Author Interviews, BMJ, OBGYNE / 21.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23665" align="alignleft" width="142"]Joel Ray, MD MSc FRCPC Clinician-Scientist St. Michael’s Hospital Toronto, ON Dr. Joel Ray[/caption] Joel Ray, MD MSc FRCPC Clinician-Scientist St. Michael’s Hospital Toronto, ON MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Ray:
  • Clinical practice guidelines strongly recommend that physicians and midwives start aspirin before 20 weeks gestation in a woman at high risk of preeclampsia (PE).
  • However, these guidelines do not provide a systematic approach for identifying a woman at high risk of pre-eclampsia (PE), using readily available clinical risk factors (RFs) known before 20 weeks gestation.
  • Thus, there is a need for a clear, concise and evidence-based list of risk factors that clinicians can use, before 20 weeks gestation, to estimate a woman’s risk of pre-eclampsia.
  • We systemically analyzed large cohort studies and estimates of the absolute pooled risk of developing pre-eclampsia in the presence vs. absence of one of 14 common risk factors.
Author Interviews, OBGYNE, Weight Research / 12.04.2016

MedicalResearch.com Interview with: Laura Mullaney School of Biological Sciences Dublin Institute of Technology Dublin Ireland. MedicalResearch.com: What is the background for this study? What are the main findings? Response:  There are gaps in our knowledge regarding postpartum changes in weight. There continues to be a dramatic increase in adult obesity and the postpartum period is a vulnerable life-stage for weight gain in women. Maternal obesity matters because it is associated with an increase in both fetal and maternal complications, it is technically challenging, it is economically costly and it carries potential lifelong health consequences for the woman and her offspring. Thus, our aim was to compare trajectories in maternal weight and BMI between early pregnancy and four months postpartum and nine months postpartum, and to analyse these trajectories by BMI category. Of the 328 women who attended all appointments, mean weight at the first antenatal visit was 69.3 ±14.3 kg, mean Body Mass Index (BMI) was 25.3 ±5.0 kg/m2 and 14.4% were obese. At four months postpartum, the mean change in weight from the first antenatal visit was +1.6 ±4.2 kg, the mean change in BMI was +0.6 ±1.5 kg/m2 and 19.2% were obese. At nine months postpartum, the mean change in weight was +0.2 ±4.7 kg, the mean BMI change was -0.06 ±1.8 kg/m2 and 16.8% were obese. Of women who had an ideal BMI in early pregnancy, 16.6% and 11.1% were overweight at four and nine months postpartum respectively. Of women who were overweight in early pregnancy, 20.3%and 14.3% had become obese at four and nine months postpartum respectively. Ninety percent of women who were obese in early pregnancy remained obese at four and nine months postpartum. Women who had gained weight between early pregnancy and four months postpartum had a lower early pregnancy BMI and were less likely to be obese in early pregnancy. However women who gained weight between four and nine months postpartum were more likely to be obese in early pregnancy.
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA, OBGYNE / 14.03.2016

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). 
Author Interviews, Infections, OBGYNE, Pediatrics / 14.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22601" align="alignleft" width="200"]Elaine Tuomanen, MD Chair and Full Member Dept of Infectious Diseases St Jude Children’s Research Hospital 262 Danny Thomas Place Memphis, TN 38105 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
Author Interviews, Dengue, Lancet, OBGYNE / 07.03.2016

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.
Alcohol, Author Interviews, Cognitive Issues, NYU/NYMC, OBGYNE, Sleep Disorders / 27.02.2016

MedicalResearch.com Interview with: [caption id="attachment_22137" align="alignleft" width="200"]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 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.
Author Interviews, Diabetes, OBGYNE, Pediatrics / 22.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21895" align="alignleft" width="200"]Laurie A. Nommsen-Rivers, PhD, RD, IBCLC Assistant Professor, UC Department of Pediatrics Cincinnati Children's Hospital Medical Center 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.
Author Interviews, Blood Pressure - Hypertension, OBGYNE, Stroke / 19.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21777" align="alignleft" width="80"]Dr. Adnan Quershi MD Professor of Neurology, Neurosurgery and Radiology University of Minnesota 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.
Author Interviews, Diabetes, OBGYNE, Weight Research / 16.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21640" align="alignleft" width="200"]Katherine Bowers, PhD, MPH Division of Biostatistics and Epidemiology Cincinnati Children's Hospital 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).
Author Interviews, CDC, Flu - Influenza, OBGYNE, Vaccine Studies / 04.02.2016

[caption id="attachment_21281" align="alignleft" width="145"]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 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.
Author Interviews, Compliance, HIV, Lancet / 03.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21259" align="alignleft" width="134"]Dr Marcel Yotebieng, PhD Department of Epidemiology Ohio State University, 304 Cunz Hall Columbus, OH Dr. Marcel Yotenbieng[/caption] Dr Marcel Yotebieng, PhD Department of Epidemiology Ohio State University, 304 Cunz Hall Columbus, OH Medical Research: What is the background for this study? What are the main findings? Response: With the current World Health Organization recommended treatment for the prevention of mother-to-child HIV transmission (PMTCT), the risk of transmission of HIV from an infected mother to her baby can be cut from 35-45% to less than 5% in breastfeeding population and <1% in non-breastfeeding population. But in sub-Saharan Africa where over 90% of HIV-infected pregnant women worldwide live, transportation costs and opportunity costs to attend regular clinic visits (to collect drugs) have been identified as important barriers to PMTCT. The provision of economic incentives has the potential to help women overcome these economic barriers. In addition, by creating immediate rewards that “nudge” individuals towards positive health behaviors, financial incentives can also address psychological barriers to health-seeking behavior of HIV-infected pregnant and breastfeeding women. This is the first study to use small cash incentives to encourage women to attend clinic visit and received available PMTCT care. We found that, among newly diagnosed HIV-infected women, small, incremental cash incentives resulted in increased retention along the  prevention of mother-to-child HIV transmission cascade and uptake of available services.
Author Interviews, Blood Pressure - Hypertension, Kaiser Permanente, OBGYNE / 01.02.2016

MEDICALRESEARCH.COM INTERVIEW WITH: KRISTI REYNOLDS, PHD, MPH  [caption id="attachment_21205" align="alignleft" width="146"]MEDICALRESEARCH.COM INTERVIEW WITH: KRISTI REYNOLDS, PHD, MPH KAISER PERMANENTE RESEARCH RESEARCH & EVALUATION PASADENA, CA 91101 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.
Author Interviews, BMJ, Diabetes, NIH, OBGYNE / 13.01.2016

[caption id="attachment_20536" align="alignleft" width="158"]Cuilin Zhang MD, PhD Senior Investigator, Epidemiology Branch Division of Intramural Population Health Research NICHD/National Institutes of Health Rockville, MD 20852 Dr. Cuilin Zhang[/caption] MedicalResearch.com Interview with: Cuilin Zhang MD, PhD Senior Investigator, Epidemiology Branch Division of Intramural Population Health Research NICHD/National Institutes of Health Rockville, MD 20852  Medical Research: What is the background for this study? What are the main findings? Dr. Zhang: Potatoes are the third most commonly consumed food crop in the world. In the United States, about 35% of women of reproductive age consume potatoes daily, accounting for 8% of daily total energy intake.  Gestational diabetes mellitus (GDM) is a common complication of pregnancy characterized by glucose intolerance with onset or first recognition during pregnancy. GDM is at the center of a vicious circle of 'diabetes begets diabetes' across generations. Potato foods are typically higher in glycemic index and glycemic load, but data are lacking regarding whether potato consumption is associated with the risk of Gestational diabetes mellitus. Medical Research: What is the background for this study? What are the main findings? Dr. Zhang: Women who eat more potatoes before pregnancy may have higher risk of gestational diabetes—the form of diabetes that occurs or first diagnosed during pregnancy—compared to women who consume fewer potatoes. Substituting potatoes with other vegetables, legumes or whole grains may help lower gestational diabetes risk.
Author Interviews, Diabetes, Diabetes Care, OBGYNE / 23.12.2015

[caption id="attachment_20294" align="alignleft" width="150"]Dr. Janet Rowan Obstetric Physician National Women's Health, Auckland Dr. Rowan[/caption] MedicalResearch.com Interview with: Dr. Janet Rowan Obstetric Physician National Women's Health, Auckland Medical Research: What is the background for this study? Dr. Rowan: Clinicians are interested in screening during early pregnancy to identify women with previously unrecognised diabetes, as these women have increased risks of adverse pregnancy outcomes. HbA1c is a simple and reproducible measure of glucose elevations, but its usefulness as an early pregnancy screening test is not clear. The aim of this study was to examine whether pregnant women with an HbA1c of 41-49mmol/mol (5.9-6.6%) are a high risk subgroup and whether treating these women from early pregnancy improves outcomes compared with identifying them during routine screening for gestational diabetes (GDM) from 24 weeks’ gestation. This observational study compared women referred to the diabetes clinic <24 weeks’ who had an early pregnancy HbA1c of 41-49mmol/mol (5.9-6.6%) with women who, at the time of diagnosis of GDM ≥24 weeks’ (typically by 75gOGTT), had an HbA1c of 41-49mmol/mol (5.9-6.6%). Both groups were compared with women diagnosed with GDM who had a lower HbA1c at diagnosis.
Author Interviews, Karolinski Institute, Lancet, OBGYNE, Weight Research / 03.12.2015

[caption id="attachment_19785" align="alignleft" width="180"]Professor Sven Cnattingius Professor in reproductive epidemiology Clinical Epidemiology Unit, Department of Medicine Karolinska University Hospital Karolinska Institutet, Stockholm, Sweden Prof. Cnattingius[/caption] MedicalResearch.com Interview with: Professor Sven Cnattingius Professor in reproductive epidemiology Clinical Epidemiology Unit, Department of Medicine Karolinska University Hospital Karolinska Institutet, Stockholm, Sweden  Medical Research: What is the background for this study? Prof. Cnattingius: Maternal overweight and obesity are associated with increased risks of stillbirth and infant mortality. Weight gain between pregnancies increases risks of other obesity-related complications, including preeclampsia, gestational diabetes, and preterm birth. Weight gain appear to increase these risks especially in women who start off with normal weight. As these complications increases risks of stillbirth and infant mortality, we wanted to study the associations between weight change between successive pregnancies and risks of stillbirth and infant mortality (deaths during the first year of life). Medical Research: What are the main findings? Prof. Cnattingius: The main findings include:
  • Weight gain increases risk of stillbirth in a dose-response manner.
  • In women starting off with normal weight (BMI <25), weight gain  increases risk of infant mortality in a dose-response manner.
  • In women starting off with overweight or obesity (BMI >25), weight loss reduces the risk of neonatal mortality (deaths during the first four weeks of life).
Author Interviews, Coffee, OBGYNE, Pediatrics / 20.11.2015

[caption id="attachment_19533" align="alignleft" width="145"]Mark A. Klebanoff, MD Center for Perinatal Research The Research Institute Nationwide Children's Hospital Dr. Klebanoff[/caption] MedicalResearch.com Interview with: Mark A. Klebanoff, MD Center for Perinatal Research The Research Institute Nationwide Children's Hospital Medical Research: What is the background for this study? What are the main findings? Dr. Klebanoff: Caffeine is among the substances most commonly consumed by pregnant women.  There are numerous sources of caffeine in the diet—regular (non-decaf) coffee, regular tea, many soft drinks, energy drinks, and some power bars. Even chocolate contains some caffeine.  It’s also included in some over the counter pain relievers, and in over the counter ‘keep awake’ pills such as No-Doz.  As a result of its wide availability, most pregnant women consume at least some caffeine.  In spite of over 30 years of research, whether moderate amounts of caffeine (up to 200 milligrams, the amount contained in about 2 normal-sized cups of coffee, per day) during pregnancy are harmful is uncertain.  However almost all previous research has been about events related to pregnancy, such as difficulty becoming pregnant, miscarriage, birth defects, and the size of the newborn.  Whether maternal caffeine use during pregnancy has an impact on things later in childhood, such as obesity and neurologic development, has hardly been studied. We used a biomarker, measured in the mother’s blood during pregnancy, for caffeine use, and found that more caffeine use was not associated with the child’s body mass index at either 4 or 7 years of age, and that at blood levels of the marker that we saw in the vast majority, caffeine was not associated with the child’s IQ, nor with behavioral abnormalities at those ages.
Author Interviews, CDC, Infections, OBGYNE, STD / 13.11.2015

MedicalResearch.com Interview with: Dr. Virginia Bowen PhD Epidemic Intelligence Service Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention,CDC  Medical Research: What is the background for this study? What are the main findings? Dr. Bowen: Congenital syphilis (CS) occurs when a mother infected with syphilis transmits the infection to her child during the course of pregnancy. Our study looked at recent trends in CS between 2008 and 2014. After four years of decline, Congenital syphilis rates increased by 38% from 2012 to 2014. The findings from this report show we are missing opportunities to screen and treat pregnant women for STDs. Syphilis in pregnant women can cause miscarriages, premature births, stillbirths, or death of newborn babies. We have effective tests and treatment for syphilis – there’s no excuse for allowing it to resurge. Every case of CS is one too many.
Author Interviews, OBGYNE, Pediatrics, Toxin Research, Weight Research / 13.11.2015

[caption id="attachment_19300" align="alignleft" width="133"]Joseph M. Braun PhD Assistant Professor Department of Epidemiology in the Program in Public Health Brown University Dr. Braun[/caption] MedicalResearch.com Interview with: Joseph M. Braun PhD Assistant Professor Department of Epidemiology in the Program in Public Health Brown University Medical Research: What is the background for this study? Dr. Braun:  Perfluoroalkyl substances are a class of chemicals used to produce stain/water repellent textiles, fire fighting foams, and non-stick coatings. Virtually all people in the US have measurable levels of several different perfluoroalkyl substances in their blood. There is concern that early life exposure to these chemicals can increase the risk of obesity by reducing fetal growth or promoting adipogenesis. What are the main findings? Dr. Braun:  Pregnant women in our study had perfluorooctanoic acid (PFOA) concentrations in their blood that were over 2-fold higher than pregnant women in the United States (median: 5.3 vs. 2.3 ng/mL) during the same time period (2003-2006). Children born to women with higher serum PFOA concentrations during pregnancy had a higher body mass index, greater waist circumference, and more body fat at 8 years of age compared to children born to women with lower serum PFOA concentrations. In addition, children born to women with higher serum PFOA concentrations during pregnancy gained more fat mass between 2 and 8 years of age than children born to women with lower PFOA concentrations.
Author Interviews, Melanoma, OBGYNE / 06.11.2015

[caption id="attachment_19139" align="alignleft" width="128"]Pedram Gerami, MD Department of Dermatology Northwestern University Chicago, IL Dr. Gerami[/caption] MedicalResearch.com Interview with: Pedram Gerami, MD Department of Dermatology Northwestern University Chicago, IL Medical Research: What is the background for this study? What are the main findings?   Dr. Gerami: The influence of pregnancy on the prognosis of melanoma has been debated for decades. Even in the last ten years, population-based and cohort studies have given us mixed results, with some suggesting no adverse influence of pregnancy, and others reporting poorer outcomes and increased cause-specific mortality. The conflicting data leave many clinicians uncertain of how to advise patients to proceed with family planning after a diagnosis of melanoma. Since one-third of all new cases of melanoma diagnosed in women will occur during childbearing age, this represents a fairly common clinical dilemma for physicians and their patients. We suspected that the different results from different investigators maybe related to the melanoma stage of the patients being studied. We investigated the impact of pregnancy on tumor proliferation in women with primarily early stage melanoma. In comparing melanomas from a group of women with pregnancy-associated melanoma (PAM) and a non-PAM group, we found that women with pregnancy-associated melanoma  actually had a significantly greater proportion of in situ disease, and for cases of invasive melanoma there was no significant difference in proliferative activity, as assessed by mitotic count or two immunohistochemical markers of cell proliferation. In a comparison of additional prognostic features such as Breslow depth and ulceration, we found no significant differences between groups to suggest more aggressive tumor behavior in association with pregnancy.
Author Interviews, Columbia, OBGYNE, Weight Research / 26.10.2015

Elizabeth M. Widen, PhD, RD Postdoctoral Fellow in the Department of Medicine, Institute of Human Nutrition & Department of Epidemiology Columbia University Mailman School of Public Health New York, NY 10032MedicalResearch.com Interview with: Elizabeth M. Widen, PhD, RD Postdoctoral Fellow in the Department of Medicine, Institute of Human Nutrition & Department of Epidemiology Columbia University Mailman School of Public Health New York, NY 10032 Medical Research: What is the background for this study? What are the main findings? Dr. Widen: The Columbia Center for Children’s Environmental Health Mothers and Newborns Study was started in 1998 and is based in Northern Manhattan and the South Bronx. Pregnant African American and Dominican mothers were enrolled from 1998 to 2006, and mothers and their children have been followed since this time. Pregnancy weight gain and maternal size and body fat was measured at seven years postpartum, allowing us to examine the role of nutrition in pregnancy on long-term maternal health. We found that high pregnancy weight gain, above the Institute of Medicine 2009 guidelines, was associated with long-term weight retention and higher body fat at seven years postpartum among women who began pregnancy with underweight, normal weight and modest overweight body mass index (BMI). These findings suggest that prepregnancy BMI and high pregnancy weight gain have long-term implications for maternal weight-related health, especially among mothers who begin pregnancy with lower prepregnancy BMI values.
Author Interviews, Infections, NEJM, OBGYNE / 24.10.2015

Alfredo Mayor Aparicio PhD Associate Research Professor Barcelona Institute for Global HealthMedicalResearch.com Interview with: Alfredo Mayor Aparicio PhD Associate Research Professor Barcelona Institute for Global Health Medical Research: What is the background for this study? What are the main findings? Dr. Mayor: The malaria parasite is a well-adapted pathogen which can persist and reappear in areas where infection is no longer circulating or at very low levels. Prevention of such reinfections and resurgences is critical for the current goal of malaria eradication. However, little is known about the determinants and consequences of malaria declines and resurgences. For this reason, understanding the relationship between malaria transmission, immunity and disease burdens is essential to rationalise malaria interventions aimed at reducing host-parasite encounters. We have described changes in prevalence among pregnant women delivering between 2003 and 2012 at antenatal clinics in Southern Mozambique, and showed that a reduction of malaria-specific immunity associated with drops in transmission is accompanied with an increase the severity of malaria infection among those women becoming infected. These results suggest that success of control and elimination activities may lead through a transitional period where infrequent infections will likely slowdown the rate of acquisition of host defenses and will be thus associated with more deleterious effects during pregnancy, thus requiring more precise diagnosis and surveillance methods, as well as improved prevention.
Author Interviews, CDC, JAMA, OBGYNE, Vaccine Studies / 21.10.2015

MedicalResearch.com Interview with: Dr.Lakshmi Sukumaran MD, MPH Immunization Safety Office, Centers for Disease Control and Prevention Department of Pediatrics, Emory University School of Medicine Atlanta, Georgia Medical Research: What is the background for this study? What are the main findings? Dr. Sukumaran: Pertussis (whooping cough) is a vaccine-preventable disease that has been increasing in incidence over the past decade in the United States. Newborns and infants are at increased risk of pertussis-related hospitalization and death compared with older children and adults. The Advisory Committee on Immunization Practices (ACIP) recommends that pregnant women receive a tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) during each pregnancy to protect her infant from pertussis disease, regardless of prior immunization status. However, there is limited data on the safety of repeated Tdap vaccines in pregnant women. Our study evaluated medically attended (associated with doctor visit or hospitalization) adverse events in mothers, such as fever, allergy and local reactions, and adverse birth outcomes, such as prematurity and low birth weight in newborns, in women receiving Tdap in pregnancy who had received a prior tetanus-containing vaccine. We found no significant differences in rates of these adverse outcomes in women who received Tdap in pregnancy following a prior tetanus-containing vaccine less than 2 years before, 2 to 5 years before, and more than 5 years before.
Author Interviews, OBGYNE, Toxin Research / 11.10.2015

Joan A. Casey, PhD, MA Health and Society Scholar Robert Wood Johnson Foundation UC San Francisco/UC Berkeley MedicalResearch.com Interview with: Joan A. Casey, PhD, MA Health and Society Scholar Robert Wood Johnson Foundation UC San Francisco/UC Berkeley  Medical Research: What is the background for this study? What are the main findings? Dr. Casey: ​Eighteen percent of global gas production now comes from unconventional sources. Pennsylvania, in particular, has seen huge increases in unconventional natural gas development (i.e., "fracking") over the past decade. In 2006, there were fewer than 100 unconventional wells, by 2013, there were over 7,000. Developing a single unconventional well takes hundreds to thousands of diesel truck trips to bring in materials, millions of gallons of water mixed with chemicals and sand, and hydraulic fracturing and production, which can release air pollutants and create noise and other community disturbances. We evaluated whether exposure to unconventional natural gas development activity in Pennsylvania was associated with adverse birth outcomes in those living nearby. Mothers who lived near active natural gas wells operated by the fracking industry in Pennsylvania were at an increased risk for preterm birth and for having a high-risk pregnancy.
Author Interviews, Depression, OBGYNE, Pediatrics / 02.10.2015

Marte Handal PhD Division of Epidemiology Norwegian Institute of Public Health Oslo, Norway MedicalResearch.com Interview with: Marte Handal PhD Division of Epidemiology Norwegian Institute of Public Health Oslo, Norway  Medical Research: What is the background for this study? Dr. Handal: The prevalence of depression during pregnancy is estimated to be as high as between 7 and 15%. It is well understood that untreated maternal depression may be harmful to both the mother and the child. When medical treatment of pregnant women is necessary, selective serotonin reuptake inhibitors (SSRIs) is the most common treatment. However, limited information is available on the potential effect of prenatal exposure to SSRIs on the child’s motor development. Medical Research: What are the main findings? Dr. Handal: We did find a week association between prolonged maternal use of SSRIs during pregnancy and delayed motor development in the child even after we had taken the mothers history of depression and her symptoms of anxiety and depression during and after pregnancy into account. However, only a few children were in the least developed category, corresponding to clinical motor delay, indicating that clinical importance is limited.
Author Interviews, Biomarkers, OBGYNE, Rheumatology / 30.09.2015

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

Cheryl H. Tan, M.P.H. Epidemiologist and lead author of the study National Center on Birth Defects and Developmental Disabilities CDCMedicalResearch.com Interview with: Cheryl H. Tan, M.P.H. Epidemiologist and lead author of the study National Center on Birth Defects and Developmental Disabilities CDC Medical Research: What is the background for this study? What are the main findings? Response: One in 10 pregnant women in the United States aged 18 to 44 years reports drinking alcohol in the past 30 days and 3.1 percent of pregnant women report binge drinking – defined as 4 or more alcoholic beverages on one occasion. That means about a third of pregnant women who consume alcohol engage in binge drinking. This is concerning because women who are pregnant or who might be pregnant should avoid drinking alcohol. Alcohol use during pregnancy is associated with an increased risk of birth defects and developmental disabilities in babies, as well as other pregnancy problems, such as miscarriage, stillbirth, and prematurity. Alcohol consumption during pregnancy causes Fetal alcohol spectrum disorders (FASDs), which are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. These conditions include physical problems, behavioral problems, and leaning disabilities. FASDs are completely preventable: if a woman does not drink alcohol during pregnancy, her child has zero risk of an FASD.
AHA Journals, Author Interviews, Heart Disease, OBGYNE, Women's Heart Health / 22.09.2015

Barbara A. Cohn, PhD Director of the Child Health and Development Studies at the Public Health Institute. Berkeley, CaliforniaMedicalResearch.com Interview with: Barbara A. Cohn, PhD Director of the Child Health and Development Studies at the Public Health Institute. Berkeley, California Medical Research: What is the background for this study? Dr. Cohn: I guessed that pregnancy complications would be an early warning sign of cardiovascular problems because of the extraordinary demands that pregnancy places on a woman’s cardiovascular system. Medical Research: What data were used for this study? Dr. Cohn: The Child Health and Development Studies is a large pregnancy cohort that enrolled more than 20,000 pregnancies in the 1960’s. Women and their families have been followed now for more than 50 years. Information on pregnancy complications was captured from medical records as they occurred, long before cardiovascular disease developed. These data are the basis for the current study. Medical Research: Why hasn’t this study already been done? Dr. Cohn: Long-term, large studies of pregnancy are rare. I first tried to do this study forty years ago when I was in graduate school.   At that time, Dr. Bea van den Berg, the late, second director of the Child Health and Development Studies advised that the study mothers were still too young to observe their cardiovascular disease experience. Now 40 years later, my colleague Piera Cirillo and I have been able to test the idea that combinations of pregnancy complications are linked to cardiovascular disease death for women.
Author Interviews, OBGYNE, Pediatrics / 19.08.2015

Jennifer B. Kane PhD Assistant professor of Sociology University of California, Irvine MedicalResearch.com Interview with: Jennifer B. Kane PhD Assistant professor of Sociology University of California, Irvine Medical Research: What is the background for this study? Dr. Kane: We know that low-birth-weight babies are more susceptible to later physical and cognitive difficulties and that these difficulties can sharpen the social divide in the U.S. But knowing more about what causes low birth weight can help alleviate this intergenerational perpetuation of social inequality through poor infant health. This study was designed to expand our knowledge of these causes. Medical Research: What are the main findings? Dr. Kane: This study found that risk factors for low birth weight extend far beyond pregnancy—dating all the way back to women’s early life environment as well as to conditions dating back three generations. For example, a woman’s own weight at birth, as well as her education level and marital status pre-pregnancy can have repercussions for two generations, putting her children and grandchildren at higher risk of low birth weight. This study also discovered new pathways of risk that contribute to poor infant health. For example, intergenerational transmissions of maternal education, potentially reflecting parent-child socialization or role modeling, appear to have a long-term influence on birth outcomes of future generations. In addition, this study showed that intra-generational and inter-generational processes work in conjunction with one another to place some infants at higher risk of low birth weight.
Author Interviews, Hepatitis - Liver Disease, OBGYNE / 12.08.2015

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

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