Weight Matters in Pregnancy: Part III

Last week I wrote two posts about how excess weight during pregnancy may result in poor infant outcomes, including large for gestational age newborns and a variety of birth defects. A study published this week provides further evidence for watching weight before and during pregnancy - only this time the evidence focuses on moms.

After reviewing long-term medical data from over 37,000 women who had live births in Israel, the researchers found that women who were diagnosed with gestational diabetes (diabetes during pregnancy) had increased risk for later cancer of the pancreas. They did not find the same cancer risk for women who had insulin-dependent (type I) diabetes.

What does this have to do with obesity, you ask? One of the primary risk factors for gestational diabetes is a high body mass index (BMI). And research shows that more and more women are being diagnosed with gestational diabetes - which is not surprising given the growing problem of overweight and obesity in the United States. So, I’ve said it before and I’ll say it again: If your BMI is high and you’re thinking about pregnancy, you may want to talk to your doctor about how to lose weight first. It’s a decision that will improve not only your baby’s health, but your own.

Making Babies Part II - Alternative Therapies

I had a request for information about yoga for infertility, so I did some investigating. When I say investigating, it means I checked PubMed, which is considered "the source" for medical research. Here's what I found.

To date, no published studies have actually documented yoga in relation to fertility outcomes (so here's a novel study idea for the complementary and alternative medicine [CAM] researchers out there). However, a single article on yoga and meditation for infertility published in the journal Fertility and Sterility did suggest that yoga and meditation can help patients to handle the challenges of fertility treatments, including developing patience (which is a requirement when first attempts at assisted pregnancy fail), reducing overall stress, and growing more in touch with their bodies.

Studies have documented, however, the use of acupuncture as an adjunct therapy to infertility treatments, and specifically IVF. A recent review of these studies suggested that acupuncture may indeed be a useful aid in improving the success rate of IVF, as well as improving the quality of life of women who undergo it.

According to another review of the effectiveness of vitamins and herb supplements, too few studies have been conducted on how well they work for infertility. However, the author noted preliminary evidence suggests chasteberry, antioxidants, and Fertility Blend may have some benefit.

One thing that is important, couples who decide to use CAM therapies in conjunction with fertility treatments should inform their doctors, so they can be certain doctor-prescribed therapies are not contraindicated with the naturopathic remedies. Also, while there are no published studies on the subject, if you do want to try yoga for infertility you might find some ideas here.

(Note: As stated in my sidebar, always check with your doctor before starting any physical activity.)

Making Babies - Assisted Reproductive Technology Style

Anyone who has had fertility issues knows that it is a huge investment emotionally, physically, psychologically, and financially. Of the many things to think about when undergoing fertility treatment, one issues has been how to factor in the relationship between fertility treatments today and possible breast cancer tomorrow. Does the benefit of having a child outweight the risk of possible future disease that may take you from your child at some point?

A new study may help couples answer this question. Danish researchers reviewed records of over 54,000 women who received fertility treatments to investigate the suspected link between fertility drugs and breast cancer. They found there was no overall increase in breast cancer risk after using the most common of fertility drugs, including gonadotrophins (e.g., Factrel, Lutrepulse, Relisorm), clomiphene citrate (clomid), human chorionic gonadotropin (e.g., Novarel, Ovidrel, Pregnyl, Profasi), or gonadotropin-releasing hormone (e.g., Lupron, Synarel). There also was no relationship with how many cycles the woman received fertility treatments.

The study did show, however, that women who used progesterone were three times as likely to develop later breast cancer risk. There also was a slightly elevated breast cancer risk for women who had never had children and used gonadotropins.

If you are considering or undergoing fertility treatments and you are using some of the more common drugs, hopefully this study will give you some peace of mind. However, if you're being prescribed progesterone or gonadotropins, this study suggests that a frank discussion with your doctor about the risks and benefits is in order. Your future health may depend on it.

What's sex got to do with it?

Apparently a lot, according to a new study published in Gynecologic Oncology this month. In the first (!!) study of its kind, researchers examined the sexual health and functioning of long-time survivors of vaginal and cervical cancers. Compared to similar women without cancer, the cancer survivors were more likely to experience a variety of sexual problems, including lack of desire, painful intercourse, inability to have an orgasm, vaginal dryness, and anxiety about their sexual performance. Further, despite the fact that most of these women had their sexual organs removed or destroyed during their cancer treatments, only one-third of doctors actually talked to these women about their sexual health.

The lack of talking isn't for lack of wanting to talk either - at least not on the patients' part. Most of the cancer survivors surveyed believe sex is an important part of life and they want their doctors to discuss their sexual health. So why aren't they?

It's no secret that we Americans have a lot of hang-ups when it comes to sex. Just take a look at your neighborhood abstinence-only (sex) education program ("zippers closed, buttons buttoned") to see that. But we're talking about consenting adult women (average age = 49 years), nearly three-fourths of whom were married and several more who were in long-term partnerships. In my view, doctors need to step it up and take responsibility for initiating conversations about sexual health with female patients. Further, these conversations need to occur not only with cancer survivors, but with all women across the lifespan, and especially as women age and hormonal shifts affect sexual health and functioning.

While I would like to think my call to arms will inspire physicians to talk to their patients about sex and sexual functioning, it's clear from this study that women unfortunately can't depend on their doctors to initiate such conversations. Rather, women need to be proactive partners in their health care, and sometimes this means bringing up difficult conversations. ("Well, Dr. X, I'm not having orgasms when I make love to my husband.") Women deserve to enjoy sex in the same way as men - and the way that little blue pill flies off the shelves, my guess is men are enjoying it fully, doctor-approved.

Moms Get "A" for Minding Children's Health

Single moms often receive a lot of flack for, well, being single moms, whereas single dads are patted on the back for "stepping up" to their parenting responsibilities. A study published online this week should give single moms a boost, however. Apparently, when it comes to their children's health, single moms are way ahead of single dads in terms of health behaviors.

Researchers examined data from over 62,000 children (0-17 years) in the United States. They found that only 1/2 of children in single-father families saw a doctor for a check-up. Conversely, more than 2/3 of children in single-mother households received a "well-child" check-up. Further, children in single-mother families had a lower risk of drug use, had fewer problems in school, and exhibited fewer risky behaviors compared to children in single-father families - all this despite the fact that single moms are more likely to be poor, which is a risk factor for both limited health care access and a variety of health problems.

Why are moms better than dads at getting their kids in for a check-up? The authors of the study suggest that single moms may have a better grasp of the public programs available to them. The authors also suggest that dads may be bigger risk-takers, whereas moms don't want to take a chance with their children's health. Clearly, this is an area for more research. Meantime, single moms everywhere should be applauded for taking care of their children's health.

Weight Matters in Pregnancy: Part II

If my previous post on weight matters in pregnancy didn't convince you that starting your pregnancy obese can be bad for your baby, findings from a study published this week just might.

Researchers reviewed the birth outcomes of more than 4,000 women in eight states over a five-year period. They found that mothers who were obese (defined as a body mass index of 30 or greater) prior to pregnancy were significantly more likely to have infants with birth defects, including spina bifida, heart deformities, malformed rectums, hypospadias (abnormal opening of the urethra in males), short or missing limbs, hernias in the diaphragm, and abdominal wall defects. These researchers made sure that this was an obesity issue by not including infants whose birth defects had a known or suspected genetic cause and adjusting their calculations for women who took folic acid, which has been shown to reduce some birth defects.

I may sound like a broken record here, but the evidence continues to mount regarding the need to address overweight and obesity, especially among women of childbearing age. Additionally, given that: (1) Kentucky's rate of neural tube defects (such as spina bifida) is 1.5 times the national average; (2) birth defects are the leading cause of infant mortality in Kentucky; and (3) we already know that we're the fifth heaviest state in the nation, we've got some work to do if we want to meet our goals for improved birth outcomes in the Commonwealth.

FREE Antibiotics (yes, your contacts are working)

Although this blog is primarily dedicated to relaying research findings, every now and then a story will capture my interest that I have to share.

This week, Publix (a major supermarket in the South and one I used to frequent when I lived in Athens, GA) announced that they will be offering a FREE prescription drug program at all of its 684 pharmacies for the 7 following antibiotics: Amoxicillin, Cephalexin, Sulfamethoxazole / Trimethoprim (SMZ-TMP), Ciprofloxacin (excluding ciprofloxacin XR),
Penicillin VK, Ampicillin, and Erythromycin (excluding Ery-Tab).

Anyone (that's right, anyone - no income or insurance requirements to be met) who has a prescription can receive up to 14 day's worth of the above antibiotics, which will be filled free of charge. Furthermore, Publix is not limiting the number of prescriptions customers may fill. So if you get a sinus infection every month for the rest of the year and need antibiotics each month, you can get your medicine for free each time. (Of course, if that's the case, I might recommend a new doctor.)

As a researcher who studies low-income families, I am thrilled that Publix has taken this step. There are so many documented cases of families choosing among rent, food, and medicine. In fact, next week a student and I will be presenting on unmet health care needs at a conference on rural women's health sponsored by the Office of Women's Health. One of our findings in this low-income group was that the women with acute needs (i.e., unexpected illness or injury) did not fill their prescriptions. There will be more to come on our research next week. For now, I'm excited about this trend of companies stepping up to help families meet their economic and health care challenges. And, if you live in Alabama, Florida, Georgia, South Carolina, or Tennessee, find the Publix nearest you and take advantage of this great opportunity.