Women's Health
Pregnancy Complications May Predict Heart Trouble Later
MONDAY, Feb. 20 -- Certain complications during pregnancy appear to raise the mother's risk of cardiovascular disease during middle age, a new study has found.
Women with high blood pressure in pregnancy, known as preeclampsia, or pregnancy-related diabetes were more likely to have cardiovascular disease risk factors at around 50, the British researchers found. The risk was greater with preeclampsia.
"For women, this study suggests that if they have experienced any of the pregnancy complications [evaluated], they may consider seeking advice regarding effective interventions and lifestyle changes in order to modify their CVD [cardiovascular disease] risk," said study leader Abigail Fraser, a research fellow at the University of Bristol School of Social and Community Medicine.
For women not yet pregnant, maintaining a healthy weight before getting pregnant may help them avoid the problems, Fraser said.
Moms-to-be with preeclampsia were 31 percent more likely to have risk factors for heart disease at around age 50 than those who had normal blood pressure during pregnancy. They tended to be heavier and have higher blood pressure and irregular blood sugar control than women with a healthy pregnancy.
Women who developed diabetes in pregnancy, called gestational diabetes, were 26 percent more likely to have heart-disease risk factors, particularly abnormally high blood sugar levels.
For the study, published Feb. 20 in the journal Circulation, the researchers looked at the pregnancies of more than 3,400 women enrolled in the Avon Longitudinal Study of Parents and Children in the early 1990s.
Nearly 30 percent had one complication, and about 5 percent had two. Besides high blood pressure and diabetes, the researchers were interested in whether preterm delivery and babies born small or large for gestational age affected heart disease risk later.
After 18 years, they reassessed the women, who then averaged 48 years old. They used the Framingham prediction score, a respected measure, to evaluate their risk of getting cardiovascular disease in the next 10 years.
Giving birth to babies large for gestational age was linked with higher blood sugar and wider waists. Giving birth to babies small for gestational age and delivering before term was linked with higher blood pressure.
The findings make sense to Marie Frazzitta, a nurse practitioner and coordinator of the North Shore University Hospital's Center for Diabetes in Pregnancy, Manhasset, N.Y.
"Pregnancy is like a stress test that can identify what chronic conditions a woman may be susceptible to later in life," she explained.
Dr. Tara Narula, a cardiologist at Lenox Hill Hospital, New York City, agreed. "Pregnancy may be a unique point in time where physicians get a window into a woman's future risk for cardiovascular disease," she said. Factors such as preterm delivery and baby's size may help predict a woman's long term risk of developing cardiovascular disease or risk factors, she said.
"If physicians can use the information gained during pregnancy to appropriately manage a woman's risk, we may be able to limit the number of deaths caused by CVD, the number one killer of American women," Narula said.
She said the study provides good information, but is limited in that "the follow-up occurred at an age in women (younger than 50) when CVD events are low in general."
The study, which builds on previous research, was funded by the U.S. National Institute of Diabetes and Digestive and Kidney Disease, the British Heart Association and Wellcome Trust.
SOURCES: Abigail Fraser, Ph.D., M.P.H., research fellow, School of Social and Community Medicine, University of Bristol, England; Marie Frazzitta, nurse practitioner, coordinator, North Shore University Hospital's Center for Diabetes in Pregnancy, Manhasset, N.Y.; Tara Narula, M.D., cardiologist, Lenox Hill Hospital, New York City; Feb. 20, 2012, Circulation
THURSDAY, Feb. 16 -- An alarming increase in ectopic pregnancy-related deaths among Florida women is likely caused by illicit drug use and delays in seeking medical care, a U.S. report released Thursday says.
The finding that deaths from ectopic pregnancies jumped fourfold in the past decade in Florida points to a need for improved access to health care and greater awareness of the importance of early pregnancy testing, officials from the U.S. Centers for Disease Control and Prevention said in a report published in the Feb. 17 issue of the agency's Morbidity and Mortality Weekly Report.
"This is the first report of an abrupt increase in ectopic pregnancy deaths identified in the United States in recent times," the CDC researchers said in the report.
Ectopic pregnancy is a life-threatening condition that occurs when an egg is fertilized outside of the uterus, usually in the fallopian tube. If undetected, the mother-to-be may die from hemorrhage due to tubal rupture.
From 1999 to 2008, Florida's death rate from ectopic pregnancy was similar to the national rate -- 0.6 deaths per 100,000 live births -- but it jumped dramatically in recent years to 2.5 per 100,000 births in 2009-2010. While 13 ectopic-related deaths were reported in Florida in the decade 1999 to 2008, nearly that number -- 11 -- were reported in just 2009-2010, the agency said. During that time, the proportion of deaths caused by ectopic pregnancies soared from 3.5 percent of all pregnancy-related deaths to 10.8 percent, the report noted.
Compared to the earlier period, the women who died from tubal pregnancy in 2009-2010 were more likely to be single, white or Hispanic, lack health insurance and have less than a high school education, the report found.
Officials said the women who died during 2009-2010 were more likely to have collapsed from hemorrhage before seeing a health care provider than the women who died during 1999-2008. And several women tested positive for illicit drug use, including cocaine.
Nationwide, between 1 percent and 2 percent of pregnancies are ectopic, but these abnormal pregnancies account for between 3 percent and 4 percent of pregnancy-related deaths. However, the death rate from ectopic pregnancies steadily declined nationally in the late 20th century through 2007, the latest year for which figures are available.
The study has several limitations, the researchers stressed. Full medical information was not available for the deceased women, and drug testing was not routine during much of the earlier period.
Efforts to educate women on the dangers of drug use before and during pregnancy are essential, the CDC researchers added.
-- Margaret Steele
SOURCE: Morbidity and Mortality Weekly Report, news release, Feb. 16, 2012
Women With the Autoimmune Diseases Often Have Fewer Children Than Desired, Study Finds
By Salynn Boyles
WebMD Health News
Reviewed by Louise Chang, MD
Feb. 16, 2012 -- More than half of women diagnosed with lupus or rheumatoid arthritis prior to completing their families end up having fewer children than they had planned for, new research suggests.
The study is among the first to examine infertility, pregnancy loss, and family planning choices in women with the autoimmune diseases.
Lupus, RA, and Childbirth
Rheumatoid arthritis (RA) and lupus are often diagnosed in younger women, yet their impact on childbearing is not well understood.
It is clear from earlier research that women with rheumatoid arthritis tend to have fewer children than healthy women and that women with lupus have more miscarriages.
But the reasons for this are not so clear, and prior studies have not examined how living with a chronic autoimmune disease impacts family size and family planning decisions, says Duke University Medical Center investigator Megan Clowse, MD, who runs the center's autoimmune disease pregnancy registry.
"We wanted to learn more about how having lupus or rheumatoid arthritis influenced these decisions," she says.
Clowse and colleagues surveyed 578 women with rheumatoid arthritis and 114 with lupus enrolled in a national autoimmune disease registry.
Among their findings:
- 55% of the women with rheumatoid arthritis and 64% of those with lupus who were interested in having children reported having fewer children than they had hoped to have.
- Rheumatoid arthritis patients who had fewer children than planned were one-and-a-half times more likely to report problems with infertility than patients who had as many children as they had hoped for.
- Lupus patients who had fewer children than they had planned to have had a three-fold higher miscarriage rate than lupus patients who had the number they had planned for. There was no significant difference in infertility rates.
WEDNESDAY, Feb. 15 -- Infants with birth defects who are born on weekends or at night do just as well as those delivered on a weekday, a new study says.
Both groups of infants stayed at the hospital for the same amount of time, had the same rates of admission to the neonatal intensive care unit, and required antibiotics or breathing assistance the same number of times, said the researchers from the University of Rochester Medical Center in New York.
The findings suggest that pregnant women carrying babies with birth defects should deliver when their bodies are ready, regardless of the day or time, the researchers said.
They analyzed data from 220 infants with known, non-lethal birth defects who were born between 2000 and 2010.
A number of studies have examined the association between delivery time and outcomes for healthy infants, but there was no current research on infants with birth defects, according to the authors of the new study.
"When we know that a baby will need further testing or surgical repair during the newborn period due to an identified abnormality, we typically try to arrange the delivery on a weekday," Dr. Eva Pressman, a professor and director of the high-risk pregnancy program at the medical center, said in a university news release.
"But the bottom line is that the timing of delivery isn't terribly important; if a woman goes into labor in the middle of the night or over the weekend her baby will do just as well," she added.
The findings suggest there is no reason to induce labor or perform a cesarean section solely to deliver an infant with a birth defect during the day, said senior study author Dr. Loralei Thornburg, an assistant professor of maternal-fetal medicine.
"If there is no medical reason for inducing labor it is best to let the baby come on its own time, because we know elective induction is associated with negative outcomes for mom, including increased rates of cesarean delivery, greater blood loss and an extended length of stay in the hospital, and is without significant benefits for the baby," she said in the news release.
The study was scheduled for presentation Friday at the annual meeting of the Society for Maternal-Fetal Medicine in Dallas.
Research and conclusions presented at medical meetings should be considered preliminary until published in a peer-reviewed medical journal.
-- Robert Preidt
SOURCE: University of Rochester, news release, Feb. 10, 2012
FRIDAY, Feb. 10 -- A new childbirth study says 39 weeks' gestation is the best time for elective Cesarean delivery for women who have previously delivered via C-section.
The research was slated for presentation Friday at a meeting of the Society for Maternal-Fetal Medicine in Dallas.
"Prior studies have compared the perinatal risks of elective delivery at 37 to 41 weeks' gestation, but didn't evaluate the hazard of delivery versus not delivering at a specific time point," Dr. Giuseppe Chiossi, who conducted the study for the U.S. National Institute of Child Health and Human Development, said in a society news release.
"We wanted to compare the risks of elective repeat Cesarean at each gestational age starting at 37 weeks with the cumulative maternal and neonatal risks of not delivering at that particular gestational age," Chiossi said.
The researchers found that elective repeat Cesarean deliveries at a later gestational age were associated with much lower rates of poor health results for infants compared to deliveries at 37 and 38 weeks.
They also found that poor infant results were much more frequent in pregnancies that continued beyond 39 weeks compared to those in which the baby was delivered through elective surgery at 39 weeks.
Mothers' health results tended to be better with continued pregnancy rather than elective Cesarean at 37 or 38 weeks, but the difference was significant only at 37 weeks. Mothers' results were much worse for later deliveries compared to elective Cesarean at 39 weeks.
Research presented at medical meetings should be considered preliminary until published in a peer-reviewed medical journal.
-- Robert Preidt
SOURCE: Society for Maternal-Fetal Medicine, news release, Feb. 7, 2012
FRIDAY, Feb. 10 -- Breast-feeding reduces the risk of obesity in children born to mothers with diabetes during their pregnancy, a new study indicates.
Researchers followed 94 children of diabetic mothers and 399 children of non-diabetic mothers from birth until age 13.
It's known that children of diabetic pregnancies are at increased risk for obesity. The Colorado School of Public Health researchers wanted to assess how breast-feeding affected the growth of body-mass index (BMI), an indicator of childhood obesity.
The study found that children of diabetic pregnancies who were breast-fed for at least six months had a slower BMI growth as they grew older than those who were breast-fed for less than six months. The study found similar results in children of non-diabetic pregnancies.
The study was published online recently in the International Journal of Obesity.
"Breast-feeding support represents an important clinical and public health strategy to reduce the risk of childhood obesity," study author and epidemiologist Tessa Crume said in a University of Colorado Denver news release.
The findings offer another reason to encourage and support mothers to breast-feed for at least six months, the time recommended by the American Academy of Pediatrics, the release said.
"We can work with pediatricians, obstetricians and the public health community to give these women targeted support immediately following birth," Crume said.
-- Robert Preidt
SOURCE: University Colorado Denver, news release, Feb. 8, 2012
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