Category: Obstetrics & Gynaecology

Categories : Mental Health Obstetrics & GynaecologyTags :

Antiseizure Drugs during Pregnancy may Affect Neurodevelopment

On By ModernMedia
Photo by SHVETS production

Children whose mothers have taken antiseizure drugs during pregnancy are more likely than others to receive a neuropsychiatric diagnosis. This is according to a comprehensive study by researchers at Karolinska Institutet and elsewhere, published in Nature Communications. However, the researchers emphasise that the absolute risk is low.

Antiseizure drugs are used to treat epilepsy and to stabilise mood in certain psychiatric conditions. However, some of these drugs, such as valproate, are known to affect the foetus if used during pregnancy. 

The current study included data from over three million children in the UK and Sweden, 17 495 of whom had been exposed to antiseizure drugs during pregnancy. 

As expected, children exposed to valproate were more likely to be diagnosed with autism, intellectual disability or ADHD compared to children not exposed to antiseizure drugs. Children exposed to topiramate had a 2.5-fold increased risk of intellectual disability, while those exposed to carbamazepine had a 25 per cent increased risk of being diagnosed with autism and a 30 per cent increased risk of intellectual disability. 

No increased risk with lamotrigine 

However, the researchers found no evidence that taking the antiseizure drug lamotrigine during pregnancy increases the risk of neuropsychiatric diagnoses in the child. 

“Our findings suggest that while certain medications may pose some risk, lamotrigine may be a less risky option, but active monitoring of any antiseizure medication is critical to ensure safety and effectiveness, particularly during pregnancy,” says Brian K. Lee, Professor at Drexel University Dornsife School of Public Health, USA, and affiliated researcher at the Department of Global Public Health, Karolinska Institutet, Sweden. 

The researchers emphasise that the absolute risk of the child receiving a neuropsychiatric diagnosis is low and that there may also be risks associated with not taking antiseizure medication during pregnancy. 

“If you’re pregnant or trying to become pregnant, and taking one of these medications, it may be worth talking with your physician to make sure you’re taking the best medicine for your needs, while minimising risk to future children,” says Viktor H. Ahlqvist, researcher at the Institute of Environmental Medicine, Karolinska Institutet, and joint first author with Paul Madley-Dowd at the University of Bristol, UK. 

The results support previous findings from smaller studies that found links between antiseizure drugs during pregnancy and the risk of neuropsychiatric diagnoses in the child. One difference is that the new study found no statistically significant association between topiramate or levetiracetam and ADHD in the child. 

Source: Karolinska Institutet

Categories : Obstetrics & GynaecologyTags :

Having the Choice of Birth Position is Key in Satisfaction of Expectant Mothers

On By ModernMedia
Photo by Duda Oliveira

Whether supine, all-fours position, sitting upright or squatting – women adopt different birthing positions during childbirth. But until now, how the final birthing position affects the satisfaction of the woman giving birth had not been known. Researchers in Germany investigated the relationship. In particular, they also took into account whether the choice of birthing position was voluntary. The results, which appear in Archives of Gynecology and Obstetrics, showed that having the choice counted the most for mothers’ satisfaction.

Around three quarters of those surveyed were lying during the birth and were particularly dissatisfied if they felt that they had not made this choice themselves. But if the expectant mothers had chosen the supine or lateral supine position themselves, the position actually tended to make them more satisfied.

For a long time, the supine position was the most common birth position in Western countries, giving obstetricians unhindered access to the woman and child.  In various cultures, however, upright birthing positions, such as sitting or squatting, are also widespread. Which position is best for expectant mothers and the unborn child is controversial in the literature.

“Until today, international guidelines usually only recommend that women should adopt their preferred birthing position,” explains Prof Dr Nadine Scholten, professor in psychosomatic and psycho-oncological health services research at the University of Bonn. With regard to birthing positions, the German guideline also states that women should adopt the position that seems most comfortable to them. However, they should also be encouraged to adopt an upright position in the final phase of birth.

“In reality, whether they ultimately lie, sit or squat depends on the wishes of the expectant mothers themselves, but also on the suggestions of the midwives, obstetricians and sometimes necessary medical measures,” explains Prof Dr Brigitte Strizek, Director of the Clinic for Obstetrics and Prenatal Medicine at the University Hospital Bonn (UKB).

Focus on women’s satisfaction

A team led by Prof Scholten, who carried out the study at the Institute for Medical Sociology, Health Services Research and Rehabilitation Research (IMVR) at the University of Cologne and the UKB, wanted to find out which birthing position women were most satisfied with afterwards. Almost 800 mothers were asked about their final birthing position and how satisfied they were with the birth overall using an anonymous questionnaire. All of the data analysed here was from women who had given birth vaginally in a hospital without the use of a vacuum extraction or forceps, and who had given birth eight to twelve months previously at the time of the survey. In their study, the researchers also asked about the satisfaction of the mothers – depending on whether the birth position was freely chosen or not. The reasons for not choosing a free position were also asked.

It was found that over three quarters of mothers gave birth to their child lying on their side or on their back. Of these women, up to 40% stated that they had not chosen the birth position voluntarily. “The most common reason given by respondents was instructions from medical staff,” explains Prof Scholten, first and corresponding author. The most common position assigned by obstetricians was the supine position. It was striking that women were more satisfied with their birth if they were allowed to choose the position voluntarily – especially if they chose the supine position themselves. Women who were not free to choose their birthing position were particularly dissatisfied if the medical staff specified this and not the CTG to record the heart rate of the unborn child and labour activity or the epidural, the anaesthetic to relieve pain, prevented the desired position.

Self-determination not always given in the delivery room

“The number of women who did not choose the birth position themselves is particularly striking, as is the associated lower level of satisfaction with the birth,” summarises co-author Prof Strizek. However, the team cannot confirm whether an increased voluntary choice of birth position in the future would result in fewer women giving birth in the supine position. “In order to increase women’s subjective satisfaction with their birth experience, they should be given the opportunity to adopt their preferred position,” appeals lead author Prof Scholten. “The first step is to increase the awareness of medical staff and empower women to understand and better communicate their preferences.”

Prof Strizek adds: “If a certain position would be advantageous for the woman giving birth from a medical point of view, we as obstetric teams need to explain this better to the women so that they rarely have the feeling that they have not determined the birth position themselves.”

Source: Universitatsklinikum Bonn

Categories : Gender Obstetrics & GynaecologyTags :

Boy or Girl? This Genetic Mutation Increases Odds of Having a Daughter

On By ModernMedia
Source: Pixabay CC0

Each year, roughly the same numbers of boys and girls are born. But in individual families, some couples have four or more daughters and no sons, and some have all male children and no female children, points out University of Michigan evolutionary geneticist Jianzhi Zhang. This has led some scientists to question whether this skewed sex ratio is a result of the genes of the parents.

Now, Zhang and U-M doctoral student Siliang Song have detected a human genetic variant that influences the sex ratio of children. Additionally, they found that many hidden genetic variants of sex ratio may exist in human populations. Their results are published in the Proceedings of the Royal Society B: Biological Sciences.

“Scientists have been pondering and researching a genetic basis for sex ratio for decades, yet no unambiguous evidence for a genetic variation that alters the human sex ratio from an approximately 50:50 ratio has been found,” said Zhang, professor of ecology and evolutionary biology.

Zhang says this has led some scientists to think that the human sex ratio is not subject to mutation.

“But this scenario seems unlikely, because almost all human characteristics are subject to mutation and genetic variation,” he said. “Instead, we think genetic variation of sex ratio is too difficult to detect because sex ratio is not measured precisely.”

That is, each person typically has a very small number of children, which can lead to large errors in the estimation of the true sex ratio of a person’s children. For example, if a person only has one child, the estimated sex ratio would be either zero (if it’s a girl) or 1 (if it’s a boy) even if the true sex ratio is 0.5.

To detect genetic influence on sex ratio, the researchers realised they needed a much larger sample than in all previous studies. They turned to the UK Biobank, a biomedical database that contains the genetic and phenotypic information of about 500 000 British participants.

Analysing this data, the researchers identified a single nucleotide change named rs144724107 that is associated with a 10% increase in the probability of giving birth to a girl as opposed to a boy. But this nucleotide change is rare among the UK Biobank participants: About 0.5% of the participants carry this change. The nucleotide change is located near a gene named ADAMTS14, which is a member of the ADAMTS gene family known to be involved in spermatogenesis and fertilisation. The researchers also note that their discovery has not yet been confirmed in other samples.

The researchers also identified two genes, called RLF and KIF20B, that may also influence the sex ratio.

The study’s findings align with a theory in evolutionary biology called Fisher’s principle, which states that natural selection favours the genetic variant that increases the births of the rare sex. That is, if fewer males than females are born in a population, natural selection favours genetic variants that increase the number of males born, and vice versa. As a result, this selection yields a more or less even sex ratio in the population

“For Fisher’s principle to work, there must be mutations that influence the sex ratio,” Zhang said. “The fact that no genetic variation on human sex ratio had been identified has led some scientists to question the applicability of Fisher’s principle in humans.

“Our study shows that in fact, human data are consistent with Fisher’s principle and the reason no genetic variants of sex ratio had been discovered was the imprecision of the measure of a person’s offspring sex ratio.”

Next, the researchers hope to verify their findings in other samples – not an easy task, Zhang says, because of the large sample size requirement and the rareness of the identified genetic variant.

Source: University of Michigan

Categories : Lab Tests and Imaging Obstetrics & GynaecologyTags :

A Potential Stool Test for Endometriosis also Suggests an IBD Link

On By ModernMedia
Photo by Sora Shimazaki on Pexels

Promising findings by researchers at Baylor College of Medicine and collaborating institutions could lead to the development of a non-invasive stool test and a new therapy for endometriosis, a painful condition that affects nearly 200 million women worldwide. The study appeared in the journal Med.

“Endometriosis develops when lining inside the womb grows outside its normal location, for instance attached to surrounding intestine or the membrane lining the abdominal cavity. This typically causes bleeding, pain, inflammation and infertility,” said corresponding author Dr Rama Kommagani, associate professor in the Department of Pathology and Immunology at Baylor. “Generally, it takes approximately seven years to detect endometriosis and is often diagnosed incorrectly as a bowel condition. Thus, delayed diagnosis, together with the current use of invasive diagnostic procedures and ineffective treatments underscore the need for improvements in the management of endometriosis.”

“Our previous studies in mice have shown that the microbiome, the communities of bacteria living in the body, or their metabolites, the products they produce, can contribute to endometriosis progression,” Kommagani said. “In the current study, we took a closer look at the role of the microbiome in endometriosis by comparing the bacteria and metabolites present in stools of women with the condition with those of healthy women. We discovered significant differences between them.”

The findings suggested that stool metabolites found in women with endometriosis could be the basis for a non-invasive diagnostic test as well as a potential strategy to reduce disease progression.

The researchers discovered a combination of bacterial metabolites that is unique to endometriosis. Among them is the metabolite called 4-hydroxyindole. “This compound is produced by ‘good bacteria,’ but there is less of it in women with endometriosis than in women without the condition,” said first author Dr Chandni Talwar, postdoctoral associate in Kommagani’s lab.

“These findings are very exciting,” Talwar said. “There are studies in animal models of the disease that have shown specific bacterial metabolite signatures associated with endometriosis. Our study is the first to discover a unique metabolite profile linked to human endometriosis, which brings us closer to better understanding the human condition and potentially identifying better ways to manage it.”

Furthermore, extensive studies also showed that administering 4-hydroxyindole to animal models of the disease prevented the initiation and progression of endometriosis-associated inflammation and pain. 

“Interestingly, our findings also may have implications for another condition. The metabolite profile we identified in endometriosis is similar to that observed in inflammatory bowel disease (IBD), revealing intriguing connections between these two conditions,” Kommagani said. “Our findings support a role for the microbiome in endometriosis and IBD.”

The researchers are continuing their work toward the development of a non-invasive stool test for endometriosis. They are also conducting the necessary studies to evaluate the safety and efficacy of 4-hydroxyindole as a potential treatment for this condition.

Source: Baylor College of Medicine

Categories : Obstetrics & GynaecologyTags :

Defective Sperm in IVF Doubles the Risk of Preeclampsia

On By ModernMedia
Intracytoplasmic Sperm Injection (ICSI) procedure. Credit: Scientific Animations CC4.0

For the first time, researchers have linked specific frequent defects in sperm to risk of pregnancy complications and negative impacts on the health of the baby. The study from Lund University in Sweden shows that a high proportion of father’s spermatozoa possessing DNA strand breaks is associated with a doubled risk of preeclampsia in women who have become pregnant by IVF. It also increases the risk of the baby being born prematurely.

Infertility is a growing problem and the number of in vitro fertilisation procedures is increasing rapidly. It is already known that women who become pregnant by assisted reproduction techniques have an increased risk of preeclampsia, repeated miscarriages and the baby being born prematurely and with a lower birth weight. Yet, the reasons behind this have not been fully understood. 

“Before a planned in vitro fertilisation, the man’s sperm sample is analysed for concentration, motility and morphology. But there are men who, according to this analysis, have normal sperm, but still have reduced fertility,” says Amelie Stenqvist, lecturer at Lund University and first author of the study published in Fertility and Sterility. She received her PhD from Lund and now works as a specialist in gynaecology and obstetrics at Skåne University Hospital in Malmö.

Around 20-30% of babies born through IVF have fathers with damaged DNA in their sperm, as shown by elevated levels of DNA fragmentation. The DNA fragmentation index (DFI) is a measure of the amount of strand breaks in the DNA and is used to provide important new information about male fertility. Sperm with DNA damage may still be fertile, but the chances of fertilisation are lower and if the percentage of DFI exceeds 30%, the chances of natural conception are close to zero.

Although current in vitro techniques mean that men with a high DFI can become fathers, until now very little has been known about the impact of DNA fragmentation on pregnancy and the health of the baby. It has been difficult to research the topic because the DFI value is not included in the standard measurements currently taken by Sweden’s fertility clinics. It also requires a large study population and access to national medical registries.

“Since half of the placenta’s DNA comes from the father and placental development and function play a central role in preeclampsia, we wanted to investigate whether a high percentage of DNA damage in the sperm affected the risk of preeclampsia,” says Aleksander Giwercman.

He is a professor of reproductive medicine at Lund University, a consultant at Skåne University Hospital in Malmö. Aleksander Giwercman also led a research study that included 1660 children conceived through IVF and ICSI at the Reproductive Medicine Centre in Malmö over the period 2007-2018. 

The results showed that in the 841 couples who underwent IVF, a DFI of over 20% doubled the risk of the woman developing preeclampsia (10.5%) and also increased the risk of premature birth. In the IVF group with a DFI below 20%, there was a 4.8% risk of preeclampsia, which is comparable to pregnancies that occur naturally. For couples undergoing ICSI, there was no association with preeclampsia.

“Today, DFI analysis is only performed at some fertility clinics in Sweden, but we think that it should be introduced as standard at all clinics. It can give couples answers as to why they are not getting pregnant and can influence the chosen method of assisted fertilisation. Not only that, our latest results show that a DFI analysis could be used to identify high-risk pregnancies,” says Aleksander Giwercman.

 What makes this finding even more interesting is that high DNA fragmentation in sperm is linked to the overall health of the father and is potentially treatable. Most DNA damage is caused by oxidative stress, which is an imbalance between harmful molecules and the antioxidants that protect cells. Other factors that increase DNA fragmentation include the man’s age, smoking, obesity and infections. 

“The next step is to identify which group of men respond best to methods to prevent and treat sperm DNA damage, and to test these methods to prevent pregnancy complications,” concludes Amelie Stenqvist.

Source: Lund University

Categories : Emergency Medicine Obstetrics & GynaecologyTags :

Sharp Spike Seen in Emergency Visits for Life Threatening Pregnancy Complication

On By ModernMedia

Findings suggest significant increase in emergency department utilisation for hypertensive disorders of pregnancy over 14 year span

Photo by Camilo Jimenez on Unsplash

Hypertensive disorders of pregnancy, the second leading cause of maternal deaths worldwide, may be sending a significantly higher number of pregnant people to the emergency department. Between 2006 and 2020, researchers found a surge in emergency visits and admissions for the condition that causes serious maternal and neonatal complications and accounts for 6.3% of all pregnancy-related deaths in the United States.

The study, which appears in JAMA Network Open, also suggests greater emergency utilisation for the disease among underrepresented racial and ethnic groups. 

“Hypertensive disorders of pregnancy often develop suddenly, even in healthy women, and symptoms may appear without warning and progress rapidly,” said senior author Erica Marsh, MD, professor of obstetrics and gynaecology at the University of Michigan Medical School and chief of the division of reproductive endocrinology and infertility at U-M Health Von Voigtlander Women’s Hospital, of Michigan Medicine.

“Ideally, this risk would be detected during prenatal care and lead to early intervention. Our study indicates more people turning to the emergency department, which may reflect a higher prevalence of the condition or an increased awareness for prompt assessment and treatment.”

Hypertensive disorders of pregnancy, which could include preeclampsia, gestational hypertension, and eclampsia, are serious complications that involve elevated blood pressure. 

The American College of Obstetricians and Gynecologists recommends management of severe blood pressure in pregnancy within 30 to 60 minutes of diagnosis to prevent complications such as stroke, myocardial ischaemia, seizure, placental abruption, and maternal and neonatal mortality.

Disparities in ED reliance, disease severity

Researchers analysed nationally representative data, finding a 76% increase in emergency encounters related to the condition over the 14-year span, up from 31  623 to 55  893, and nearly 1.5 times as many ED admissions – up from 17 338 to 43 563.

Concerns about costs, time constraints, misconceptions about the necessity of early care or barriers to accessing prenatal care may be possible factors for the increase, authors say.

“The disparities in reliance on emergency rooms for this disease may imply limited access to timely outpatient care or other health system barriers,” said lead author Courtney Townsel, MD, MSc, who was at Michigan Medicine at the time of the study and is now at the University of Maryland.

Black, Hispanic, and Asian or Pacific Islander groups were also more likely to both utilise emergency care and be admitted to the hospital for hypertensive disorders of pregnancy.

“The disproportionate rate of admissions among certain racial and ethnic groups suggests worse disease severity by the time people seek care,” Townsel said.

“Racial differences in emergency care utilisation for hypertensive disorders of pregnancy underscore the ongoing racial disparities in US maternal morbidity and mortality and highlight a critical need for accessible, culturally competent community-level interventions for all.”

Original written by Beata Mostafavi. Republished under a Creative Commons Licence.

Source: Michigan Medicine – University of Michigan

 

Categories : Immunology Obstetrics & GynaecologyTags :

New Treatment for Pregnancy Loss Caused by Specific Autoantibody

On By ModernMedia
Photo by SHVETS production

Amongst women who experience recurrent pregnancy loss, around 20% test positive for a specific autoantibody. A Kobe University-led research team now found a treatment using either of two common drugs that drastically increases these women’s chances of carrying to full-term without complications, reporting their findings in Frontiers in Immunology.

Recurrent pregnancy loss is a condition of women who have lost two or more pregnancies for non-obvious reasons. Kobe University obstetrician Tanimura Kenji and his team have previously found that in 20% of these women, they can detect a specific antibody in their blood that targets their own bodies: anti-β2-glycoprotein I/HLA-DR autoantibodies.

Tanimura explains: “There is no known treatment for this particular condition, but the antibodies have a similar target to those that play a role in a different condition that has an established treatment.” Therefore, he wanted to test whether that treatment also works in the cases with the newly discovered antibody.

Tanimura enlisted the help of obstetricians across five hospitals in Japan and over the course of two years analysed the blood of consenting women suffering from recurrent pregnancy loss for the antibodies. If any of these women got pregnant during this time frame, their doctors would offer treatment options also containing those drugs that are effective against the chemically similar condition, specifically, low-dose aspirin or heparin. The research team then observed how many of the women who included these drugs in their treatment had full-term live births or pregnancy complications and compared that to the pregnancy outcomes in women who did not take either of the two drugs.

They report that women who received the treatment were much more likely to have live births (87% did) compared to the ones without treatment (of which only 50% had live births). In addition, amongst the live births, the treatment reduced the likelihood of complications from 50% to 6%. “The sample size was rather small (39 women received the treatment and 8 did not), but the results still clearly show that a treatment with low-dose aspirin or heparin is very effective in preventing pregnancy loss or complications also in women who have these newly discovered self-targeting antibodies,” summarises Tanimura.

Many women who tested positive for the newly discovered self-targeting antibodies also tested positive for the previously known ones. However, the Kobe University-led team found that women who only had the newly discovered antibodies and who received the treatment were even more likely to have a live birth (93%) and, amongst these, none had pregnancy complications.

Looking ahead, Tanimura says: “The newly discovered self-targeting antibody has been demonstrated to be involved also in infertility and recurrent implantation failure, as well as a risk factor for arterial thrombosis in women with systemic rheumatic diseases. I therefore expect that studies about the effectivity of the treatment against a broader range of conditions might produce encouraging results.”

Source: Kobe University

Categories : Cardiovascular Disease Obstetrics & GynaecologyTags :

Heart Defects in Babies Born after Fertility Treatment are More Common

On By ModernMedia
Intracytoplasmic Sperm Injection (ICSI) procedure. Credit: Scientific Animations CC4.0

The risk of being born with a major heart defect is 36% higher in babies who were conceived after assisted reproductive technology, such as in vitro fertilisation (IVF), according to results of a very large study published in the European Heart Journal.

Researchers say the finding is important since congenital heart defects are the most common form of birth defects, and some of them are associated with life threatening complications.

The study also shows that the increase in risk is particularly associated with multiple births which are more common in assisted reproduction.

 The study was led by Professor Ulla-Britt Wennerholm from the University of Gothenburg in Sweden. She said: “Previous research shows that there are increased risks for babies conceived with the help of assisted reproductive technology. These include preterm birth and low birth weight. We wanted to investigate whether the risk of heart defects was higher for babies born following assisted reproduction.”

The research included all liveborn children born in Denmark between 1994 and 2014, all children born in Finland between 1990 and 2014, those born in Norway between 1984 and 2015 and those born in Sweden from 1987 to 2015; more than 7.7 million in total.

Researchers compared data on babies born following assisted reproduction, including IVF, intracytoplasmic sperm injection (ICSI) and embryo freezing, with data on babies conceived naturally.

They assessed how many liveborn children in each group were diagnosed with a major heart defect or with a serious heart defect either in the womb or in the first year of life. They took into account other factors that can increase the risk of congenital heart defects, such as child’s year of birth, country of birth, mother’s age at delivery, if the mother smoked during pregnancy, or if the mother had diabetes or heart defects.

This showed that heart defects were around 36% more common in babies born after assisted reproduction, compared to babies conceived without such treatment (absolute risk 1.84% vs 1.15%). This risk was similar regardless of the type of assisted reproduction used (IVF or ICSI, fresh or frozen embryos). However, the risk was greater for multiple births following assisted reproduction compared to singleton births following assisted reproduction (2.47% vs 1.62%).

Professor Wennerholm said: “We already know that babies born after assisted reproductive technology have a higher risk of birth defects in general however, we have found a higher risk also in congenital heart defects, the most common major birth defect.

“The fact that the risk of heart defects is similar regardless of the type of assisted reproduction used may indicate that there is some common factor underlying infertility in parents and congenital heart disease in their babies.

“Congenital heart defects can be extremely serious requiring specialist surgery when babies are very young, so knowing which babies are at the greatest risk can help us diagnose heart defects as early as possible and ensure the right care and treatment are given. More and more people are conceiving with the help of assisted reproductive technology, so we might expect to see increases in cases of congenital heart defects worldwide.”

In an accompanying editorial, Dr Nathalie Auger from University of Montreal Hospital Research Centre in Canada and colleagues said: “Assisted reproductive technology is a popular intervention in reproductive medicine, with these procedures accounting for 2% to 8% of births depending on the country. While most neonates born after assisted reproductive technology are healthy, these procedures are not without risks.

“In one of the largest studies to date, the researchers found that assisted reproductive technology was associated with the risk of major heart defects diagnosed prenatally or up to one year of age.

“Patients who use assisted reproductive technology tend to differ from the general population. These patients may have underlying morbidities that affect both fertility and the risk of heart defects.”

Source: European Society of Cardiology

Categories : Obstetrics & GynaecologyTags :

Intravenous Iron is Faster and Better than Oral Form for Pregnant Women

On By ModernMedia
Photo by Marcelo Leal on Unsplash

Researchers found that an intravenous iron preparation, ferric carboxymaltose, works faster and better than an oral iron tablet taken by mouth for the treatment of anaemia, with comparable safety. The findings were published in Lancet Global Health.

Anaemia is a common cause of ill-health or death in mothers and their babies, especially in sub-Saharan Africa and South-East Asia where more than four out of ten pregnant women have the condition. A sizeable proportion of pregnant women in Nigeria proceed to giving birth while still anaemic despite taking iron tablet for prevention during pregnancy. Some reasons for this are that some women do not tolerate the tablets because of side effects like diarrhoea, nausea, or vomiting, or they forget to take the tablets. Available iron preparations given through drip in Nigeria like iron dextran have been associated with high risk of severe side effect, while iron sucrose needs repeat dosing. There is a need for an effective and safer alternative to overcome these problems. 

A team of researchers in a recently concluded clinical trial, called the IVON TRIAL, tested ferric carboxymaltose, which is new in Nigeria and most of sub-Saharan Africa. 

They compared the effectiveness and safety of this medicine with that of a popular tablet preparation, ferrous sulphate, which is currently being used to treat anaemia in Nigeria. They found that this new medicine given intravenously works faster and better for anaemia treatment than oral iron tablets; and it is as safe as the tablet. 

The study enrolled 1056 pregnant women, aged 15–49 years, who were between five and seven-and-half months pregnant and had anaemia with haemoglobin measurement less than 10 g/dL.

“We used a web-based platform to assign them to treatment groups. Half of the women were treated with one dose of iron given in drip through the vein while half took iron tablets three times a day till they gave birth”, says Ochuwa A. Babah, a doctoral student at the Department of Global Public Health, Karolinska Institutet and one of the authors of the paper. 

Their haemoglobin levels and iron levels were checked, and they were screened` for depression at specific time points. They were followed-up until six weeks after delivery to collect more data from mother and baby. Blood was collected from the baby’s cord at delivery to know if the medicine affected the baby’s phosphate level.

Works better for iron deficiency anaemia

Only one dose of iron (ferric carboxymaltose) given by drip through a vein during pregnancy causes a faster rise in blood level after four weeks compared to iron tablet taken by mouth three times every day. The drip iron also corrects low body iron better than iron tablets. The side effects of the drip iron are comparable to that with iron tablets, with no adverse effect on the babies. 

“These findings are reassuring because pregnant women often reject new medicines because of fear of harm to their babies. We now have evidence that implementing the use of this new iron via drip (ferric carboxymaltose) in regions where many pregnant women suffer anaemia like Africa, will be a valuable step towards reducing the proportion of pregnant women who suffer from this condition and its complications”, says Ochuwa A. Babah and continues:

“The pregnant women were willing to accept iron via drip during pregnancy, supported by their families. The healthcare workers were ready to administer iron via drip but identified a need to increase staff strength and possibly medicine subsidy. We know from the clinical trial that the intravenous iron is effective and safe, so we are already liaising with the Federal Ministry of Health, Nigeria to add it to the essential drug list.”

Source: Karolinska Institutet

Categories : Obstetrics & Gynaecology Respiratory DiseasesTags :

Higher Odds of Miscarriage, Needing Fertility Treatment for Women with Asthma

On By ModernMedia
Credit: Pixabay CC0

Women who are being treated for asthma are more likely to miscarry and need fertility treatment to get pregnant, according to a large study presented at the European Respiratory Society (ERS) Congress in Vienna, Austria. The study also suggests that most women with asthma are able to have babies.

The study was presented by Dr Anne Vejen Hansen from the department of respiratory medicine at Copenhagen University Hospital, Denmark.

She said: “Asthma is common in women of reproductive age. Previous studies have shown that it takes women with asthma longer to get pregnant than those without asthma when undergoing fertility treatment, and that asthmatic women who succeed in getting pregnant have more often had fertility treatment than non-asthmatic women. But most existing studies are on women who have actually got pregnant, so we wanted to examine fertility outcomes on a national scale, to also include those that might not become pregnant at all.”

The team analysed reproductive outcomes for all Danish women born from 1976 to 1999, following them from 1994 to 2017. In total, 769,880 women were included and followed; anyone who took anti-asthma medication on a regular basis was classified as asthmatic.

They found that women with asthma experienced a higher degree of foetal loss compared to women without asthma (17.0% vs. 15.7%) and more use of fertility treatment (5.6% vs. 5.0%). However, the proportion who subsequently gave birth was 77% in women with and without asthma, suggesting that asthma does not seem to affect the number of live births.

Dr Vejen Hansen said: “We found that women fulfilling the definition of asthma had a higher rate of foetal loss and an increased use of fertility treatment. The more severe the asthma and the more flare ups the women experienced, the more likely they were to need fertility treatment. Why this is, is not clear. It might be related to systemic inflammation throughout the body, including women’s reproductive organs.

“But the numbers also show that these same women who redeem asthma medication still have as many live births in the end as women who don’t. This suggests that most women with asthma probably do manage to become pregnant and have babies in the end.

“We also plan to investigate the possible effect of male asthma on fertility, and, therefore, have another similar registry-based study in the pipeline.”

Professor Lena Uller is Chair of the ERS group on Airway Pharmacology and Treatment and Head of the Respiratory Immunopharmacology research group at Lund University, Sweden, and was not involved in the research. She said: “It’s reassuring that women seem to have the same live birth rate regardless of their asthma. However, the results also indicate that women with asthma should take into consideration potential reproductive challenges in their family planning. If women with asthma are worried about their fertility, they should speak to their doctor.

“The results of this study also underscore the importance of managing asthma in reproductive-aged women. The fact that the more severe the asthma, the more the problems with fertility, suggests that uncontrolled asthma is the problem and we should be helping women to get their asthma under control.”

Source: European Respiratory Society