WOMEN'S HEALTH
Higher acetaminophen intake in pregnancy
linked to attention deficits in young children
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A NEW STUDY LINKS MORE FREQUENT ACETAMINOPHEN USE IN PREGNANCY TO MODEST BUT SIGNIFICANT PROBLEMS WITH ATTENTION IN YOUNG CHILDREN. SUSAN SHANTZ, LEFT, THE ILLINOIS KIDS DEVELOPMENT STUDY PRINCIPAL INVESTIGATOR AND A U. OF I. PROFESSOR EMERITA OF COMPARATIVE BIOSCIENCES, LED THE RESEARCH WITH FORMER U. OF I. GRADUATE STUDENT MEGAN WOODBURY, NOW A POSTDOCTORAL RESEARCHER AT NORTHEASTERN UNIVERSITY IN BOSTON.
view moreCREDIT: PHOTO BY FRED ZWICKY
CHAMPAIGN, Ill. — A new study links increased use of acetaminophen during pregnancy – particularly in the second trimester – to modest but noticeable increases in problems with attention and behavior in 2-, 3- and 4-year-olds. The study adds to a growing body of evidence linking the frequent use of acetaminophen in pregnancy to developmental problems in offspring.
The findings are detailed in the journal Neurotoxicology and Teratology.
The research is part of the Illinois Kids Development Study at the University of Illinois Urbana-Champaign, which explores how environmental exposures influence child development. The study tracked hundreds of children, collecting data on their prenatal chemical exposures and asking caregivers to assess their behaviors and traits at ages 2, 3 and 4.
While acetaminophen is considered the safest painkiller and fever reducer available during pregnancy, previous studies have found evidence of a range of possible negative outcomes for children exposed to the drug in gestation, said Megan Woodbury, who led the research as a graduate student at the U. of I. with comparative biosciences professor emerita Susan Schantz, the principal investigator of the IKIDS program at Illinois. Woodbury is now a postdoctoral researcher at Northeastern University in Boston. Schantz is a faculty member of the Beckman Institute for Advanced Science and Technology at the U. of I.
A recent study led by Woodbury and Schantz linked higher acetaminophen exposure in pregnancy to language delays in children.
Some previous studies have found no relationship between acetaminophen use in pregnancy and attention and behavior in childhood, while other, usually larger studies found relationships between more frequent use of the medication during pregnancy and attention-related and behavioral problems in offspring. Most of the latter studies were conducted in older children and questioned pregnant participants about their use of acetaminophen at most once per trimester. The new study asked pregnant parents about their acetaminophen use six times over the course of the pregnancy – roughly once every four-to-six weeks – offering a more precise picture of the magnitude and timing of the drug exposures.
The researchers also asked caregivers to answer dozens of standardized questions about their child’s behavior and ability to pay attention at ages 2, 3 and 4. More than 300 children were assessed at age 2, with 262 assessed again at 3, and 196 at age 4.
“Our most important finding was that with increasing acetaminophen use by pregnant participants, especially during the second trimester, their children showed more attention-related problems and ADHD-type behaviors, which we call ‘externalizing behaviors,’ at every age we measured,” Woodbury said.
“The kinds of behaviors the caregivers reported included things like the child talking out of turn, not paying attention, not being quiet when they were supposed to be quiet, not sitting down when they were supposed to be sitting down, and being a little aggressive with other children,” Schantz said.
The findings are not an indication that the children have attention-deficit/hyperactivity disorder or that they will be diagnosed with ADHD at a later date, Schantz said. But the children seem to be having more trouble with attention than peers of the same age who were less exposed or not exposed to acetaminophen in the womb.
Woodbury, who herself is pregnant, says she does not want to scare others away from using acetaminophen in pregnancy when needed. Extreme headaches or other painful episodes and fevers can be debilitating and even dangerous, calling for use of the drug. She said she has turned to acetaminophen once per trimester so far. But she also chooses not to use it for minor aches, pains or slight fevers.
More research is needed to test whether more frequent use of acetaminophen during the second trimester of pregnancy may be particularly problematic for the developing brain, the researchers said. The study also is limited as participants were mostly white, non-Hispanic and of higher economic status. Schantz and her team are working to broaden the cohort of participants in IKIDS to include pregnant people from a greater diversity of social, economic and racial backgrounds.
This research was supported by the Children’s Environmental Health and Disease Prevention Research Center funded by the National Institute of Environmental Health Sciences and the U.S. Environmental Protection Agency and the National Institutes of Health Environmental Influences on Child Health Outcomes program.
Editor’s notes:
To reach Susan Schantz, email schantz@illinois.edu.
To reach Megan Woodbury, email m.woodbury@northeastern.edu.
The paper “The relationship of prenatal acetaminophen exposure and attention-related behavior in early childhood” is available online.
JOURNAL
Neurotoxicology and Teratology
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
he relationship of prenatal acetaminophen exposure and attention-related behavior in early childhood
ARTICLE PUBLICATION DATE
16-Jan-2024
Mothers with high levels of dental plaque are 8 times more likely to transfer Candida albicans, involved in tooth decay, to their babies, underlining the need for moms to keep their own teeth clean
PLOS
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MOTHERS WITH HIGH LEVELS OF DENTAL PLAQUE ARE 8 TIMES MORE LIKELY TO TRANSFER CANDIDA ALBICANS, INVOLVED IN TOOTH DECAY, TO THEIR BABIES, UNDERLINING THE NEED FOR MOMS TO KEEP THEIR OWN TEETH CLEAN.
view moreCREDIT: JENNYFRIEDRICHS, PIXABAY, CC0 (HTTPS://CREATIVECOMMONS.ORG/PUBLICDOMAIN/ZERO/1.0/)
Mothers with high levels of dental plaque are 8 times more likely to transfer Candida albicans, involved in tooth decay, to their babies, underlining the need for moms to keep their own teeth clean
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Article URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0290938
Article Title: Multilocus sequence typing of Candida albicans oral isolates reveals high genetic relatedness of mother-child dyads in early life
Author Countries: Kuwait, USA
Funding: JX; grants K23DE027412 and R01DE031025 from the National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/ The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
JOURNAL
PLoS ONE
ARTICLE TITLE
Multilocus sequence typing of Candida albicans oral isolates reveals high genetic relatedness of mother-child dyads in early life
ARTICLE PUBLICATION DATE
17-Jan-2024
Mini-placentas’ help scientists understand the causes of pre-eclampsia and pregnancy disorders
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PLACENTAL ORGANOID (CIRCLE IN THE CENTRE). TROPHOBLAST CELLS ARE INVADING OUT OF THE ORGANOID, MIMICKING PLACENTAL CELLS INVADING THE UTERUS IN THE EARLY WEEKS OF PREGNANCY.
view moreCREDIT: FRIEDRICH MIESCHER INSTITUTE/UNIVERSITY OF CAMBRIDGE
Scientists have grown ‘mini-placentas’ in the lab and used them to shed light on how the placenta develops and interacts with the inner lining of the womb – findings that could help scientists better understand and, in future, potentially treat pre-eclampsia.
The study, published today in Cell Stem Cell, shows that it is possible to experiment on a developing human placenta, rather than merely observe specimens, in order to study major disorders of pregnancy.
Successful pregnancy depends on the development of the placenta in the first few weeks of gestation. During this period, the placenta implants itself into the endometrium – the mucosal lining of the mother’s uterus.
Interactions between the cells of the endometrium and the cells of the placenta are critical to whether a pregnancy is successful. In particular, these interactions are essential to increase the maternal blood supply to the placenta, necessary for fetal growth and development.
When these interactions do not work properly, they can lead to complications, such as pre-eclampsia, a condition that causes high blood pressure during pregnancy. Pre-eclampsia occurs in around six in 100 first pregnancies and can put at risk the health of both the mother and the baby.
Professor Ashley Moffett from the Department of Pathology at the University of Cambridge said: “Most of the major disorders of pregnancy – pre-eclampsia, still birth, growth restriction, for example – depend on failings in the way the placenta develops in the first few weeks. This is a process that is incredibly difficult to study – the period after implantation, when the placenta embeds itself into the endometrium, is often described as a ‘black box of human development’.
“Over the past few years, many scientists – including several at Cambridge – have developed embryo-like models to help us understand early pre-implantation development. But further development is impeded because we understand so little about the interactions between the placenta and the uterus.”
Professor Moffett and colleagues at the Friedrich Miescher Institute, Switzerland, and the Wellcome Sanger Institute, Cambridge, have used ‘mini-placentas’ – a cellular model of the early stages of the placenta – to provide a window into early pregnancy and help improve our understanding of reproductive disorders. Known as ‘trophoblast organoids’, these are grown from placenta cells and model the early placenta so closely that they have previously been shown to record a positive response on an over-the-counter pregnancy test.
In previous work, Professor Moffett and colleagues identified genes that increase the risk of or protect against conditions such as pre-eclampsia. These highlighted the important role of immune cells uniquely found in the uterus, known as ‘uterine natural killer cells’, which cluster in the lining of the womb at the site where the placenta implants. These cells mediate the interactions between the endometrium and the cells of the placenta.
In their new study, her team applied proteins secreted by the uterine natural killer cells to the trophoblast organoids so that they could mimic the conditions where the placenta implants itself. They identified particular proteins that were crucial to helping the organoids develop. These proteins will contribute to successful implantation, allowing the placenta to invade the uterus and transform the mother’s arteries.
“This is the only time that we know of where a normal cell invades and transforms an artery, and these cells are coming from another individual, the baby,” said Professor Moffett, who is also a Fellow at King’s College, Cambridge.
“If the cells aren’t able to invade properly, the arteries in the womb don’t open up and so the placenta – and therefore the baby – are starved of nutrients and oxygen. That's why you get problems later on in pregnancy, when there just isn't enough blood to feed the baby and it either dies or is very tiny.”
The researchers also found several genes that regulate blood flow and help with this implantation, which Professor Moffett says provide pointers for future research to better understand pre-eclampsia and similar disorders.
Dr Margherita Turco, from the Friedrich Miescher Institute in Switzerland and co-lead of this work, added: “Despite affecting millions of women a year worldwide, we still understand very little about pre-eclampsia. Women usually present with pre-eclampsia at the end of pregnancy, but really to understand it – to predict it and prevent it – we have to look at what's happening in the first few weeks.
“Using ‘mini-placentas’, we can do just that, providing clues as to how and why pre-eclampsia occurs. This has helped us unpick some of the key processes that we should now focus on far more. It shows the power of basic science in helping us understand our fundamental biology, something that we hope will one day make a major difference to the health of mothers and their babies.”
The research was supported by Wellcome, the Royal Society, European Research Council and Medical Research Council.
Reference
Li, Q et al. Human uterine natural killer cells regulate differentiation of extravillous trophoblast early in pregnancy. Cell Stem Cell; 17 Jan 2024; DOI: doi.org/10.1016/j.stem.2023.12.013
JOURNAL
Cell Stem Cell
METHOD OF RESEARCH
Experimental study
SUBJECT OF RESEARCH
Cells
ARTICLE TITLE
Human uterine natural killer cells regulate differentiation of extravillous trophoblast early in pregnancy
ARTICLE PUBLICATION DATE
17-Jan-2024
Prenatal opioid exposure and immune-related conditions in children
JAMA Network Open
Peer-Reviewed PublicationAbout The Study: Prenatal opioid exposure was associated with an increased risk of infection, eczema and dermatitis, and asthma, but not allergies and anaphylaxis or autoimmune conditions in this study of 401,000 neonates. These findings highlight the importance of further study of opioid-induced immune changes during pregnancy, the potential impact on long-term health in exposed children, and the mechanisms of opioid-induced immune dysregulation.
Authors: Erin Kelty, Ph.D., of the University of Western Australia in Crawley, Western Australia, Australia, is the corresponding author.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jamanetworkopen.2023.51933)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2023.51933?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=011724
JOURNAL
JAMA Network Open
High-school students with neurodevelopmental disorders experience worse premenstrual syndrome symptoms
Researchers investigate how menstruation affects school adjustment, performance, and mood in high-school females with early neurodevelopmental disorders
Scientists have shown that females with traits of neurodevelopmental disabilities are more likely to suffer from premenstrual dysphoric disorder (PMDD), but how this affects their adjustment in high school remains unclear. To tackle this gap, researchers from Japan conducted a survey among high-school and college students. Their findings reveal that PMDD can pose a significant challenge to female high-school students with sub-threshold ADHD and autism traits, calling for the development of better support systems.
Premenstrual syndrome (PMS) is a relatively common condition that affects most women who menstruate, at some point in their lives. Typically, PMS can cause a variety of symptoms, including mood swings, irritability, bloating, and fatigue. Moreover, PMS tends to worsen the symptoms of certain psychiatric and personality disorders. In certain instances, PMS can lead to premenstrual dysphoric disorder (PMDD), a type of severe depressive disorder that impairs daily life activities and interpersonal relationships.
According to several studies, women with intellectual or developmental disabilities, such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), are more likely to have menstrual abnormalities, PMS symptoms, and PMDD. It is possible that female adolescents with developmental disabilities are at a higher risk of experiencing exacerbated mood disturbances, and that these may impact their adjustment in high school. Unfortunately, there have been no studies demonstrating associations between these concepts among female high-school students with sub-threshold neurodevelopmental disabilities.
Against this backdrop, Associate Professor Takuya Miura of Tokyo University of Agriculture and Technology and Professor Soichi Hashimoto from Tokyo Gakugei University, Japan, conducted a study to address this knowledge gap. Their findings are published in the Journal of Developmental Disabilities Research in November 2023.
The researchers performed a questionnaire-based survey that involved 500 high-school and first/second-year college students in Japan. The survey contained seven items related to sub-threshold neurodevelopmental disability traits, 12 items related to PMDD symptoms, and two items related to school adjustment. The accuracy of the scales used in the questionnaire was validated by resorting to item response theory, which ensures that the survey items effectively measure the traits and symptoms under investigation.
The researchers found that female high-school students with traits of sub-threshold neurodevelopmental disabilities tended to be more uncomfortable before menstruation compared to female college students or female high-school students with typical development. Moreover, they found interesting differences between female students exhibiting ASD traits and ADHD traits, as Associate Prof. Miura remarks: “Female high-school students with sub-threshold ASD traits were more likely to have depressed or hopeless moods and higher levels of anxiety and tension.” The results also indicated that female high-school students with sub-threshold ASD traits faced difficulties with school life and study performance, whereas PMDD interfered with relationship building at school more in those with ADHD traits.
Taken together, the findings of this study shed light on the additional challenges that female high-school students with sub-threshold neurodevelopmental traits face before menstruation. These insights should be considered by school management and teachers alike to develop strategies that can help these students adjust better and have improved mental health. In this regard, Assoc. Prof. Miura comments: “The results suggest that there is an urgent need to develop classroom-based support techniques that allow for good communication between female high-school students with sub-threshold neurodevelopmental disabilities traits and their peers.”
Hopefully, this work will help develop systems where reproductive health education is paramount and the difficulties caused by developmental characteristics are considered. Such systems may help affected high-school females adjust better, making their experiences at school more enjoyable and productive.
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About Tokyo University of Agriculture and Technology
The Tokyo University of Agriculture and Technology (TUAT) is a prominent institution of higher education located in Tokyo, Japan. With a rich history of approximately 150 years and a strong reputation for its contributions to several fields, TUAT is known for its dedication to research and innovation, offering a wide range of academic programs in agriculture, engineering, and related disciplines. With a commitment to fostering scientific advancements and addressing the challenges of a rapidly changing world, TUAT strives to weave science and society to create a globally sustainable future.
Website: https://www.tuat.ac.jp/en/
About Associate Professor Takuya Miura from Tokyo University of Agriculture and Technology
Dr. Takuya Miura is a qualified Clinical Developmental Psychologist, Clinical Psychologist, School Psychologist, and Chartered Psychologist. He obtained a PhD degree from Tokyo Gakugei University in 2014 and currently serves as Associate Professor at the Division of Advanced Health Science at the Institute of Engineering, Tokyo University of Agriculture and Technology. Here, he conducts research related to school clinical psychology and clinical developmental psychology. He has authored over 55 papers on these topics, as well as several books.
Funding Information
This work was supported by JSPS KAKENHI Grant Numbers JP23K02567 and JP20K14064.
METHOD OF RESEARCH
Survey
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Effects of Sub-Threshold Neurodevelopmental Traits on the Adjustment of Female Students to High School: A Study Focused on Premenstrual Dysphoric Mood
Perinatal depression and risk of suicidal behavior
JAMA Network Open
Peer-Reviewed PublicationAbout The Study: In this study of 952,000 participants, women with perinatal depression were at an increased risk of suicidal behavior, particularly within the first year after diagnosis with persistent risk elevations throughout the 18 years of follow-up, highlighting the need for vigilant clinical monitoring of this vulnerable group.
Authors: Hang Yu, M.Sc., and Donghao Lu, M.D., Ph.D., of the Karolinska Institutet in Stockholm, are the corresponding authors.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jamanetworkopen.2023.50897)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
# # #
Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2023.50897?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=010924
About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.
JOURNAL
JAMA Network Open
Perinatal depression linked to increased risk of death
Particularly due to suicide and during the first year after diagnosis, irrespective of psychiatric history
Peer-Reviewed PublicationClinically diagnosed perinatal depression is associated with an increased risk of death, particularly due to suicide and during the first year after diagnosis, finds a study published by The BMJ today.
Perinatal depression was defined as any diagnosis of depression during pregnancy and up to one year after delivery and deaths were tracked over an 18-year period.
The association cannot be explained by shared family factors and is independent of pre-existing psychiatric disorders, the results show. The researchers say women who are affected, their families, and health professionals should be aware of these severe health hazards.
Perinatal depression is one of the most common complications of pregnancy, affecting up to 20% of women around delivery, but the association between perinatal depression and risk of death among affected women has not been examined.
There is also limited evidence about how factors within families, such as shared childhood experiences, might contribute to the risks of perinatal depression.
To fill these knowledge gaps, an international team of researchers set out to determine whether women with perinatal depression are at an increased risk of death compared with unaffected women and sisters.
Using Swedish national registry data from 2001 and 2018, they identified 86,551 women with a first ever diagnosis of perinatal depression and 865,510 unaffected women matched by age and calendar year at delivery.
To control for shared family factors, they also compared data for 24,473 of the women who had perinatal depression with 246,113 unaffected full sisters who delivered at least one baby during the study period.
A range of known risk factors for both depression and premature death were taken into account, including socioeconomic status, pre-existing psychiatric disorders, adverse birth outcomes, and death of a child within the first year after birth.
During the 18-year study follow-up period, 522 deaths (0.82 per 1000 person years) were reported among women with perinatal depression diagnosed at an average age of 31 years and 1,568 deaths (0.26 per 1000 person years) among unaffected women.
The results show that women with perinatal depression were more than twice as likely to die than women who did not have perinatal depression. Results were similar when comparing deaths between sisters and among women who did and did not have a pre-existing psychiatric disorder.
The increased risk associated with perinatal depression was most pronounced in the first year after diagnosis, and although it gradually reduced over time, it remained higher throughout the18 years of study follow up.
Overall, the increased risk associated with perinatal depression was greater for death caused by unnatural causes (0.46 per 1000 person years) than by natural causes (0.36 per 1000 person years).
Although suicide was rare (0.23 per 1000 person years), women with perinatal depression were more than six times as likely to die from suicide, and three times as likely to die from an accident, than women who did not have perinatal depression.
These are observational findings and the researchers point to several limitations, such as only including women who sought specialist care for their depression and possible misclassification of some suicide events as accidents.
And while they controlled for a range of factors, including those shared within families, they can’t rule out the possibility that some other unknown or unmeasured factors may have influenced their results.
They conclude: “Women affected with perinatal depression, their families, and health professionals, particularly those working in primary, maternal, and mental care, need to be aware of the serious health hazards regardless of psychiatric history. Early detection and treatment are needed for groups at high risk of perinatal depression to prevent the fatal outcomes.”
JOURNAL
The BMJ
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Perinatal depression and risk of mortality: nationwide, register based study in Sweden
ARTICLE PUBLICATION DATE
10-Jan-2024
COI STATEMENT
All authors have completed the ICMJE uniform disclosure form atwww.icmje.org/disclosure-of-interest/ and declare: support from the Swedish Research Council for Health, Working Life and Welfare (FORTE) (No. 2020-00971 to DL), the Swedish Research Council (Vetenskapsrådet) (No. 2020-01003 to DL), the Karolinska Institutet Strategic Research Area in Epidemiology and Biostatistics (to DL), the Icelandic Research Fund (No. 218274-051 to Dr Valdimarsdóttir), the Outstanding Clinical Discipline Project of Shanghai Pudong (grant No.: PWYgy2021-02) and the Fundamental Research Funds for the Central Universities (No. 22120230066 to QS) for the submitted work; UAV declares receiving support for travel as keynote speaker from the ISTSS 2022; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Racial and ethnic disparities in receipt of general anesthesia for cesarean delivery
JAMA Network Open
Peer-Reviewed PublicationAbout The Study: Racial disparities in rates of general anesthesia continue to exist; however, the findings of this study including 35,000 patients who underwent cesarean delivery suggest that, for laboring patients who had labor epidural catheters in situ, no disparity by race or ethnicity existed. Future studies should address whether disparities in care that occur prior to neuraxial catheter placement are associated with higher rates of general anesthesia among patients from ethnic and racial minority groups.
Authors: Caroline Leigh Thomas, M.D., of the University of Chicago Medical Center, is the corresponding author.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jamanetworkopen.2023.50825)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
# # #
Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2023.50825?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=010924
About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.
JOURNAL
JAMA Network Open
Clinical research shows AI-enabled digital stethoscope can detect pregnancy-related heart disease
JACKSONVILLE, Florida — New research from Mayo Clinic suggests that artificial intelligence (AI) could improve the diagnosis of peripartum cardiomyopathy, a potentially life-threatening and treatable condition that weakens the heart muscle of women during pregnancy or in the months after giving birth. Researchers used an AI-enabled digital stethoscope that captures electrocardiogram (ECG) data and heart sounds to identify twice as many cases of peripartum cardiomyopathy as compared to regular care, according to a news release from the American Heart Association.
Identifying a weak heart pump caused by pregnancy is important because the symptoms, such as shortness of breath when lying down, swelling of hands and feet, weight gain, and rapid heartbeat, can be confused with normal symptoms of pregnancy.
Dr. Demilade Adedinsewo, a cardiologist at Mayo Clinic, led the research.
Women in Nigeria have the highest reported incidence of peripartum cardiomyopathy. The randomized pragmatic clinical trial enrolled 1,195 women receiving pregnancy care in Nigeria. Approximately half were evaluated with AI-guided screening using the digital stethoscope, and half received usual obstetric care in addition to a clinical ECG. An echocardiogram was used to confirm when the AI-enabled digital stethoscope predicted peripartum cardiomyopathy. Overall, 4% of the pregnant and postpartum women in the intervention arm of the clinical trial had cardiomyopathy compared to 2% in the control arm, suggesting that half are likely undetected with usual care.
Watch: Dr. Adedinsewo explains the red flags for heart failure during pregnancy
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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.
Intravaginal sponge can make treatment of candidiasis more comfortable and effective
The device is under preclinical trials; the sponge is made of soft, biodegradable material and releases medication slowly into the organism.
IMAGE:
THE SPONGE IS MADE OF MATERIALS THAT ARE BIOCOMPATIBLE WITH VAGINAL TRACT CELLS, AND THE GEL PRODUCED BY CONTACT WITH FLUID IN THE REGION DISSOLVES, SO THAT THERE IS NO NEED FOR REMOVAL AFTER THE TREATMENT, IN CONTRAST WITH POLYURETHANE DEVICES
view moreCREDIT: FIAMA MARTINS
A biodegradable sponge made of chitosan, a biopolymer derived from the shells of crustaceans, releases medication slowly into the organism and makes treatment of candidiasis more comfortable and effective, judging from the results of tests performed by researchers at the University of Porto in Portugal and the Federal University of São Paulo (UNIFESP) in Brazil. An article describing them is published in the International Journal of Pharmaceutics.
Vulvovaginal candidiasis is one of the most prevalent infections of the female genital tract, estimated to affect some 75% of all women at least once in their lifetime. It is caused by fungi of the genus Candida, a type of yeast, and its symptoms include itching, burning, swelling, redness, and a thick white discharge.
It is usually mild but can become severe, affect other organs and even recur after a course of treatment, impairing the quality of the patient’s life. The available treatments are often disagreeable as they include creams and vaginal suppositories, and their efficacy is easily compromised by untimely administration.
“We developed a sponge that combines the comfort of a soft material with ease of use and the efficacy of the available medications,” said Fiama Martins, first author of the article and a researcher in the Department of Chemistry (DQ-UFSCar).
Its functioning is simple and similar to that of the intrauterine device (IUD) or coil used for decades as a non-hormonal contraceptive method. Thanks to its porous structure, the sponge absorbs a large amount of clotrimazole or other antifungal creams widely used for topical management of vulvovaginal candidiasis, which it releases slowly and steadily at normal body temperature and pH. One of the advantages is that the sponge can be inserted into the vagina by the patient herself.
“Our in vitro trials with vaginal tract cells showed activity of the medication against six different strains of Candida, full release within four hours, and bioequivalence between the free drug and the drug loaded into the sponge, demonstrating its effectiveness as a release system for clotrimazole,” Martins said.
Another advantage is that the device is made from biocompatible materials (chitosan and polyvinyl caprolactam) that rapidly absorb vaginal fluid and form a gel that erodes in four to eight hours, making removal unnecessary, in contrast with polyurethane devices, for example.
The researchers tested various types of sponges and also compared the anti-fungal activity of various drugs with and without sponges, confirming that the sponge material did not adversely affect the action of the drugs.
Commercial product
“The study showed that novel devices can be designed with improved biopharmaceutical properties and acceptability for patients, which is fundamental for public health,” said Emerson Rodrigues de Camargo, co-corresponding author of the article and a professor at DQ-UFSCar.
The study was supported by FAPESP under the aegis of the Center for Development of Functional Materials (CDMF), a Research, Innovation and Dissemination Center (RIDC) funded by FAPESP and hosted by UFSCar.
“The study combined basic science, which looks for answers to general questions, and applied science, which addresses specific questions and leverages knowledge to achieve short-, medium- and long-term social benefits. Neither can exist without the other,” Camargo said.
According to the researchers, the next step will be to conduct clinical trials, aimed among other things to assess use of the device with anti-inflammatory and wound healing medications to treat other diseases besides candidiasis. The possibilities include filling the ocular cavity in cases of eye loss to prevent facial muscle atrophy and impairment of the ability to chew, with the advantage over prosthetics of administering medication to prevent infection, Camargo explained.
“We expect the chitosan sponge to become a mass-produced commercial product in Brazil in the medium term and to cost less than imported products,” he said.
About São Paulo Research Foundation (FAPESP)
The São Paulo Research Foundation (FAPESP) is a public institution with the mission of supporting scientific research in all fields of knowledge by awarding scholarships, fellowships and grants to investigators linked with higher education and research institutions in the State of São Paulo, Brazil. FAPESP is aware that the very best research can only be done by working with the best researchers internationally. Therefore, it has established partnerships with funding agencies, higher education, private companies, and research organizations in other countries known for the quality of their research and has been encouraging scientists funded by its grants to further develop their international collaboration. You can learn more about FAPESP at www.fapesp.br/en and visit FAPESP news agency at www.agencia.fapesp.br/en to keep updated with the latest scientific breakthroughs FAPESP helps achieve through its many programs, awards and research centers. You may also subscribe to FAPESP news agency at http://agencia.fapesp.br/subscribe.
JOURNAL
International Journal of Pharmaceutics
ARTICLE TITLE
Intravaginal sponge can make treatment of candidiasis more comfortable and effective
Natural compounds derived from soy and other plants reduce breast cancer recurrence and improve survival, research shows
Soy compounds called isoflavones are among the plant-derived compounds that may significantly reduce the risk of breast cancer recurrence or death, according to a new meta-analysis co-directed by investigators from the Johns Hopkins Kimmel Cancer Center. The results were published Jan. 10 in the journal JNCI Cancer Spectrum.
Investigators in Australia, Denmark, England, Norway and the U.S. reviewed 22 published observational studies that examined the impact of dietary intake of soybeans, lignans (compounds found in a variety of plants including seeds and nuts), cruciferous/cabbage-family vegetables, and green tea — and these substances’ phytonutrients (natural compounds derived from plants) — on breast cancer recurrence and mortality, as well as on mortality from all causes. This included 11 studies of soy isoflavones, three of cruciferous vegetables, two of green tea, three of lignans, and three of enterolactone, which is formed in the gut when lignans are digested.
Soy isoflavones were associated with a 26% reduced risk of breast cancer recurrence, according to a meta-analysis that included six of the studies (of 11,837 women) reviewed by investigators. The results were most notable among post-menopausal survivors. The greatest risk reduction was seen at 60 milligrams per day. This is equivalent to two to three servings per day, where one serving equates to a cup of soy milk, three ounces of tofu or a half-cup of cooked soybeans. However, the effect of soy consumption on risk of mortality was smaller (12%) and not statistically significant, and was seen mostly at 20-40 mg per day, or one to two servings.
Another finding, reported for the first time in a meta-analysis, relates to enterolactone, a compound metabolized from lignans. Lignans are found in a wide variety of plants, such as seeds, nuts, legumes, whole grains, fruit and vegetables. High levels are found in flaxseeds, cashew nuts, broccoli and brussels sprouts, among other sources. Enterolactone was found to reduce the risk of breast cancer-specific mortality by 28% and death from any cause by 31%, particularly in post-menopausal women (35% reduction in death from any cause). It is not possible to calculate the effective dose of lignans in the diet from these enterolactone findings, because the gut microbiome that plays a role in metabolism of lignans varies among individuals.
“These findings were graded probable, which means there is strong research showing that they contributed to the results we are seeing,” says lead study author Diana van Die, Ph.D., of NICM Health Research Institute at Western Sydney University, Australia.
The review also found some suggestive results, which means the results are generally consistent but rarely strong enough to justify recommendations:
- Consumption of green tea suggests an effect of reducing the risk of breast cancer recurrence by 44% in women with stage I or II breast cancer. The greatest effect was seen from consuming three to five cups per day and from five or more cups per day, as documented in two Japanese studies .
- Among those who consumed lignans prior to breast cancer diagnosis, there was a non-significant 34% risk reduction in cancer-specific mortality and 19% reduction in all causes of death in post-menopausal women. However, consumption of lignans by pre-menopausal women suggests an increased risk of mortality. This result indicates that the effects of lignans are dependent on the hormonal environment, although it was likely driven by one large study and needs further investigation. The highest intake was nine or more servings per day in the studies reviewed.
- The impact of cruciferous vegetables was inconclusive, possibly influenced by the average intake being quite low (less than a half-cup per day) in the studies reviewed.
Investigators also looked into whether consuming soy, lignans, cruciferous vegetables and green tea, or their phytonutrients in the diet before or after breast cancer diagnosis made a difference. However, the data did not provide a concrete answer. All studies on green tea and lignans measured pre-diagnosis intake, while soy results came from studies that measured intake before and after diagnosis.
“It is critically important to stress that these studies were conducted on women who received medical and/or surgical treatment for breast cancer, and that these foods and phytonutrients should not be considered as alternatives to treatment,” says senior study author Channing Paller, M.D., director of prostate cancer clinical research and an associate professor of oncology at Johns Hopkins.
“This research highlights the need for more robust studies in this area looking at the most effective dosages of these compounds, and whether starting to consume them after diagnosis has the same effect as a lifelong dietary habit before diagnosis. This is what patients are looking for,” Paller added .
Kala Visvanathan, M.D., M.H.S., director of the Clinical Cancer Genetics and Prevention Service at the Kimmel Cancer Center, was a co-author of the review. Additional co-authors were from Integria (MediHerb) in Australia, the Danish Cancer Institute, Imperial College London, Oslo New University College and The Cancer Registry of Norway.
JOURNAL
JNCI Cancer Spectrum
Where do patients choose to undergo breast cancer surgery, and do these choices drive health care inequality?
Study links certain patient characteristics with the likelihood of bypassing the nearest surgical center for treatment
Peer-Reviewed PublicationIncluding patients as partners for making decisions about their medical treatments is an important aspect of patient-centered care. A new study from England examined choices that patients with breast cancer make when considering where to have surgery for their condition and assessed how policies that offer such choices might affect inequalities in the health care system. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.
For the study, investigators analyzed data from the National Health Service (NHS), the publicly funded health care system in the United Kingdom that offers patients with cancer the opportunity to select any hospital providing cancer treatment, and identified all women diagnosed with breast cancer from 2016 to 2018 who had breast-conserving surgery or a mastectomy.
Records showed that 22,622 of 69,153 patients undergoing breast-conserving surgery (32.7%) and 7,179 of 23,536 patients undergoing mastectomy (30.5%) bypassed their nearest hospital to receive surgery farther away from home. Women who were younger, without additional medical conditions, of white ethnic background, or lived in rural areas were more likely to travel to more distant hospitals.
Patients were more likely to be treated at hospitals classified as specialist breast reconstruction centers even if they personally were not undergoing breast reconstruction after surgery. Patients who had a mastectomy and immediate breast reconstruction were more likely to travel to hospitals that had surgeons with a strong media reputation for breast cancer surgery, and patients were less likely to travel to hospitals with shorter surgical waiting times. Patients did not seem to make choices based on hospitals’ research activity, quality rating, breast re-operation rates (to remove additional cancer cells that were missed), or status as a multidisciplinary cancer center (where patients can receive all their care at one location).
The investigators noted that this separation—elderly patients, those with comorbidities, and those from ethnic minority backgrounds receiving care at their local hospital, while others travel to other hospitals and specialist centers—could further drive inequalities in access to quality care.
“As marginalized groups already face barriers to high-quality care, it is important for policy makers to consider measures that mitigate against the risks of increasing inequalities in access and outcomes, by for example providing free transport, accommodation, or even protection against loss of income,” said co-author Lu Han, PhD, of the London School of Hygiene & Tropical Medicine. “Moreover, patients prefer to access information on the quality of breast cancer care of the hospitals in their region at the start of the management pathway when a diagnosis is sought. Such information should be easy to understand and presented in a format that can support the trade-offs that patients have to make.”
Additional information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the CANCER Newsroom upon online publication. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com
Full Citation:
“Association of travel time, patient characteristics and hospital quality with patient mobility for breast cancer surgery: a national population-based study.” Ajay Aggarwal, Lu Han, Daniel Lewis, Jeanette Costigan, Alison Hubbard, Joanne Taylor, Anne Rigg, Arnie Purushotham, and Jan van der Meulen. CANCER; Published Online: January 8 2024 (DOI: 10.1002/cncr.35153).
URL Upon Publication: http://doi.wiley.com/10.1002/cncr.35153
Author Contact: press@lshtm.ac.uk
About the Journal
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online. Follow CANCER on Twitter @JournalCancer and Instagram @ACSJournalCancer, and stay up to date with the American Cancer Society Journals on LinkedIn.
About Wiley
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JOURNAL
Cancer
ARTICLE TITLE
Association of travel time, patient characteristics and hospital quality with patient mobility for breast cancer surgery: a national population-based study
ARTICLE PUBLICATION DATE
8-Jan-2024
