestational weight gain recommendations and a gradual increase (0.8 percentage points every 2 years) in women gaining above IOM recommendations while the percentage of women gaining weight below IOM recommendations remained relatively constant. Although there were slight differences in mean gestational weight gain by BMI group, gestational weight gain was about 31 pounds on average. The decreasing percentage of women gaining within IOM recommendations during our study period may be influenced by increases in prepregnancy BMI during the same time period because women in higher BMI groups are recommended to gain less weight during pregnancy compared to women in lower BMI groups. Thus, even with no change in gestational weight gain over time, an increase in the proportion of women who are obese could result in a decrease in the proportion of women gaining within gestational weight gain recommendations. (more…)
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