Wednesday, April 9th, 2014
For women who are at high risk of developing pre-eclampsia, a potentially dangerous condition in which pregnant women’s blood pressure spikes and their babies need to be delivered immediately, a low dose of aspirin during pregnancy might be a wise preventative measure, according to a new recommendation by a federal government task force. More from The New York Times:
The United States Preventive Services Task Force’s draft recommendation follows a growing scientific consensus that low doses may be beneficial to some high-risk women and their offspring. Low-dose aspirin reduced the risk of pre-eclampsia by 24 percent in clinical trials, according to a systematic review underpinning the new recommendation, which was published in Annals of Internal Medicine.
Low-dose aspirin also reduced the risk of premature birth by 14 percent and of intrauterine growth restriction — a condition in which the fetus doesn’t grow as fast as expected — by 20 percent.
“For every four women who would have gotten pre-eclampsia, one case is prevented,” said Dr. Ira M. Bernstein, the chair of department of obstetrics, gynecology and reproductive sciences at the University of Vermont. “The ability to prevent a quarter of disease is substantial.”
Pre-eclampsia is a condition usually occurring in the second half of pregnancy and characterized by high blood pressure, protein in the urine, liver disease and blood-clotting abnormalities.
It is a leading complication for expectant mothers and their infants, affecting roughly 4 percent of pregnancies nationwide. The only “cure” is delivery. When a pregnant women develops pre-eclampsia in the second trimester, her infant often must be delivered prematurely to avoid severe maternal complications, like stroke.
The task force recommended that women at high risk for pre-eclampsia take 81 milligrams of low-dose aspirin daily after 12 weeks of gestation. High-risk women include those who have had pre-eclampsia in a prior pregnancy, especially those who have had to deliver preterm; women carrying multiple fetuses; and women who had diabetes or high blood pressure at conception.
But the task force also advised that expectant women with multiple moderate-risk factors “may also benefit from low-dose aspirin.” These risks include obesity, a family history of pre-eclampsia, women older than 35, and African-American women.
Image: Pregnant woman taking pill, via Shutterstock
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Thursday, February 6th, 2014
Fewer than half of women keep the appointments their doctors recommend they make shortly after giving birth, according to a new study conducted by researchers at Johns Hopkins University. Especially for women with complications like gestational diabetes or high blood pressure, those visits are important to future health, the researchers said. More from the university:
The researchers found that women with pregnancy complications were more likely to see a doctor post-delivery, but overall, visit rates were low.
“Women need to understand the importance of a six-week visit to the obstetrician — not only to address concerns and healing after delivery, but also to follow up on possible future health risks, review the pregnancy and make the transition to primary care,” says Wendy Bennett, M.D., assistant professor of medicine and the lead researcher for the study, described online last week in the Journal of General Internal Medicine. “Women with pregnancy complications are at higher risk for some chronic diseases, such as diabetes, high blood pressure and heart disease, and these visits are an opportunity to assess risks and refer to primary care providers to work on long-term preventive care.”
Physician groups, such as the American College of Obstetrics and Gynecology, recommend women with complications like high blood pressure during pregnancy or gestational diabetes not only visit their obstetricians six weeks after a birth, but that they also see their primary care doctors within a year.
For the study, the researchers collected data from one commercial health insurance plan and multiple Medicaid insurance plans in Maryland. The aims were to determine different predictors of receiving post-delivery primary and obstetric care in women with and without pregnancy complications, including gestational or pregestational diabetes mellitus and hypertensive disorders, such as preeclampsia. Women with these conditions are much more likely to develop long-term health problems, such as type 2 diabetes and cardiovascular disease.
Among women with tax-supported Medicaid insurance, 56.6 percent of those with a complicated pregnancy and 51.7 percent of those without a complicated pregnancy visited a primary care doctor within a year. Among women with commercial health insurance, 60 percent of those with a complicated pregnancy and 49.6 percent of those without a complicated pregnancy did so.
White patients, older patients and patients with depression or preeclampsia were also more likely to visit their primary care doctor.
Of the women on Medicaid, 65 percent of those with complicated pregnancies and 61.5 percent of those without complicated pregnancies had a postpartum obstetric visit within three months. Numbers were slightly lower for those with commercial insurance, at 50.8 percent of those with complicated pregnancies and 44.6 percent of those without complicated pregnancies.
Bennett says providers need to develop creative ways to improve attendance at postpartum visits. A pilot project at Johns Hopkins Bayview Medical Center, for example, involves combined “mommy-baby” visits, she says. If the baby’s checkup is included in the mother’s visit, the mother may be more likely to keep the appointment, and thus would receive important education about improving health behaviors and the need for primary care follow-up. Other options are home visits and collaborations with day care centers, community centers and churches to make visits and health promotional activities more convenient.
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Thursday, December 13th, 2012
Babies who experience oxygen deprivation in utero–due to conditions including birth asphyxia, neonatal respiratory distress syndrome and preeclampsia–are more likely to develop attention deficit hyperactivity disorder (ADHD) later in childhood, a new study has found. ADHD affects an estimated 8.4 percent of American children between ages 3 and 7, the Centers for Disease Control says.
CNN.com has more on the new study:
“Dr. Darios Getahun, lead author of the study, said that although there may not be any interventions aside from monitoring a mother and her child through pregnancy, knowing these factors can better assist physicians in tracking and diagnosing ADHD in children.
Getahun, who works with the Kaiser Permanente Department of Research and Evaluation, added, “The study leads us to suggest that those children that are exposed, they are at risk. And it’s important to closely monitor these children as early diagnosis and treatment is most important.”
When looking at specific factors, children who had exposure to neonatal respiratory distress syndrome had a 47% greater risk of developing ADHD, followed by children whose mothers had preeclampsia, or high blood pressure during pregnancy, with a 34% greater risk. Children who had been exposed to birth asphyxia – when a baby doesn’t receive enough oxygen at birth – carried a 26% greater risk of developing ADHD.
Researchers also found that the risk of ADHD was increased if the risk factors were present and the birth was preterm.
However, Getahun and researchers were quick to also note that the percentage of ADHD cases attributed to ischemic-hypoxic conditions is small – just about 3% – and said that rather on focusing on preventing such conditions, these factors were a tool.”
Image: Blood pressure cuff, via Shutterstock
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