Birth control type tied to time between pregnancies

Women using intrauterine devices (IUDs) and other types of long-term reversible birth control after having a baby are less likely to get pregnant again quickly, a new study suggests.

Women who used those methods were four times more likely to wait more than 18 months between pregnancies compared to those relying on condoms, researchers found.

The World Health Organization endorses a two-year period between birth and a woman’s next conception.

Still, one third of all repeat pregnancies in the U.S. occur within 18 months of the previous child’s birth. And a growing body of evidence shows this close timing increases the risk a baby will be born early or at a low birth weight.

The time between pregnancies “cannot be explained only by the mother’s preferences,” Heike Thiel de Bocanegra said.

She and her colleagues from the University of California, San Francisco investigated the link between access to birth control or family planning services and pregnancy spacing.

In the current study of 117,644 California women who’d had at least two children, 64 percent waited 18 months or more between pregnancies and the rest did not.

All women included in the study filed claims through the state’s Medicaid program for the poor, called Medi-Cal, or through health providers offering state-funded family planning services.

The researchers matched data on claims for contraceptives to California’s birth registry.

“We assumed that access to contraception . . . would improve birth spacing,” Dr. Anitra Beasley wrote in an email to Reuters Health.

“This study actually examines this assumption,” she said.

Beasley, who studies family planning at Baylor College of Medicine in Houston, was not part of the current research.

Women who used long-acting reversible contraception, including IUDs or implants, were four times more likely to wait at least 18 months to conceive again, compared to those who only used “barrier” contraceptives like condoms or spermicide.

More than half of women started using birth control pills, the ring or the patch after giving birth. They were twice as likely to wait at least 18 months between pregnancies as condom users.

Those relationships stood firm even when the researchers looked at possible influences like the mother’s race, education, age and whether she was born in the U.S., according to the report published in the American Journal of Obstetrics and Gynecology.

Women in the study counseled by a certified family planning service provider were 67 percent more likely to wait 18 months between pregnancies, compared with women who utilized Medi-Cal services only.

“Low-income women are sometimes seen only once after giving birth,” Thiel de Bocanegra said.

“Some women receive contraception – some do not,” she said.

Women in the study received four months worth of covered contraceptives, on average. That number was dragged down by the one third of women in the study who had no contraceptive claims at all.

For Meredith Matone, a researcher with PolicyLab at Children’s Hospital of Philadelphia, the study’s large size helps build a better understanding of how public health initiatives work in the real world.

“The results we find in clinical trials do not always translate well when implemented on a large scale, where they are subject to challenges that include provider performance, patient compliance and operational hurdles,” Matone wrote in an email to Reuters Health.

“Under health care reform, there are opportunities to continue to support such evidence-based public health programs for families,” said Matone, who was not involved in the new research.

“Health care providers should know that the optimal pregnancy interval is 18 months or more, and should encourage the use of highly effective contraception during this period,” Thiel de Bocanegra said.

“Pediatricians can help, too, by asking the mother what type of contraception she is using,” she said.


Avoid Confusing Thyroid Symptoms With Menopause

Many middle-aged women experiencing menopausal-like symptoms may be experiencing thyroid-related problems. They are often difficult to tell apart but lab tests may help with the diagnosis.

Millions of women with menopausal-like symptoms may be suffering from undiagnosed thyroid disease. These non-specific symptoms consist of fatigue, depression, mood swings, weight gain, irregular menstrual periods, and sleep disturbances.

These are frequently associated with menopause, especially when they occur in women who are in their 40s.

However, only one out of four of these women who have described these menopause-like symptoms with a physician are actually tested for thyroid disease.

Perimenopausal Symptoms

It is common for women in their late 40s to their early 50s to expect the symptoms of menopause. This perimenopausal stage is the period when the signs and symptoms of menopause have not stabilized. Menopause is defined as the complete cessation of menstrual periods and loss of fertility. Before this occurs, a woman may undergo a long transition stage, called perimenopause, which may start as early as their mid-30s, although most women experiences changes in their mid to late 40s. This transition period may last for five to ten years, during which, one may undergo these signs and symptoms:

Irregular menstrual periods
Longer or shorter periods
Heavy menstrual flow or spotting
Absent periods
Menstrual cramping
Breast tenderness
Premenstrual syndrome, or PMS, which consists of fatigue, irritability, food cravings, and depression
Sleep problems

Hot flushes alternating with intermittent coldness

Weight gain

Menopause is a natural stage in a woman’s life that begins with a gradual decline in estrogen levels and ends with cessation of menses and with the ovaries failing to release eggs.

Symptoms related to these hormonal changes may come and go, some days being better than others are, especially during the long perimenopausal stage. For some women, undergoing these changes may be very challenging and they may feel that these are unnatural or perhaps related to some other health condition. They may seek medical consultation for vague symptoms, for which they may not get satisfactory treatment.

However, the diagnosis of menopause is usually made retrospectively, since it is established only a year after menses disappear.

Source: steady health


Women may skip radiation therapy over child care concerns

Child care issues may keep breast cancer patients from getting the treatments they need, a new study suggests.

Mothers with young children were more likely to skip recommended radiation treatments after breast cancer surgery because of worries about the time involved, researchers found.

In particular, women who had a breast tumor removed were less likely to undergo radiation therapy afterwards if they had kids age seven or younger at home.About 81 per cent of women surveyed in the study who had younger kids received radiation therapy. The rates of radiation therapy for women with older kids or none at all ranged between 84 and 87 per cent.

Put another way, one in five women with young kids in the study skipped potentially life-saving post-surgery treatment, said Ya-Chen Tina Shih, an economist and associate professor of medicine at the University of Chicago in Illinois who co-led the study.

“We were surprised because women in the younger age range have the longest life expectancy, so we expected to see a higher compliance rate among them,” she told Reuters Health.

“Women may think, ‘I really need to take care of the kids at home,’ and they may act on what they believe is most important at that time,” Shih said.

“But they may not be aware of how important radiation therapy is.”

Women who have “lumpectomy” surgery to remove a breast tumor – the researchers did not include patients who had mastectomies – are usually advised to follow up with radiation therapy, which requires a serious time commitment. The radiation treatments take up to an hour, five days a week, for up to seven weeks, the researchers report.

“Many have hypothesized that young children might be a barrier for younger women, but this paper is the first to demonstrate that,” wrote Dr. Nancy Keating in an email to Reuters Health.

Keating, an associate professor at Harvard Medical School’s Department of Health Care Policy in Boston, was not involved in the new study.

“It suggests there is a modifiable barrier to improving care: providing child care,” Keating said.

For their study, Shih and her team looked at 21,008 patients who filed breast cancer surgery claims between 2004 and 2009 with employer-sponsored insurance.

From the data provided by Truven Health Analytics, researchers knew how many kids – dependents – were in a woman’s household.

The team found additional barriers to radiation therapy. Patients who enrolled in HMO plans, or PPO plans with fixed reimbursement amounts, were less likely to follow through with the treatment. If a patient had to travel far for the surgery itself, then she was also less likely to get radiation.

But this study’s biggest contribution is highlighting how childcare may play a role, Keating said.

Women, like those in the study, who chose breast-conserving surgery and not a mastectomy, “may not understand that the surgery is equivalent to mastectomy in terms of outcomes if women also get the radiation,” Keating wrote.

Shih pointed out that one weakness in her team’s report, published in the Journal of the National Cancer Institute, was that they did not talk to the patients themselves to record their reasons for not getting radiation therapy.

The study shows an association between the age of a woman’s children and her likelihood of opting out of radiation, but does not prove cause and effect.

Future studies could also investigate the rates of radiation therapy among women without insurance, or with less generous benefits, Shih said.

But for now, “the person in charge of a patient’s entire cancer care needs to make sure that they know if a patient has younger kids,” Shih said.

“If friends and family can make a commitment to help with the patient’s child care needs for a month or two – that could make a big difference,” she said.

The findings “suggest that providers, like hospitals, physician groups or health systems, could potentially help by providing assistance with child care,” Keating said.

Source: Khaleej times


Low oxygen bad for breast cancer patients

Breast cancer cells, when exposed to low oxygen conditions, trigger the production of two proteins that make the cancer cells spread fast — making the patient’s condition worse, a new paper has contended.

Researchers at The Johns Hopkins University reached the conclusion that low oxygen conditions, frequently present in breast cancers, facilitates the production of RhoA and ROCK1 proteins that, in turn, endow the cancer cells with the ability to move.

“High levels of RhoA and ROCK1 were known to worsen outcomes for breast cancer patients by endowing cancer cells with the ability to move, but the trigger for their production was a mystery,” said Gregg Semenza, Professor of Medicine at The Johns Hopkins University.

The researchers found that women with high levels of RhoA or ROCK1, and especially those women with high levels of both, were more likely to die of breast cancer than those with low levels.

“We now know that the production of these proteins increases dramatically when breast cancer cells are exposed to low oxygen conditions,” said the paper, published in the journal Proceedings of the National Academy of Sciences.

With the multiplying of tumour cells, the interior of the tumour begins to run out of oxygen simply because they are not being supplied by blood vessels.

“The lack of oxygen activates the hypoxia-inducible factors, which are master control proteins that switch on many genes that help cells adapt to the scarcity of oxygen,” explained Semenza.

Hypoxia refers to a condition in which the body or a part of the body is deprived of adequate supply of oxygen.

Hypoxia-inducible factors also turn on genes that help cancer cells escape from the oxygen-starved tumour by invading blood vessels, through which they spread to other parts of the body, the paper added.

Here is a breather, though.

“We have successfully decreased the mobility of breast cancer cells in the lab by using genetic tricks to knock the hypoxia-inducible factors down,” said Daniele Gilkes, lead author of the paper.

“Now that we understand the mechanism at play, we hope that clinical trials will be performed to test whether drugs that inhibit hypoxia-inducible factors will have the double effect of blocking production of RhoA and ROCK1 and preventing metastases in women with breast cancer,” Gilkes added.

Source: Pak tribune


Persistent pain after breast cancer treatment

In a study that included more than 800 women who had undergone surgery for breast cancer, the majority reported some level of pain 12 months after surgery, and factors associated with pain included chronic preoperative pain, chemotherapy, preoperative depression and pain in the area to be operated, according to a study appearing in the January 1 issue of JAMA.

“Persistent pain following breast cancer treatments remains a significant clinical problem despite improved treatment strategies. Data on factors associated with persistent pain are needed to develop prevention and treatment strategies and to improve the quality of life for breast cancer patients,” according to background information in the article.
Tuomo J. Meretoja, M.D., Ph.D., of Helsinki University Central Hospital, Helsinki, Finland, and colleagues examined the prevalence and severity and factors associated with chronic pain after breast cancer surgery and treatments. The study included 860 patients younger than 75 years with nonmetastasized breast cancer treated at the Helsinki University Central Hospital in 2006-2010. A questionnaire was sent to patients 12 months after surgery, with assessments of presence and intensity of pain.

At 12 months after surgery, 34.5 percent of the patients reported no pain, 49.7 percent mild pain, 12.1 percent moderate pain, and 3.7 percent severe pain. The factors associated with pain at 12 months were chronic preoperative pain, preoperative pain in the area to be operated, axillary lymph node dissection, preoperative depression, chemotherapy and radiotherapy.
“These findings may be useful in developing strategies for preventing persistent pain following breast cancer treatment. To identify patients who would benefit from preventive interventions, a risk assessment tool is needed,” the authors write.

Source; Medical Express


4 reasons why pregnant women should consider the flu shot

With flu season in full swing, attention must be paid to pregnant women when it comes to this potentially dangerous virus.

Expectant mothers must be encouraged to get a flu shot – and if they notice flu-like symptoms, they need to seek medical help immediately.

The mortality and complications of the flu in pregnancy are enormous. And these complications are not only significant to the mother, but can also affect her baby by causing premature labor, premature delivery and even death.

There are four key issues that make the flu so problematic in pregnancy.

The first one is that pregnant women have more difficulty in fighting off infections – both viral and bacterial. The reason for this is that the immune system often is underperforming due to the hormonal changes in pregnancy, which can have effects similar to those seen in people on chronic steroid medications.

Once a severe infection develops, the chances the virus or bacteria can overrun the mother are proportionally higher.

The second point has to do with those pregnancy hormones themselves, in particular – progesterone. One of the effects of progesterone in pregnancy is that it creates capillary engorgement and swelling of the lining of the nose and oral pharynx. This predisposes a pregnant women to contract viruses and infuse them quickly into circulation.

Next, there are significant physical changes in the breathing system of a pregnant women. There’s an upward displacement of the diaphragm, which grows over time as the belly becomes bigger – and means the total lung capacity is decreased. What happens is the expiratory reserve volume and the residual volume of the lungs are decreased by 20 percent, so you have less air every time you take a breath.

Now, imagine having the flu and having your lungs full of mucous. With these changes, if the patient is lying down, the chest wall function makes it harder for her to breathe.

This brings me to my last point of significance. The need for oxygen is much greater in pregnant women than non-pregnant women. The reason there is an increased oxygen consumption is because you’re now breathing for two — literally.

Ultimately, the flu can infect a pregnant woman’s lungs, not only with the flu virus, but with a secondary infection – like bacterial pneumonia, making oxygen delivery to the mother and child more problematic – and could even lead to death.

If you are pregnant, and haven’t already gotten your flu shot, you should talk to your doctor about it right away.

Source: news.nom


Why stress is taking a toll on moms and how to handle it

Moms are more stressed out than ever before and it’s taking a toll on their health, their relationships and their happiness.

In fact, a survey from the American Psychological Association shows that women are more likely than men to experience physical and emotional symptoms of stress. Furthermore, moms spend 14 more hours per week on childcare and housework than fathers do, according to a recent Pew Research Center report.

Katrina Alcorn, author of Maxed Out: American Moms on the Brink said stressed-out moms are actually a phenomenon, one she knows all too well. After having her third child, Alcorn was busy juggling a full time job, a home, and all of her family’s needs, but it became too much for her to handle.

“On the surface everything looked fine, but I was crumbling inside,” Alcorn said.

Alcorn suffered from panic attacks and sleepless nights for months when finally, on a trip to buy diapers, she had yet another panic attack and realized something had to give. She needed to make changes now if she wanted to be a healthy mom.

Between clocking extra hours at work, caring for spouses and families and managing all of life’s curveballs, it’s not surprising many moms feel like they’re at their breaking points. And if you’re one of them, here’s what you can do to manage your stress now:

1. Say no
You’ll always have obligations, but volunteering on another committee or chauffeuring your kids to extra after-school activities can wear you down.

“We have to figure out what is really important and let everything else go,” Alcorn said.

2. Push back
“Work will take up every inch of your life if you let it,” according to Alcorn who said telecommuting even one or two days a week can help.

Be sure to back up your request with research that shows how working from home can make you more productive and benefit your company.

2. Eat healthy
“Moms tend to snack and grab whatever they can,” according to Christie Rampone, captain of the U.S. women’s soccer team, mother of 2 and spokesperson for EpiCor.

Planning ahead is key to maintaining your energy throughout the day so be sure to decide on your meals ahead of time, if possible, and always have healthy snacks on hand – a handful of almonds or an apple with peanut butter, and a bottle of water.

4. Sleep
Feel like a rock star on just 5 hours of sleep? You might be able to get through the day but consistent sleep-deprivation can make you feel worse. If you have a baby, nap when he or she does or ask your partner to take a nighttime feeding or let you sleep in on the weekends. Or try to go to bed earlier, even if it’s just one night a week, Rampone suggests.

5. Prioritize
“Often when we feel overwhelmed, it’s not because we’re being perfectionists,” Alcorn said. “There really objectively are too many things pulling at our time.”

Instead of trying to do it all, decide on what must be done today, what can wait for tomorrow, and what you can let go of.

6. Swap with a friend
Offering help can be just as powerful as asking for it. So the next time you make dinner, double the recipe, drop off half to a friend and let her reciprocate. Or offer to run errands, swap babysitting, or carpool.

7. Shut down
Your smartphone is always in your hand, you read email incessantly, and can’t go 30 minutes without checking Facebook.

“There’s a mental clutter that we’re all struggling with and we need quiet and peace,” Alcorn said.

It might be hard to step away from work, but if you can check email only at certain times or shut down all your devices at the same time each night, chances are you’ll feel less frazzled.

8. Get help
Hire a babysitter so you can run errands or catch up on your to-do list. Or ask your partner to pitch in on specific tasks and accept what he does as good enough.

9. Exercise
A good workout gives you an endorphin rush, helps to clear your mind and can help you relax – but don’t overdo it or you’ll feel more exhausted than you did before, Rampone said.

10. Make “me-time”
Your needs are last on the list but making time for yourself every day can help you feel less stressed out. Even if it’s just 10 minutes to take a bath, or an hour for lunch with a friend, carve out “me time” every day.

11. Take a break
Rampone suggests establishing an “independent hour,” every day. Sneak into another room to read, watch TV or meditate and have your kids play by themselves—no interruptions allowed.

Source: all voices


Breast-feeding longer than six months tied to better cognitive development

Breast-feeding’s benefits have been backed by yet another study, the latest finding kids who were breast-fed for more than six months scored the highest on cognitive, language and motor development tests as toddler.

Earlier research tied breast-feeding to better thinking and memory skills. But how it’s related to language skills and movement and coordination had been less clear.

The new study, out of Greece, doesn’t prove breast-feeding is responsible for better development, but it shows a strong association, researchers said.

Most evidence “pretty clearly shows there are significant medical benefits of breast-feeding,” Dr. Dimitri Christakis, professor of pediatrics at the University of Washington and director of the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute, told Reuters Health in an email.

“I think that the evidence is now of sufficient quality that we can close the book on these benefits and focus instead on how do we succeed in promoting breast-feeding because all of the studies, including this one, that have looked at it have found a linear relationship, which is to say that the benefits accrue with each additional month that a child is breast-fed,” added Christakis, who was not involved in the study.

In the U.S., about 77 percent of new moms breast-feed their babies, according to an August study from the Centers for Disease Control and Prevention (CDC). Almost half follow the American Academy of Pediatrics’ recommendation of breast-feeding exclusively for first six months of a newborn’s life. Moms are also recommended to provide supplemental breast milk until a child is aged 1 year old or older.

The World Health Organization recommends breast-feeding even longer with complementary foods through age 2 and beyond.

But a March 2013 study found 40 percent of parents introduce solid foods too soon, before a baby turns 4 months old.

Given these rates, health officials often urge longer breast-feeding because it may protect against gastrointestinal tract infections, diabetes, respiratory infections, asthma and obesity, although one recent study did not find protections against childhood obesity. Moms have also been found to be less likely to develop breast and ovarian cancer if they breast-fed.

For the new study, Dr. Leda Chatzi from the University of Crete and her colleagues used data from a long-term study of 540 mothers and their kids.

When the babies were nine months old, researchers asked moms when they started breast-feeding and how long they breast-fed. They updated the information when the children were 18 months old. Psychologists also tested children’s cognitive abilities, language skills and motor development at 18 months.

About 89 percent of the babies were ever breast-fed. Of those, 13 percent were breast-fed for less than one month, 52 percent for between one and six months, and 35 percent for longer than six months.

Children who were breast-fed for any amount of time scored higher on the cognitive, receptive communication and fine motor portions of the test than children who weren’t breast-fed.

Scores on the cognitive, receptive and expressive communication and fine motor sections were highest among children who were breast-fed for more than six months, the researchers reported in the Journal of Epidemiology and Community Health.

For instance, on cognitive assessments with a normal score of 100, toddlers who were never breast-fed scored about a 97, on average. Kids who were breast-fed for more than six months scored a 104.

Chatzi and her colleagues expected to see more breast-feeding than they did.

“We were surprised by the fact that breast-feeding levels in Greece remain low, even though there is an ongoing effort by the Greek State to promote breast-feeding practices,” Chatzi told Reuters Health in an email.

“One of the reasons we see such a big drop off in the United States and elsewhere around four months is because women return to work,” Christakis said.

“The real challenge we have is with sustaining breast-feeding,” he said. “I believe very strongly that we need a public health approach to doing so because these are public health issues – improving child cognition and improving in this case as they showed a child’s physical development, benefits society as a whole and society has to support women achieving that goal.”

“We need to have baby-friendly work places that help women continue to either breast-feed or pump when they return to work,” Christakis said. “There’s that African proverb, ‘it takes a village to raise a child,'” he said. “It takes a village to breast-feed a child as well, and all sectors have to contribute.”

Source: Reuters


Flu Vaccine Works Better for Women: Study

The flu vaccine is generally less effective for men than for women, scientists said in a study Monday, tracing the effect to higher levels of testosterone that curb the immune response.

It has long been known that men are more vulnerable than women to bacterial, viral and parasitic infections, but scientists have never been able to clearly explain why.

It was also known that men don’t respond as strongly as women to vaccines against yellow fever, measles and hepatitis, said the authors of the study, which appears in this week’s Proceedings of the American Academy of Sciences.

The new research, using samples from 34 men and 53 women, suggested that the cause could be traced to testosterone: only men with higher levels of the sex hormone demonstrated the lower antibody response to the flu vaccine.

Among men with lower levels of testosterone, the immune response was “more or less equivalent to that of women,” said a statement from Stanford University, whose researchers collaborated with others at the French governmental research organization INSERM for the study.

Previous studies on animals and in cell-culture experiments had previously suggested a link between testosterone and immune response, which creates inflammation as it battles the invasion of a pathogen.

This latest study doesn’t indicate a direct link between testosterone and the lowered immune response. Instead, the immune system’s reaction was reduced by the activation of a group of genes that are also linked to a higher level of testosterone, explained Mark Davis, immunology professor at Stanford University.

The researchers also considered an apparent evolutionary paradox — wondering how natural selection could favor a hormone responsible both for characteristics such as strength and a taste for taking risks, and for weakening the immune system.

They speculated that in prehistoric times, men’s roles as hunters and warriors tended to expose them to more wounds and resulting infections.

A decent immune response to these infections is an evolutionary advantage, but an overly abundant one — which can occur in certain diseases including some virulent forms of the flu — could prove more dangerous than the pathogen itself, they said.

Thus, perhaps men with less aggressive immune responses tended to be better able to survive, the researchers said.

Source: News Max health


Eating nuts during pregnancy may lower child’s chance of peanut allergy

Pregnant peanut lovers can celebrate, perhaps with a PB&J snack: A study out Monday shows an association between pregnant women who ate the most peanuts and tree nuts and children with a decreased risk of allergy.

Women had been advised to avoid peanuts and tree nuts, as well as other highly allergic foods, during pregnancy and until the child turned 3, as a way to try to reduce the chances of an allergy. But those recommendations were rescinded after researchers found that the effort didn’t work.

In the current study — from Boston Children’s Hospital and published Monday in the Journal of the American Medical Assn. Pediatrics – found that women who ate nuts more than five times a month had the lowest incidence of allergic children.

“By linking maternal peanut consumption to reduced allergy risk, we are providing new data to support the hypothesis that early allergen exposure increases tolerance and reduces risk of childhood food allergy,” Dr. Michael Young, lead author of the study, said in a statement.

Current guidelines recommend that mothers should not restrict their diets during pregnancy, but this recommendation remains a widely debated topic among food allergy experts,” Dr. Ruchi Gupta wrote in an opinion piece accompanying the study. Further research is needed, Gupta wrote, to determine why one in 13 U.S. children has a food allergy of some kind.

Despite recommendations to avoid allergens, more children were found to be allergic to nuts and other foods, with the rate tripling from 1997 to 2007. Peanut allergies affect 1% to 3% of people in most Western countries. In the U.S., it’s at 4%, the study said. The reasons are not known.

“No one can say for sure if the avoidance recommendation for peanuts was related to the rising number of peanut allergies seen in the late 1990s and early 2000s, but one thing is certain: It did not stop the increase,” Young said.

The researchers looked at data from 8,205 children, whose parents were part of the Nurses Study, a long-term health study. They found 140 cases of peanut or tree nut allergy among the children born between Jan. 1, 1990, and Dec. 31, 1994.

Animal studies have shown a protective effect of maternal exposure to allergens in foods. The human data, Young said, are not strong enough to conclude a cause and effect relationship. He said more research is needed.

Tree nuts are walnuts, almonds, pistachios, cashews, pecans, hazelnuts, macadamia nuts and Brazil nuts. Peanuts, Gupta noted, are a good source of protein, and they provide folic acid, which has the potential to prevent neural tube defects.

Of course, the researchers said, women who are themselves allergic should not eat peanuts or tree nuts.
Source: La times