'This Is Personal' Campaign for Women's Reproductive Rights
Posted by on September 27, 2012 - 9:55am

The 2012 election cycle has seen unprecedented coverage (and often misinformation) on women’s reproductive health care due to the Affordable Care Act’s immediate impact and nonstop campaign gaffes related to women’s health.

Last Thursday, the National Women’s Law Center (NWLC) launched a new campaign to improve access to women’s health information called This Is Personal. The mission of the campaign is to target, engage and inform younger women about reproductive rights and help disseminate information related to women’s health topics ranging from contraception, maternity care, and what Congress is presently voting on.

It is therefore vitally important that women get involved in the decision-making process to ensure that the women impacted by these deeply personal issues have real world input.  “Decisions about women’s reproductive health are personal. Period.” said NWLC Co-President Marcia Greenberger. “These decisions should be a woman’s to make with the important people in her life. The personal beliefs of lawmakers should not trump a woman’s ability to take care of her health.” Despite the private nature of decisions impacting reproductive health care, they are often made at the federal, state or local levels instead of the individual level.

The This Is Personal campaign hopes that through social media, celebrity involvement in videos and satire, young women (and men) will become increasingly active and interactive about reproductive rights. For example, through the new website’s interactive action tabs women can gather more information about state and federal health care decisions, sign petitions and contact legislators.

Decisions about women’s reproductive health care are greatly personal and deserve intimate involvement from women themselves. This Is Personal has a Facebook, Twitter and website with data and satirical videos which should be used as an educational tool and a place for women to educate themselves for the upcoming election. It is also a place where women can actively use their beliefs and knowledge to have their voices heard by decision makers.  Sharing of ideas and knowledge is the only way to put decision making into the hands of the women who will be affected by the policies of the 113th Congress.

Women who are obese before pregnancy put child at risk
Posted by on August 15, 2012 - 8:35am

Women who are obese before they become pregnant may be putting their child at a disadvantage. New research shows that reading and math scores for kids ages 5 to 7 were lower if the mother was obese before she got pregnant. Obesity can alter how a baby receives nutrients and grows inside the womb.

“Fetal period is known as a critical period of brain development, where any disruption in the development during this sensitive period may cause sustained or permanent changes in structures or functions,"  says Rika Tanda at Ohio State University.

Future moms can give their children the best chance at success by maintaining a healthy weight.

The study in the Maternal and Child Health Journal was supported by the National Institutes of Health.

Health reasons to avoid pregnancy
Posted by on July 18, 2012 - 4:03pm

We know that many women use contraceptives to prevent unwanted pregnancy often for social, career or economic reasons. In other words, it's not the right time.   There are also health reasons for avoiding or delaying pregnancy.   The Association of Reproductive Health Professional has identified conditions associated with increased risk for adverse health events as a result of pregnancy.  This does NOT mean that all women with these conditions should never get pregnant, but they should have serious discussions with their health providers before they become pregnant, and in some cases, may need to avoid.  Conditions that could lead to a complicated or risky pregnancy, putting the woman at risk include

  • Breast cancer
  • Complicated valvular heart disease
  • diabetes;  insulin dependent with complications
  • Endometrial or ovarian cancer
  • epilepsy
  • Hypertension (high blood pressure)
  • Bariatric Surgery in the past two years
  • HIV/AIDS
  • Ischemic heart disease
  • Malignant liver tumors and certain liver disease
  • Peripartum cardiomyopathy
  • sickle cell disease
  • Solid organ transplant within the past two years
  • stroke
  • systemic lupus
  • platelet mutations
  • tuberculosis

When politicians debate access to contraception and insurance coverage, they need to be aware that there are conditions women may have that put them at high risk for a complicated pregnancy.  Having access to contraceptive methods is critical to planning and/or preventing pregnancy in high risk women.  It's not always about the baby---in these cases,  it is the potential mother!

 

Pregnant women have longer labor now than 50 years ago
Posted by on April 11, 2012 - 10:45am

Women take longer to give birth today than did women 50 years ago, according to an analysis of nearly 140,000 deliveries conducted by researchers at the National Institutes of Health.

The researchers compared data on deliveries in the early 1960s to data gathered in the early 2000s. They found that the first stage of labor had increased by 2.6 hours for first-time mothers. For women who had previously given birth, this early stage of labor took two hours longer in recent years than for women in the 1960s. The first stage of labor is the stage during which the cervix dilates, before active pushing begins.

Infants born in the contemporary group vs those from the 1960s

  • Tended to weigh more
  • Were born 5 days earlier, on average

Women today vs the 1960s

  • Weighed more
  • Were, on average, four years older at the time of birth

The women in the contemporary cohort had an average pre-pregnancy Body Mass Index  of 24.9. A BMI of 25 is considered overweight. Overweight and obesity raise the risk of pregnancy complications for mother and baby. Women who are overweight or obese and who would like to become pregnant should speak with their health care provider about losing weight before becoming pregnant.“Older mothers tend to take longer to give birth than do younger mothers,” said the study's lead author, S. Katherine Laughon, M.D., of the National Institute of Child Health and Human Development (NICHD). “But when we take maternal age into account, it doesn't completely explain the difference in labor times.”

Changes in delivery practice the researchers found included an increase in the use of epidural anesthesia (half of recent deliveries, compared with 4 percent of deliveries in the 1960s.) Doctors in the early 2000s also administered the hormone oxytocin more frequently (in 31 percent of deliveries, compared with 12 percent in the 1960s), the researchers found. Oxytocin is given to speed up labor, often when contractions seem to have slowed. "Its use should be expected to shorten labor times, " Dr. Laughon explained, “ and without it, labor might even be longer in current obstetrics than what we found".

Other differences between the two groups reflect changes in later stage delivery practices. For example, in 1960s-era deliveries the use of episiotomy (surgical incision to enlarge the vaginal opening during delivery), and the use of forceps, surgical instruments used to extract the baby from the birth canal, was notably more common than they are today.

In current practice, doctors may intervene when labor fails to progress. This could happen if the dilation of the cervix slows or the active phase of labor stops for several hours, Dr. Laughon explained. In these cases, intervention can include administering oxytocin or performing a cesarean delivery.

In fact, the study found that the rate of cesarean delivery was four times higher today than it was 50 years ago (12 percent vs. 3 percent).

The authors note that while their study does not identify all the factors contributing to longer delivery times, the findings do indicate that current delivery practices may need to be re-evaluated.The study authors called for further research to determine whether modern delivery practices are contributing to the increase in labor duration.

Their analysis was published online in the American Journal of Obstetrics and Gynecology.

Heavy metal exposure in men and women may delay pregnancy
Posted by on February 13, 2012 - 9:50am

Higher blood levels of cadmium in females, and higher blood levels of lead in males, delayed pregnancy in couples trying to become pregnant, according to a study by researchers at the National Institutes of Health and other academic research institutions.

Cigarette smoke is the most common source of exposure to cadmium, a toxic metal found in the earth’s crust, which is used in batteries, pigments, metal coatings and plastics. Smokers are estimated to have twice the levels of cadmium as do non-smokers. Exposure also occurs in workplaces where cadmium-containing products are made, and from the air near industrial facilities that emit cadmium. Airborne cadmium particles can travel long distances before settling on the ground or water. Soil levels of cadmium vary with location. Fish, plants, and animals absorb cadmium from the environment, and all foods contain at least low levels of the metal.

Lead, a toxic metal also found in the earth's crust, is used in a variety of products, such as ceramics, pipes, and batteries. Common sources of lead exposure in the United States include lead-based paint in older homes, lead-glazed pottery, contaminated soil, and contaminated drinking water.

Exposure to these metals is known to have a number of effects on human health, but the effects on human fertility have not been extensively studied, especially when studying both partners of a couple.

The study was published online in Chemosphere (Feb 4, 2012)   The study's principal investigator was Germaine M. Buck Louis, Ph.D., director of the Division of Epidemiology, Statistics, and Prevention Research at the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

"Our results indicate that men and women planning to have children should minimize their exposure to lead and cadmium," Dr. Buck Louis said. "They can reduce cadmium exposure by avoiding cigarettes or by quitting if they are current smokers, especially if they intend to become pregnant in the future. Similarly, they can take steps to reduce their exposure to lead based paints, which may occur in older housing, including during periods of home renovation."

To conduct the study, the researchers enrolled 501 couples from four counties in Michigan and 12 counties in Texas, from 2005 to 2009. The women ranged from 18 to 44 years of age, and the men were over 18. Couples provided blood samples for the analysis of three heavy metals. Women kept journals to record their monthly menstrual cycles and the results of home pregnancy tests. The couples were followed until pregnancy or for up to one year of trying.

The researchers ranked the study participants on the basis of their blood levels of lead and cadmium. The researchers also measured the participants’ blood mercury levels, but found they were not associated with the length of time couples required to become pregnant. Nearly every study participant had some exposure to these common metals, although blood levels of the metals varied across participants.

Researchers calculated the probability that a couple would achieve pregnancy by levels of blood cadmium and lead with a statistical measure called the fecundability odds ratio. The measure estimates couples' probability of pregnancy each cycle, by their blood concentration of metals. A ratio less than one suggests a longer time to pregnancy, while a ratio greater than one suggests a shorter time to pregnancy. Females' blood cadmium concentration was associated with a ratio below 1 (0.78), which means that the probability of pregnancy was reduced by 22 percent with each increase in the level of cadmium. Males’ blood lead exposure also was associated with a ratio below 1 (0.85) with increasing levels, or about a 15 percent reduction in the probability of pregnancy for each increase in the level of blood lead concentrations.

"The findings highlight the importance of assessing couples' exposure jointly, in a single, combined measure," Dr. Buck Louis said. "Males matter, because couples' chances of becoming pregnant each cycle were reduced with increasing blood lead concentrations in men."

 

Pregnancy and hypothyroidism
Posted by on January 23, 2012 - 7:20am

Based on a new study of nearly 118,000 women, researchers estimated that nearly 500,000 pregnant women with gestational hypothyroidism may go undetected each year.

Asian women were almost five times more likely to test positive for gestational hypothyroidism than African-American women (19.3% compared with 6.7%) and slightly more likely than Caucasian and Hispanic women (16.4% and 15.2%, respectively).

Gestational hypothyroidism has been linked to medical complications for both mothers and babies. However, the appropriate diagnostic approach and management of the condition remains controversial. The researchers wanted to analyze the current status of testing for thyroid disease during pregnancy.

Of the pregnant women in the study, Asian women had the highest testing rate of 28% and African-American woman had the lowest rate at just 19%. Testing rates increased with maternal age.

The analysis found that women 35 to 40 years of age were 2.2 times more likely to be tested when compared than women between 18 and 24.  Weight was also a factor as those over 275 pounds  were 1.3 times more likely to be tested than those weighing between 100 and 124 pounds .

Younger women were slightly underrepresented in the study population and older women were slightly overrepresented. Given the higher rates of gestational hypothyroidism among older women, the authors suggested that the overall rate is slightly lower than what they report.

"Because national and international endocrine and obstetrical organizations may consider the implications of universal prenatal and antenatal screening, this study demonstrates that the proportion of women tested for gestational hypothyroidism is low," wrote the authors. "(I)f outcomes are shown to improve with intervention, then this may have a significant impact on the health of a large number of women and their children."

All three authors are employed by Quest Diagnostics.
Source reference:
Blatt AJ, et al "National status of testing for hypothyroidism during pregnancy and postpartum" J Clin Endocrinol Metab 2012; 97: DOI: 10.1210/jc.2011-2038.

 

 

Report provides new insight into risks for stillbirths
Posted by on December 26, 2011 - 8:16am

Half of all stillbirths result from pregnancy disorders and conditions that affect the placenta, according to a new report. Risk factors already known at the start of pregnancy—such as previous pregnancy loss or obesity—accounted for only a small proportion of the overall risk of stillbirth.

Stillbirth is the death of a baby during the second half of pregnancy—at or after the 20th week of gestation. It occurs in 1 out of 160 pregnancies nationwide. Some risk factors had previously been linked to stillbirth, including maternal diabetes or high blood pressure. But the underlying causes of stillbirth remained unknown in as many as half of stillbirths.

To learn more about the origins and prevention of stillbirth, the National Institutes of Health created the Stillbirth Collaborative Research Network.  The network enrolled more than 600 women who delivered a stillbirth in certain regions of the country.

In one of the studies, the researchers compared 614 stillbirths with 1,816 live births. They searched for factors at the start of pregnancy that might raise the risk for stillbirth. The analysis strongly linked stillbirth with several reproductive features, including being a first-time mother or having stillbirth or miscarriage in earlier pregnancies. Other maternal factors linked with stillbirth include being overweight or obese, age 40 or older, AB blood type, a history of drug addiction and smoking 3 months prior to pregnancy. Still, these early risk factors represented little of the overall risk, and so they have limited usefulness as predictors of stillbirth.

The analysis confirmed earlier findings that African-American women are at greater risk for stillbirth compared with white or Hispanic women. The stillbirth risk for African Americans was greatest for deliveries before the 24th week of pregnancy. Further analyses of early pregnancy may yield insights for reducing the racial disparity in stillbirth rates.

In the other study, researchers completed comprehensive medical evaluations of 512 stillborn babies to identify the causes of death. Evaluation included an autopsy of the fetus, examination of the placenta, a karyotype test to check for abnormalities in the baby's chromosomes, and a review of the medical records.     The detailed medical evaluations allowed scientists to identify a probable cause of death in 61% of cases and a probable or possible cause of death in 76% of cases. Earlier studies, which typically were limited to analyzing medical records, could identify a cause of death in only about half of cases.

The researchers found that pregnancy or birth-related complications contributed to the largest proportion of stillbirths (29%). These complications include preterm labor or premature rupture of membranes that hold the amniotic fluid. Another such complication is abruption of the placenta, in which the placenta separates from the wall of the uterus. Other identified causes included abnormalities of the placenta (24% of cases), genetic conditions or birth defects (14%), infection (13%), problems with the umbilical cord (10%) and maternal high blood pressure (9%).

“Our study showed that a probable cause of death—more than 60%—could be found by a thorough medical evaluation,” says study co-author Dr. Uma M. Reddy of NICHD. “Greater availability of medical evaluation of stillborn infants, particularly autopsy, placental exam and karyotype, would provide information to better understand the causes of stillbirth.”

RELATED LINKS:
http://www.nichd.nih.gov/health/topics/Stillbirth.cfm

Newer Contraceptive Methods Needed Among Developing Countries
Posted by on May 23, 2011 - 8:24am

Seven out of 10 women in Sub-Saharan Africa, South Central Asia and Southeast Asia who want to avoid pregnancy but are not using modern contraceptives report reasons for nonuse that indicate currently available methods do not satisfy their needs, according to new Guttmacher research. The findings suggest that substantially bringing down unintended pregnancy rates in these developing regions will require increased investment in the development of new methods that better address women’s concerns and life circumstances.

The report, Contraceptive Technologies: Responding to Women’s Needs, focuses on the three regions that together account for the majority of women in the developing world with an unmet need for contraception. Overall, 40% of pregnancies in these regions—about 49 million—are unintended. Each year, these pregnancies result in 21 million unplanned births, an equal number of abortions (three-quarters of which are unsafe) and 116,000 maternal deaths.

“The findings make clear that meeting the need for contraception requires not only increased access and counseling, but the development of new methods that better meet women’s needs,” says Jacqueline E Darroch, senior fellow at the Guttmacher Institute and one of the study’s authors.

To gain insight into why so many women in developing countries are not using modern contraceptives, researchers analyzed nationally representative data from Demographic and Health Surveys and other sources. They found that the majority of women with an unmet need for contraception are 25 or older and live in rural areas, and about four in 10 are poor. The reasons women most frequently given for not using a method are concerns about health risks or side effects (23%); infrequent sex (21%); being postpartum or breast-feeding (17%); and opposition from their partners (10%).
The findings shed light on the types of methods that could have the greatest impact on increasing contraceptive use: Developing new contraceptive methods that have negligible side effects, are appropriate for breast-feeding women and could be used on demand has the potential to greatly reduce unmet need for contraception. So would methods that women can use without their partner’s knowledge.

The report shows that overcoming method-related reasons for contraceptive nonuse could reduce unintended pregnancy by as much as 59% in these regions. Unintended births and induced abortions could be reduced by similar proportions, and 70,000 maternal deaths could be prevented. However, the researchers note that new contraceptive methods alone will not overcome all reasons for nonuse. Other causes, including poor access to and quality of contraceptive services must also be addressed.

Currently, 104 million women in Sub-Saharan Africa, South Central Asia and Southeast Asia have an unmet need for modern contraceptive methods because of method-related reasons. Taking into account projected population growth, this number will increase to 161 million in the next four decades if concerns about currently available methods are not addressed. The researchers note that there has been a lack of attention and resources dedicated to contraceptive research and development, and that there is a vital, immediate need to reinvigorate the field.
In addition to long-term work to develop new contraceptive methods, they point out that adaptations to current methods could make them more widely acceptable and easier to use. They conclude that immediate headway toward satisfying unmet need could be made by ensuring that women and couples receive more accurate information about the risk of unintended pregnancy and have greater access to quality counseling and services that offer a range of methods.
The report, Contraceptive Technologies: Responding to Women’s Needs, was funded by a grant from the Bill & Melinda Gates Foundation. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation.
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Source:  Guttmacher Institute

Sex Differences in Fetal Alcohol Syndrome
Posted by on April 18, 2011 - 2:52pm

Male fetuses most vulnerable to alcohol.

Exposure to alcohol in the womb doesn’t affect all fetuses equally. Why does one woman who drinks alcohol during pregnancy give birth to a child with physical, behavioral or learning problems -- known as fetal alcohol spectrum disorder -- while another woman who also drinks has a child without these problems?

One answer is a gene variation passed on by the mother to her son, according to new Northwestern Medicine research. This gene variation contributes to a fetus’ vulnerability to even moderate alcohol exposure by upsetting the balance of thyroid hormones in the brain.  The Northwestern Medicine study with rats is the first to identify a direct genetic mechanism of behavioral deficits caused by fetal alcohol exposure. The study is published today in the FASEB Journal.

“The findings open up the possibility of using dietary supplements that have the potential to reverse or fix the dosage of the thyroid hormones in the brain to correct the problems caused by the alcohol exposure,” said Eva E. Redei, senior author of the study and professor of Psychiatry at Northwestern University Feinberg School of Medicine.

“In the not-too-distant future we could identify a woman’s vulnerability to alcohol if she is pregnant and target this enzyme imbalance with drugs, a supplement or another method that will increase the production of this enzyme in the hippocampus, which is where it’s needed,” Redei said.

Efforts to educate pregnant women about the risks of alcohol have not changed the percentage of children born with fetal alcohol spectrum disorder, Redei noted.

The gene involved, Dio3, makes the enzyme that controls how much active thyroid hormone is in the brain. A delicate balance of the thyroid hormone is critically important in the development of the fetal brain and in the maintenance of adult brain function. Too much of it is as bad as too little.

When males inherit this variation of the Dio3 gene from their mother, they don’t make enough of this enzyme in their hippocampus to prevent an excess of thyroid hormones. The resulting overdose of the hormones makes the hippocampus vulnerable to damage by even a moderate amount of alcohol. The rat mothers in the study drank the human equivalent of two to three glasses of wine a day. Their male offspring showed deficits in social behavior and memory similar to humans whose mothers drank alcohol.

The alcohol causes the problem by almost completely silencing the father’s copy of the Dio3 gene in animals whose mother has the gene variation. As a result, the offspring don’t make enough of this enzyme, disrupting the delicate balance of the thyroid hormone levels. This is an example of an interaction between genetic variation in the DNA sequence, and epigenetics, which is when the environment, such as alcohol in utero, modifies the DNA.

“The identification of this novel mechanism will stimulate more research on other genes that also influence alcohol-related disorders, especially in females,” said Laura Sittig, the lead author of the study and a graduate student in Redei’s lab.

In the study, the rats’ social behavior was measured by putting a pup into a cage with an adult. Normal adult behavior is to lick and smell the pup. The adults exposed to alcohol in utero, however, interacted with the pup half as much as normal. They also forgot where to navigate in a maze that evaluated spatial memory.

“These results show they had social and memory deficits,” Redei said. “This indicates the damage to the hippocampus from the alcohol exposure.”

by Marla Paul, health sciences editor, Northwestern U.

The Pill, HRT and Pregnancy may Increase Risk for High Blood Pressure
Posted by on March 31, 2011 - 3:32pm

Women who tend to have high blood pressure (HBP) should be particularly vigilant if they are on oral contraceptives, are pregnant, or on hormone replacement therapy.

Women on oral contraceptives (OC) experience small but detectable increase in both systolic and diastolic blood pressure, usually in the normal range.  If it runs higher than normal make sure you talk to your doctor about it.   Women taking OCs who are 35 years and older and who smoke cigarettes are at even greater risk for heart disease and stroke and are encouraged to quit smoking.   If they are unable to quit smoking, they should talk to their doctor about using other forms of contraception.

Most studies show that blood pressure does not increase significantly with hormone replacement therapy in most women with and without high blood pressure.   However, a few women may experience a rise in blood pressure attributable to estrogen therapy.   It is recommended that women on HRT have their blood pressure monitored more often.

Many woman with HBP can have healthy babies but HBP during pregnancy can be dangerous for both mother and fetus.  Women with pre-existing, or chronic, high blood pressure are more likely to have certain complications during pregnancy than those with normal blood pressure.   Some women who have normal blood pressure before pregnancy may develop high blood pressure during pregnancy, called gestational hypertension.   The effects of high blood pressure range from mild to severe.   High PB can harm the mother's kidneys and other organs, and it can cause low birth weight and early delivery.  In the most serious cases, the mother develops pre-eclampsia or "toxemia of pregnancy" which can be life threatening.  More guidance for handling HPB during pregnancy can be found HERE.

Below is a chart for average normal blood pressure ranges.   However, age can effect the range, with slightly higher normal ranges as one ages.

Systolic pressure (mm Hg) Diastolic pressure (mm Hg) Pressure Range
130 85 High Normal Blood  Pressure
120 80 Normal Blood Pressure
110 75 Low Normal Blood  Pressure

Source:   National Heart, Lung and Blood Institute

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