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Substance Abuse during Pregnancy Reproductive Health Services | Infants Conceived Unassisted Have Similar Risk of Birth Defects as Infants Conceived Using Fertility Treatments, Study Says [Nov 01, 2005] Infants conceived with the help of fertility treatments, including in vitro fertilization, have a similar risk of birth defects or chromosomal abnormalities as infants conceived unassisted, according to a study sponsored by the National Institute of Child Health and Human Development and published in the November issue of the journal Obstetrics & Gynecology, the San Jose Mercury News reports. Researchers studied data from 36,062 pregnancies. Of those pregnancies, 34,286 were unassisted, 1,222 involved fertility treatments such as ovulation induction and 554 resulted from IVF. The study also found that women who conceive through IVF might experience more complications during pregnancy because of the increased potential for multiple births. The risk of multiple births as a result of IVF can be reduced by limiting the number of fertilized eggs implanted into a woman's uterus, doctors say. The American College of Obstetricians and Gynecologists recommends that health care workers counsel couples about the association between multiple births and an increased risk of infant health problems, low birthweight and prematurity. However, the study's results should help to reassure women that fertility drugs, IVF and other fertility treatments are not harmful to their offspring. The study "is good news," lead study author Tracy Shevell of Stamford Hospital in Connecticut said, adding, "The chances of conceiving and having a healthy baby using assisted reproductive technology overall are very high" (Beck/Lyons, San Jose Mercury News, 10/31). http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=33437
Public Health & Education | New York Times Examines Different Breast Cancer Screening Methods [Nov 01, 2005] The New York Times on Tuesday examined the different types of breast cancer screening methods -- including film and digital mammography, ultrasound and MRI scanning -- and whether a specific type of test is better for women with certain risk factors. Widespread annual film mammography screening of women ages 40 and older has contributed to much of the 24% drop in breast cancer-related deaths in the U.S. since 1990, according to a new analysis of national breast cancer statistics published in the Oct. 27 issue of the New England Journal of Medicine. However, "film mammography is not perfect," and "none of the alternatives have yet been as thoroughly vetted in terms of lives saved," the Times reports. Data released in September by the National Cancer Institute showed that digital mammography is a better detection tool than traditional film mammography for women with dense breasts; women under age 50, despite breast density; and women of any age who were premenopausal or who had experienced at least one menstrual period within 12 months of her last mammogram. Researchers are designing clinical trials to further test ultrasound exams, which use sound waves to find abnormalities in breast tissue, and MRI screenings, which use a large magnet to track blood flow through the breast to distinguish healthy tissue from malignancies, to determine what groups of women might benefit most from those tests (Franklin, New York Times, 11/1). http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=334 Lethal Avian Influenza A (H5N1) Infection in a Pregnant Woman in Anhui Province, China To the Editor: On November 2, 2005 fFever, chills, and cough developed in a previously healthy woman who was four months pregnant. Chickens and ducks in her household had become ill and had died during October. From October 25 through October 30, the patient had been actively involved in slaughtering and defeathering sick poultry before they were cooked for family consumption. She presented to the hospital in Tongling City, China, on November 7 with dyspnea, cyanosis, a temperature of 38.8°C, a pulse of 118 beats per minute, a respiratory rate of 37 breaths per minute, and an oxygen saturation of 69 percent. Her white-cell count was 4050 per cubic millimeter, with a lymphocyte count of 608 per cubic millimeter. A chest radiograph showed bilateral diffuse infiltrates in the lower lobes. Her condition deteriorated despite treatment with azithromycin and cefotaxime. She required intubation that evening. The following day, her chest radiograph showed extensive infiltration of both lungs. Despite intensive supportive care, disseminated intravascular coagulation and multiorgan failure developed, and she died on November 10. Three tracheal aspirates obtained on November 8 tested positive for the H5 strain of avian influenza A virus and for the genes encoding M protein by reverse-transcriptase–polymerase chain reaction (PCR) and by real-time PCR. Influenza A/Anhui/1/2005 virus was isolated from a specimen of tracheal aspirate. Whole-genome sequencing indicated that all segments were of avian origin. The hemagglutinin-receptor–binding site was similar to those of other avian H5N1 viruses, and a polybasic amino acid cleavage site (LRERRRKRG) was present. Changes in amino acids related to antiviral resistance were not detected in the M-protein or neuraminidase genes. The hemagglutinin gene sequence was different from that of other H5N1 human isolates (Figure 1) and was similar to that of influenza A/duck/Fujian/1734/2005 (GenBank accession number DQ095629 [GenBank] ), a clade 2 virus. Other fatal human infections with clade 2 viruses have been identified in China and are genetically related to the isolate in this case (Anhui/2/2005 and Guangxi/1/2005). Women in the second and third trimesters of pregnancy are at increased risk for complications of influenza and should be considered for vaccination.1,2 The genetic diversity of H5N1 influenza strains causing serious human disease is greater than previously recognized. These observations have important implications for vaccine development, since the vaccine strains being developed include A/Vietnam/1194/2004 (in China) and A/Vietnam/1203/2004,3 which belongs to clade 1. Guidelines for Identifying and Referring Persons with Fetal Alcohol Syndrome
Advocacy Group Urges FDA To Promote Warnings at Seafood Counters Linking Mercury to Birth Defects [Dec 08, 2005] The health and nutrition advocacy group Center for Science in the Public Interest on Tuesday called on FDA to ask states to require seafood counters to post warnings of mercury in fish, which at high levels has been shown to contribute to birth defects, CQ HealthBeat reports (CQ HealthBeat, 12/6). FDA has issued public advisories warning about the possible effects of elevated mercury levels and recommending limits on the consumption of mercury-containing fish by children and women of childbearing age (Kaiser Daily Women's Health Policy Report, 8/23). According to CSPI Food Safety Director Caroline DeWaal, current FDA mercury advisories are "very complex" and "clearly not intended for the general public." A federal standardized warning could decrease confusion about mercury's potential risks among state policymakers, seafood retailers and consumers, according to CSPI. DeWaal added that FDA should ask stores "to put clear information right at the fish counter, where pregnant women or those serving young children can easily see it" (CSPI release, 12/6). However, David Acheson, director of food safety and security at FDA's Center for Food Safety and Applied Nutrition, said, "A generic message could be misinterpreted and lead the general public, as well as the targeted audience, to miss out on the benefits of eating fish," adding that "science indicates that the message needs to be targeted" at pregnant women and parents of young children (CQ HealthBeat, 12/6). http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=34202
Meeting To Determine Risks, Benefits of Pre-Planned C-Sections Begins [Mar 28, 2006] NIH on Monday opened a three-day meeting that aims to determine what is known about the risks and benefits of pre-planned caesarean sections and how to ensure that pregnant women receive appropriate information about the procedure, the AP/Seattle Post-Intelligencer reports (Neegaard, AP/Seattle Post-Intelligencer, 3/27). Preliminary results from a survey released last week by the not-for-profit maternity care group Childbirth Connection finds that many pregnant women are inadequately informed about potential complications relating to c-section delivery, and almost all women surveyed believed that there was a medical reason for having their c-section (Kaiser Daily Women's Health Policy Report, 3/21). A c-section can save the life of the pregnant woman, but there are infrequent but severe potential complications such as hemorrhages, infections and blood clots. According to the AP/Post-Intelligencer, women opt for c-section deliveries for a variety of reasons, including convenience, worries about a riskier emergency c-section if there are problems during vaginal delivery or complications that can result from a vaginal delivery. While there are no statistics showing precisely how many c-sections are elective, "more and more [women] seem to be choosing a surgical birth even when there's no clear medical need," according to the AP/Post-Intelligencer. Some recent studies looking at birth certificates and insurance claims estimate that about 80,000 women undergo elective c-sections annually, the AP/Post-Intelligencer reports. The lack of data on elective c-sections is in part because there is no exact definition of elective, Wendy Wilcox of the Montefiore Medical Center in New York City said, adding that obesity increases the risk of complications during labor but is not often listed as a reason for a c-section. In addition, there is little data comparing women who undergo elective c-sections and their infants with healthy women who undergo vaginal delivery. *http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=36254 Women’s Health Insurance Coverage Fact Sheets As the cost of health insurance continues to increase, women in particular face difficult challenges because they are more likely to be low-income and use more health care services throughout their lives. To help understand the status of women’s health coverage, the Kaiser Family Foundation has new data on national and state-level coverage in the U.S. These new statistics are available in our fact sheet on women’s health insurance coverage that is available at http://www.kff.org/womenshealth/6000.cfm and our state by state data fact sheet available at http://www.kff.org/womenshealth/1613.cfm . Highlights include: Please contact Usha Ranji, uranji@kff.org for additional information.
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