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.

Om Sweet Om

As a long-time yoga practitioner and instructor, I am always interested in new research on the benefits of yoga practice. Two recent studies suggest that yoga can both boost your mood and improve your migraines.

In one recent study, researchers compared the effects of one hour of reading to one hour of practicing yoga on brain functioning. They found the yoga practitioners had a 27% increase in GABA levels, while the readers experienced no change. GABA is the primary inhibitory neurotransmitter in the central nervous system, and low levels of GABA are associated with mood disorders, including depression, anxiety, and manic-depression (bipolar).

In a randomized controlled trial of yoga versus self-care for migraine sufferers, the patients who were randomly assigned to yoga showed significant improvements over those assigned to self-care in headache intensity, frequency, and pain levels. The yoga practitioners also had significant reductions in symptoms of anxiety and depression and use of migraine medications compared to those in the self-care group.

Other research suggests that yoga can improve quality of life in breast cancer patients, decrease seizure activity in individuals with drug-resistant epilepsy, improve gastrointestinal symptoms in adolescents with irritable bowel syndrome, and improve chronic lower back pain. Sound too good to be true? Learn more and judge for yourself. Meanwhile I'll keep doing my sun salutations. Namaste.

Weight Matters in Pregnancy

Ask the average woman how much weight she should gain during pregnancy, and she'll probably respond 25-35 pounds. This Institute of Medicine guideline has been the practice for nearly 20 years. However, this recommendation is for normal weight women (i.e., body mass index [BMI] 18.5-24.9). The IOM also recommends that overweight and obese women limit their gestational weight gain according to their prepregnancy BMI.

A recent study, however, shows that many overweight and obese women are not limiting their weight gain during pregnancy, and this can have serious consequences for both the mother and newborn. In their study of over 7,500 women, researchers found that 64.3% of overweight and 52.9% of obese women gained more weight during pregnancy than recommended by the IOM for their BMI. Further, overweight and obese women were more likely to deliver by C-section and give birth to infants who were large for gestational age, with associated complications including the infant’s anterior shoulder becoming stuck above the pubic bones during delivery, birth canal lacerations, and fetal hypoglycemia (low blood sugar). Overweight/obese women also were less likely to initiate or continue breastfeeding beyond 10 weeks.

So if you are planning to become pregnant in the next year, take a look at your BMI. If you're above 25, talk to your doctor about steps to lose weight. Further, once you become pregnant, keep an eye on your diet and the scale. Pregnant women need only an additional 300 calories per day. By watching your weight before and during pregnancy, you'll not only improve your own health, but you'll also improve the health of your baby.

Stop Smoking, Start Gaining?

Many women who smoke say they are afraid to stop smoking for fear of gaining weight. However, new research suggests that reductions in smoking rates had less than a 1% effect on increased rates of obesity nationwide. Further, a forthcoming study shows that among weight-concerned smokers trying to quit, nicotine has only a small and temporary effect on weight maintenance.

What does contribute to weight gain? A social network analysis of over 12,000 people between 1971 and 2003 showed that friends and family are key. Individuals were 57% more likely to become obese if a friend became obese, 40% more likely if a sibling became obese, and 37% more likely if a spouse became obese. Further, same sex friends and family members had more influence on weight gain than opposite sex friends and family members.

So if you're worried about how quitting smoking might affect your waistline, fret no more. And whether you smoke or not, do take a look around your inner circle. If you see women friends and family members packing on the pounds, you may want to suggest a walk as opposed to a meal when spending time together.

ATTENTION MOMS: GOT STRESS?

Well, duh, you say. Just the fact that you are a mom means you have stress. It's also not news to you that more stress means worse mental health. However, researchers have found that the source of your stress matters. Using nationally representative data, these researchers identified three key predictors of poor mental health:

(1) lack of support, including nobody to provide you emotional help with parenting or give you a break when you need it;

(2) spending too much time with your child. That's right too much time - moms who think they don't spend enough time with their kids don't experience the same negative mental health effects; and

(3) difficulty paying for child care. Other financial difficulties, such as trouble paying for medical care or supplies for the child, lack of health insurance for the child, and missed or delayed health care for the child did not produce the same negative mental effects.

Further, these authors found that having more than one stressor exponentially increased the likelihood that moms experience poor mental health. Moms with two or more stressors were nearly 12 times as likely to have poor mental health compared to moms with no stressors (apparently these women exist, but I have yet to meet them).

So what does this all mean for moms out there? It means get help when you need it - ask your partner, your family, your friends. It means there really is too much time with your child and not enough time for yourself, so don't feel guilty about taking me-time when you need it. (Recall the last flight you took....first put the oxygen mask on yourself, then help children and disabled passengers.) It means as a society we need to do a much better job of helping working moms with childcare strategies they feel good about. Co-op (pdf) anyone?

Mandate HPV Vaccine for Boys?

A new research finding on HPV is certain to add to the controversy about whether young women should be mandated to receive the HPV vaccine. Wait - did I say young women? It seems this new finding implicates young men. Dr. Laura Koutsky, a researcher at the University of Washington who led some of the original research and clinical trials that resulted in Gardasil, Merck's HPV vaccine, has discovered the presence of HPV under the fingernails of young men.

I'm going to be completely transparent here and say that when I first heard about states (including my own) wanting to mandate the HPV vaccine for school-age girls, I was none too pleased. Don't get me wrong, I'm not against vaccines in general. I have no problem vaccinating against chicken pox, tetanus, diphtheria, pertussis, flu, etc. for a couple of reasons. One - in most cases we're talking about airborne diseases, and two - we're not focusing on one sex or the other - both male and female children and adolescents receive them equally.

I DO have a problem mandating a new vaccine for girls only for a disease that until now was assumed to be contracted solely through sexual contact. Why? For a number of reasons. First, and perhaps most importantly, I believe this is a collaborative decision (read choice) for the parents, the physician, and the patient to make that should involve a very important discussion. By mandating this vaccine, we're removing a potential opportunity for parents to have the "sex talk" with their pre-teens. As dreaded as this talk may be to some parents, allowing families to make the decision about the HPV vaccine opens up an important opportunity to discuss: (1) how HPV gets transmitted (SEX); (2) how you can protect yourself (CONDOMS, ABSTINENCE, TALKING WITH YOUR PARTNER ABOUT PREVIOUS PARTNERS); and (3) the fact that this is just one STD of many (HIV, HERPES, GONORRHEA, CHLAMYDIA, to name a few) that the vaccine doesn't protect you from. My fear is that mandating this vaccine may facilitate parents avoiding "the talk" by giving them a false sense of security about their child's health.

Second, I feel uncomfortable mandating a vaccine that is so new to the market. Despite the best attempts at ensuring the safety of a product, there are enough cases of other products deemed to be safe in clinical trials that ultimately were found to cause severe adverse reactions, including death in some cases. Think Vioxx (another Merck product, by the way), Fen-Phen, and Rezulin among others. I'm uncomfortable with taking the decision-making out of parents' hands when we have no long-term data on the vaccine's safety. I think we need to trust parents and physicians to evaluate the data on their own terms and decide independently whether this is the route they want to choose for their daughters and patients. Not to mention, if there were significant adverse events associated with the vaccine over the long-term, is the government agency that mandated the vaccine going to take responsibility for any adverse outcomes? Somehow I doubt it.

Third (and this is the feminist in me talking) I just don't believe that we'd be mandating a vaccine for young men only. This is why Dr. Koutsky's finding is so important. One of the clear principles of epidemiology is to identify the source of an infection and at-risk populations in order to implement control and prevention strategies. With this principle in mind, scientific evidence that reveals the presence of HPV under the fingernails of young men suggests we need to be targeting young men in our control and prevention strategies - not just rushing to vaccinate all young girls and holding young boys unaccountable for their role in HPV transmission. While the HPV vaccine has some very positive potential, for now I'd like parents to retain the choice about whether to vaccinate until we see more long-term safety data on the vaccine and more research on prevention strategies for young men, including a vaccine for pre-teen boys. If and when such a vaccine hits the market, I'll be interested in seeing how many folks want to mandate it for boys.