Immaturity Plays Leading Role in Late Preterm Complications

MedicalResearch.com Interview with:

Melissa Lorenzo MD Pediatric medical resident

Dr. Lorenzo

Melissa Lorenzo MD
Pediatric medical resident
Dr. Lorenzo is currently training at the University of Toronto, however the research was conducted while a medical student at Queens University

MedicalResearch.com: What is the background for this study?

Response: Preterm infants are born before 37 weeks gestation, with late preterm neonates defined as infants born between 34 weeks to 37 weeks gestation. Of all preterm births, over 70% of babies are born in the late preterm period. Late preterm births are common, affecting 12.5% of all births in the United States.

Compared to infants born at term, late preterm neonates are at increased risk for many common complications following birth such as jaundice, low blood sugar, and respiratory distress, prolong hospital stay, admission to the neonatal intensive care unit, and increase readmission rate after hospital discharge. There are many causes for preterm delivery- two important ones are early onset of labour either spontaneous or after premature rupture of membranes, and medically indicated delivery prior to full term gestation due to chronic diseases in mother affecting her health in pregnancy, fetal medical reasons, or placental insufficiency. There is a debate that the risk of neonatal complications is affected by the causes of preterm delivery with immaturity acting as a contributing factor. The relative contribution of immaturity versus the reason for delivery and the resulting neonatal complications is unclear.

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Forceps and Vacuum Delivery to Reduce Cesareans Could Lead To More Birth Trauma

MedicalResearch.com Interview with:
“Birth” by Sharon Mollerus is licensed under CC BY 2.0Giulia Muraca, PhD, MPH
Postdoctoral Fellow
School of Population and Public Health
BC Children’s Hospital Research Institute
Faculty of Medicine
University of British Columbia

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: While cesarean delivery rates have increased in Canada over the last few decades, as in most industrialized settings, the rate of forceps and vacuum deliveries have declined. These opposing trends have led to recommendations to increase forceps and vacuum delivery rates as a strategy to reduce cesarean delivery rates.

We found that the rate of obstetric trauma in Canada increased significantly in recent years, especially among forceps deliveries. In first-time mothers, the rate of obstetric trauma increased by 7% among forceps deliveries (from 19.4% in 2004 to 26.5% in 2014) and in women who had a previous cesarean delivery, the rate of obstetric trauma among forceps deliveries increased by 9% (from 16.6% to 25.6%).

We found that a 1% increase in the forceps and vacuum delivery rate in Canada was associated with approximately 700 additional cases of obstetric trauma and 18 additional cases of severe birth trauma annually among first-time mothers alone.  Continue reading

No Link Found Between Caesarean Delivery and Childhood Obesity

MedicalResearch.com Interview with:
Sheryl L. Rifas-Shiman, MPH
Lead Research Analyst
Department of Population Medicine
Harvard Medical School and Harvard Pilgrim Health Care Institute
Landmark Center
Boston, MA 02215 

MedicalResearch.com: What is the background for this study?

Response: Caesarean delivery rates remain high and variable across hospitals, regions, and countries.
Caesarean delivery may be a risk factor for childhood obesity, possibly because delivery route can influence the intestinal microbiomes, which may influence energy regulation.

Previously reported associations of caesarean delivery with childhood obesity may be confounded by maternal BMI and sociocultural factors. To address this possibility, we studied sibling pairs from the Linked CENTURY Study, a longitudinal clinical database of well-child visits in Massachusetts linked to each child’s birth certificate, to isolate the effect of caesarean delivery from most other factors. Continue reading

Unique Vaginal Cells Facilitate HIV Infection and Persistence

MedicalResearch.com Interview with:

Manish Sagar, MD Assistant Professor of Medicine, Boston University School of Medicine Boston MA 

Dr. Sagar

Manish Sagar, MD
Infectious Disease Physician at Boston Medical Center
Boston MA 

MedicalResearch.com: What is the background for this study?

Response: Women compromise the majority of new infections in the world and most of them acquire the virus after sexual exposure.  The goal of the study was to understand how HIV establishes initial infection in the female genital tract. We obtained discarded vaginal tissue and isolated cells present in the outermost layer that contact the virus during exposure.

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Children of Older Mothers More Susceptible to Heart Disease

MedicalResearch.com Interview with:

Sandra T. Davidge, PhD, FCAHS Executive Director, Women and Children's Health Research Institute Canada Research Chair in Maternal and Perinatal Cardiovascular Health Professor, Depts. of Ob/Gyn and Physiology University of Alberta Edmonton, Alberta Canada

Dr. Davidge

Sandra T. Davidge, PhD, FCAHS
Executive Director, Women and Children’s Health Research Institute
Canada Research Chair in Maternal and Perinatal Cardiovascular Health
Professor, Depts. of Ob/Gyn and Physiology
University of Alberta
Edmonton, Alberta
Canada

MedicalResearch.com: What is the background for this study?

Response: This research contributes to the growing body of literature that developmental programming of adult onset cardiovascular disease originates in the womb.

Our study is among the first to discover that maternal age may be considered a ‘prenatal stress’ in certain circumstances.

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Changes in Gestational Age and Perinatal Mortality in US

MedicalResearch.com Interview with:

Dr. Cande V. Ananth, PhD, MPH Professor of Epidemiology and Vigil G. Damon Professor of Obstetrics and Gynecology Columbia University Medical Center

Dr. Ananth

Dr. Cande V. Ananth, PhD, MPH
Adjunct professor
Department of Health Policy and Management
Mailman School of Public Health
Columbia University, NY

MedicalResearch.com: What is the background for this study?

Response: Preterm delivery rates have declined between 2005 and 2014 in the US and in several European countries. Since reductions in preterm and early term deliveries, and perinatal mortality remain a global health priority, determining the relationship between gestational age distribution and perinatal mortality, remains a challenge. Efforts expended to a more complete understanding of the impact of new interventions, policies, and practices on reducing the burden of early deliveries, and in turn improvements in perinatal survival will be of tremendous benefit for clinical management and care of women during their pregnancy and the newborn.

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Women With PCOS Should Be Screened for Mental Health Issues

MedicalResearch.com Interview with:
Aled Rees, MD, PhD
Neuroscience and Mental Health Research Institute
Cardiff University School of Medicine, Health Park
Cardiff United Kingdom

MedicalResearch.com: What is the background for this study?  

Response: PCOS is a common condition, affecting 5-10% of women globally, in which elevated male hormone levels can cause a range of distressing and life-limiting symptoms, including reduced fertility, irregular periods, excessive facial and body hair, and acne. Previous studies have suggested a link between PCOS and poor mental health in women but the studies were small and did not adequately take other factors that can affect mental health into consideration. In addition, high levels of testosterone during pregnancy have been reported to increase the risk of neurodevelopmental disorders, such as ADHD and autism, in children.

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Two Genes Linked to Severe Nausea and Vomiting in Pregnancy

MedicalResearch.com Interview with:

Marlena Fejzo, PhD Aassociate researche David Geffen School of Medicine UCLA.

Dr. Fejzo

Marlena Fejzo, PhD
Aassociate researche
David Geffen School of Medicine
UCLA. 

MedicalResearch.com: What is the background for this study?

Response: Most women experience some nausea and vomiting of pregnancy, and the worst 2% are diagnosed with Hyperemesis Gravidarum which is associated with poor maternal and fetal outcomes. I had HG in 2 pregnancies. In my second pregnancy my HG was so severe that I could not move without vomiting and did not keep any food or water down for 10 weeks. I was put on a feeding tube, but ultimately lost the baby in the second trimester. I am a medical scientist by training so I looked into what was known about HG. At the time, very little was known, so I decided to study it. I partnered with the Hyperemesis Education and Research Foundation (HER) and we did a survey on family history of .Hyperemesis Gravidarum that provided evidence to support a role for genes. I collected saliva samples from HG patients and their unaffected acquaintances to do a DNA study. Then I partnered with the personal genetics company, 23andMe to do a genome scan and validation study, which identified 2 genes, GDF15 and IGFBP7, linked to HG.

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Teenage Daughters More Likely To Have Abortion If Their Mother Had One

MedicalResearch.com Interview with:
“Don't forget the teens” by Jon Seidman is licensed under CC BY 2.0Ning Liu PhD Student

Senior Research Analyst at ICES
Institute of Health Policy, Management and Evaluation
Institute for Clinical Evaluative Sciences
University of Toronto

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous studies suggested intergenerational tendencies between a mother and her daughter in fertility patterns, such as when they give birth to a child for the first time, or the total number of children they have during their lifetime.

We explored whether there is also an intergenerational tendency for induced abortion practices between a mother and her teen daughter.

To do so, we used anonymized records of 431,623 daughters and their mothers, and found that a teenage daughter was twice as likely to have an induced abortion if her mother had had an induced abortion.  Continue reading

Study Evaluates Effects of Probiotics During Pregnancy

MedicalResearch.com Interview with:
“My nightly probiotics to help me :) barely holding back PostOp issues! Very GRATEFUL for them!” by Ashley Steel is licensed under CC BY 2.0Mahsa Nordqvist MD
Department of Obstetrics and Gynecology
Sahlgrenska University Hospital
Gothenburg, Sweden 

MedicalResearch.com: What is the background for this study?

Response: We have shown in earlier observational studies that there is an association between probiotic intake and lower risk of preterm delivery and preeclampsia. Since pregnancy is a time of rapid change and different exposures can have different effect depending on the time of exposure, we wanted to find out if there is any special time point of consumption that might be of greater importance when it comes to these associations.

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Cervical Pessaries May Reduce Risk of Some Preterm Births

MedicalResearch.com Interview with:
Gabriele Saccone, MD
Department of Neuroscience
Reproductive Sciences and Dentistry
School of Medicine
University of Naples Federico II
Naples, Italy

MedicalResearch.com: What is the background for this study?

Response: Preterm birth is a major cause of perinatal morbidity and mortality. About 15 million infants were born too soon every year, causing 1.1 million deaths. The cervical pessary is a silicone device that has been studied to prevent preterm birth. However, the efficacy of this device in preventing preterm birth is still subject of debate.

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Maternal Ingestion of Placenta Has No Proven Therapeutic Benefit

MedicalResearch.com Interview with:

Placenta – Wikipedia Image

Daniel C Benyshek, PhD
Professor, Department of Anthropology
Adjunct Professor, UNLV School of Medicine
Co-Director, Metabolism, Anthropometry and Nutrition Lab
UNLV
Sharon M. Young, PhD (first author)

MedicalResearch.com: What is the background for this study?

Response: Over the last several decades, human maternal placentophagy (postpartum ingestion of the placenta by the mother) has emerged as a rare but increasingly popular practice among women in industrialized countries seeking its many purported health benefits. Human placentophagy advocates, including many midwives, placenta encapsulation specialists, lactation consultants, and mothers who have experienced positive results previously from the practice, regularly claim improved lactation, energy levels, and postpartum mood, among other benefits, as a result of placentophagy. These advocates regularly speculate that these self-reported effects are likely due to (beneficial) changes to postpartum maternal hormone profiles as a result of the practice. While maternal placentophagy is ubiquitous among land mammals, including our closest primate relatives, recent research has shown that human maternal placentophagy is unknown as a traditional cultural practice. The conspicuous cross-cultural absence of maternal placentophagy among humans (as a long-standing traditional practice) thus remains a mystery. Our study is an important first step in the scientific (evolutionary and clinical) investigation of this rare but increasingly popular maternal practice.

Our study was a double-blind, and placebo controlled trial, meaning that there was a placenta group and a placebo group, and the participants and researchers didn’t know which supplement a participant had until the end of the study. We included 27 healthy women, recruited during pregnancy, who met with the researchers 4 times across pregnancy and early postpartum. At each meeting, they answered questionnaires on topics of interest (e.g., mood, energy, bonding, social support etc.), and we collected blood and saliva samples. At the first two meetings, they were not yet taking a placenta or placebo supplement, so we could collect baseline measures for their hormones and questionnaire data. After the second meeting, they were instructed to take either placenta or placebo supplements. Once the study had ended, we compared data between the two groups to identify any differences.

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Improved DNA Analysis Reduces False Positive Prenatal DNA Testing For Trisomy Conditions

MedicalResearch.com Interview with:

Professor Sir Nicholas Wald FRCP FRS Professor of Preventive Medicine Wolfson Institute of Preventive Medicine Barts and The London School of Medicine and Dentistry Queen Mary University of London London

Prof. Wald

Professor Sir Nicholas Wald FRCP FRS
Professor of Preventive Medicine
Wolfson Institute of Preventive Medicine
Barts and The London School of Medicine and Dentistry
Queen Mary University of London
London

MedicalResearch.com: What is the background for this study?

Response: Prenatal screening for Down’s syndrome (trisomy 21), Edwards syndrome (trisomy 18) and Patau syndrome (trisomy 13) by maternal plasma DNA analysis has an improved screening performance compared with conventional screening but is too expensive to be performed routinely and has a technical failure rate.

The aim of the study was to take advantage of the improved screening performance of the DNA analysis in conjunction with the existing methods thereby providing a seamless testing interface between the “old” and the “new” methods that would detect a larger proportion of affected pregnancies with a much lower false-positive rate, at a much reduced cost compared with universal DNA testing and with no failed tests. The novel approach was to conduct a conventional screening test using a screening cut-off level that identifies about 10% of women with the highest risks of having an affected pregnancy (much higher than in conventional screening) and then to perform a DNA test using a portion of the original blood sample collected for the conventional test. Progressing to the DNA test was automatic for these high risk women without their having to be recalled for counseling and a fresh blood sample (ie as a reflex response hence the term “reflex DNA screening”).

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Having Highly Educated, Wealthy Neighbors Reduces Expectant Mother’s Chance of Having Preterm or Low Weight Baby

MedicalResearch.com Interview with:

Jennifer Buher Kane PhD Assistant Professor, Department of Sociology University of California, Irvine 92697-510 

Dr. Buher-Kane

Jennifer Buher Kane PhD
Assistant Professor, Department of Sociology
University of California, Irvine 92697-510 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It’s not uncommon for new parents to relocate in search of neighborhoods with better schools, safer streets and healthier, more kid-friendly activities. But our new study found that living in such neighborhoods before a baby is born protects against the risks of poor birth outcomes.

Published online this month in SSM – Population Health, the research shows that having highly educated, wealthy neighbors reduces an expectant mother’s risk of delivering a low-weight or preterm baby – health markers that can be associated with neurodevelopmental problems, language disorders, learning disabilities and poor health later in life.

Our study is the first to look at how both the level of affluence and disadvantage — two sociologically distinct attributes of neighborhoods — affect newborn health; past studies have only explored the impact of neighborhood disadvantage. Neighborhood disadvantage signals factors such as poverty, unemployment, or underemployment. On the other hand, neighborhood affluence is thought to signal the presence of locally-based community organizations that can meet the needs of all residents – health-related and otherwise – regardless of one’s own socioeconomic resources.

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Does Brand Name 17P Work Better Than Generic In Reducing Preterm Births?

MedicalResearch.com Interview with:

Andrew L. Beam, PhD Instructor in Biomedical Informatics Department of Biomedical Informatics Harvard Medical School

Dr. Beam

Andrew L. Beam, PhD
Instructor in Biomedical Informatics
Department of Biomedical Informatics
Harvard Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study is one piece of a larger story regarding the use of 17-alpha-hydroxyprogesterone caproate (17P) to treat recurrent preterm birth. This drug was originally only available in a compounded form, but since receiving an orphan drug designation in 2011, a branded and manufactured form was marketed under the name “Makena”. This branded form was then sold for a much higher price than the compounded version, but a study that provided concrete data on pricing and outcomes had not been done.
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