From Reuters Health Information
NEW YORK (Reuters Health) Apr 14 - For a woman eating a healthy diet, multivitamin supplements during late pregnancy could do more harm than good, a new study suggests.
British researchers found that a woman's risk of delivering prematurely tripled if she continued taking the prenatal pills into her third trimester.
"These supplements are available over-the-counter in the United Kingdom and frequently promoted as being beneficial for mums-to-be," Dr. Nigel Simpson of the University of Leeds in the U.K., and one of the authors of the study, told Reuters Health by email.
However, some weaknesses in the study may stand in the way of translating the finding into practice, Dr. James Mills, of the U.S. National Institute of Child Health and Human Development told Reuters Health.
While some studies in developing countries have found prenatal supplements to be beneficial, whether or not they are also useful in developed countries has not been thoroughly studied.
Dr. Simpson and his colleagues assessed supplement use by nearly 1,300 pregnant women recruited at Leeds Teaching Hospitals between 2003 and 2006. They reported their findings March 29th in the British Journal of Obstetrics and Gynecology
Overall, slightly more than 4% of newborns weighed less than 2500 grams and were categorized as low birthweight. About the same number of babies were born prematurely.
The team saw no differences in the risks of having a low birthweight baby for the more than 80% of women who took supplements at any point during pregnancy compared with those who took none.
However, the approximately 30% of women taking supplements during their third trimester were three times as likely to have a premature delivery, after adjustment for smoking, alcohol consumption and other relevant factors.
Why this would be true is unclear. One possibility, according to the authors, is that interactions between different vitamins and minerals led to a reduction in the nutrients available for the growing fetus.
And women in the study were already getting enough of most vitamins and minerals contained in prenatal supplements from their diets, with the exceptions of vitamin D, iron, folate, selenium and iodine, note the authors.
The U.S. National Institute of Child Health and Human Development's Dr. Mills said that a few weaknesses of the study make its significance less clear. Since the U.K. stops short of officially recommending prenatal multivitamins, British women who chose to take the supplements may have been those who were already at a greater risk for pregnancy problems.
Dr. Mills also said the relationship with premature delivery could have simply appeared by chance, given the large number of comparisons the researchers made between various birth outcomes and supplement use.
The study team acknowledges that larger, more rigorous studies are necessary to confirm their results. For now, Dr. Simpson says pregnant women probably don't need multivitamins past their first three months, after which time they might actually do harm.
Br J Obstet Gynecol 2010.
Friday, April 16, 2010
Monday, April 12, 2010
Couples' Risk of Break-Up Higher After Pregnancy Loss
From Reuters Health Information
NEW YORK (Reuters Health) Apr 08 - Studies have shown that married couples' risk of divorce can go up after the death of a child, and now new findings suggest that relationships may also become more fragile after a miscarriage or stillbirth.
In a study of more than 3,700 U.S. married or cohabiting couples who'd had at least one pregnancy, researchers found that those who'd suffered a miscarriage or stillbirth were more likely to break up in subsequent years than couples who had a baby.
Specifically, couples who had a miscarriage were 22% more likely than those who had a live birth to separate during the 15-year study period. With stillbirth, the risk was 40% greater.
And while the increased risk associated with miscarriage was seen within three years of the loss, the risk linked to stillbirth persisted for nearly a decade.
The researchers say their study, published online April 5th in Pediatrics, is the first national study to show that couples who suffer a pregnancy loss are at increased risk of a breakup.
The findings are, however, in line with those from past studies of married couples who've lost a child. Those studies have generally found that while bereavement brings some couples closer together, the general risk of divorce appears to climb after losing a child.
Given that research, the current findings are not unexpected, according to lead researcher Dr. Katherine Gold, of the University of Michigan in Ann Arbor.
However, she told Reuters Health by email, she was "honestly surprised" at the strength of the associations between pregnancy loss and relationship breakups -- as well as how lasting the effects, particularly of stillbirth, appeared to be.
"For miscarriage, we saw the strongest risk in the first 1.5 to 3 years after a loss, but for stillbirth the risk lasted nearly a decade after a loss," Dr. Gold said. "That's a much longer period than I think any of us who work in this area would have guessed."
However, Dr. Gold also stressed that "couples should not look at this study and think that on top of a loss their relationship is doomed." Many couples, she said, cope well and can actually become closer after a pregnancy loss.
Still, the current findings point to a need to understand why these couples are at increased risk of breaking up, she said.
The study included 3,707 married or cohabiting women who had a total of 7,770 pregnancies, including 16% that ended in miscarriage and 2% in a stillbirth.
Among couples who had a live birth, more than 40% broke up within 10 years. But among couples who had a stillbirth, that figure was nearly 60%; meanwhile, close to half of couples who had a miscarriage broke up within a decade.
The findings do not prove that pregnancy loss is the reason for the higher rates of breakups, the authors point out. However, even when the researchers accounted for several other factors related to relationship dissolution -- like younger age, lower incomes and cohabitation rather than marriage -- miscarriage and stillbirth themselves were still associated with higher risks of breakups.
It's also plausible that pregnancy loss would lead to separation for some couples, according to Dr. Gold.
"Loss of a baby can be a devastating effect for a couple," she said, "and this study suggests there can be a ripple effect which probably comes from the stress of how two different people cope with the same event."
She noted that men and women tend to react to grief differently, and that may lead to stress, misunderstandings and conflicts for some couples.
She said it is important for partners to anticipate that they may react differently to their loss, and then talk to each other about how they are coping. They should also know that help is available, the researcher added.
"If a couple is struggling," Dr. Gold said, "it's very important that they know it's OK to get help from a counselor, a therapist, their doctor, or someone from their church."
Pediatrics 2010.
NEW YORK (Reuters Health) Apr 08 - Studies have shown that married couples' risk of divorce can go up after the death of a child, and now new findings suggest that relationships may also become more fragile after a miscarriage or stillbirth.
In a study of more than 3,700 U.S. married or cohabiting couples who'd had at least one pregnancy, researchers found that those who'd suffered a miscarriage or stillbirth were more likely to break up in subsequent years than couples who had a baby.
Specifically, couples who had a miscarriage were 22% more likely than those who had a live birth to separate during the 15-year study period. With stillbirth, the risk was 40% greater.
And while the increased risk associated with miscarriage was seen within three years of the loss, the risk linked to stillbirth persisted for nearly a decade.
The researchers say their study, published online April 5th in Pediatrics, is the first national study to show that couples who suffer a pregnancy loss are at increased risk of a breakup.
The findings are, however, in line with those from past studies of married couples who've lost a child. Those studies have generally found that while bereavement brings some couples closer together, the general risk of divorce appears to climb after losing a child.
Given that research, the current findings are not unexpected, according to lead researcher Dr. Katherine Gold, of the University of Michigan in Ann Arbor.
However, she told Reuters Health by email, she was "honestly surprised" at the strength of the associations between pregnancy loss and relationship breakups -- as well as how lasting the effects, particularly of stillbirth, appeared to be.
"For miscarriage, we saw the strongest risk in the first 1.5 to 3 years after a loss, but for stillbirth the risk lasted nearly a decade after a loss," Dr. Gold said. "That's a much longer period than I think any of us who work in this area would have guessed."
However, Dr. Gold also stressed that "couples should not look at this study and think that on top of a loss their relationship is doomed." Many couples, she said, cope well and can actually become closer after a pregnancy loss.
Still, the current findings point to a need to understand why these couples are at increased risk of breaking up, she said.
The study included 3,707 married or cohabiting women who had a total of 7,770 pregnancies, including 16% that ended in miscarriage and 2% in a stillbirth.
Among couples who had a live birth, more than 40% broke up within 10 years. But among couples who had a stillbirth, that figure was nearly 60%; meanwhile, close to half of couples who had a miscarriage broke up within a decade.
The findings do not prove that pregnancy loss is the reason for the higher rates of breakups, the authors point out. However, even when the researchers accounted for several other factors related to relationship dissolution -- like younger age, lower incomes and cohabitation rather than marriage -- miscarriage and stillbirth themselves were still associated with higher risks of breakups.
It's also plausible that pregnancy loss would lead to separation for some couples, according to Dr. Gold.
"Loss of a baby can be a devastating effect for a couple," she said, "and this study suggests there can be a ripple effect which probably comes from the stress of how two different people cope with the same event."
She noted that men and women tend to react to grief differently, and that may lead to stress, misunderstandings and conflicts for some couples.
She said it is important for partners to anticipate that they may react differently to their loss, and then talk to each other about how they are coping. They should also know that help is available, the researcher added.
"If a couple is struggling," Dr. Gold said, "it's very important that they know it's OK to get help from a counselor, a therapist, their doctor, or someone from their church."
Pediatrics 2010.
Wednesday, April 7, 2010
Vitamins C, E Supplementation May Not Reduce Risk for Certain Pregnancy Complications
From Medscape Medical News
Laurie Barclay, MD
April 6, 2010 — Prenatal vitamin C and E supplementation does not reduce the rate of preeclampsia or gestational hypertension (GH) but is associated with greater risk for fetal loss or perinatal death and preterm prelabor rupture of membranes (PPROM), according to the results of a multicenter, randomized controlled trial reported in the March issue of the American Journal of Obstetrics & Gynecology.
"Several lines of evidence support the hypothesis that oxidative stress, an imbalance between prooxidant and antioxidant forces, plays an essential role in the development of hypertensive disorders of pregnancy," write Hairong Xu, MD, MSc, from Hôpital Ste-Justine and Université de Montréal in Quebec City, Canada, and colleagues from the International Trial of Antioxidants in the Prevention of Preeclampsia (INTAPP) study group. "We sought to investigate whether prenatal vitamin C and E supplementation reduces the incidence of ...GH and its adverse conditions among high- and low-risk women."
Participants were stratified by risk status and were randomly assigned to receive daily supplementation with 1 g of vitamin C and 400 IU of vitamin E, or placebo. The main study endpoint was GH and its associated complications.
Among 2647 women randomly selected, data were analyzed for 2363 women because the trial was stopped prematurely when adverse outcomes from supplementation were recognized. The groups did not differ in the risk for GH and its complications (relative risk [RR], 0.99; 95% confidence interval, 0.78 - 1.26). However, vitamin C and E supplementation was associated with nonprespecified outcomes of an increased risk for fetal loss or perinatal death, as well as with PPROM.
Limitations of this study include reduced power because the trial was stopped prematurely.
"Vitamin C and E supplementation did not reduce the rate of preeclampsia or GH, but increased the risk of fetal loss or perinatal death and ...PPROM," the study authors write. "Despite the fact that the underlying mechanisms remain largely unclear, there is increasing concern that supplementation of vitamins C and E at the doses studied [ie, 1000 mg vitamin C and 400 IU vitamin E (RRR alpha-tocopherol)] may increase the risk of other adverse pregnancy outcomes such as low birthweight and PPROM. Therefore, based on our present knowledge, vitamin C and E supplementation at the above doses cannot be recommended for pregnant women to prevent adverse pregnancy outcomes including [preeclampsia]."
The Canadian Institutes of Health Research supported this study. The study authors have disclosed no relevant financial relationships.
Am J Obstet Gynecol. 2010;202:239.e1-239.e10.
Laurie Barclay, MD
April 6, 2010 — Prenatal vitamin C and E supplementation does not reduce the rate of preeclampsia or gestational hypertension (GH) but is associated with greater risk for fetal loss or perinatal death and preterm prelabor rupture of membranes (PPROM), according to the results of a multicenter, randomized controlled trial reported in the March issue of the American Journal of Obstetrics & Gynecology.
"Several lines of evidence support the hypothesis that oxidative stress, an imbalance between prooxidant and antioxidant forces, plays an essential role in the development of hypertensive disorders of pregnancy," write Hairong Xu, MD, MSc, from Hôpital Ste-Justine and Université de Montréal in Quebec City, Canada, and colleagues from the International Trial of Antioxidants in the Prevention of Preeclampsia (INTAPP) study group. "We sought to investigate whether prenatal vitamin C and E supplementation reduces the incidence of ...GH and its adverse conditions among high- and low-risk women."
Participants were stratified by risk status and were randomly assigned to receive daily supplementation with 1 g of vitamin C and 400 IU of vitamin E, or placebo. The main study endpoint was GH and its associated complications.
Among 2647 women randomly selected, data were analyzed for 2363 women because the trial was stopped prematurely when adverse outcomes from supplementation were recognized. The groups did not differ in the risk for GH and its complications (relative risk [RR], 0.99; 95% confidence interval, 0.78 - 1.26). However, vitamin C and E supplementation was associated with nonprespecified outcomes of an increased risk for fetal loss or perinatal death, as well as with PPROM.
Limitations of this study include reduced power because the trial was stopped prematurely.
"Vitamin C and E supplementation did not reduce the rate of preeclampsia or GH, but increased the risk of fetal loss or perinatal death and ...PPROM," the study authors write. "Despite the fact that the underlying mechanisms remain largely unclear, there is increasing concern that supplementation of vitamins C and E at the doses studied [ie, 1000 mg vitamin C and 400 IU vitamin E (RRR alpha-tocopherol)] may increase the risk of other adverse pregnancy outcomes such as low birthweight and PPROM. Therefore, based on our present knowledge, vitamin C and E supplementation at the above doses cannot be recommended for pregnant women to prevent adverse pregnancy outcomes including [preeclampsia]."
The Canadian Institutes of Health Research supported this study. The study authors have disclosed no relevant financial relationships.
Am J Obstet Gynecol. 2010;202:239.e1-239.e10.
Friday, April 2, 2010
Teenage Boys and Young Men Who Lack Mumps Vaccinations Are at Risk for Reduced Fertility
From Medscape Medical News
Nancy Fowler Larson
March 31, 2010 — A reduction in mumps vaccinations in the 1990s has produced a spike in infections, raising concerns about fertility issues in men aged 15 to 24 years, according to an article published in the April issue of the British Journal of Urology International.
The introduction of the measles, mumps, and rubella, or MMR, vaccine in 1968 led to a sharp decline — 99% in the United States — in cases of mumps, a contagious viral disease. In the mid-1990s, the inoculation rate plunged in the United States, the United Kingdom, and other locations for 2 reasons: a global shortage of the vaccine, and publicity about its alleged, unproven connections to autism, inflammatory bowel disease, and Crohn's disease. In some parts of the United Kingdom, vaccination rates fell from 91% to 58%.
This failure to vaccinate had clear consequences. In 2001, confirmed cases of mumps hovered close to zero in England and Wales. By 2004, more than 56,000 cases were reported, according to the authors' examination of data spanning a 5-year period. As many as 40% of men who are infected with mumps experience 1 or more complications, including mumps orchitis, which can result in impaired fertility.
"This is of considerable concern as epidemics of mumps orchitis are now being reported more frequently in many countries worldwide," said Niall Davis, research registrar, Department of Urology, Mater Misericordiae Hospital, Dublin, Ireland, in a press release.
One case of mumps can result in 12 secondary infections in a vulnerable population. Today, many of the unvaccinated 15- to 20-year-olds are gathered in close quarters in secondary schools, colleges and universities.
"This clustered environment provides a perfect breeding ground for the virus," write Mr. Davis and colleagues.
Mumps orchitis typically appears 10 days after the disease's hallmark facial swelling, but it can occur up to 6 weeks later. Thirty percent to 50% of men with mumps orchitis, 1 or both testicles will atrophy, resulting in reduced size. Among other findings is the fact that complications can affect fertility even if swelling does not occur. For example, 13% of patients experience subfertility, whether or not they have had testicular atrophy, and up to 50% of patients produce abnormal sperm as long as 3 months after recovery — 24% of adults and 38% of teenagers can have abnormal sperm up to 3 years later.
The term "abnormal sperm" is used to reference sperm count, motility, and/or morphology. A significant relationship was found between the extent of testicular swelling and the degree of sperm abnormalities. The researchers found only a slight (incidence of 0.5%) association between mumps orchitis and testicular cancer.
The investigators call on physicians to become familiar with mumps and its complications and to recommend vaccinations for teenage boys and adult men who are not already inoculated.
"Clinicians should be aware of this epidemiological shift and of the resurgence of mumps orchitis," the authors write. "Unvaccinated male patients in this age group should be offered the MMR vaccine and educated about mumps orchitis and its potential complications."
The study authors have disclosed no relevant financial relationships.
BJU Int. 2010;105:1060-1065.
Nancy Fowler Larson
March 31, 2010 — A reduction in mumps vaccinations in the 1990s has produced a spike in infections, raising concerns about fertility issues in men aged 15 to 24 years, according to an article published in the April issue of the British Journal of Urology International.
The introduction of the measles, mumps, and rubella, or MMR, vaccine in 1968 led to a sharp decline — 99% in the United States — in cases of mumps, a contagious viral disease. In the mid-1990s, the inoculation rate plunged in the United States, the United Kingdom, and other locations for 2 reasons: a global shortage of the vaccine, and publicity about its alleged, unproven connections to autism, inflammatory bowel disease, and Crohn's disease. In some parts of the United Kingdom, vaccination rates fell from 91% to 58%.
This failure to vaccinate had clear consequences. In 2001, confirmed cases of mumps hovered close to zero in England and Wales. By 2004, more than 56,000 cases were reported, according to the authors' examination of data spanning a 5-year period. As many as 40% of men who are infected with mumps experience 1 or more complications, including mumps orchitis, which can result in impaired fertility.
"This is of considerable concern as epidemics of mumps orchitis are now being reported more frequently in many countries worldwide," said Niall Davis, research registrar, Department of Urology, Mater Misericordiae Hospital, Dublin, Ireland, in a press release.
One case of mumps can result in 12 secondary infections in a vulnerable population. Today, many of the unvaccinated 15- to 20-year-olds are gathered in close quarters in secondary schools, colleges and universities.
"This clustered environment provides a perfect breeding ground for the virus," write Mr. Davis and colleagues.
Mumps orchitis typically appears 10 days after the disease's hallmark facial swelling, but it can occur up to 6 weeks later. Thirty percent to 50% of men with mumps orchitis, 1 or both testicles will atrophy, resulting in reduced size. Among other findings is the fact that complications can affect fertility even if swelling does not occur. For example, 13% of patients experience subfertility, whether or not they have had testicular atrophy, and up to 50% of patients produce abnormal sperm as long as 3 months after recovery — 24% of adults and 38% of teenagers can have abnormal sperm up to 3 years later.
The term "abnormal sperm" is used to reference sperm count, motility, and/or morphology. A significant relationship was found between the extent of testicular swelling and the degree of sperm abnormalities. The researchers found only a slight (incidence of 0.5%) association between mumps orchitis and testicular cancer.
The investigators call on physicians to become familiar with mumps and its complications and to recommend vaccinations for teenage boys and adult men who are not already inoculated.
"Clinicians should be aware of this epidemiological shift and of the resurgence of mumps orchitis," the authors write. "Unvaccinated male patients in this age group should be offered the MMR vaccine and educated about mumps orchitis and its potential complications."
The study authors have disclosed no relevant financial relationships.
BJU Int. 2010;105:1060-1065.
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