Birth Outcomes Among Adolescent and Young Adult Cancer Survivors

MedicalResearch.com Interview with:

Hazel B. Nichols, PhD, UNC, assistant professor Lineberger Comprehensive Cancer Center member UNC Gillings School of Global Public Health.

Dr. Nichols

Hazel B. Nichols, PhD, UNC
Assistant professor
Lineberger Comprehensive Cancer Center member
UNC Gillings School of Global Public Health.

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

Response: Each year more than 45,000 adolescent and young adult women (AYA, ages 15-39 years) are diagnosed with cancer in the United States. While many of these women may wish to have children in the years following diagnosis, there is currently little information available to address their concerns about the impact of cancer diagnosis and treatment on future pregnancy.

We identified >2,500 women who had a child after their cancer diagnosis using data from the North Carolina Central Cancer registry and statewide birth certificate files. We investigated whether adverse birth outcomes, such as preterm birth and low birth weight, were more common among AYA cancer survivors compared to women without cancer. We also looked at infant Apgar scores, which measure newborn health, and a calculation called small-for-gestational age, which can indicate restricted growth during pregnancy.

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Human Placenta May Be Most Vulnerable To Zika In First Trimester

MedicalResearch.com Interview with:

R. Michael Roberts

Dr. R. Michael Roberts

R. Michael Roberts PhD
Curators’ Distinguished Professor
240b Bond Life Sciences Center
Columbia, Missouri 65211-7310

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

Response: My background in placental biology and in communication between the embryo and the mother in early pregnancy made me curious about how the zika virus (ZIKV) crossed the placenta in early pregnancy to cause microcephaly. My group had been working on a laboratory model for placental trophoblast for over 10 years. We generate trophoblast from human pluripotent cells (embryonic stem cells and induced pluripotent stem cells) by exposing them to the growth factor BMP4 and two pharmaceuticals that inhibit the signaling pathways necessary to maintain pluripotency. I was curious to determine whether or not ZIKV could infect these cells, replicate, and release infectious virus, because work from my collaborator Yoel Sadovsky at the University of Pittsburgh indicated that the mature placenta was likely to be resistant to infection.

MedicalResearch.com: What are the main findings?

Response: There are, I believe two striking outcomes from this work.

One is that the results indicate that the human placenta is likely most vulnerable to infection by Zika during the first trimester. We also suggest that women whose fetus is affected from an infection occurring later in pregnancy likely had a past dengue infection. The second striking result is that the African strain of Zika may have greater virulence towards early placenta than the Asian strains, such as the ones that have spread in the New World.

The work with the virus only began when we realized that term trophoblasts lacked expression of the genes that encode the protein factors that promote flavivirus infection (ZIKV is a flavivirus, like dengue, West Nile virus), e.g. TYRO3, AXL, MERTK, and also had a poised innate immune system that would counteract virus replication. Conversely, the trophoblasts we create from embryonic stem cells had the factors that would promote virus uptake, but seemed ill-prepared to counteract virus replication once infection occurred. In other words, the early placental trophoblasts were potentially more susceptible to infection. We confirmed this hypothesis with two strains of ZIKV (an Asian strain related to the one encountered in Brazil, and an African strain often considered to be relatively benign). What was unexpected was the African strain appeared to be more virulent than the Asian strain.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Whether the early placenta could be protected by some sort of immune therapy or by prior vaccination of the mother is clearly uncertain at present. Vaccination programs have not been altogether successful when used to protect against Dengue, which is a virus related to ZIKV.

There is evidence that the early placenta is also permissive to other viruses, such as Rubella. Also there is a very interesting paper in the Journal of the American medical Association by Honein et al. that was published on December 15, 2016. In this study, the overall risk for microcephaly and other brain abnormalities in infants born to a large cohort of U.S. women exposed to ZIKV while traveling (n = 442) was 5.9 % (18), and, of these, there were no cases noted among the women known to have been infected during their second or third trimesters. In Brazil, women appear to be at risk for fetal infections by ZIKV throughout their pregnancies but this may be because they had experienced an earlier infection by Dengue. I have discussed this puzzle in the paper.

I have no disclosures to make, nor conflicts of interest regarding the research or this response to your queries.

Citation:

PNAS Plus – Biological Sciences – Applied Biological Sciences:
Megan A. Sheridan, Dinar Yunusov, Velmurugan Balaraman, Andrei P. Alexenko, Shinichiro Yabe, Sergio Verjovski-Almeida, Danny J. Schust, Alexander W. Franz, Yoel Sadovsky, Toshihiko Ezashi, and R. Michael Roberts
Vulnerability of primitive human placental trophoblast to Zika virus PNAS 2017 114 (9) E1587-E1596; published ahead of print February 13, 2017, doi:10.1073/pnas.1616097114

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Maternal Cancer During Pregnancy Linked To Stillbirths and Infant Mortality

MedicalResearch.com Interview with:

Donghao Lu. PhD student Department of Medical Epidemiology and Biostatistics Karolinska Institute

Dr. Donghao Lu

Donghao Lu PhD student
Department of Medical Epidemiology and Biostatistics
Karolinska Institute

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

Response: Cancer during pregnancy is a rare event. Whether prenatal exposure to a maternal malignancy and its treatment during pregnancy impair fetal development and neonatal health is, however, of great clinical concern. The risks of fatal outcomes such as stillbirth and infant mortality, however, have rarely been successfully explored in pregnancies complicated with cancer, in either clinical or population-based studies.

MedicalResearch.com: What are the main findings?

Response: Maternal cancer diagnosed during pregnancy was associated with increased risk of stillbirth (Incidence Rate Ratio, IRR, 2.5; 95% CI, 1.2 to 5.0), mainly stillbirths assessed as small for gestational age (SGA), and with increased risk of preterm SGA births (relative risk 3.0; 95% CI, 2.1 to 4.4). Maternal cancer diagnosed during pregnancy or the year after pregnancy were associated with increased risks of both neonatal mortality (deaths within 0 to 27 days; IRR, 2.7; 95% CI, 1.3 to 5.6 and IRR, 2.0; 95% CI, 1.2 to 3.2, respectively) and preterm birth (IRR, 5.8; 95% CI, 5.3 to 6.5 and IRR, 1.6; 95% CI, 1.4 to 1.8, respectively). The positive association with preterm birth was due to iatrogenic instead of spontaneous preterm birth. Preterm birth explained 89% of the association of maternal cancer during pregnancy with neonatal mortality.

MedicalResearch.com: What should readers take away from your report?

Response: Maternal cancer diagnosed during pregnancy was associated with increased risks of stillbirths assessed as SGA and preterm SGA live birth, suggesting that cancer and its treatment during pregnancy may impair fetal growth. Maternal cancer diagnosed during or shortly after pregnancy was associated with an increased risk of neonatal mortality, largely attributable to iatrogenic preterm birth. Although stillbirth and neonatal death are rare outcomes, the absolute risks of SGA and preterm birth are not small in pregnancies complicated with cancer. Careful monitoring of fetal growth and cautious decision making on the choices as well as the timing of preterm delivery should therefore be reinforced in these pregnancies.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Sweden is among the high-income countries with the lowest stillbirth and infant mortality rates, and these rates have decreased over time in many populations. Future studies in other populations are warranted to confirm our findings. Our data have also highlighted several cancer types, such as blood cancer, ovarian cancer, and cervical cancer, which entail highly increased risk of SGA or preterm birth and might be worthy of further exploration. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Maternal Cancer During Pregnancy and Risks of Stillbirth and Infant Mortality

Donghao Lu, Jonas F. Ludvigsson, Karin E. Smedby, Katja Fall, Unnur Valdimarsdóttir, Sven Cnattingius, and Fang Fang

Journal of Clinical Oncology
DOI: 10.1200/JCO.2016.69.9439 Journal of Clinical Oncology – published online before print March 6, 2017

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Almost 40% of Assisted Reproductive Infants Are Multiple Births

MedicalResearch.com Interview with:
Saswati Sunderam, PhD

Division of Reproductive Health
National Center for Chronic Disease Prevention and Health Promotion
CDC.

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

Response: Assisted Reproductive Technology Surveillance – United States, 2014, the surveillance summary published this week in CDC’s Morbidity and Mortality Weekly Report (MMWR), presents state-specific data on assisted reproductive technology (ART) use and outcomes.

The report compares ART infant outcome data with outcomes for all infants born in the U.S. in 2014, and provides data on the contributions of  Assisted Reproductive Technology to total infants born, multiple birth infants, low birth weight infants, and preterm infants for each U.S. state, the District of Columbia, and Puerto Rico.

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Oxytocin During Labor Linked to Increased Risk of Postpartum Depression

MedicalResearch.com Interview with:

Kristina M. Deligiannidis, MD Associate Professor, Center for Psychiatric Neuroscience The Feinstein Institute for Medical Research Director, Women’s Behavioral Health, Zucker Hillside Hospital Northwell Health Associate Professor, Psychiatry and Obstetrics & Gynecology Hofstra Northwell School of Medicine

Dr. Kristina Deligiannidis

Kristina M. Deligiannidis, MD
Associate Professor
Center for Psychiatric Neuroscience
The Feinstein Institute for Medical Research
Director, Women’s Behavioral Health
Zucker Hillside Hospital Northwell Health
Associate Professor
Psychiatry and Obstetrics & Gynecology
Hofstra Northwell School of Medicine

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

Response: Because of effects on social behavior, including maternal behavior, oxytocin has often been seen as a potential mediator of postpartum depression and anxiety.

The original objective of our study was to examine the relationship between the use of synthetic oxytocin during and after labor and the development of depressive and anxiety disorders within the first year postpartum. We hypothesized that women exposed to synthetic oxytocin before or during labor would have a reduced risk of postpartum depressive and anxiety disorders compared with those without any exposure. Our findings told the opposite story.

We found that peripartum synthetic oxytocin exposure was associated with an increase in risk for the development of postpartum depression and anxiety.

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Maternal Mortality and Morbidity Increased on Weekends

MedicalResearch.com Interview with;
Dr. Amirhossein Moaddab
Postdoctoral Research Fellow at Baylor College of Medicine
Houston, Texas

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

Response: Based on data from the Centers for Disease Control and Prevention, the United States maternal mortality ratio is three to four times higher than that of most other developed nations. Previous studies from the demonstrated a possible association between weekend hospital admissions and higher rates of mortality and poor health outcomes.

We investigated differences in maternal and fetal death ratios on weekends compared to weekdays and during different months of the year. In addition we investigated the presence of any medical and obstetrics complications in women who gave birth to a live child and in their offspring by day of delivery.

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Effects of Delayed Vs Early Umbilical Cord Clamping on Infant Anemia

Ola Andersson, MD, PhD Department of Women’s and Children’s Health Uppsala University, Uppsala, Sweden

MedicalResearch.com Interview with:
Dr. Ola Andersson MD, PhD
Uppsala University,
Uppsala, Sweden

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

Response: Anemia affects over 40% of all children under 5 years of age in the world. Anemia can impinge mental and physical performance, and is associated with long-term deterioration in growth and development. Iron deficiency is the reason for anemia in approximately 50% of the children.is. When clamping of the umbilical cord is delayed, ie after 3 minutes, iron deficiency up to 6 months of age can be prevented, but it has not been shown to prevent iron deficiency or anemia in older infants.

At birth, approximately 1/3 of the child’s blood is in the placenta. If clamping of the umbilical cord is done immediately (early cord clamping), the blood will remain in the placenta and go to waste (or can be stored in stem cell banks). If instead clamping is postponed for 3 minutes, most of the blood can flow back to the child as an extra blood transfusion, consisting of about one deciliter (1/2 cup) of blood, equivalent to about 2 liters (half a US gallon) of an adult. A blood donor leaves 0.4-0.5 liters of blood.

Blood contains red blood cells that contain hemoglobin. Hemoglobin carries oxygen to the tissues of the body. Hemoglobin contains a lot of iron, and the extra deciliter of blood may contain iron that corresponds to 3-4 months of the need for an infant.

The World Health Organization (WHO) recommends umbilical cord clamping at 1 minute or later, American College of Obstetricians and Gynecologists (ACOG) recommends umbilical cord clamping at 30-60 seconds or later.

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Cesarean Section Rates Vary Across US Hospitals

MedicalResearch.com Interview with:
Kamila Mistry, PhD MPH
AHRQ

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

Response: Although the overall cesarean section (C-section) rate in the United States has declined slightly in recent years, nearly a third of all births continue to be delivered by C-section—higher than in many other industrialized countries. A number of medical as well as nonmedical factors may contribute to high C-section rates.

C-section is the most common surgical procedure performed in the United States. This operation carries additional risks compared with vaginal delivery, such as infection and postoperative pain. A C-section also may make it more difficult for the mother to establish breastfeeding and may complicate subsequent pregnancies.

Consensus guidelines from the American Congress of Obstetricians and Gynecologists and other national efforts to improve perinatal care have shown promise in reducing nonmedically indicated C-sections. However, recent research has found wide variation in hospital C-section rates even for low-risk deliveries.
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Breastfeeding Important For Mothers’ Health As Well As Babies

MedicalResearch.com Interview with:

Melissa C. Bartick, MD, MSc Department of Medicine Cambridge Health Alliance Harvard Medical School Cambridge, MA

Dr. Melissa Bartick

Melissa C. Bartick, MD, MSc
Department of Medicine
Cambridge Health Alliance
Harvard Medical School
Cambridge, MA

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

Response: This is the first study ever to combine maternal and pediatric health outcomes from breastfeeding into a single model.

We had published a cost analysis of suboptimal breastfeeding for pediatric disease in 2010, which found that suboptimal breastfeeding cost the US $13 billion in costs of premature death costs and medical expenses, and 911 excess deaths. We followed that up with a maternal cost analysis which found about $18 billion in premature death costs and medical expenses.

In both these studies, most of the costs were from premature death. We were unable to combine the results of these two studies because their methodologies were different, and both of them, especially the pediatric portion needed to be updated.

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High Cortisol Levels in Hair May Be Linked To Lower IVF Success

MedicalResearch.com Interview with:

Kavita Vedhara FAcSS Professor of Health Psychology Division of Primary Care School of Medicine University Park,N ottingham

Prof. Kavita Vedhara

Kavita Vedhara FAcSS  
Professor of Health Psychology
Division of Primary Care
School of Medicine
University Park,Nottingham

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

Response: There has been a longstanding interest in the role of the hormone cortisol in fertility, because of its potential to affect the functioning of the biological systems that influence both conception and pregnancy.

This interest has extended to IVF, with researchers exploring the relationship between levels of the hormone and pregnancy since the advent of the treatment in the late 1970s.

However, a recent review showed that the relationship between cortisol and pregnancy in IVF was unclear. A number of reasons were highlighted for this, including that all of the studies to date had relied on short-term measures of the hormone measured in blood, saliva, urine and sometimes follicular fluid. Such measures can only capture hormone levels over a matter of minutes and hours. Such ‘snapshots’ are unable to give us an accurate picture of the levels of hormone over longer periods of time. This is important because any clinically relevant effects of cortisol on fertility are only likely to occur in the context of long-term changes in the hormone.

In recent years it has become possible to measure long-term levels of cortisol in hair. Cortisol is deposited in the hair shaft and because human hair grows, on average, 1cm per month, a 3cm sample of hair closest to the scalp can tell us about levels of cortisol in the previous 3 months.

We used the development of this technique to examine whether long term levels of cortisol (as measured in hair), or short term levels of cortisol (as measured in saliva) could predict whether or not women going through IVF would become pregnant.

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Maternal Use of SSRIs May Be Related to Speech and Language Disorders in Offspring

MedicalResearch.com Interview with:

Alan S. Brown, M.D., M.P.H. Professor of Psychiatry and Epidemiology Columbia University Medical Center Director, Program in Birth Cohort Studies, Division of Epidemiology New York State Psychiatric Institute

Dr. Alan Brown

Alan S. Brown, M.D., M.P.H.
Professor of Psychiatry and Epidemiology
Columbia University Medical Center
Director, Program in Birth Cohort Studies, Division of Epidemiology
New York State Psychiatric Institute 

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

Response: Maternal use of antidepressants during pregnancy has been increasing.  A previous study from a team that I led in a national birth cohort in Finland showed that mother’s use of a serotonin reuptake inhibitor antidepressant is related to an increased risk of depression in offspring.  We sought to evaluate whether these medications also increased risk of speech/language, scholastic, and motor outcomes in offspring.  We found an increased risk (37% higher risk) of speech/language disorders in offspring of mothers exposed to SSRIs in pregnancy compared to mothers who were depressed during pregnancy but did not take an SSRI during pregnancy.

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Perinatal Adverse Events Linked To Increased Risk of OCD

MedicalResearch.com Interview with:
Gustaf Brander
Department of Clinical Neuroscience
Karolinska Institutet

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

Response: Obsessive-compulsive disorder (OCD) is believed to be caused by a complex interaction between genetic and environmental factors. Whereas genetic studies are well underway, the research on environmental factors has been lagging behind. As they explain a significant portion of the variance, are potentially malleable, and are essential for understanding how the genetic component works, this area of research is of great importance.

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