WOMEN'S HEALTH
Rheumatic diseases associated with childbearing problems
OXFORD UNIVERSITY PRESS USA
A new paper in Rheumatology, published by Oxford University Press, finds that rheumatic diseases can lead to reproductive problems, though some conditions have more detrimental effects than others.
Immune-mediated diseases are a varied group of conditions, but each display an aberrant activity of the immune system. Some diseases, such as juvenile idiopathic arthritis and type 1 diabetes, occur mostly before patients reach their reproductive years, but others show up later in life. Scientists have investigated systemic lupus erythematosus for its impact on reproductive health; the condition increases the risk for some adverse pregnancy outcomes, including pre-eclampsia, preterm delivery, C-sections, and low birth weight. But the impact of other autoimmune diseases—such as spondyloarthritides, psoriasis, or alopecia areata—on fertility and pregnancy is unclear or the research is inconsistent.
Researchers here used data from Finnish nationwide health registers to study the impact of immune-mediated diseases on reproductive health measures such as reproductive success, and for women, ever having experienced adverse maternal and perinatal outcomes. Out of all people in Finland born between 1964 and 1984, 7.9% of the women and 7.8% of the men had an autoimmune disease diagnosed before or during reproductive years.
The researchers found that many immune-mediated diseases had little impact on the number of children. However, women with selected immune-mediated diseases experience a higher prevalence of childlessness, with the top three diseases with largest differences being Addison’s disease (23.9% more childlessness), juvenile idiopathic arthritis (9.3%), and vitamin B12 deficiency anemia (8.6%). Several of the rheumatic diseases—particularly systemic lupus erythematosus, juvenile idiopathic arthritis, and seropositive rheumatoid arthritis—lead to higher rates of childlessness and fewer children. The investigation also revealed that, on average, people with rheumatic diseases had children earlier.
The risks for pre-eclampsia, low birth weight, preterm delivery, non-elective C-sections and need of neonatal intensive care were increased for many conditions. Systemic lupus erythematosus, Sjögren’s syndrome, type 1 diabetes, and Addison’s disease showed over two-fold risks for some of these outcomes. However, the risk of gestational diabetes was not higher for patients with any of the rheumatic diseases compared to the population.
Men with rheumatic conditions also had a higher prevalence of childlessness than controls (mean difference 4.7%), with most diseases showing no difference but some diseases resulting in much higher prevalence of childlessness, with the top three diseases being myasthenia gravis (20.1% more childlessness), Addison’s disease (16.4%), and vitamin B12 deficiency anemia (13.7%).
“Despite seeing an elevated risk for diverse childbearing problems in rheumatic and other immune-mediated diseases, many of the complications are still fairly rare,” said Anne Kerola, the lead author of the study. “Family planning should actively be discussed between patients, both men and women, with rheumatic diseases and their healthcare providers. Pregnancies in women with rheumatic diseases are carefully followed up to tailor medications appropriately, which helps reduce risks.”
The paper, “Patterns of reproductive health in inflammatory rheumatic diseases and other immune-mediated diseases: a nationwide registry study,” is available (at midnight on March 20th) at https://doi.org/10.1093/rheumatology/keae122.
Direct correspondence to:
Nina Mars
Institute for Molecular Medicine Finland (FIMM), HiLIFE
University of Helsinki
Tukholmankatu 8, Helsinki, FINLAND
nina.mars@helsinki.fi
To request a copy of the study, please contact:
Daniel Luzer
daniel.luzer@oup.com
JOURNAL
Rheumatology
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Patterns of reproductive health in inflammatory rheumatic diseases and other immune-mediated diseases: a nationwide registry study
ARTICLE PUBLICATION DATE
20-Mar-2024
COI STATEMENT
One of the authors has received speaker fees from Boehringer-Ingelheim and Sanofi; has participated in advisory boards of Pfizer, Gilead, and Boehringer-Ingelheim; and has received congress sponsorship from Abbvie. Another author has participated on the advisory boards of AbbVie and Amgen, received lecture fees from Boehringer-Ingelheim, Pfizer, and Abbvie, and received payment for travel expenses from Abbvie and Novartis. Another author has received lecture fees from Pfizer, Lilly, and Celltrion.
'3D mammography' almost halves the incidence of breast cancer between two screening tests
UNIVERSITY OF CÓRDOBA
IMAGE:
DOCTORS MARINA ÁLVAREZ AND CRISTINA PULIDO, IN THE RADIODIAGNOSTIC UNIT AT THE REINA SOFÍA HOSPITAL
view moreCREDIT: UNIVERSITY OF CÓRDOBA
Interval breast cancer is one that appears between two reviews of a screening program. That is, it is diagnosed after a test whose result was negative and before the next evaluation. For obvious reasons, it is a very reliable indicator of the effectiveness of early detection programs for this disease: if the number of cancers that appear after a screening is high, it is a sign that the program is not working. Conversely, if the number of tumors diagnosed after screening is low, it indicates that the program is fulfilling its function: to detect this disease at an early stage.
A clinical trial published by the University of Cordoba, the Maimonides Institute for Biomedical Research (IMIBIC) and the Reina Sofía Hospital in Cordoba, has revealed the effectiveness of breast 'tomosynthesis' in reducing by almost half the incidence of this type of cancer appearing between two rounds of screening, suggesting the advisability of including this test in a standardized way in breast cancer early detection programs.
It is a screening method complementary to traditional mammography, or '2D mammography' which, like the latter, uses x-rays. The difference is that tomosynthesis avoids the overlapping of structures and allows the lesions to be seen better when recreating a volumetric image, such that it is also known as' 3D mammography.' "Despite the fact that this technique has become widespread in diagnostic units, it is still not as standardized in screening programs," says Marina Alvarez, head of the Radiodiagnostic Unit at the Reina Sofía Hospital, one of the authors of the study and a nationally prominent figure advocating for the early diagnosis of breast cancer.
For two years, the study has worked with the population screening carried out by the Junta de Andalucía (regional government). Almost 24,000 women were examined only with 2D mammograms, while another group of 16,000 was also evaluated with breast tomosynthesis. According to the results of the work, in the first group the interval cancer rate was 1.8 per thousand people, while in the second it was 0.93. In other words, the likelihood of being diagnosed with an interval cancer was 49% lower in women who were also screened with the '3D mammogram'.
Other relevant results
As explained by the main author of the study, Cristina Pulido, the impact of tomosynthesis on the rate of interval carcinoma is even more evident in women with dense breasts, "an especially relevant fact" taking into account that "in this type of breasts, with a higher proportion of glandular tissue, it is more complicated to explore and assess the existence of lesions.
The results of the work also show that the interval cancers detected in women who have been screened with tomosynthesis are smaller than those detected in women screened with digital mammography, which is positive considering that the size of the tumors is closely related to the prognosis. This may be due to the greater diagnostic capacity of the method itself. If this technique allows for a more accurate detection of the lesions, it implies that the tumors that have gone unnoticed are smaller.
The work, in short, highlights the desirability of incorporating this test in a systematic way into the population programs for the early detection of breast cancer, an advance towards which significant steps are already being taken. "Many radiologists are already being trained in this technique. Andalusia has just renewed a significant number of mammograms with tomosynthesis, and this type of testing is already being recommended for screening," explains Dr. Álvarez.
In this way, it could further improve the diagnosis of a disease that, according to the Spanish Society of Medical Oncology, accounts for 28.9% of total cancers in women, and is the leading cause of death from cancer in this population. Despite this, survival and prognosis has improved exponentially thanks to medical advances. Everything indicates that science will continue to make progress against this disease in the years to come.
References
JOURNAL
European Radiology
ARTICLE TITLE
Interval cancer in the Córdoba Breast Tomosynthesis Screening Trial (CBTST): a comparison of digital breast tomosynthesis plus digital mammography to digital mammography alone
Is the secret to anxiety in young women hidden in our brain chemistry?
The development of anxiety in girls and young women may stem from an imbalance between two crucial brain chemicals, Gamma-Aminobutyric Acid (GABA) and Glutamate, according to a new study from the University of Surrey. This discovery offers promising insights into potential treatment avenues for girls and women dealing with anxiety.
The study revealed that as young women mature, the levels of GABA (a calming brain chemical) increase, while those of glutamate, known for its role in boosting brain activity, decrease.
Dr Nicola Johnstone, a Research Fellow at the University of Surrey's School of Psychology and co-author of the study, said:
"Our research indicates that the equilibrium between GABA and glutamate in the dorsolateral prefrontal cortex serves as a vital indicator of anxiety levels. While glutamate propels brain activity, GABA acts as a brake. Our findings suggest that anxiety, often characterised by impaired rational thought, is intricately linked to the overactive braking system in the brain."
These revelations not only shed light on the underlying mechanisms of anxiety but also pave the way for targeted interventions that address the delicate balance of GABA and glutamate in the brain.
Dr Kathrin Cohen Kadosh, Associate Professor in Developmental Cognitive Neuroscience at the University of Surrey and co-author of the study, said:
"Grasping how key brain chemicals, GABA and glutamate, fluctuate during important growth stages like adolescence is vital for spotting and stopping anxiety disorders early. This study shines a light on the possibility of focusing on these brain chemicals for new treatments, particularly in young women."
By unravelling the mysteries of brain chemistry, the researchers aim to offer more effective treatments for anxiety, ultimately empowering girls and young women to lead healthier, more fulfilling lives.
The research used 81 participants from two age groups:
49 participants aged 10-12 years
32 participants aged 18-25 years
The team used a brain imaging technique called magnetic resonance spectroscopy to measure the levels of the brain chemicals in different areas of the brain.
The research has been published in Developmental Cognitive Neuroscience.
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JOURNAL
Developmental Cognitive Neuroscience
ARTICLE TITLE
Excitatory and inhibitory neurochemical markers of anxiety in young females
ARTICLE PUBLICATION DATE
1-Apr-2024
Laws that punish drug use during pregnancy likely lead to worse health outcomes for families
COLUMBIA UNIVERSITY'S MAILMAN SCHOOL OF PUBLIC HEALTH
March 18, 2024-- Contrary to some claims, laws that criminalize or otherwise punish drug use during pregnancy are more likely to worsen rather than improve health outcomes, according to a paper by researchers at Columbia University Mailman School of Public Health. The study is the first to systematically review the literature on punitive prenatal drug laws—an increasingly common state policy strategy for addressing rising rates of prenatal drug use. The findings are published in the International Journal on Drug Policy.
The authors collected data on the number of states with laws that explicitly allow criminal prosecution, involuntary commitment or that revoke custody rights following allegations of drug use during pregnancy. They then evaluated existing studies testing whether the enactment of such laws was associated health improvements, either for pregnant people themselves or their babies.
Of the 16 studies reviewed, the authors found that contrary to the intent of legislation, most evidence suggested that punitive laws either had no beneficial effects or made things worse. For example, four of the reviewed studies tested whether the adoption of punitive laws was associated with reductions in neonatal drug withdrawal syndrome (NDWS)—a condition that can occur after exposure to opioids and other drugs in utero. Two of the studies found little change while the two others found increased NWDS after a punitive law was adopted.
“There has been considerable concern from within legal, medical and public health communities that punitive prenatal drug policies might increase potential harms. Our findings support this premise and suggest that such approaches constitute ineffective policy,” said lead author Emilie Bruzelius, PhD, a postdoctoral research fellow in the Department of Epidemiology.
“Identifying effective policy strategies to support pregnant people with drug use disorder outside of the criminal-legal system is an important priority,” noted Silvia S. Martins, MD, PhD, professor of Epidemiology at Columbia Mailman School, and senior author.
Co-authors include Melanie S. Askari, Sandhya Kajeepta, Lisa Bates, Seth J. Prins (Columbia University Mailman School of Public Health), Kristen Underhill (Cornell University Law School), and Marian Jarlenski (Pittsburgh School of Public Health).
The study was supported by the National Institutes on Drug Abuse (R01DA045872 and R01DA053745 and T32DA031099).
Columbia University Mailman School of Public Health
Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the fourth largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.
JOURNAL
International Journal of Drug Policy
ARTICLE TITLE
Punitive legal responses to prenatal drug use in the United States: A survey of state policies and systematic review of their public health impacts
Study explores homeless women’s experiences of ‘period poverty’
UNIVERSITY OF SOUTHAMPTON
Research from the University of Southampton has identified common issues women face when experiencing periods while homeless.
A review of research published in Women and Health has found homeless women experienced practical challenges in managing menstruation alongside feelings of embarrassment and shame, with many ‘making do’ due to inadequate provision.
The researchers say it’s high time to address the provision of menstrual health resources as a basic human right.
Dr Stephanie Barker, a teaching fellow at the University of Southampton who co-led the review said: “So-called ‘period poverty’ is a global concern. Our findings highlight the need to stop gatekeeping and limiting access to menstrual health products. This is both a public health issue and a human rights one.”
The review of research evidence is the first to explore homeless women’s experiences of menstruation. The University of Southampton team identified and analysed nine studies on the topic conducted in the United Kingdom, the United States, Canada and Nepal. Three key themes emerged from the research.
The first is challenges in the logistics of managing menstruation while homeless. Finding a clean, private space to use and change menstrual products was a common issue. The few options available, such as public toilets, were described as unsanitary and not fit for purpose. The stigma attached to homelessness means women are often turned away from public and privately owned bathroom facilities.
Dr Polly Hardy-Johnson, also a teaching fellow at the University of Southampton and co-lead author on the paper, added: “Even as paying customers, women were subject to stigma around assumed drug use, limiting their access to bathrooms. Being able to pass as ‘not homeless’ was more difficult when women were unable to maintain menstrual health.
“Limited access to facilities led to infections and increased the need for costly laundry services, due to leakages and blood-stained clothing. There is a need for private, safe and clean locations for managing menstruation, as well as access to laundry facilities.”
Rough sleepers relied on service providers for menstrual products, but several studies noted that provision fell short and was sporadic. This meant women would sometimes forgo food to buy menstrual products or shoplift them.
The second theme was around feelings of embarrassment, shame and dignity linked to maintaining menstrual health. Women felt the need to hide that they were menstruating and felt judged when they could not maintain menstrual health, causing anxiety and discomfort.
Women reported services rationing free menstrual supplies, forcing them to have to ask staff (sometimes men) multiple times per day for tampons, sanitary pads, and other products.
The third theme was around women ‘making do’ to manage the challenges they were facing. Several women reported using sponges, clothes, and cut-up t-shirts as reusable ways of soaking up menstrual blood and avoiding leaks. Others used layered wads of toilet paper, and some reused soiled disposable menstrual products. To treat infections some women turned to cheap herbal remedies rather than more expensive treatments.
Studies also looked at what services the women found useful. The provision of menstrual health products and birth control products was useful, alongside sexual health services. Warm, welcoming cafes and day centres helped to soothe period pain and discomfort.
Shared information within the homeless community about the support available, showering facilities and the sharing of products helped to improve menstrual health management.
The research team found there is a lack of evidence on the experiences of homeless people who do not identify as women and who menstruate. To address this, the team has received £9.9K in funding from British Academy/Leverhulme Small Research Grants to better understand the menstruation needs of all people experiencing homelessness.
The project will conduct in-depth interviews and use creative ways to amplify marginalised voices, and co-create a policy brief with the homeless community and key stakeholders on improving access to menstrual healthcare.
The homeless period: a qualitative evidence synthesis is published in Women and Health and is available online.
Ends
Contact
Steve Williams, Media Manager, University of Southampton, press@soton.ac.uk or 023 8059 3212.
Notes for editors
- The homeless period: a qualitative evidence synthesis is published in Women and Health and is available at: https://www.tandfonline.com/doi/full/10.1080/03630242.2024.2310716
- For Interviews with Dr Stephanie Barker and Dr Polly Hardy-Johnson please contact Steve Williams, Media Manager, University of Southampton press@soton.ac.uk or 023 8059 3212.
Additional information
The University of Southampton drives original thinking, turns knowledge into action and impact, and creates solutions to the world’s challenges. We are among the top 100 institutions globally (QS World University Rankings 2023). Our academics are leaders in their fields, forging links with high-profile international businesses and organisations, and inspiring a 22,000-strong community of exceptional students, from over 135 countries worldwide. Through our high-quality education, the University helps students on a journey of discovery to realise their potential and join our global network of over 200,000 alumni. www.southampton.ac.uk
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JOURNAL
Women & Health
METHOD OF RESEARCH
Literature review
SUBJECT OF RESEARCH
People
ARTICLE TITLE
The homeless period: a qualitative evidence synthesis
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