Booster Shots

Oddities, musings and news from the health world

Category: pregnancy

Drink during pregnancy and your sons may suffer, researchers say

June 29, 2010 |  2:21 pm

Women who drink during pregnancy may be reducing their chances of someday becoming grandparents.

Wine Danish researchers examined the sperm counts of 347 young men whose mothers participated in the “Healthy Habits for Two” study while they were pregnant in the mid-1980s. At the time, the women completed a questionnaire about their lifestyle habits, including their consumption of beer, wine and spirits.

Linking the data on alcohol exposure in utero with sperm counts as adults, the researchers found that sons of mothers who consumed at least 4.5 alcoholic drinks per week during pregnancy had sperm concentration of 25 million per milliliter. That was 32% lower than the 40 million/mL measured among sons whose mothers had fewer than one drink per week while they were pregnant. (One “drink” was defined as 12 grams of alcohol – roughly equivalent to a 12-ounce beer or a small glass of wine.)

The World Health Organization said last year that it considers sperm concentration of about 15 million/ML to be normal, so everyone who participated in the Danish study would seem to be fine. But Cecilia Ramlau-Hansen, one of the researchers, pointed out that the lower one’s sperm count, the lower the odds of conception.

Ramlau-Hansen, a senior researcher at the Aarhus University Hospital’s department of occupational medicine, discussed her study Tuesday at the annual meeting of the European Society of Human Reproduction and Embryology, which is underway in Rome. She said the link is merely an association, not proof that alcohol is to blame for the reduced sperm counts observed in the study, but the finding warrants further study.

-- Karen Kaplan

Photo: This is a dangerous habit for pregnant women who want to have grandchildren someday. Credit: Christina House / For The Times

Pregnant moms living near cellphone towers: No worries, study says

June 22, 2010 |  4:02 pm

Expectant parents may have one less thing to worry about. British researchers say a new study shows that the children of women who live near cellphone towers during pregnancy do not have an increased risk of childhood cancer.

Cell tower no risk for childhood cancer The researchers, from Imperial College London’s School of Public Health, identified all 1,926 cases of childhood cancers in Britain from 1999 to 2001. In 529 cases, either the mother’s whereabouts during pregnancy or the radio-frequency exposure from nearby cellphone towers could not be determined. Each of the remaining 1,397 cases was matched with four healthy children of the same age and gender. All of the kids had similar demographic characteristics.

The team also gathered detailed data about all 81,781 cellphone towers that were operational in the country during that time, including each tower’s location, height, output power and how many antennas it had.

Then they crunched the numbers. In virtually every permutation of their calculations, there was no correlation between the cellphone towers and the cancer cases.

For instance, the mothers whose children were diagnosed with cancer lived an average of 1,173 yards from a cellphone tower while they were pregnant -- statistically indistinguishable from the 1,211 yards that separated the other pregnant women from their nearest cellphone towers. Tallying up the total power output of all cellphone towers within 766 yards of each pregnant woman’s home, they found that both groups had nearly the same exposure -- 2.89 kilowatts for the mothers of cancer victims and 3.00 kilowatts for the other mothers.

Only one of their models revealed a difference that was statistically significant, though just barely. In that case, higher radio-frequency exposure was associated with a reduced risk of cancer of the brain or central nervous system. (This result calls to mind a mouse study from last year that found that electromagnetic radiation from cellphones actually protected mice from Alzheimer’s.) The results were published online Tuesday by the British Medical Journal.

The British researchers admitted their study would have been stronger if there had been some way to determine the actual radiation exposure for each pregnant woman instead of relying on mathematical models. They also would have liked to have tracked the exposure of babies after they were born, but the necessary data weren’t available. Still, they said that if the cellphone towers had doubled the risk for these childhood cancers, the odds that their study would have picked up on it were greater than 90%.

In an editorial, John Bithell of the University of Oxford’s Childhood Cancer Research Group wrote that the study was convincing.

“Clinicians should reassure patients not to worry about proximity to mobile phone masts,” they wrote. “Moving away from a mast, with all its stresses and costs, cannot be justified on health grounds in light of current evidence.”

-- Karen Kaplan

Photo: Cellphone towers. Credit: Sean Masterson / EPA

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Study underscores importance of a father's involvement during pregnancy

June 21, 2010 | 12:22 pm

It seems like every other day healthcare professionals are coming up with new pregnancy wellness tips -- ones generally aimed at expectant mothers. But future dads have roles to play -- and a study by researchers at the University of Southern Florida shows just how important the man's role can be during this critical time.

The findings, published in the Journal of Community Health, reported that involvement of future fathers during a woman’s pregnancy was linked to a reduced risk of death during the first year of the child’s life.

The researchers examined birth records of more than 1.39 million live births in Florida from 1998 to 2005. Paternal involvement during pregnancy was defined by the presence of the father’s name on the infant’s birth certificate. Though this is far from a perfect measure of a father's involvement in the pregnancy, the methodology has worked fairly well in prior studies, said lead author Amina Alio, a research assistant professor of community and family health at the USF College of Public Health.

The study’s findings, encapsulated:
  • Regardless of the mother's race, ethnicity or socioeconomic status, death during the first year of life was nearly four times more likely for infants who lacked paternal prenatal influence.
  • The risk of infant mortality for babies born to black mothers who lacked paternal involvement during their pregnancies was seven times higher than for babies born to Latino and white women in the same paternal situation.

-- Jessie Schiewe

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Flame retardants alter thyroid hormone in pregnant women

June 21, 2010 | 11:01 am

High levels of common flame-retardant chemicals appear to alter thyroid hormone levels in pregnant women, according to a new study. The chemicals, called PBDEs, or polybrominated diphenyl ethers, are known to interfere with blood chemistry in animals, but this is the first large study to investigate levels of PBDEs and a sensitive thyroid hormone in pregnant women.

Pregnant The link is important because the chemicals, in high enough levels, could affect the pregnancy and the health of the fetus, said one of the study's authors, Jonathan Chevrier, a researcher in epidemiology and in environmental health sciences at UC Berkeley.

"Normal maternal thyroid hormone levels are essential for normal fetal growth and brain development, so our findings could have significant public health implications," Chevrier said in a news release. "These results suggest that a closer examination between PBDEs and these outcomes is needed.”
The study was released Monday in the journal Environmental Health Perspectives.
PBDEs are found in carpets, textiles, foam furnishings, electronics and plastics. U.S. fire safety standards implemented in the 1970s led to increased use of PBDEs, which can leach out into the environment and accumulate in human fat cells. PBDEs can be found in the blood of most American residents, and levels are especially high among California residents because of the state's rigorous flammability laws. Concentrations of the chemicals in blood and breast milk have increased dramatically in the last three decades.
The researchers analyzed blood samples from 270 women taken around the end of their second trimester of pregnancy. The researchers measured concentrations of 10 PBDE chemicals, two types of thyroxine (T4) and thyroid-stimulating hormone (TSH). TSH is a substance that drops when the thyroid gland is producing too much hormone. The study also controlled for such factors as maternal smoking, alcohol and drug use, and exposure to lead and pesticides.

The researchers found that a 10-fold increase in each of the PBDE chemicals was associated with decreases in TSH ranging from 10.9% to 18.7%. At these levels, the women met the definition of subclinical hyperthyroidism, which indicates an early stage of thyroid malfunction.
"Low TSH and normal T4 levels are an indication of subclinical hyperthyroidism, which is often the first step leading toward clinical hyperthyroidism," Chevrier said. "Though the health effect of subclinical hyperthyroidism during pregnancy is not well understood, maternal clinical hyperthyroidism is linked to altered fetal neurodevelopment, increased risk of miscarriage, premature birth and intrauterine growth retardation."
It's not known just how the chemicals interfere with thyroid function. PBDEs could bind to thyroid receptors and alter how the hormone is released.
A study released earlier this year from the same research group found that women with higher exposures to flame retardants took longer to get pregnant.
"Our results suggest that exposure to PBDE flame retardants may have unanticipated human health risks," said Brenda Eskenazi, a professor of epidemiology and of maternal and child health at UC Berkeley.
-- Shari Roan

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Photo credit: Mark Boster / Los Angeles Times

FDA panel recommends approval of 5-day 'morning after' pill

June 18, 2010 | 12:16 pm

A Food and Drug Administration advisory panel Thursday recommended that the agency approve a "morning after" pill that is effective for five days after unprotected sex, providing an alternative to existing drugs that can be used only for three days. The agency is not required to follow the advice of its advisory panels, but usually does.

The new drug, whose proposed brand name is ella, is already marketed in Europe as ellaOne. It blocks the effect of progesterone, a female hormone that spurs ovulation. There has been spirited debate about whether the drug simply blocks ovulation or, because it is related to the abortion drug RU-486, whether it actually produces an abortion. The Washington Post and the New York Times have outlined the parameters of the debate.

The agency has set no timetable for a decision. The drug will most likely be available only by prescription, at least initially.

-- Thomas H. Maugh II

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When it comes to womb time, even a week matters to child's future education

June 11, 2010 |  9:16 am

Newborn Extreme prematurity can lead to a lifetime of special education needs. But being born a few weeks early -- even a week early -- can matter too, researchers have learned.

Scottish researchers analyzed data on more than 400,000 schoolchildren, paying attention to gestational age at delivery and the children's use of special education services. In a study published this week in PLoS Medicine, they write quite bluntly:

"... deliveries should ideally wait until 40 weeks of gestation because even a baby born at 39 weeks — the normal timing for elective deliveries these days — has an increased risk of [special educational need] compared with a baby born a week later."

Read the full gestatation-and-special-education study here.

It includes a link to a March of Dimes explanation of why the last weeks of pregnancy count -- something to consider when scheduling that C-section.

-- Tami Dennis

Photo credit: Los Angeles Times


More women are refused healthcare due to hospital ideology, report says

May 27, 2010 | 12:27 pm

Contraceptives and abortion may be denied at Catholic hospitals; nun was excommunicated for approving an abortion in Phoenix A Phoenix-area nun was recently removed from her job as a senior administrator of a Catholic hospital and was excommunicated by the Catholic church because she was part of a hospital board that approved an emergency abortion last year for a woman -- a mother of four children -- whose life was in danger due to complications of the 11-week pregnancy.

That the nun, Sister Margaret McBride, should be punished for providing what is considered standard and appropriate medical care has led to a huge national outcry. But the issue goes further, according to a report released this week by the National Health Law Program, a national public-interest group that seeks to improve care for the working class, poor and minorities. The report claims that a growing number of patients are encountering hospital policies that deny some types of medical care -- such as abortion or contraceptive services -- due to ideological or religious beliefs. One in six Americans is seen in hospitals that have some restrictions, according to the report "Health Care Refusals: Undermining Quality Care for Women."

"When people go to the doctor, they should be able to expect that the care they receive meets prevailing medical standards," Susan Berke Fogel, the lead author of the report, said in a news release. "We reviewed policies at hospital systems representing more than 650 facilities across the U.S. and have documented the conditions and circumstances where that is not happening. We found a disturbing number of case studies where patients ended up far worse off either because their healthcare providers refused care or because their hospitals prohibited the care they needed for ideological or religious reasons."

This issue is typically framed as a moral contest between health providers' rights of conscience versus patient autonomy, Fogel writes in the report. But that narrow framework overlooks the most important factor in the debate: an evidence-based analysis of what constitutes the best medical practice.

-- Shari Roan

Photo: Daniel Hulshizer  /  Associated Press

Infertility group says better insurance coverage, not government oversight, is needed

May 25, 2010 |  9:01 pm

SulemanBaby The birth last year in Los Angeles of eight babies to Nadya Suleman after IVF treatment -- as well as cases in which embryos have been stolen or transferred into the wrong patients -- has spurred discussion about whether the field of assisted reproductive technologies should be subjected to government oversight.

The major professional group of infertility specialists hinted in statements last year that perhaps the field -- which is largely self-governed and relies on voluntary participation of doctors -- could use a greater degree of regulation. As we reported last September in Booster Shots, Robert W. Rebar, executive director of the American Society for Reproductive Medicine said:

"The time has come for policy makers to sit down with the leading experts in the field to explore ways we can codify our standards to give them additional regulatory teeth. . .We will lead an effort involving our members, representatives of patient groups, policy makers and other stakeholders to work together to come up with solutions."

The ASRM then held a workshop in December in Washington, D.C., to seek input on oversight from government agencies, patients, physicians, academic experts and others.

The group issued its decision on further oversight in a paper released Wednesday that -- stunningly -- finds that no further oversight is needed to prevent "Octomom" cases and other ethically and medically questionable incidents. The report concludes that better insurance coverage of assisted reproductive technologies would greatly reduce inappropriate uses of the technology.

If everyone had infertility treatment insurance coverage, ASRM leaders argue in the report, patients would be less tempted to transfer a high number of embryos or use dangerous fertility drugs. Insurance providers, moreover, could then enact rules that limit the number of embryos transferred and select which reputable doctors and centers would be allowed to perform specific treatments. "Unlike most medical procedures to treat most diseases, insurance coverage for ART treatments remains rare in the United States," the report states.

ART practitioners must abide by federal, state and Food and Drug Administration rules, as well as professional self-regulation and physician board certification, thus making the field already "one of the most highly regulated of all medical practices in the United States." Thus, ASRM leaders conclude, no further government oversight is necessary at this time. "A simple legal restriction on the number of embryos transferred would not be desirable," they wrote.

The report notes that the doctor involved in the "Octomom" cases is being appropriately punished under existing state medical regulations and that this one notorious case has led to unnecessary calls for additional legal enforcement and punishments of doctors who breach voluntary guidelines. But, the report says, "Standards set by members of the profession for the practice of reproductive medicine are widely followed and successful."

Given the comments that L.A. Times readers submitted to our website after Octomom gave birth, however, it seems that many people do believe further regulation of the industry is needed -- even if it's to control the occasional rogue doctor. The ASRM's "We're just fine, thanks" position is sure to be challenged. According to a position paper by ethics think tank the Hastings Center, the ASRM clearly lacks the ability to enforce its voluntary guidelines.

"Without governmental oversight, clinicians may practice medicine in accordance with their own beliefs. Variability in the beliefs of different practitioners permits most patients turned down by one clinic to find another where practitioners will feel comfortable treating them," the Hastings Center's position paper states. "The lack of regulation and practitioner variability means that individual decisions about eligibility for ARTs may be arbitrary, biased and inconsistent, shielding practitioner prejudices, subjecting prospective parents to great uncertainty and avoiding public discussion of difficult policy issues in reproductive policy."

-- Shari Roan

Photo: One of the Suleman babies. Credit: AP Photo  /  NBC NEWS

Hysterectomy after childbirth carries higher risks

May 25, 2010 |  7:00 am

In Sunday's L.A. Times, we reported on rising rates of maternal mortality in the United States. Two studies in the June issue of the journal Obstetrics & Gynecology address this disturbing development. On Monday in Booster Shots, we reported on the first study, which shows why it may be safer for some women to have vaginal birth after a cesarean instead of repeat cesareans.

MortalityCHART The second relevant study in the journal describes the stunning complications of having an emergency hysterectomy following childbirth. According to the authors of the paper, cesarean delivery is the most important risk factor for childbirth-related hysterectomy. Although this complication is uncommon, women who have C-sections are six times more likely to need a hysterectomy compared to women who have vaginal birth.

At other times of life, hysterectomies are typically very safe. When the surgery is performed after childbirth, however, it is often an emergency procedure due to a hemorrhage following a cesarean section. One would expect that complications would be greater in hysterectomies performed in this type of situation -- and are they ever. The study, by researchers at Columbia University College of Physicians & Surgeons examined data from almost 5,000 women who had a hysterectomy following childbirth and compared that group to 578,179 women who had a non-obstetric hysterectomy.

Although deaths are rare, they were 25 times higher when performed following childbirth compared to non-obstetric hysterectomies. Bladder and ureteral injuries were more common in hysterectomy following childbirth (9% and 0.7% compared to 1% and 0.1% in the non-obstetric hysterectomy). The need for a second operation was higher (4% compared to 0.5%) as was postoperative hemorrhage (5% compared to 2%), wound complications (10% compared to 3%) and blood clots (1% compared to 0.7%). This is despite the fact that women having post-childbirth hysterectomies are likely to be much younger and in generally better health than women having non-obstetric hysterectomy.

Changes have been proposed to lower maternal mortality rates, including lowering the rate of Cesarean sections and having rapid response teams in case of a hemorrhage. The authors of the study note that the complications and risks associated with a subsequent hysterectomy should be part of the focus on expanding patient safety in obstetrics.

-- Shari Roan

Praphic: Maternal mortality has risen in the United States and in California in the past decade. Credit: Los Angeles Times.

Bring back vaginal birth after C-section, study says

May 24, 2010 |  2:00 pm

Deaths and severe complications in pregnancy and childbirth are increasing in the United States, according to an article, "Rising Maternal Mortality Rate Cases Alarm, Calls for Action," published Sunday in the Los Angeles Times. Experts on maternal health think there are several reasons for this trend: More pregnant women today are older and obese, and childbirth practices have changed greatly over the past two decades with more cesarean sections and induction of labor. The death of a new mother at what should be a joyous time is unspeakably sad. We profiled a Los Angeles man, Matt Logelin, whose wife died unexpectedly a day after giving birth to their daughter.

Why is having a baby today less safe than it was two decades ago? Two studies published Monday in the journal Obstetrics & Gynecology, one on vaginal birth after C-section and one on childbirth-related hysterectomy, make suggestions for addressing the crisis in obstetrics.

The first paper summarizes the findings of a government consensus conference that took place in March at the National Institutes of Health. Researchers concluded that vaginal birth after cesarean is "a reasonable choice for the majority of women." The paper is based on a large database of births and finds that although both elective repeat cesarean section and VBAC are highly safe, maternal death was higher for elective repeat Cesarean sections (0.013% versus 0.004% for a trial of labor). The rates of hysterectomy, hemorrhage and transfusions did not differ between the two groups. Uterine rupture -- the complication that is usually given for discouraging VBACs -- was rare but higher in the trial of labor group (0.47% compared with 0.03% in the repeat C-section group). Infant death was higher in the trial of labor group (0.13% compared with 0.05% in the repeat C-section group).

About one-third of all births today in the U.S. are cesareans, and the most common reason for needing a C-section is that the mother has already had one. But recent studies show that two or more cesareans increase the risk of dangerous complications of the placenta that may be contributing to the increase in maternal deaths in recent years. That complication may prove to be more significant than the risk of uterine rupture in a woman attempting a VBAC, said Dr. James R. Scott, the editor in chief of Obstetrics & Gynecology, in an editorial accompanying the study.

It's time to start reversing C-section rates in part by allowing VBACs in carefully selected patients, Scott wrote. For that to happen, he said, hospitals and insurance companies need to lift their flat-out bans on VBACs. "Instead, the patient should be allowed to make that choice after she has been informed of the facts and has been counseled by her physician thoroughly," Scott said.

Tuesday in Booster Shots: A bad combination -- childbirth and hysterectomy.

-- Shari Roan

Photo: Matt Logelin and daughter Madeline. Logelin's wife, Liz, died of a blood clot one day after giving birth in March 2008. Credit: Allen Brisson-Smith / For The Times


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