Women who are vegans and vegetarians most affected, study says

Women who do not have enough vitamin B12 in their blood before and after conception have a greater chance of having a baby with brain or spinal cord defects, a new study says.

Most at risk may be vegans and vegetarians, since B12 is far more common in meat and animal-based foods, noted an American and Irish research team whose findings were published in the March issue of Pediatrics..

According to the study, women with low levels of B12 had at least 2.5 times the risk of giving birth to a child with these neural tube defects, which can lead to partial paralysis or even death, than women with the highest B12 levels.

“Vitamin B12 is essential for the functioning of the nervous system and for the production of red blood cells,” Dr. Duane Alexander, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in a news release issued by its parent organization, the U.S. National Institutes of Health. “The results of this study suggest that women with low levels of B12 not only may risk health problems of their own, but also may increase the chance that their children may be born with a serious birth defect.”

Researchers analyzed blood collected during the early pregnancy stages of hundreds of women from Ireland, a country with a high rate of neural tube defects. Either the women had previously given birth to a baby with a neural tube defect or were known to be carrying babies with the disorder.

Women with B12 concentrations below 250 ng/L before pregnancy had roughly three times the risk of having a child with a neural tube defect as those with higher B12 blood levels. Those women whose levels were less than 150 ng/L, which is considered B12 deficient, had five times the risk of women with higher levels.

The researchers used statistical techniques to focus solely on B12 levels and factor out the role of folic acid, a nutrient known to help prevent pregnant women from birthing babies with neural tube defects. The study authors noted that B12 and folate are jointly linked to several key biochemical reactions, but that a lack of either B12 or folate increased the risk of a neural tube defect.

While confirmation from other studies is needed, the authors suggested women should have vitamin B12 levels above 300 ng/L before becoming pregnant. Study co-author Dr. James L. Mills, a senior investigator in the NICHD division of epidemiology, statistics and prevention research, went further, recommending all women of childbearing age always consume the daily recommended amount of vitamin B12 and at least 400 micrograms of folic acid.

Pregnant women who develop breast cancer have the same risks as other young breast cancer patients that their cancer will recur, spread or lead to death, according to a study published Monday in the journal Cancer, the AP/Arizona Daily Star reports. The study, which is the largest to examine the impact of breast cancer on currently or recently pregnant women, refutes findings from earlier, smaller studies that suggested pregnancy increased risks associated with breast cancer.

For the study, researchers examined data from 652 women ages 35 and younger who received breast cancer treatment at the University of Texas M.D. Anderson Cancer Center between 1973 and 2006. They focused on 104 women with pregnancy-associated cancers, including 51 who developed breast cancer during pregnancy and 53 who developed breast cancer within one year after pregnancy. After examining disease progression for 10 years after the cancer diagnosis, the researchers determined that the rates of cancer recurrence, cancer spread and survival were about the same for women with pregnancy-associated breast cancers and women with non-pregnancy associated cancers. The study also found that tumors were more likely to be at an advanced stage among pregnant women. However, this could be because women and their physicians attributed breast changes to pregnancy or breastfeeding, the researchers said. In addition, the study found no evidence that tumors grew faster among pregnant women, according to Beth Beadle, a radiation oncologist at the cancer center. Breast cancer is often more aggressive among younger women, and survival rates are significantly lower, Beadle said.

According to the AP/Star, treating pregnant women who have breast cancer poses several challenges, and some physicians discuss the option of abortion so treatment can focus on the woman. Radiation, which is used for mammography and many breast cancer treatments, can be harmful to fetuses. However, physicians can use ultrasounds to look for breast tumors, and surgery and certain types of chemotherapy can treat breast cancer without harming the fetus. Beadle said that if physicians detect tumors early, they can “treat them aggressively and have good and promising outcomes for both woman and child.” Ruth O’Regan, associate professor at Emory University’s Winship Cancer Center, said treating pregnant women is a complicated situation that depends on the cancer’s severity and the amount of time the woman has been pregnant (Stobbe, AP/Arizona Daily Star, 2/9).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

A new study finds women who develop breast cancer while pregnant or soon afterwards do not experience any differences in disease severity or likelihood of survival compared to other women with breast cancer. The study is published in the March 15, 2009 issue of CANCER, a peer-reviewed journal of the American Cancer Society.

So-called pregnancy-associated breast cancers (PABC), defined as breast cancer that develops either during or within one year following pregnancy, is relatively rare and presents a dilemma for clinicians. An estimated 0.2 to 3.8 percent of pregnancies are complicated by breast cancer, and approximately 10 percent of breast cancer patients under age 40 develop the disease during pregnancy. But as age at the time of pregnancy continues to increase, the incidence of PABC can be expected to increase.

Previous research has suggested that pregnancy is associated with poorer outcomes among women with breast cancer. To clarify the issue, Drs. George Perkins, Beth Beadle and colleagues at The University of Texas M.D. Anderson Cancer Center analyzed data from 668 breast cancers in 652 patients aged 35 years or younger. Among that group, 104 breast cancers (15.6 percent) were pregnancy-associated: 51 cancers developed during pregnancy and 53 developed within one year following pregnancy.

There were no statistically significant differences in 10-year rates of cancer recurrence, cancer spread, or survival among patients with PABC compared with other women who developed breast cancer. However, pregnancy contributed to a delay in breast cancer diagnosis, evaluation and treatment. The researchers also found treatment during pregnancy improved survival compared with delaying treatment until after delivery among those who with PABC.

“Primary care and reproductive physicians should be aggressive in the work-up of breast symptoms in the pregnant population to expedite diagnosis and allow multidisciplinary treatment,” the authors write. “Balancing the health of mother and child is… paramount; new evidence suggests that both can be prioritized and successful outcomes managed for both,” they added.

Article: “The impact of pregnancy on breast cancer outcomes in women ?35 years old.” Beth M. Beadle, Wendy A. Woodward, Lavinia P. Middleton, Welela Tereffe, Eric A. Strom, Jennifer K. Litton, Funda Meric-Bernstam, Richard L. Theriault, Thomas A. Buchholz, and George H. Perkins. CANCER; Published Online: February 09, 2009 (DOI: 10.1002/cncr.24165); Print Issue Date: March 15, 2009.

Babies born via cesarean section are more likely to be asthmatic in comparison to babies delivered naturally, according to an article released on December 2, 2008 in Thorax, one of the BMJ Specialist journals.

In the past decades, asthma rates have increased dramatically, paralleling an increase in cesarean section births. The proportion of these procedures has increased from 5% in the 1970s to more than 30% in 2000. However, studies examining the potential link between asthma and cesarean delivery have been inconclusive.

About 3,000 children were followed until the age of 8 years with regard to respiratory health, and this data was compared to the methods of birth. At age 8, 12.4% (362) had been diagnosed with asthma and thus prescribed inhaled steroids. While only 8.5% (247) of the children were born by cesarean, but these children were nearly 80% more likely to have a diagnosis of asthma, in comparison to the children delivered naturally. This association between cesarean section and asthma was strengthened by the presence of two allergic parents, indicating a hereditary predisposition to asthma. In children with two allergic parents, cesarean-born children were 200% times more likely to be asthmatic, in comparison with children without allergic parents, who were 36% more likely.

The authors suggest that this association may be linked to the development of the immune system at birth. That is, a cesarean may prevent the baby from being exposed to certain microbes earlier in life. They also suggest that their findings are quite robust given the sample size, long period of followup, and the strict definition of asthma.

They say: “The increased rate of caesarean section is partly due to maternal demand without medical reason.” The authors continue: “In this situation the mother should be informed of the risk of asthma for her child, especially when the parents have a history of allergy or asthma.”

Asthma at 8 years of age in children born by caesarean section
C Roduit, S Scholtens, J C de Jongste, A H Wijga, J Gerritsen, DS Postma, B Brunekreef, MO Hoekstra, R Aalberse, H A Smit
Online First Thorax 2008;
doi 10.1136/thx.2008.100875

Cryptorchidism, the congenital birth defect in which one or both testicles fail to descend into the scrotum, has been associated with certain genetic mutations, including a syndrome which is also a common cause of infertility, according to a study released on November 19, 2008 in JAMA.

As the most common congenital birth defect in male children, cryptorchidism may occur in 2-4% of all full-term male births. However, its cause is largely unknown, and the authors point out that, “although cryptorchidism is often considered a mild malformation, it can seriously affect men’s health, representing the best characterized risk factor for infertility and testicular cancer in adulthood.”

To investigate the potential cause of cryptorchidism, Alberto Ferlin, Ph.D., of the University of Padova, Italy, and colleagues performed a case-control study evaluating the frequency of genetic alterations in 600 male children with and 300 male children without the disease. the children were followed up for 2 to 3 years for persistence of the malformation.

In the genetic examination, abnormalities were low even in the group of cases (2.8%), but statistically significantly higher than those of the controls. This was true in for children with persistent cryptochidism (5.3%) and bilateral cryptorchidism (8.3%) in which both testes fail to descend at once. The odds of a genetic alteration in children with persistent cryptorchidism was 17 times that of controls; the odds of a genetic alteration in children with bilateral persistent cryptorchidism was 27 times that of controls.

The types of genetic mutation were varied. In the small proportion of cases with genetic abnormalities, the most common was Klinefelter syndrome, the most common genetic cause of male infertility. Additionally, several cases had mutations in the INSL3 receptor gene, which affects descent of the testes. Genetic alterations were found exclusively in children with normal weights and gestational ages.

The authors point out the exclusive presence of Klinefelter syndrome: “We found that chromosomal aberrations represent the most frequent genetic alteration in participants with isolated cryptorchidism, particularly in those with persistent cryptorchidism (1.6 percent in the unilateral forms and 4.2 percent in the bilateral forms), and that chromosomal alterations were exclusively represented by Klinefelter syndrome.”

They continue, summarizing the results of the study: “In this study, we found genetic alterations in a small percentage of boys with cryptorchidism. We found a significant association between bilateral and persistent cryptorchidism and genetic alterations, including mutations in the INSL3 receptor gene and Klinefelter syndrome. Genetic alterations were not found in participants with low birth weight or low gestational age …”

However, the authors finally caution against strong generalization of these results, noting the limitations of their study. “Our findings have the limitations of a case-control study, and the main limitation is the small number of genetic abnormalities found. Future studies involving a higher number of participants are necessary to confirm our findings. This study should therefore be considered preliminary, and strong conclusions about association cannot be drawn,” they write.

A stunning discovery based on epigenetics (the inheritance of propensities acquired in the womb) reveals that consuming choline – a nutrient found in eggs and other foods – during pregnancy may significantly affect breast cancer outcomes for a mother’s offspring. This finding by a team of biologists at Boston University is the first to link choline consumption during pregnancy to breast cancer. It also is the first to identify possible choline-related genetic changes that affect breast cancer survival rates.

“We’ve known for a long time that some agents taken by pregnant women, such as diethylstibesterol, have adverse consequences for their daughters,” said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. “But there’s an upside. The emerging science of epigenetics has yielded a breakthrough. For the first time, we’ve learned that we might be able to prevent breast cancer as early as a mother’s pregnancy.”

The researchers made the discovery in rats by studying females whose mothers were fed varying amounts of choline during pregnancy. Different groups of pregnant rats received diets containing standard amounts of choline, no choline at all, or extra choline. Then the researchers treated the female offspring with a chemical that causes cancer of the mammary gland (breast cancer). Although animals in all groups developed mammary cancer, the daughters of mothers that had received extra choline during pregnancy had slow growing tumors while daughters of mothers that had no choline during pregnancy had fast growing tumors.

“Our study provides additional support for the notion that choline is an important nutrient that has to be considered when dietary guidelines are developed,” said Krzysztof Blusztajn, Ph.D., Professor of Pathology at Boston University and the study’s senior researcher. “We hope it will be possible to develop nutritional guidelines for pregnant women that ensure the good health of their offspring well into old age.”

The researchers also found multiple genetic and molecular changes in the rats’ tumors that correlated with survival outcomes. For example, the slow growing tumors in rats had a genetic pattern similar to those seen in breast cancers of women who are considered to have a good prognosis. The fast growing tumors in mice had a pattern of genetic changes similar to those seen in women with a more aggressive disease. The researchers also found evidence that these genetic changes may result from the way that choline affects modifications of the DNA within the mammary gland of fetuses as they develop in the womb.

The National Cancer Institute estimates that there will be more than 184,000 new cases of breast cancer in 2008 and more than 40,000 deaths. Treatments for women suffering from breast cancer range from hormone therapy to surgery.

Notes:

The FASEB Journal (http://www.fasebj.org) is published by the Federation of American Societies for Experimental Biology (FASEB) and is the most cited biology journal worldwide according to the Institute for Scientific Information. FASEB comprises 21 nonprofit societies with more than 80,000 members, making it the largest coalition of biomedical research associations in the United States. FASEB advances biological science through collaborative advocacy for research policies that promote scientific progress and education and lead to improvements in human health

The Australian government, newly led by the Labor Party, will begin monitoring the performance of a government-funded pregnancy helpline operated by McKesson Asia-Pacific, the Australian reports. Former Health Minister Tony Abbott last year established the helpline with a four-year grant of 15.5 million Australian dollars, or about $13.6 million, with the aim of reducing the number of abortions in the country. According to the Australian, there had been concerns over Catholic Church links to guidelines used by helpline counselors, but callers have not been directed to any particular service and have been given informal, non-directive advice on where to look for information.

The helpline has neither met government expectations nor helped more women than a private sector helpline, which closed down after the government launched its program, the Australian reports.

In its first seven months of operation, the government-funded helpline received 2,238 calls for more than 11 counselors on staff. According to the Australian, the helpline is expected to receive about 4,000 calls in its first year, compared with the private helpline, which reported an average of 5,000 calls annually. Government documents reveal the 10 companies that bid for the four-year contract were assessed on their ability to handle a higher volume of calls than has been received by McKesson’s helpline. Details of the contract with the company have not been released, the Australian reports.

A spokesperson for Health Minister Nicola Roxon said the government would monitor the performance of the helpline, but it had the Labor Party’s “in-principle” support, the Australian reports. “We support the continued provision of balanced information and support but we’re keeping a close eye on the pregnancy support line,” Roxon’s spokesperson said. A spokesperson for the health department said, “The helpline has been designed to assist women, their partners and family to access nondirective counseling in a timely fashion when experiencing an unplanned pregnancy,” adding that “initial feedback has confirmed that callers have found the service to be of assistance.” According to the health department spokesperson, “A reduction in abortion rates is not a formal objective of the service and will not be measured as part of any evaluation.” There are about 100,000 abortions in Australia annually (Parnell, Australian, 1/4).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2007 The Advisory Board Company. All rights reserved.

HHS and CDC officials on Wednesday said they are encouraged that the mortality rate of women and infants at the HHS-funded Rabia Balkhi Women’s Hospital in Kabul, Afghanistan, can be reduced, the Atlanta Journal-Constitution reports. A team of experts — led by Mary Lou Valdez, deputy director of HHS’ Office of Global Health Affairs — evaluated the Balkhi Hospital from Nov. 29 to Dec. 13, 2007, and the agency plans to send pediatric and obstetric experts to the hospital to work with Afghan physicians this month or next month (Young, Atlanta Journal-Constitution, 1/3).

CDC and Afghan health ministry officials became concerned that the HHS training program in Kabul encouraged physicians to perform caesarean sections before physicians were adequately trained after a 67% increase in infant mortality at the hospital occurred in 2006. Infants delivered by c-section at the hospital are nearly four times more likely to die than those delivered vaginally. Of the 18 maternal deaths at the hospital in 2006, two-thirds involved c-sections infants. The c-section rate and postoperative infection rate at the hospital increased by 45% and 66%, respectively, in 2006, according to CDC data.

A contractor’s assessment of the hospital found that Afghan physicians at the hospital often did not have basic knowledge of anatomy and physiology and lacked skills needed to resuscitate women and infants. In addition, the hospital routinely lacked basic supplies, including surgical gloves and antibiotics.

HHS in November 2002 had started a maternal and child health campaign in Afghanistan after a UNICEF-CDC survey revealed that the country had a maternal mortality rate of approximately 1,600 deaths for every 100,000 live births, one of the highest rates in the world. Former HHS Secretary Tommy Thompson and officials from the U.S. Department of Defense and Afghanistan’s Ministry of Public Health in April 2003 opened the renovated Balkhi Hospital. About $23 million has been spent on the project.

Rep. Henry Waxman (D-Calif.), chair of the House Committee on Oversight and Government Reform, last month opened an investigation into possible mismanagement of the hospital and requested documents from HHS Secretary Mike Leavitt about Balkhi’s training program (Daily Women’s Health Policy Report, 12/7/07). According to the Journal-Constitution, HHS currently is developing a joint quality assurance program at Balkhi and three other Kabul maternity hospitals.

Brian McCarthy, a maternal health expert and head of CDC’s mission at Balkhi, said that he is hopeful that the new training and quality assurance programs will reduce c-section-related deaths among infants with normal weights, adding that he feels “much better” about where the project is headed (Atlanta Journal-Constitution, 1/3).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2007 The Advisory Board Company. All rights reserved.

A group of UK doctors have called on the UK government to proceed with folic acid fortification of flour to prevent neural tube defects in pregnancies, and not to be delayed by two papers which they say do not prove any connection between folic acid and colorectal cancer.

Dr Roger Bayston, Association for Spina Bifida and Hydrocephalus, Peterborough, UK, and colleagues discuss the delay, announced by the UK Food Standards Agency (FSA) on October 17, 2007, so that the Chief Medical Officer can consider “recent publications on the issue of folic acid and colorectal cancer.”

The doctors say that the two likely papers to be considered are by Cole and colleagues and Mason and colleagues; in the former, they say no link between colorectal carcinoma and folic acid supplementation is proven. And in the latter, the authors of that paper suggest that there is a temporal association between folic acid supplementation and the increase in colorectal cancer in the USA and Canada since 1996. But the doctors say: “Mandatory folic acid fortification was in place by Jan 1, 1998, in the USA and about a year later in Canada. The rise in colorectal cancer incidence therefore started before the introduction of fortification on any large scale and so could not have been caused by fortification.”

They conclude: “The FSA and the Chief Medical Officer can be confident in recommending that the UK government introduce the mandatory fortification of flour, which could prevent about 400 pregnancies affected by neural tube defects each year, reducing both the number of terminations of pregnancy and of children born with these defects.”

The Lancet

A popular epilepsy drug taken by pregnant women with epilepsy because of its mild risk of birth defects has been linked to increased seizure activity in up to 75 percent of pregnancies. Now, new research shows that monitoring the level of the drug in the blood helps to reduce the increased seizure activity associated with the drug lamotrigine and improve the overall health of pregnant women and their fetuses. The findings are published November 28, 2007, in the online edition of Neurology®, the medical journal of the American Academy of Neurology.

“This is important data considering current treatment guidelines do not address how to dose epilepsy drugs once women become pregnant,” said study author Page B. Pennell, MD, with Emory University School of Medicine in Atlanta, GA, and member of the American Academy of Neurology.

For the study, 53 women taking lamotrigine underwent therapeutic drug monitoring every one to three months throughout their pregnancies.

Researchers measured seizure activity and the amount of lamotrigine in the blood since past studies have shown lamotrigine levels significantly drop during pregnancy, causing seizures to worsen. In the current study, the clearance of lamotrigine increased by 89 percent in the third trimester compared to non-pregnant levels. Dosages were adjusted depending on the lamotrigine blood levels with the goal of maintaining each patient’s target concentration determined by pre-pregnancy information.

The study found that although 39 percent of women reported an increase in seizure activity during their pregnancy, 33 percent actually reported a decrease in seizures and 28 percent no change. The health of the babies born was similar to that found in women who do not have epilepsy.

“These rates are more consistent with what’s been reported for pregnant women with epilepsy using other medications, and show the effectiveness of drug monitoring,” said Pennell. “Our findings provide a foundation for treatment guidelines to prevent increased seizure frequency and ultimately improve the health of the mother and fetus.”

“This type of drug monitoring is relatively easy since pregnant women can give blood for lamotrigine testing during their regular visits with their obstetrician or neurologist,” said Pennell. “It’s really a benefit for both mothers and babies.”

The study also found the amount of lamotrigine leaving the blood during pregnancy was higher in white women compared to African American women.

The study was supported by grants from the National Institutes of Health.

The American Academy of Neurology, an association of more than 20,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer’s disease, epilepsy, Parkinson’s disease, and multiple sclerosis.