Booster Shots

Oddities, musings and news from the health world

Category: pregnancy

State teen pregnancy prevention efforts garner praise

May 21, 2010 | 10:51 am

Crib California has distinguished itself among states for its strong teen pregnancy prevention strategy dating back to the early 1990s, says the author of a paper published this week in the Guttmacher Policy Review. The state achieved these results by being bold enough to carve out its own strategy on teen pregnancy prevention and by bucking the popular politics of the last decade that promoted abstinence-only sex education, the report states.

The state's Department of Public Health reported in February that births to teen mothers reached a record low in 2008 of about 35 births per every 1,000. Nationwide, however, teen pregnancy rates have risen in recent years.

According to the report in the Guttmacher journal by Heather Boonstra, a senior public policy associate for the Guttmacher Institute, California's program was notable because the state made teen pregnancy prevention a priority and because the effort encompassed comprehensive sex education, healthcare services and counseling to prevent pregnancy. California is the only state that did not accept federal abstinence-only funds. Moreover, Boonstra said, California's 1997 launch of the Family PACT (Family Planning, Access, Care, and Treatment) program to provide reproductive health services and contraception free to low-income individuals was particularly successful in meeting the health needs of adolescents. Private sector foundations in the state also played a large role in teen pregnancy prevention efforts.

Further, the policy was bipartisan. The state's efforts to prevent teen pregnancy have spanned three administrations -- two Republicans and one Democratic. But this strong politic will be tested in the future with state budget cutbacks, Boonstra warned.

"The California experience demonstrates what can happen when there is long-term bipartisan support for a concerted, statewide effort, involving various actors from both the public and private sections, all working in the same direction," Boostra wrote. " ... In California, the whole of the effort clearly added up to more than the sum of its parts."

I like to think of the success of this program in terms of the teenagers. Because of fact-based sex education and access to reproductive health services, thousands of young women have been able to proceed with their education, jobs and lives without the premature responsibility of pregnancy and motherhood.

-- Shari Roan

Photo credit: Louie Balukoff  /  Associated Press

Limit the number of embryos transferred in IVF, essay says

May 14, 2010 |  6:00 am

The United States should adopt a law similar to what is practiced in Sweden allowing, in most cases, only single-embryo transfers during in vitro fertilization treatment, according to an essay published Thursday in the Hastings Center Report.

SulemanBaby Infertility doctors have been urged for several years to voluntarily limit the number of embryos transferred during IVF in order to avoid multiple births, such as the famous eight babies born last year to Los Angeles resident Nadya Suleman after IVF treatment.

Studies show that success rates are still good in healthy women when only one embryo is transferred instead of two or three. But the informal policy, while reducing the rate of high-order multiples, hasn't had as much success in lowering the rate of twin births. Any birth of multiples increases the risks of complications to both the babies and mothers and significantly increases healthcare costs. Many couples would rather have twins or triplets than pay out-of-pocket for multiple single-embryo transfers to build their families, notes the author of the opinion, David Orentlicher, of the Indiana University School of Law.

That's why he suggests that the United States enact legal limits to transfer only one embryo. Double-embryo transfer could be permitted for women at low risk of multiple births or because of a woman's age or medical history. Such a law reduced multiple births in Sweden from 35% to 5%, he said in his report.

"If the outcomes were similar to those in Sweden, and if transfer restrictions were coupled with insurance coverage of IVF, the restrictions would not limit reproductive rights," Orentlicher wrote.

— Shari Roan

Photo: One of the Suleman octuplets born in January 2009. Credit: Associated Press. 

50 years of 'the pill' -- and here's yet another one

May 7, 2010 |  6:45 pm

Pill "The pill" appears to be evolving, but to what end? On Thursday, the Food and Drug Administration approved a new oral contraceptive called Natazia. It's the first to offer doses of progestin and estrogen that vary at four times throughout the 28-day treatment cycle.  

Here's the FDA announcement of the new oral contraceptive.

And here's a recent Health section story that provides an explainer on the evolution of birth control pills (they're not just for preventing pregnancy any more) -- and how two of the offerings in particular have proved especially controversial in recent years. That story, "Birth control pill concerns bring lawsuits but few solid answers," begins:

"When the oral contraceptives Yasmin and Yaz came on the market in 2001 and 2006, respectively, they were thought to be safer than other birth control pills because they contained a different kind of synthetic progestin.

But in a flurry of lawsuits against the pills' maker, Bayer HealthCare, attorneys claim that the progestin contained in the pills, drospirenone, is the cause of health problems, including deep vein thrombosis (blood clots in the deep veins), strokes, heart attacks and gallbladder disease."

Meanwhile, Times staff writer Shari Roan offered a perspective worth mulling this week amid all the reflections on the 50th anniversary of oral contraceptives. As she notes in that story, "'The pill': 50 years after":

"But despite the freedom in career and family planning it extended to so many women and couples, the pill has not fulfilled one big hope. Fifty years on, about half of all pregnancies in the U.S. are unintended and 22% of pregnancies end in abortion.

'It's not going to be the answer to unintended pregnancy — we can be sure of that,' said James Trussell, director of Princeton University's Office of Population Research and a leading authority on contraception.

Trussell thinks that the pill's time is passing — and that the future lies instead with fool-proof contraceptives that require almost no thought or action."

The new pill still requires both thought and action. 

Not all contraceptives do. Here's more on hormonal contraceptives from the American Congress of Obstetricians and Gynecologists, including those that require no daily reminders.

Plus, here's more complete Natazia information from manufacturer Bayer.

-- Tami Dennis

Photo: Which to choose? The (by now) traditional hormonal contraceptive in pill form or an injectable version. Credit: Associated Press

H1N1 flu death rates higher among pregnant women

April 21, 2010 |  6:00 am

Romo20 Pregnant women who were infected with H1N1 influenza last year had a much higher risk of dying from complications of the illness compared with other groups, government researchers reported Tuesday.

Data from the Centers for Disease Control and Prevention show that, during the five-month peak of the outbreak from April through August, 5% of H1N1 deaths were among pregnant women although they account for only 1% of the population.

The study, published in the Journal of the American Medical Assn., supports previous research that found H1N1 is particularly dangerous during the third trimester of pregnancy. Taken together, the research leaves no doubt about the value of H1N1 flu vaccination for all pregnant women and rapid treatment with antiviral medications (TamiFlu) as soon as flu symptoms become apparent.

The dozens of young women who died in 2009 left behind grieving families who can scarcely believe how a healthy wife and mother could be taken so swiftly. A story on one such family, who live in Santa Ana, was published earlier this year in the Los Angeles Times.

-- Shari Roan

Photo: A memorial to a Santa Ana woman who developed H1N1 flu while pregnant and later died. Photo credit: Don Barletti  /  Los Angeles Times

To tackle childhood obesity, focus more on pregnancy and infancy

April 15, 2010 | 11:32 am

Childhood obesity campaigns such as First Lady Michelle Obama's "Let's Move" program are good, but they may not be enough to truly stem the tide of obesity, according to a perspective article published online Wednesday in the New England Journal of Medicine.

Kz0kjqncThere's no doubt that school and home interventions focusing on nutrition and exercise are helpful, and more attention is being paid to improving school lunches and encouraging physical activity. But some studies show that those efforts may be too little too late, say the paper's authors, Janet Wojcicki and Dr. Melvin B. Heyman of the department of pediatrics at UC San Francisco, who make a strong case that more importance needs to be placed on pregnancy and infancy.

Too many overweight and obese children are exhibiting ill effects such as high blood pressure and early signs of heart disease by the time they're in school. And that doesn't bode well for later years. "[P]revention must start as early as possible," the authors wrote, "since school-age children already have an unacceptably high prevalence of obesity and associated medical conditions." This topic was covered in depth by Times health writer Shari Roan.

Issues that should be targeted include excessive maternal weight gain, smoking during pregnancy and truncated breast feeding. "Studies have shown," the authors wrote, "that early interventions can potentially prevent the development of obesity in school-age children, along with associated health conditions."

Wojcicki and Heyman point out that attempts are being made to address this critical period, such as stop-smoking campaigns and the Institute of Medicine's stricter guidelines for pregnancy weight gain for obese women. But they add, "The Let's Move campaign could synchronize its efforts more directly with these existing campaigns and try to ensure that the IOM recommendations are more widely known and followed by pregnant women."

-- Jeannine Stein

Photo credit: Viktor Drachev / AFP/Getty Images

Vitamins C and E don't prevent preeclampsia and other pregnancy complications, study finds

April 9, 2010 | 11:02 am

Contrary to the results of earlier studies, large quantities of vitamins C and E do not prevent preeclampsia, high blood pressure and other complications of pregnancy, researchers found in the largest study of the vitamins to date. British researchers reported about a decade ago that the vitamins, which are known to be antioxidants, lowered the risk of preeclampsia, but subsequent studies have yielded mixed results.

Preeclampsia, which affects about 6% of pregnancies, is a sudden increase in blood pressure, usually occurring after the 20th week of pregnancy. It can damage the mother's kidney, liver and brain and lead to the death of the mother and infant if left untreated.

To examine the subject more thoroughly, a team headed by Dr. James M. Roberts of the University of Pittsburgh enrolled 10,154 pregnant women in the ninth to 16th week of their pregnancies. All were in their first pregnancy, were healthy and did not have hypertension or gestational diabetes. In addition to their normal pregnancy vitamins, half received 1,000 milligrams of vitamin C and 400 international units of vitamin E daily--about 10 times the normal daily dose--or a placebo.

The rate of preeclampsia was 7.2% among those taking the vitamins compared with 6.7% among those taking a placebo, a statistically insignificant difference.  The rate of simple hypertension and other complications was 6.1% among those taking vitamins and 5.7% among those taking the placebo.

"These results are very useful," said Dr. Catherine Y. Spong of the National Institute of Child Health and Human Development in a statement. "In this case, it shows us that what originally appeared to be a promising treatment did not actually offer any benefit clinically."

Roberts cautioned women against discontinuing their pregnancy vitamins, which are important to maintain the health of the mother and fetus. At the level of vitamins used in the study, he said, they should be considered drugs, not supplements.

-- Thomas H. Maugh II

Another loss can follow for couples who lose a pregnancy

April 5, 2010 |  5:25 pm

Scientists have had a hard time finding data to support the widespread notion that parents are more likely to divorce following the death of a child. But a new study finds that the risk is indeed higher for couples after a pregnancy goes awry.

Baby Researchers from the University of Michigan Medical School used nationwide data on U.S. families to track the outcomes of pregnancies and the effects on parents. They calculated that couples who experienced a miscarriage were 22% more likely to break up than couples whose pregnancies resulted in the birth of a child. The increased risk persisted for three years.

Things were even worse for couples coping with a stillbirth – their odds of splitting were 40% higher, and the risk persisted for nine years, the researchers found.

About 15% of pregnancies end in miscarriage (the loss of a pregnancy during the first 20 weeks of gestation) and 1% end in stillbirth (loss after 20 weeks), so the number of relationships that end in the wake of these losses is significant, according to the researchers.

The study will be published in the May edition of the journal Pediatrics.

-- Karen Kaplan

Photo: When pregnancies don't end in a live birth, couples face an increased risk of separation. Photo credit: Chris Sweda/Chicago Tribune/MCT

Exercise in pregnancy leads to lower (still healthy) birth weight

April 5, 2010 | 10:01 am

Pregnancy Many infants in the U.S. today are born too large for their gestational age. However, a new study shows that exercise during pregnancy may help babies start life at a healthy weight.

Researchers in New Zealand compared 84 first-time mothers who either exercised during pregnancy or were sedentary. The women who exercised participated in stationary cycling five times a week for 40 minutes. Those women gave birth to babies that were, on average, three to five ounces lighter than the babies of the non-exercisers. There was no difference in birth length between the two groups of babies. The exercise had no effect on maternal body mass index and no detrimental effect on insulin resistance. Previous studies have shown that exercise during pregnancy prevents excessive weight gain in women and can reduce the risk of gestational diabetes.

"Given that large birth size is associated with an increased risk of obesity, a modest reduction in birth weight may have long-term health benefits for offspring by lowering this risk later in life," the lead author of the paper, Dr. Paul Hofman, of the University of Auckland, said in a news release.

The study was released Monday online in the Journal of Clinical Endocrinology & Metabolism.

-- Shari Roan

Photo: Ricardo DeAratanha  /  Los Angeles Times

The postmortem on pregnancy and H1N1 flu

March 25, 2010 | 11:30 am

Miguel Romo As early as last July, federal health officials warned doctors and pregnant women that the H1N1 (swine) flu virus appeared especially hazardous for pregnant women. In the fall, officials urged pregnant women to be vaccinated against H1N1, although surveys showed that pregnant women often hesitated to get any vaccines. Health authorities also instructed doctors, by way of several bulletins to practitioners nationwide, that pregnant women who showed symptoms of the flu should be treated immediately with antiviral medications, even before H1N1 infection was confirmed.

A growing body of scientific evidence has crystallized regarding how important this advice is. A study published last week in the British Medical Journal found that pregnant women in Australia and New Zealand who had H1N1 were 13 times more likely to be admitted to the hospital with a critical illness compared with others who had H1N1. The study found that 11% of mothers and 12% of their babies who were admitted to an intensive care unit died.

Another study, from the U.S. Centers for Disease Control and Statistics, examined 2009 H1N1 cases among pregnant women in New York City last year and found the hospitalization rate was 55.3 per 100,000 people among pregnant women compared with 7.7 per 100,000 non-pregnant women.

Moreover, the study affirmed the importance of rapid treatment with antiviral medications. Among the pregnant women who received Tamiflu within two days of the onset of symptoms, only one of 30 women (3.3%) died. Among those who started Tamiflu on the third and fourth days, three of 14 women (21.4%) died. Among women who started treatment five or more days after the onset of symptoms, four of nine (44.4%) died. According to the study, published Monday in the journal Obstetrics & Gynecology, the infants died in five of the six cases of women with severe illness who delivered while hospitalized.

After the deaths that occurred in 2009, it will be hard to understand if pregnant women and their doctors don’t take the threat of H1N1 even more seriously in the coming year. Two safety nets exist: vaccination and rapid antiviral treatment. Click here for a story in February in The Times about a pregnant mother of six who died after contracting H1N1.

-- Shari Roan

Photo: Miguel Romo, of Santa Ana, lost his wife to an H1N1 infection in the eighth month of her pregnancy. Her daughter, named Virginia after her mother, survived. Credit: Don Barletti / Los Angeles Times


Antithrombotic therapy for miscarriage fails in study

March 24, 2010 |  2:00 pm

There is a real dearth of answers for the many women who have repeated miscarriages. Five percent of reproductive-age women have two or more known miscarriages and 1% have at least three. The reasons for many miscarriages are unknown, although doctors have long suspected that blood clotting disorders are the cause of at least some.

A new study, however, casts doubt on antithrombotic therapy -- therapy to reduce clotting -- for women with recurrent miscarriages. The research, published Wednesday in the New England Journal of Medicine, assigned 299 pregnant women to either aspirin and heparin (a blood-thinner), aspirin alone or a placebo. The trial was stopped early because there were no differences in the miscarriage rates in the three groups. A previous randomized, controlled trial in Scotland also found the therapy is ineffective.

In an editorial accompanying the study, Dr. Ian Greer, a pregnancy expert at the University of York, United Kingdom, says that antithrombotic therapy may still help some women who have a known tendency to form blood clots although more research is needed on those women. But, he wrote: "The widespread use of antithrombotic interventions for women with two or more miscarriages appears to be no more than another false start in the race to identify an effective intervention for this distressing condition that affects so many women."

-- Shari Roan


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