Vaginal Progesterone Reduces Preterm Birth, Neonatal Morbidity And Mortality In Women At Risk

Main Category: Pregnancy / Obstetrics
Also Included In: Menopause;  Women's Health / Gynecology
Article Date: 15 Dec 2011 - 2:00 PST

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Women with a short cervix should be treated with vaginal progesterone to prevent preterm birth, according to a landmark study by leading obstetricians around the world. Vaginal progesterone decreased the rate of preterm birth by 42%, and significantly reduced the rate of respiratory distress syndrome and the need for mechanical ventilation, as well as a composite of several complications of premature newborns (e.g. infection, necrotizing enterocolitis, intracranial hemorrhage, etc.). An early online version of the study was published today in the American Journal of Obstetrics and Gynecology (AJOG), and is available on the AJOG website free of charge.

"Our analysis provides compelling evidence that vaginal progesterone prevents preterm birth and reduces neonatal morbidity/mortality in women with a short cervix," said lead investigator Dr. Roberto Romero, Chief of the Perinatology Research Branch and Head of the Program in Perinatal Research and Obstetrics of the Division of Intramural Research for the NICHD/NIH/DHHS, Bethesda, MD and Detroit, MI. "Importantly, progesterone reduced early preterm birth (those occurring before 33 or 28 weeks of gestation). These immature babies are at the greatest risk for complications, death, and long-term disability (e.g. cerebral palsy). Progesterone also decreased a fraction of 'late preterm births,' which are the most common preterm deliveries. The profile of adverse events was no different from placebo.

Follow-up studies of babies exposed to progesterone in utero to the age of 18 or 24 months showed no evidence of any behavioral or physical problems. The authors of this study recommend that transvaginal sonographic measurement of the cervix be performed in all pregnant women between 19 to 24 weeks of gestation to assess the risk of preterm delivery. This strategy also allows the identification of women at risk for preterm delivery during their first pregnancy. Other strategies, which are based on treating women with a previous preterm birth, do not address the challenge of prevention in women with their first pregnancy."

Preterm birth is the leading cause of perinatal morbidity and mortality worldwide. Moreover, preterm birth is also the main cause of infant mortality (death to the age of one year). Approximately 12.9 million births worldwide are preterm, of which 92.3% occur in Africa, Asia, Latin America, and the Caribbean. In the United States and Europe, there are 1,000,000 preterm births per year.

Progesterone is a natural hormone produced by the ovary during the menstrual cycle and in early pregnancy, and subsequently, in the placenta. A decline in progesterone action is considered to be important for the onset of labor. If such a decline occurs in the mid-trimester, cervical shortening may lead to the onset of preterm labor. The administration of progesterone is postulated to work by maintaining a high concentration of the hormone in the uterine cervix.

Several studies had evaluated the administration of vaginal progesterone versus placebo to prevent preterm birth when a short cervix was found by ultrasound in the mid-trimester of pregnancy. What is unique about the study published today is that investigators worldwide pooled the data from the different studies and performed a meta-analysis of individual patient data (IPD). This is the "gold standard" for summarizing evidence across clinical trials. It has the advantage of increasing the power to detect differences in efficacy and adverse events, and also allows subgroup analyses that may not have been possible in each individual study.

The IPD meta-analysis included five high-quality trials of vaginal progesterone versus placebo, was conducted at multiple centers in both developed and developing countries, and included a total of 775 women and 927 infants. The primary endpoints were: 1) preterm birth at <33 weeks; and 2) a composite index of perinatal morbidity and mortality. The authors also studied other secondary endpoints and explored the effect of cervical length, a history of previous preterm birth, maternal age, race/ethnicity, and body mass index on progesterone action.

The results were remarkably consistent and significant across trials performed in different parts of the world. Administering vaginal progesterone to asymptomatic women with a short cervix revealed by sonogram in the mid-trimester was associated with a 42% reduction in the rate of preterm birth before 33 weeks of gestation. There was also a significant reduction in the risk of preterm birth before 35, 34, and 28 weeks.

The study also found a 43% decrease in neonatal morbidity and mortality. Vaginal progesterone significantly reduced the risk of respiratory distress syndrome by 52%, and there was significantly lower admission to NICUs (placebo, 20.7% vs. progesterone, 29.1%).

Results of previous trials about the effects of vaginal progesterone or injectable progestins (synthetic compounds with progesterone action) in women with a twin gestation had been negative. However, a subset of patients in the study published today focused on women with a twin gestation and a short cervix. In this particular group, vaginal progesterone reduced the rate of preterm birth at <33 weeks by 30% and significantly reduced the composite neonatal morbidity/mortality of twins. Dr. Romero indicated that a study of vaginal progesterone in twin pregnancies with a short cervix is urgently needed to confirm these findings because the reduction in preterm birth did not reach significance (most likely due to the small number of twins available to study).

A major finding of this study is that progesterone benefits not only women who have a short cervix, but also those who have a prior preterm birth and a short cervix. This has practical implications, because vaginal progesterone is a less expensive and less invasive alternative than the placement of a cervical suture (cerclage) in patients who had a previous preterm birth and have a short cervix.

"The results of this analysis of five large randomized trials have the potential to result in a sea change in obstetrical practice in the U.S. and Europe and eventually in the rest of the world," commented AJOG Co-Editor-in-Chief, Thomas J. Garite, MD. "Prematurity is the leading cause of death and damage for newly born babies and despite enormous efforts, no impact has been made in the rate of preterm birth, which is actually rising in recent years."

As advocated in an accompanying editorial by C. Andrew Combs, MD, PhD, Obstetrix Medical Group, San Jose, CA, in the print version of the Journal, the potential for reducing prematurity lies in implementing routine vaginal ultrasound for all pregnant women in the middle months of pregnancy to measure the length of the cervix and if a short cervix is found, treat these patients with progesterone. The majority of premature births occur in women with no risk factors, so this approach has real potential to make an impact in the overall premature birth rate. Two recently published cost analysis studies, suggest that this approach can not only save lives and prevent the devastating damages often caused by prematurity, but can also result in a annual savings of nearly 1/2 billion dollars in health care costs in the U.S. alone.

Article adapted by Medical News Today from original press release. Source: Elsevier
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1 In 50 Babies Has Birth Defect: Report Highlights Worrying Gaps In Regional Monitoring

Main Category: Pediatrics / Children's Health
Also Included In: Heart Disease;  Neurology / Neuroscience;  Pregnancy / Obstetrics
Article Date: 15 Dec 2011 - 0:00 PST

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More than one baby in every 50 is born with a birth defect (congenital anomaly) according to the latest annual report by the British Isles Network of Congenital Anomaly Registers (BINOCAR) - significantly more common than previously reported estimates of around one in 80.

The study* - led by researchers at Queen Mary, University of London and commissioned by the Healthcare Quality Improvement Partnership (HQIP) - is the most up-to-date and comprehensive of its kind, bringing together existing data in England and Wales from 2005 to 2009.

However, the report's authors remain concerned that data for substantial parts of the country, including London, are not currently monitored, meaning large regional increases in birth defects could go unnoticed and their causes not investigated.

"This is a major issue," commented Joan Morris, Professor of Medical Statistics at Queen Mary, University of London and editor of the report. "It is essential we know how many babies are being born with anomalies and how good their survival is across the whole country, so we can identify ways to reduce the occurrence of anomalies and plan for the care of these babies."

This national report includes data from five regional registers and two disease specific national registers†. Three additional registers exist and it is hoped that with further funding they will contribute data to future reports. Currently there are no registers in London and the South East, the North West and East Anglia.

Professor Elizabeth Draper from the University of Leicester who is Chair of BINOCAR commented: "This report is important, not least because it highlights the need to increase the number of regional registers in England. We are very grateful for the ongoing support from HQIP, but to provide national coverage will require a sustained commitment of additional resources. Funding for national surveillance of congenital anomalies is being considered as part of the surveillance program in Public Health England and we hope it will be in place by April 2013."

The number and types of birth defects have been monitored since the thalidomide epidemic in the 1960s. Under the original system, cases were notified to the Office for National Statistics by doctors, nurses, midwives and health visitors. Since the 1980s, regional registers have been established in some parts of the country to actively collect data from hospitals, laboratories and health records.

In the intervening years, lack of strategic funding coupled with a lack of support at national level has led to the closure of the national system and some of the regional registers. This report collates data from five regional registers, which together cover 28 per cent of the population of England and Wales, leaving the vast majority of birth defects unreported. Previous estimates, based on data from the Office for National Statistics, suggested that 1.3 per cent of babies have a birth defect. The new report indicates that the figure is more than two per cent. The researchers estimate that there were at least 14,500 babies born with birth defects in England and Wales in 2009. The most common defect was congenital heart disease, which affects at least five in 1,000 births. Some cases require major operations and around six per cent of babies born with a heart defect will die before the age of one. Neural tube defects, such as spina bifida, affect one in 1,000 babies, many of these may be prevented by women taking folic acid supplements before becoming pregnant. Gastroschisis - a defect where the intestines develop outside the abdomen - affect one in 1,000 babies. Regional monitoring has shown that this condition has become more common in some areas including Wales and that babies born to younger mothers are at greater risk. Over half of all major birth defects were detected during pregnancy. Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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One Malaria Episode Early In Pregnancy Triples Miscarriage Risk

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Main Category: Tropical Diseases
Also Included In: Pregnancy / Obstetrics
Article Date: 14 Dec 2011 - 9:00 PST

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According to the largest study on the effects of malaria and different anti-malarial drugs in early pregnancy to date, just one episode of malaria in the first trimester is linked to a three-fold greater risk of miscarriage. Researchers also discovered that women treated with anti-malarial drugs did not suffer any serious side effects or increase their likelihood of miscarriage. The study was published Online First in The Lancet Infectious Diseases.

According to estimates each year, 125 million pregnancies are at risk of malaria. During pregnancy, malaria can cause both severe anemia and parasitic infection in the fetus and increase the risk of low birth-weight, preterm birth, and maternal death.

Until now, scientists know little about the effects of malaria in early pregnancy or the benefits and harms of anti-malarial drugs during the early stages of pregnancy. The treatment of all falciparum malaria is artesunate-based combination therapy (ACT), however, it is not recommend during the first pregnancy trimester as it has been proven toxic in animal studies, potentially causing birth defects or miscarriage.

Leading author Rose McGready from Shoklo Malaria Research Unit in Thailand, explained:

"Both vivax and falciparum malaria contribute significantly to avoidable fetal and infant death. These results suggest that the adverse effects of malaria in the first trimester substantially outweigh any adverse effects of its treatment...[and] emphasizes the importance of early detection of malaria and prompt effective treatment for all pregnant women."

McGready and his team set out to provide more evidence and reviewed records of pregnant women who attended antenatal clinics of the Shoklo Malaria Research Unit on the northwestern border of Thailand between May 1986 and October 2010. They compared outcomes of 16,668 women who no malaria during pregnancy with 945 women who had only a single episode in the first trimester, i.e. at less than 14 weeks into their pregnancy, and discovered that asymptomatic malaria, showing no noticeable symptoms, was linked to almost a three times higher risk of miscarriage compared with those who did not contract malaria, whilst the risk of miscarriage for those with symptomatic malaria tended to be at least four-times more likely. In women with vivax and falciparum malaria the risk of miscarriage was similar.

The researchers discovered that the chances of miscarriage was comparable in women who received chloroquine (26%), quinine (27%), and artesunate (31%) during the first-trimester, with no substantial difference reported between treatments in other birth outcomes, such as still birth or low birth weights. Unlike the findings from animal studies, the researchers detected no additional toxic effects in women treated with artesunate.

The authors comment: "Miscarriage in 24 first-trimester episodes of hyperparasitaemia or severe malaria was high but artesunate did not result in higher rates of miscarriage than did quinine," and conclude saying, that: "These findings have serious implications for malaria treatment and prevention policies, which currently ignore the first trimester...A randomized trial of first-trimester artemisinin-based treatment is now needed to make firm recommendations on the safety of first-trimester malaria treatments with this class of anti-malarial drug."

Meghna Desai and Stephanie Dellicour from the Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya write in an associated comment:

"This study provides a level of reassurance regarding the potential risk associated with artemisinin exposure in early pregnancy, compared with the established risk of malaria. This study, combined with data from ongoing studies done in sub-Saharan Africa, will for the first time allow an informed risk/benefit assessment of disease versus treatment with artemisinin combination treatments in pregnancy."

Written by Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our tropical diseases section for the latest news on this subject. ”Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: a population-based study”
Dr R McGready et al.
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Stress Can Shorten A Pregnancy And Result In Fewer Boys Being Born

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Main Category: Pregnancy / Obstetrics
Also Included In: Anxiety / Stress
Article Date: 12 Dec 2011 - 8:00 PST

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According to a study published online in Europe's leading reproductive medicine journal Human Reproduction on December 8th, mothers who are stressed during the second and third trimester of pregnancy can reduce the length of their pregnancy and increase the risk of their unborn child being born prematurely. In addition, stress may also affect the ratio of boys to girls born, leading to a decline in male babies. The study examined the effect stress caused by the 2005 Tarapaca earthquake in Chile had on pregnant women.

Even though researchers know that stress may shorten pregnancy, until now, no investigation has examined the impact of the timing of the stress and the effect stress may have on the ratio of boys to girls being born.

These questions are covered in the new study which also indicates that its exposure to stress itself instead of other factors that can often contribute or cause stress, such as poverty, that seems to affect pregnancy.

In Chile between 2004-2006, there were more than 200,000 births per year. Birth certificates of all babies born during this duration were examined by Professors Florencia Torche (PhD) and Karine Kleinhaus (MD, MPH), of New York University (New York, USA).

Each birth record included data on gestational age at delivery, weight, height, and sex of the baby as well as if any medical attention was needed. In addition, the records provided data on the mother's age at delivery, previous pregnancies, if any, marital status, and in which of the 350 counties in Chile she resides. This data provided the team with extremely specific data on how much the mothers were exposed to the effects of the earthquake, based on how close to the epicenter they lived.

Prof Torche who is Associate Professor of Sociology, explained:

"Looking at information on gestational age at the time of the earthquake in a large, unselected group of women, enabled us to determine the risk for specific birth outcomes by gestational age of exposure to a stressor, which, because it was a natural disaster, was experienced by all at the same time, although in varying degrees of severity, depending on how close they lived to the epicenter. We were able to capture the developmental periods in which exposure to stress was most detrimental for either sex."

Iquique and Alto Hospicio, and the surrounding towns were the areas most effective by the "disastrous" earthquake which measured 7.9 on the moment-magnitude scale (the successor of the Richter scale). The team discovered that women who lived closest to the epicenter of the earthquake during their second and third trimesters of pregnancy had shorter pregnancies and were at an increased risk of delivering prematurely (before 37 weeks gestation).

On average, women exposed to the earthquake in their second trimester delivered their babies 0.17 weeks (1.3 days) earlier than women in unaffected areas of the country and those in their third trimester delivered their babies 0.27 weeks (1.9 days) earlier. Usually, approximately 6 in 100 women had a pre-term birth, however this increased by 3.4% (9 in 100 women) in women exposed to the earthquake in their third trimester.

The effect was most notable for female births; the probability of pre-term birth rose by 3.8% if the mother was exposed to the earthquake during her third trimester, and 3.9% if it occurred in the second trimester. In male births there was no statistically considerably effect observed.

When calculating the effect of stress on the sex ratio: the ratio of male to female live births, the team had to make adjustments as the stress of the quake had a more significant effect on pre-term births in girls than boys. They discovered there was a decline of 5.8% in the sex ratio among those exposed to the quake in the third trimester.

Prof Kleinhaus, who is Assistant Professor of Psychiatry, Obstetrics & Gynecology, and Environmental Medicine, said:

"Generally, there are more male than female live births. The ratio of male to female births is approximately 51:49 - in other words, out of every 100 births, 51 will be boys. Our findings indicate a 5.8% decline in this proportion, which would translate into a ratio of 45 male births per 100 births, so that there are now more female than male births. This is a significant change for this type of measure."

Previous studies had indicated that women who are stressed are more likely to miscarry male fetuses as they grow larger than females, thus requiring more resources by the mother. In addition, they may be not as strong as females and might not adapt their development to a stressful environment in the womb.

Prof. Torche, explained:

"Our findings on a decreased sex ratio support this hypothesis and suggest that stress may affect the viability of male births. In contrast, among female conceptions, stress exposure appears not to affect the viability of their conception but rather, the length of gestation."

The investigators state that the placenta, which controls the duration of the pregnancy, and the effect of the stress hormone cortisol on the placenta's function, may be possible mechanisms to explain their discoveries.

Prof Torche concluded:

"In terms of implications, it is clearly unrealistic to recommend avoiding natural disasters. However, this research suggests the need to improve access to healthcare for women from the onset of pregnancy and even before conception. Obviously this will not reduce the exposure to stress, but it may provide care, advice, and tools that would allow women to cope with stressful circumstances.

A separate implication has to do with our ability to use a "natural experiment" (the earthquake) to isolate the effect of stress from factors that commonly go with it. In particular, researchers have long suggested that poverty is bad for health outcomes because of the stress it elicits.

This is very plausible, but it is difficult to disentangle the effect of stress alone from the effect of the other factors associated with poverty, such as nutritional deprivation and poor housing, which could also have an independent impact on women's health and the outcome of their pregnancies. This makes it difficult to ascertain whether stress itself does, indeed, matter. Our research provides strong evidence that it does."

Written by: Grace Rattue

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our pregnancy / obstetrics section for the latest news on this subject. [1] "Prenatal stress, gestational age and secondary sex ratio: the sex-specific effects of exposure to a natural disaster in early pregnancy", by Florencia Torche and Karine Kleinhaus. Human Reproduction journal. doi:10.1093/humrep/der390
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Improving Patient Safety With Extra Obstetrics Training

Main Category: Women's Health / Gynecology
Also Included In: Medical Students / Training;  Pregnancy / Obstetrics
Article Date: 17 Nov 2011 - 0:00 PST

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A new study published in the Journal for Healthcare Quality reveals that a multifaceted quality initiative can significantly reduce adverse obstetric outcomes, thereby improving patient safety and enhancing staff and patient experiences.

Led by Adiel Fleischer, MD, Chairman of Ob/Gyn at North Shore University Hospital and Long Island Jewish (LIJ) Medical Center, researchers designed a program to improve perinatal safety initiatives.

Specifically, they designed and implemented a two-year comprehensive training program for all staff in the obstetrics wing at North Shore University Hospital and LIJ Medical Center. Staff was required to complete the formalized training that included evidence-based protocols to reduce adverse effects.

A team of scientists in the Division of Health Services Research in the health system's Department of Population Health, and from the Biostatistics Department analyzed almost a dozen adverse outcomes measures.

Results showed that adverse events, including returning to the operative room and birth trauma, were significantly reduced by more than half; from 2 percent to 0.8 percent. Data also showed that better outcomes were maintained over the two-year study period.

Additionally, staff perceptions of safety, patient perceptions of whether staff worked together, and documentation rates of abnormal fetal heart tracings and obstetric hemorrhage were all significantly improved.

"In order to improve care and reduce adverse events in obstetrics, a multifaceted best practice based approach that introduces standardized documentation, trains entire teams, and facilitates communication from both those trained and those being cared for, is convincingly effective," Fleischer notes.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Post-Partum Psychiatric Problems Increase Risk Of Bipolar Disorder

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Academic Journal
Main Category: Psychology / Psychiatry
Also Included In: Bipolar;  Women's Health / Gynecology;  Pregnancy / Obstetrics
Article Date: 06 Dec 2011 - 0:00 PST

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A report published by Archives of General Psychiatry, one of the JAMA/Archives journals, shows mothers experiencing a psychiatric episode in the first 30 days post-partum appear to have an increased risk of developing bipolar affective disorder.

The authors write that :

"Childbirth has an important influence on the onset and course of bipolar affective disorder, and studies have shown that episodes of post-partum psychosis are often best considered as presentations of bipolar affective disorder occurring at a time of dramatic psychological and physiological change ...

It is also clear, however, that a high number of women with the new onset of a psychiatric disorder in the immediate post-partum period do not receive a diagnosis of bipolar disorder."

Researchers including Trine Munk-Olsen, Ph.D., of the National Centre for Register-Based Research, Arhus University, Arhus, Denmark, and colleagues collected data on more than 120,000 women born in Denmark from 1950 to 1991 who were alive in 2006 and had a history of a first-time psychiatric issues, including admission or outpatient contact, with any type of psychiatric disorder, excluding bipolar affective disorder.

Each woman was followed up individually from the day of discharge, with data collected on inpatient or outpatient psychiatric contacts during the follow-up period.

More than 2.5% had their first psychiatric consultation within the first year after delivery of their first child. During follow-ups, more than 3,062 of the 120,378 women received diagnoses of bipolar affective disorder, of which 132 had their initial psychiatric contact 0 to 12 months post-partum. Researchers then adjusted the data screening for first diagnosis and family history of psychiatric illness, and showed that conversion rates to bipolar disorder were significantly predicted by the timing of initial psychiatric contact.

There appears to be a significantly higher conversion rate to bipolar affective disorder in women having their initial contact within the first post-partum month.

Furthermore, the researchers found evidence that the severity of the initial post-partum psychiatric episode may be important, as inpatient admissions were associated with a higher conversion rate than were outpatient contacts.

In Summary : Fifteen years after initial contact, 13.87 percent of women with onset in the immediate post-partum period (0 to 30 days) had converted to bipolar disorder4.69 percent of women with later onset (31 to 365 days post-partum) had converted to bipolar disorder4.04 percent of women with onset at other points had converted to bipolar disorderExtended analysis showed that 18.98 percent of women with onset in the immediate post-partum period had converted to bipolar disorder within 22 years after initial psychiatric contact.Conversely, 6.51 percent of women with later post-partum onset and 5.43 percent of women with onset at other points had converted to bipolar disorder after 22 yearsThe authors conclude that :

"The present study confirms the well-established link between childbirth and bipolar affective disorder and specifically adds to this field of research by demonstrating that initial psychiatric contact within the first 30 days post-partum significantly predicted conversion to bipolar affective disorder during the follow-up period ...

Results indicate that the presentation of mental illness in the early post-partum period is a marker of possible underlying bipolarity."

Written by Rupert Shepherd
Copyright: Medical News Today
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Visit our psychology / psychiatry section for the latest news on this subject. Arch Gen Psychiatry. Published online December 5, 2011. doi:10.1001/archgenpsychiatry.2011.157. Please use one of the following formats to cite this article in your essay, paper or report:

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Home Births - Then And Now

Main Category: Pregnancy / Obstetrics
Also Included In: Caregivers / Homecare;  Nursing / Midwifery
Article Date: 02 Dec 2011 - 0:00 PST

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A comparison of home-birth trends of the 1970s finds many similarities - and some differences - related to current trends in home births.

For instance, in the 1970s - as now - women opting to engage in home births tended to have higher levels of education. That's according to a 1978 survey by Home Oriented Maternity Experience (HOME) that was recently found by University of Cincinnati historian Wendy Kline in the archives of the American Congress of Obstetricians and Gynecologists (ACOG).

That survey showed that in the late 1970s, one third of the group's members participating in home births had a bachelor's, master's or doctoral degree. Fewer than one percent did not have a high school education.

Also, according to the 2,000 respondents to HOME's 1978 survey, 36 percent of women engaging in home births at the time were attended by physicians. That is a much higher percentage than is the case currently for mothers participating in home births. (In research by Eugene Declerq, Boston University School of Public Health, and Mairi Breen Rothman, Metro Area Midwives and Allied Services, it was found that about five percent of homebirths were attended by a physician in 2008.)

These comparisons are possible because of historical information found by UC's Kline, including "A Survey of Current Trends in Home Birth" by the founders HOME and published in 1979.

Kline is also conducting interviews with and has obtained historical documents from the founders of and the midwives first associated with HOME, a grass roots organization founded in 1974, to provide information and education related to home births.

Kline will present this research and related historical information as one of only nine international presenters invited to the "Communicating Reproduction" conference at Cambridge University Dec. 6-7.

Historical Research Lends Perspective to Current Debat

The debate surrounding health, safety and home births rose to national prominence as recently as October 2011 during the Home Birth Consensus Summit in Virginia, held because of increasing interest in home births as an option for expectant mothers.

Overall, Kline's research of HOME and of ACOG counters the stereotypical view of the 1970s home-birth movement as countercultural and peopled by "hippies." In fact, the founders of HOME deliberately reached out to a broad cross section of women across the political and religious spectrum, including religious conservatives as well as those on the left of the political spectrum.

Said Kline, "In looking through the historical record, we find that many women involved in home births in the 1970s signed their names 'Mrs. Robert Smith' or 'Mrs. William Hoffman.' The movement included professionals, business people, farmers, laborers and artists. It defies simplistic categorization."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pregnancy / obstetrics section for the latest news on this subject. Kline’s research is funded by an ACOG Fellowship in the history of American obstetrics and gynecology.
University of Cincinnati Please use one of the following formats to cite this article in your essay, paper or report:

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When Does Pregnancy Start? Doctors' Opinions Vary

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Academic Journal
Main Category: Pregnancy / Obstetrics
Also Included In: Fertility
Article Date: 19 Nov 2011 - 0:00 PST

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Does pregnancy start at conception - when the sperm fertilizes the egg? Or does it begin one week later when the embryo implants in the uterus? According to a survey carried out by researchers from the University of Chicago and published in the American Journal of Obstetrics and Gynecology, not even doctors appear to agree.

Dr. Farr A. Curlin and team set out to determine what Ob/Gyns (obstetrician-gynecologists) thought regarding the beginning of pregnancy. They also wanted to know what measure characteristics were linked to the belief that pregnancy started at implantation instead of conception.

The researchers posted a questionnaire to 1,800 Ob-Gyns in the USA, all of them practicing their profession at that time. Their main focus was when they thought pregnancy started.

The questionnaire gave the following response options: At conception (the union of the sperm and the egg, also known as fertilization)When the embryo is implanted in the uterusNot sureThe authors wrote that:

"Primary predictors were religious affiliation, importance of religion, and having a moral objection to abortion."

Below are some highlighted data from their findings: 66% (1154) of the doctors responded to the questionnaire57% answered - at conception28% answered - at implantation16% answered - not sureA higher percentage of religious doctors responded "at conception", as did those who were against abortion.

In an abstract in the journal, the authors concluded:

"Obstetrician-gynecologists' beliefs about when pregnancy begins appear to be shaped significantly by whether they object to abortion and by the importance of religion in their lives."

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our pregnancy / obstetrics section for the latest news on this subject. "Obstetrician-Gynecologists’ Beliefs about When Pregnancy Begins"
Grace S. Chunge, Ryan E. Lawrence, MD, Kenneth A. Rasinski, PhD, John D. Yoon, MD, Farr A. Curlin, MD
American Journal of Obstetrics & Gynecology. November 2011. doi:10.1016/j.ajog.2011.10.877 Please use one of the following formats to cite this article in your essay, paper or report:

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9 Dec. 2011. APA

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posted by Ryszard Chetkowski, MD on 18 Nov 2011 at 11:57 pm

If 66% of Ob-Gyns believe that pregnancy starts at fertilization (conception), then test tubes and petri dishes are pregnant after in vitro fertilization before embryos are transferred into the uterus.

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posted by Jennifer on 21 Nov 2011 at 12:28 pm

No, it means that OB Gyn's believe it is a baby and not cells in the test tube/petri dishes. Doctors are taught when conception is in medical school, are they not? (Conception is when the sperm and egg dance) Or is is dependent on you religion?

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posted by laura j. on 22 Nov 2011 at 11:37 am

One could say that in vitro does not create life because the embryo can not live outside the host, however, that would lead to the question of whether we are supposed to be the ones fertilizing the egg in a petri dish to begin with. Without in vitro there would be no such thing as an embryo without a host (hence all naturally fertilized eggs do imply life and pregnancy...but not their in vitro/artificial counterparts).

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posted by Jennifer on 23 Nov 2011 at 12:17 pm

Should we be fertilizing all of the eggs removed for IVF procedures? If a patient has 20+eggs and all of those eggs are fertilized, what happens next? Without a host they are in limbo and this is a morally complex situation for the patient. Especially if the patient believes life begins at conception, as I do. Should Fertility Specialists be creating all of these babies(embryos) that will never have a home/host?

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Suicide Risk Among Pregnant Women And New Mothers - Health Care Professionals Should Be Aware

Editor's Choice
Academic Journal
Main Category: Pregnancy / Obstetrics
Also Included In: Depression;  Primary Care / General Practice
Article Date: 01 Dec 2011 - 9:00 PST

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A study published online in General Hospital Psychiatry shows women at risk for suicide may be easier identified, by increasing screening of expectant and new mothers for major depression and conflicts with intimate partners.

Researchers say that even though only a small percentage of women who commit suicide are pregnant or new mothers, because this group of women commonly frequently use the health care system, they could offer significant opportunities for providers to intervene if the risk factors are better understood.

Leading researcher author Dr Katherine J. Gold, assistant professor of family medicine at the U-M Medical School states:

"We have a more complete picture now of who these women are and what led up to these tragic events. These deaths ripple through families and communities and cause a lot of sorrow and devastation."

Researchers from the University of Michigan evaluated suicide data from the unique National Violent Death Reporting System that was introduced in 2003, that links multiple sources of information and provides investigators with details, such as demographic data, mental health, pregnancy status, substance abuse status and precipitating circumstances.

The findings revealed that over half of the women who committed suicide had a known mental health diagnosis, the largest one being mood disorder, which affected 95% of women and almost half were known to being in a depressed mood before their suicide.

Senior researcher Dr Christie Palladino, an obstetrician and gynecologist with Georgia Health Sciences University's Education Discovery Institute explains:

"Previous research has shown that depressive disorders affect 14-23 percent of pregnant and postpartum women and anxiety disorders affect 10-12 percent. We've known that major depression is a factor in suicide for a long time. But this data tells us, for example, that pregnant and postpartum women had a much higher incidence of conflicts with intimate partners than their counterparts."

Researchers also observed that postnatal women seemed to have a higher tendency of being identified with a depressive mood in the two weeks before their suicide compared with other women.

Significantly, they also discovered many parallels with no substantial variations in terms of pregnancy status, such as 56% of all suicide victims had a known mental health diagnosis, 32% had tried to commit suicide before, and 28% had a known alcohol or substance abuse issue at the time of death.

Gold comments: "Depression and substance use are risk factors for everyone, including pregnant and postpartum women."

The findings showed that although suicides amongst pregnant, new postnatal and non-pregnant women shared a very similar level of education and marital status, Hispanic women had a much higher tendency of committing suicide during pregnancy (10%) or during the first year after pregnancy (9%) than women who were not pregnant (4%).

The researchers are aware that their study has some inherent data limitations, as their sample of 2,083 suicides amongst women aged between 15-54 years only included data from 17 states where data was available, and obviously it was not possible to interview victims to obtain a full examination of their mental health condition or check for unreported cases of domestic violence and other precipitating factors.

According to Gold:

"As a society, we tend to avoid talking about suicide. But it's important to try to understand and talk about risk factors if we are going to address suicide from a public health perspective."

Written by Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our pregnancy / obstetrics section for the latest news on this subject. “Mental Health, substance use, and intimate partner problems among pregnant and postpartum suicide victims in the National Violent Death Reporting System”
General Hospital Psychiatry, doi:10.1016/j.genhosppsych.2011.09.017

Source: University of Michigan Health System

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