In a recent analysis published in Acta Obstetricia et Gynecologica Scandinavica, researchers found no link between women’s caffeine consumption and pregnancy or live birth rate after fertility treatments – but alcohol consumption was linked to decreased pregnancy rate after treatments with more than 84g of alcohol a week (approximately 7 standard drinks).
The link held true for their spouses as well: men’s alcohol consumption was associated with decreased live birth rate after fertility treatments in women when weekly consumption was greater than 84g.
The researchers searched the available literature and found a total of 7 studies on caffeine consumption and 9 studies on alcohol consumption were included, with a total of 26 922 women and/or their spouse who underwent fertility treatment.
Compared with those abstaining from alcohol, the chance of achieving a pregnancy after fertility treatment decreased by 7% for women who consumed 84g of alcohol per week, and the chance of partners achieving a live birth decreased by 9% for men who consumed 84g of alcohol per week.
“Couples should be aware that some modifiable lifestyle factors such as drinking habits may affect their fertility treatment outcomes. But how these factors impact the reproductive system still needs more research to elucidate,” said corresponding author Yufeng Li, MD, of Tongji Hospital, in China.
Intermittent fasting has been shown to be an effective way to lose weight, but critics have worried that the practice may have a negative impact on women’s reproductive hormones. Now, researchers bring new evidence to the tablein a study published in Obesity.
The researchers, led by Krista Varady, University of Illinois Chicago professor of nutrition, followed a group of pre- and post-menopausal obese women for a period of eight weeks on the ‘warrior diet’ method of intermittent fasting.
The warrior diet prescribes a time-restricted feeding window of four hours per day, during which dieters can eat without counting calories before resuming a water fast until the next day.
They measured the differences in hormone levels, obtained by analysing blood sample data, in groups of dieters who stuck to four- and six-hour feeding windows against a control group that followed no diet restrictions.
Varady and her team found that levels of sex-binding globulin hormone, a protein that carries reproductive hormones throughout the body, was unchanged in the dieters after eight weeks. The same held true for both testosterone and androstenedione, a steroid hormone that the body uses to produce both testosterone and oestrogen.
However, dehydroepiandrosterone or DHEA, a hormone that fertility clinics prescribe to improve ovarian function and egg quality, was significantly lower in both pre-menopausal and post-menopausal women at the end of the trial, dropping by about 14%.
While the drop in DHEA levels was the most significant finding of the study, in both pre- and post-menopausal women, DHEA levels remained within the normal range by the end of the eight-week period.
“This suggests that in pre-menopausal women, the minor drop in DHEA levels has to be weighed against the proven fertility benefits of lower body mass,” Varady said. “The drop in DHEA levels in post-menopausal women could be concerning because menopause already causes a dramatic drop in estrogen, and DHEA is a primary component of estrogen. However, a survey of the participants reported no negative side effects associated with low estrogen post-menopause, such as sexual dysfunction or skin changes.”
As an added benefit, since high DHEA has been linked to breast cancer risk, Varady said a moderate drop in levels might be helpful in reducing that risk for both pre- and post-menopausal women.
The study measured levels of oestradiol, oestrone and progesterone as well, but only in post-menopausal women, due to the changing levels of these hormones throughout pre-menopausal women’s menstrual cycles. Among post-menopausal women, there was no change in these hormones at the end of eight weeks.
Women in both the four-hour and six-hour dieting groups experienced weight loss of 3% to 4% of their baseline weight throughout the course of the study, compared with the control group, which had almost no weight loss. The dieters also saw a drop in insulin resistance and in biomarkers of oxidative stress.
Perimenopausal women, who are typically in their 40s, were excluded from the study.
Still, Varady said, “I think this is a great first step. We’ve observed thousands of pre- and post-menopausal women through different alternate-day fasting and time-restricted eating strategies. All it’s doing is making people eat less. By shortening that eating window, you’re just naturally cutting calories. Much of the negative information on intermittent fasting reported has come from studies on mice or rats. We need more studies to look at the effects of intermittent fasting on humans.”
A new study, published in the International Journal of Obesity, found that 3-year-old children were more likely to exhibit risk factors for future heart disease if their mother was clinically obese during pregnancy. A behavioural lifestyle intervention reduced this risk.
There is increasing evidence to suggest that obesity in pregnancy is associated with cardiometabolic dysfunction in children, and that serious cardiovascular disease may begin in the womb.
The UPBEAT trial, conducted at Guy’s and St Thomas’ NHS Foundation Trust, randomised women with obesity (a BMI of over 30 kg/m2) in early pregnancy to a diet and exercise intervention or to standard pregnancy care. The intervention included one-to-one counselling, restricting dietary intake of saturated fat, eating foods with a low glycaemic index such as vegetables and legumes, moderate and monitored physical activity and tools to record exercise. The intervention arm saw improvements in weight gain in pregnancy, physical activity, a healthier diet, and a healthier metabolic profile across pregnancy.
Follow-up of the children at age three showed that children of women with clinical obesity had evidence of cardiac remodelling, a risk factor for future cardiovascular disease. Changes included increased heart muscle thickness, elevated resting heart rate, evidence of early impairment to the heart’s relaxation function and increased sympathetic nerve activity compared to women of normal weight. The children of women who were allocated to the intervention arm were protected from these early changes in heart structure and function.
Study lead Dr Paul Taylor, from King’s College London, said: “Maternal obesity appears to adversely impact the developing foetal nervous system and foetal heart development which is apparent up to 3 years-of-age. A complex lifestyle intervention in pregnancy was associated with protection against cardiac remodelling in infants. We can hypothesise that these changes to the heart and its function will get worse over time, putting the child at increased risk of cardiovascular disease in the future.”
The study suggests that maternal obesity may have a lasting impact on the child’s cardiovascular health. Promoting dietary changes and physical activity during pregnancy may reduce this risk.
Women at risk of pregnancy loss who need a specialist surgical procedure could benefit from a single-stranded suture thread to reduce risk of infection, results from the C-STICH clinical trial found which were published in The Lancet.
The trial involved more than 2000 expectant mothers who needed a procedure called a cerclage, where a purse string suture is placed around the cervix during their pregnancy. Women were randomly allocated to have the surgical procedure performed using either a single stranded thread or a braided thread.
Researchers tested whether there would be any difference in miscarriage or stillbirth, due to an increased risk of infection, from using a braided suture thread. The research shows that single stranded sutures could potentially improve outcomes for mothers at risk of preterm birth.
The team, led by researchers from the University of Birmingham and Birmingham Women’s and Children’s Hospital, found that the mothers treated with single stranded threads had no differences in pregnancy loss or preterm birth but reported fewer instances of infection and sepsis. This could have important implications for the health outcomes of mothers and babies who are treated with a cervical cerclage in their pregnancy.
Dr Vicky Hodgetts-Morton, NIHR Clinical Lecturer in Obstetrics at the University of Birmingham and Birmingham Women’s Hospital explained the implications of the trial results. Dr Hodgetts-Morton said:
“Preterm birth is a significant problem, complicating approximately one in ten pregnancies around the world. The consequences of preterm birth may be significant with some babies being born too early to survive, and those that survive are at increased risk of health complications. One cause for preterm birth is cervical insufficiency, occurring in 0.5% to 1% of pregnant women for which the placement of a vaginal cervical cerclage can be an effective treatment.
“Suture thread choice has the potential to improve how well a cerclage works in preventing miscarriage, stillbirth and preterm birth. Both single stranded and braided threads are commonly used to perform cerclages and our findings show no differences in pregnancy loss and preterm birth. The C-STICH trial results did show an increased risk of infections in labour and around the time of delivery with braided threads and this supported our hypothesis that a single stranded thread could reduce the risk of infection developing during the pregnancy.”
Pregnant smokers reduced their smoking by an average of one cigarette per day before becoming aware they were pregnant, according to a new study in in Addiction Biology. In the month after learning of their pregnancy, participants reduced smoking by another four cigarettes per day.
“Our findings suggest that pregnancy could curb smokers’ desire to smoke before they are even aware of having conceived,” said the study’s lead author and principal investigator, Dr Suena Huang Massey, associate professor of psychiatry and behavioural sciences and medical social sciences at Northwestern University Feinberg School of Medicine.
“While recognition of pregnancy is a common motivation to reduce or quit smoking, if biological processes in early pregnancy are also involved as suggested by this study, identifying precisely what these processes are can lead to the development of new smoking-cessation medications.”
The vast majority of research in this field focuses on the impact of a person’s smoking on the pregnancy and the baby. This study examines, instead, the impact of pregnancy on a person’s smoking behaviour.
Though it is well known that smoking is reduced in pregnancy, it was not known when it started and whether the smokers knew they were pregnant.
“Before this paper, it was largely assumed that the only thing causing pregnant smokers to cut down was a desire to protect the baby,” Dr Massey said. “While our study does support the discovery of pregnancy as a salient event, levels of pregnancy smoking began to decline before smokers suspected they were pregnant.”
These findings support a new line of research into what happens biologically during pregnancy that might be interrupting addictive behaviours, Massey said. Her hope is that the answer to this question will lead to the discovery of new and improved ways to treat addiction.
Pregnancy hormones a contributing factor?
Human chorionic gonadotropin (hCG) is a hormone produced by the placenta in early pregnancy that is linked to morning sickness (nausea and vomiting during pregnancy).
“Strikingly, we observed the steepest declines in smoking precisely when hCG levels typically peak – between five and 10 weeks of pregnancy,” Massey said. “What’s more, pregnant smokers who do not quit during the first trimester (when hCG levels are elevated) are unlikely to quit before delivery, even with assistance from medications or financial incentives.”
Study methodology
Scientists estimated changes in cigarettes per day smoked, reported retrospectively, by 416 participants from two independent cohorts (145 from 2000 to 2005 and 271 from 2006 to 2009). Every participant was a smoker prior to becoming pregnant. Women in the study were interviewed about their smoking habits at 16 weeks of pregnancy and provided urine samples, so researchers could verify their reports.
On average, participants smoked about 10 cigarettes per day before conception. Between conception and the date they realised they were pregnant (highly variable and reported by each participant), smoking fell by an average of one cigarette per day. In the month after recognising the pregnancy, smoking dropped from an average of 9 cigarettes per day to five. Importantly, these declines were seen whether pregnancies were planned or unplanned, and whether smokers quit or did not quit.
Despite the fact that dysmenorrhoea is the leading cause of school absences for adolescent girls, few girls seek treatment. A review suggests that diet may be a key contributor, specifically diets high in meat, oil, sugar, salt, and coffee, which have been shown to cause inflammation. Results will be presented during The North American Menopause Society (NAMS) Annual Meeting in Atlanta, October 12-15, 2022.
Roughly 90% of adolescent girls experience menstrual pain. Most use over-the-counter medicine to manage the pain, with limited improvement. Evidence has highlighted that diets high in omega-3 fatty acids and low in processed foods, oil, and sugar reduce inflammation, a key contributor to menstrual pain.
This analysis was designed to study the effect of diet on menstrual pain and identify which foods contribute to it and which can reduce it. Research was conducted through a literature review that found multiple studies that examined dietary patterns that resulted in menstrual pain. In general terms, these studies found that diets high in omega-6 fatty acids promote inflammation and foods high in omega-3 fatty acids reduce it. The muscles in the uterus contract because of prostaglandins, which are active in inflammatory responses. When measuring the Dietary Inflammatory Index, it was found that those on a vegan diet (that excluded animal fat) had the lowest rates of inflammation.
“Researching the effects of diet on menstrual pain started as a search to remedy the pain I personally experienced; I wanted to understand the science behind the association. Learning about different foods that increase and decrease inflammation, which subsequently increase or reduce menstrual pain, revealed that diet is one of the many contributors to health outcomes that is often overlooked. I am hopeful that this research can help those who menstruate reduce the pain they experience and shed light on the importance of holistic treatment options,” said Serah Sannoh, lead author of the poster presentation from Rutgers University.
“Since menstrual pain is a leading cause of school absenteeism for adolescent girls, it’s important to explore options that can minimise the pain. Something like diet modification could be a relatively simple solution that could provide substantial relief for them,” said Dr Stephanie Faubion, NAMS medical director.
Newly discovered biological changes in mothers who suffer postpartum depression may help explain the condition, yield long-sought treatments and let doctors identify those at risk even before their babies are born. The findings were published in Molecular Psychiatry.
Postpartum depression strikes up to 20% of new mothers, and roughly 20% of maternal deaths after childbirth are from suicide. Postpartum depression can cause anxiety and irritability, feelings of self-doubt and difficulty bonding with the baby, cognitive impairment, and interfering with sleeping and eating. For the child, maternal postpartum depression can lead to cognitive, emotional and social development problems.
Risk factors for postpartum depression are thought to include the mother’s age at childbirth, diabetes and prior history of mental health issues. But the new discovery suggests a previously unknown biological contributor: an impairment of the body’s ability to clean up old genetic material and other cellular debris.
“The finding that cells aren’t cleaning out old proteins and cellular debris, called autophagy, occurs before women develop depression symptoms, indicating that it could be part of the disease process,” explained Jennifer L. Payne, MD, director of the Reproductive Psychiatry Research Program at the University of Virginia School of Medicine. “There are several medications that promote autophagy in cells, so this finding might open the door to new treatments and to identification of women at risk of postpartum depression before they become ill.”
Understanding Postpartum Depression
Dr Payne and colleagues wanted to determine if ‘extracellular RNA communication’, a newly discovered form of communication among cells, might contribute to postpartum depression. Extracellular RNA communication is heightened during pregnancy and is critical in embryo implantation and in the body’s inflammatory response afterward.
The researchers analysed blood plasma samples from 14 research participants with and without postpartum depression, collected during and after their pregnancies. The researchers found that extracellular RNA communication in immune cells was altered extensively in women who suffered postpartum depression. Further, they determined that this “large and consistent” change significantly limited the women’s bodies’ ability to perform important cellular cleanup – suggesting a potential biological cause for their depression.
“Deficits in autophagy are thought to cause toxicity that may lead to the changes in the brain and body associated with depression,” Dr Payne said. “We have never fully understood the biological basis for postpartum depression, and this finding gets us closer to an understanding.”
Women with severe preeclampsia may be treated with extended-release nifedipine, a blood pressure-lowering medicine, daily during the labour and delivery process, according to new research published today in Hypertension. Women receiving the drug had a lower risk of dangerously high blood pressure that would require treatment with fast-acting medicines including intravenous (IV) medications.
The study examined whether treatment with nifedipine, an extended-release blood pressure-lowering medication, leading up to labour and delivery may prevent severe blood pressure levels from developing, and, as a result, avoid the need to administer fast-acting IV medications.
According to the American Heart Association, preeclampsia is typically diagnosed after 20 weeks of pregnancy and indicates high blood pressure measures with symptoms such as headaches, vision changes and swelling of the hands, feet, face or eyes. It affects up to 8% of pregnancies. A diagnosis of preeclampsia with severe features typically includes systolic BP of ≥ 160mmHg and/or diastolic BP ≥ 110mmHg, and proteinuria. It increases the risk of stroke, liver or kidney damage and pre-term delivery. Delivery of the baby is the only way to start to cure preeclampsia, and symptoms usually go away within days of delivery. However, some women require BP medication for six weeks after delivery or longer.
“We know that bringing down very high blood pressure to a safer range will help prevent maternal and foetal complications. However, besides rapid-acting, IV medicines for severe hypertension during pregnancy, optimal management for hypertension during the labour and delivery process, has not been studied,” said lead study author Erin M. Cleary, MD.
Sever hypertension also raises the risk for complications such as placental abruption, leading to serious complications for mother and/or the baby.
“Some of these complications may include emergency delivery, blood loss for the mother and may be life threatening for both the mother and baby,” Dr Cleary said. “About 10% of patients treated with a rapid-IV treatment for very high blood pressure may quickly have very low blood pressures. When blood pressure gets too low, too fast, that can lead to other serious complications.”
The study was conducted from June 2020 to April 2022 at The Ohio State University Wexner Medical Center and included 110 women who were at least 22 weeks pregnant, diagnosed with severe preeclampsia and who underwent induction of labour. Half were randomised to take a 30mg oral pill nifedipine extended-release once a day until delivery, the other half took a placebo pill daily until delivery. Participants were followed through hospital discharge, and chart review was performed through six weeks postpartum to monitor for any postpartum readmissions along with reasons for readmission.
The researchers also examined the impact of nifedipine treatment on delivery, if and how long the baby may have needed care in the neonatal intensive care unit (NICU) and other adverse outcomes for the mother and/or baby.
The study found:
34% of women in the nifedipine group needed acute hypertension therapy compared to 55.1% of those in the placebo group.
There were fewer Caesarean deliveries among the women treated with nifedipine: 20.8% of women in the nifedipine treatment group had a Caesarean section, compared to 34.7% of women in the placebo group.
The rate of NICU admission for the newborns was lower if the mother was treated with nifedipine (29.1%) compared to the placebo group (47.1%).
Poor outcomes for the infant – such as lower Apgar score, low blood sugar levels, high bilirubin or needing extra oxygen – did not differ significantly between the two treatment groups.
It’s important to note, however, that the number of participants in this study was too small to determine whether the differences in the NICU and Caesarean rates may hold true or if they may be due to chance or other factors. The researchers plan to conduct larger studies with more participants to better understand if these differences are valid.
Researchers have developed easy-to-use online prediction tools that provide personalised risk estimates for patients undergoing hysterectomy for benign disease. The models are described in a study published in the Canadian Medical Association Journal.
Hysterectomy is one of the most common surgical procedures, with one-third of women in Canada undergoing this procedure before age 60. Laparoscopic hysterectomies are more common as they are less invasive than abdominal surgery. Current practice entails that surgeons discuss benefits of the type of procedure and risks of complications with patients.
The researchers developed and tested prediction models with the aim of supplementing a surgeon’s expert opinion on patients’ risks of complications from hysterectomy. Hysterectomy complications can include ureteric, gastrointestinal and vascular injury as well as wound complications. The authors used data from the English National Health Service (NHS) on 68 599 women who had laparoscopic hysterectomies and 125 971 women who had abdominal hysterectomies between 2011 and 2018.
“Historically, a surgeon’s gut feeling has been shown to be a good indicator of postoperative outcomes; however, an expert opinion is the lowest value in evidence-based medicine,” said Dr Krupa Madhvani, Queen Mary University of London. “Although a surgeon’s experience and expert opinion carries utility, it cannot be used solely to guide risk management. In Canada and globally, the overall rate of hysterectomy for benign disease is declining, and more patients are undergoing surgery by lower-volume surgeons, who may not have expertise in every procedure,” write the authors.
Using 11 predictors, such as age, body mass index and diabetes, the researchers also included ethnicity as a potential risk factor.
“Ethnicity has been shown to be an independent factor influencing the route and complications of hysterectomy,” the authors wrote.
They found women of Asian background were at higher risk of major complications after abdominal hysterectomy compared with women who were white, although the risk was not associated with laparoscopy. The most significant risk factor for major complications in both procedures were the presence of adhesions, which is consistent with existing evidence.
“These tools will guide shared decision-making and may lead to referral to centres with greater surgical expertise or to exploration of nonsurgical treatment options,” the authors wrote.
New research suggests that the physiological ‘wear and tear’ of stress may affect a woman’s fecundability, ie her ability to fall pregnant within a menstrual cycle. The study was published in Acta Obstetricia et Gynecologica Scandinavica.
Allostatic load reflects multi-system physiological changes which occur in response to chronic psychosocial stress, reflecting a kind of ‘wear and tear’. The study investigated the link between female pre-pregnancy allostatic and time to pregnancy.
Reduced human fecundability not only results in infertility, it also creates social aging problems. Female fecundability is a complicated topic that can be influenced in many ways, including physical factors and psychological factors. Prior research tended to focus on the impact of chronic diseases, such as hypertension, diabetes and obesity. However, mental factors, including psychological pressure, anxiety and depression, could also potentially exert impact on female fecundability. Evidence supports that infertility may cause stress in many ways, but it is unclear whether stress causes infertility, or how stress and human fecundability interact.
The study assessed AL in 444 women who were trying to become pregnant. Women with higher allostatic load scores – based on nine indicators such as blood pressure, blood sugar, cortisol, noradrenaline, and cholesterol – were less likely to become pregnant within a year. For example, the women with an allostatic load score of 5–6 would have a 59% reduction of fecundability compared with those with scores of 0.
“What we found provides a new idea for preconception counselling. But obviously, how to objectively assess the stress is a complex scientific question, and how to intervene and reduce the impact of chronic stress is a burning problem, which are all things we need to study further,” said senior author Bei Wang, PhD, of Southeast University in Jiangsu, China.
