TAG: "Women’s health"

Few obstetricians counsel patients on environmental toxics


UCSF study finds most agree exposures can be reduced, but only half take patients’ histories.

Naomi Stotland, UC San Francisco

In the first national survey of U.S. obstetricians’ attitudes towards counseling pregnant patients about environmental health hazards, nearly 80 percent agreed that physicians have a role to play in helping patients reduce their exposures, but only a small minority use their limited time with patients to discuss how they might avoid exposure to toxics, according to a UC San Francisco-led study.

Only 1 in 5 of the 2,500 physicians surveyed said they routinely asked about these exposures, and just 1 in 15 said they had received training on the harmful reproductive effects of toxic chemicals that are ubiquitous in the bodies of pregnant women in the United States.

The doctors surveyed said they didn’t know enough or were too uncertain of the evidence to feel comfortable making firm recommendations to pregnant women. They also said their patients often have more pressing and immediate health concerns, such as poor diet, sedentary lifestyles, obesity and chronic medical conditions like diabetes. In focus groups, physicians said they were afraid of scaring their patients about the chemicals found in the workplace and in thousands of household and industrial products, since it’s almost impossible to avoid being exposed to them.

While acknowledging that the problem can seem overwhelming, the authors said there are still things that doctors can do to help patients, even those who may have little control over their living and working environments and cannot afford luxuries like organic food.

“Many environmental exposures are unavoidable,” said Naomi Stotland, M.D., an associate professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at UCSF, a physician at one of UCSF’s partner hospitals, San Francisco General Hospital and Trauma Center, and the study’s lead author. “So, we counsel women on the substances that we know are most likely to cause harm, while providing them with practical ways of reducing their exposures.”

The authors said that if physicians had better training and evidence-based guidelines, they could be more proactive, without fear of unduly alarming their patients. Previous studies have shown that women want to know about the adverse effects of the chemicals they’re exposed to and that they can react productively to this information.

“We have good scientific evidence demonstrating that pregnant women are exposed to toxic chemicals, and there’s a link between these exposures and adverse health outcomes in children,” said Tracey Woodruff, Ph.D., M.P.H., who directs the UCSF Program on Reproductive Health and the Environment at UCSF and is the study’s senior author. “But physicians are not offering this information to their patients.”

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Using bubbles to reveal fertility problems


New ultrasound procedure can identify blockages in fallopian tubes.

Sanjay Agarwal, UC San Diego

Many women struggling to become pregnant may suffer from some degree of tubal blockage. Traditionally, an X-ray hysterosalpingogram (HSG) that uses dye is the most common procedure to determine whether a blockage exists, but it can cause extreme discomfort to the patient. UC San Diego Health System’s doctors are the first fertility specialists in the county to use a new ultrasound technique to assess fallopian tubes by employing a mixture of saline and air bubbles that is less painful, avoids X-ray exposure and is more convenient to patients during an already vulnerable time.

Using the FemVue Sono HSG, the physician delivers the mixture of saline and air bubbles into the uterus through a small catheter, which then flows into the fallopian tubes. Under ultrasound, the air bubbles are highly visible as they travel through the tubes, allowing the physician to determine if a blockage exists.

“The traditional X-ray approach involves higher pressure and usually causes significant cramping as the dye is administered. The anticipated pain prevents some women from even attempting the test. Others cannot do the test because they are allergic to the dye. Assessing the tubes for a blockage is a key component of the diagnostic workup in fertile couples, and not doing so because of pain or allergy is a real concern,” said Sanjay Agarwal, M.D., director of fertility services in the Department of Reproductive Medicine at UC San Diego Health System. “The new approach is not only much more comfortable for patients, it also uses saline, so the issue of an allergy does not arise. We are also able to assess the cavity of the uterus at the same time – all without X-rays.”

Kristina, a mother who has been trying to conceive a second child for almost a year, agreed: “I was willing to do whatever it took to address the fertility issues we were facing, but after everything we had been through emotionally, it was a relief to undergo a procedure that wasn’t physically painful.”

The ultrasound is performed in the clinic, and at present, ideal candidates include those with a prior pregnancy and those at low risk for tubal disease.

“Like the traditional X-ray HSG, the new test should be performed after the period has ended but before ovulation. The fact that the patient can schedule this ultrasound-based test in the clinic and not in radiology prevents a delay in care and allows the patient’s physician to be more involved in the process,” said Agarwal, also director of the UC San Diego Center for Endometriosis Research and Treatment (CERT).

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Risk of pregnancy greater with newer method of female sterilization


Study provides “essential information” for women, doctors discussing permanent sterilization.

Mitchell Creinin, UC Davis

The risk of pregnancy among women using a newer method of planned sterilization called hysteroscopic sterilization is more than 10 times greater over a 10-year period than using the more commonly performed laparoscopic sterilization, a study by researchers at Yale University and UC Davis has found.

Published online today (April 22) in the medical journal Contraception, the study found the higher risk of pregnancy with a newer sterilization method marketed under the brand name Essure.

“This study provides essential information for women and their doctors discussing permanent sterilization,” said lead study author Aileen Gariepy, assistant professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the Yale School of Medicine.

Female surgical sterilization is the most popular method of pregnancy prevention worldwide and the most commonly used method of contraception among women age 35 and older in the United States. Each year, 345,000 U.S. women undergo sterilization procedures, and a total of 10.3 million U.S. women rely on female sterilization for pregnancy prevention.

Hysteroscopic sterilization is a multistep process that requires women to have a procedure to place coils inside the opening of the Fallopian tubes, use another method of contraception for three months after the procedure, and then have a special X-ray test in which dye is pushed into the uterus to confirm whether the tubes are blocked.

“When Essure was first approved by the Food and Drug Administration in 2002, data presented to physicians and patients only included those women who successfully completed all of the steps to be sterilized using the procedure,” said study co-author Mitchell Creinin, professor and chair of the Department of Obstetrics and Gynecology at the UC Davis School of Medicine.

“However, physicians quickly realized that at least 1 in 10 women would not be able to have the coils placed and that many would not return for follow-up testing,” he said.

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Experts question routine mammograms in elderly


UCSF-Harvard study finds tests offer limited benefit to oldest female patients.

Louise Walter, UC San Francisco

Doctors should focus on life expectancy when deciding whether to order mammograms for their oldest female patients, since the harms of screening likely outweigh the benefits unless women are expected to live at least another decade, according to a review of the scientific literature by experts at UC San Francisco and Harvard medical schools.

National guidelines recommend that doctors make individualized screening decisions for women 75 and older. But the analysis, published online in JAMA (March 31), concluded that since this age group was not included in mammography trials, there is no evidence that screening helps them live longer, healthier lives.

The authors said that many women in this age group receive regular mammograms anyway, with no discussion about the uncertain benefit or potential harms of continued testing, which include unnecessary treatment for slow-growing cancers or pre-cancerous lesions that pose no real threat to the women’s lives.

They concluded that women who are expected to live a decade or more should talk with their doctors and weigh the potential benefits of diagnosing a dangerous but treatable cancer through mammography against the possibility of being misdiagnosed or treated aggressively for a cancer that posed no real harm.

“People should be informed that everything we do in medicine can have good and bad effects, and that goes for mammography,” said Louise Walter, M.D., UCSF professor of medicine and chief of the Division of Geriatrics.

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Bariatric surgery decreases risk of uterine cancer


Findings indicate obesity may be a modifiable risk factor for endometrial cancer.

Researchers at the UC San Diego School of Medicine and Moores Cancer Center report that bariatric surgery resulting in dramatic weight loss in formerly severely obese women reduces the risk of endometrial (uterine) cancer by 71 percent and as much as 81 percent if normal weight is maintained after surgery.

Published in the April issue of Gynecologic Oncology, the official publication of the Society of Gynecologic Oncology, the findings indicate obesity may be a modifiable risk factor for endometrial cancer, and bariatric surgery a viable option for eligible patients. They are based on a retrospective cohort study of 7,431,858 patients in the University HealthSystem Consortium database, which contains information from contributing academic medical centers in the United States and affiliated hospitals. Of this total, 103,797 patients had a history of bariatric surgery and 44,345 had a diagnosis of uterine malignancy.

Obesity is a widespread public health problem in the United States, with an estimated two-thirds of the U.S. adult population considered to be overweight or obese. The condition is strongly linked to a host of health risks, among them heart disease, diabetes and cancer, in particular endometrial cancer.

“Estimating from various studies that looked at increasing BMI and endometrial cancer risk, a woman with a body mass index (BMI) of 40 would have approximately eight times greater risk of endometrial cancer than someone with a BMI of 25,” said first author Kristy Ward, M.D., the senior gynecologic oncology fellow in the Department of Reproductive Medicine at UC San Diego School of Medicine. “This risk likely continues to go up as BMI goes up.”

Bariatric surgery is often the last resort for obese patients after all other non-surgical weight loss efforts have failed. To qualify, patients must be an acceptable surgical risk and be defined as either severely obese with a BMI of 40 or greater or have a BMI of 35 or greater with at least one related condition: diabetes, obstructive sleep apnea, obesity-related cardiomyopathy or heart muscle disease or severe joint disease.

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Statewide public cord blood collection begins


UC Davis Health System administers the state-funded program.

Mothers of newborns can now donate their babies’ umbilical cord blood at UC Davis Medical Center and other hospitals throughout the state as part of California’s first comprehensive public system of collecting cord blood for lifesaving transplantations and medical research.

“This program enables new mothers to be both life-givers and lifesavers,” said Laurel Finta, medical director for Maternity Services at UC Davis Medical Center. “Parents now have the opportunity to donate to a publicly funded cord blood collection program that costs them nothing and can provide benefits to so many others.”

Created by state legislation in 2010, California’s Umbilical Cord Blood Collection Program (UCBCP) is a unique, state-funded system designed to broaden the diversity of umbilical cord blood units for public banking and use in unrelated transplants as well as provide a source of high-quality cord blood units for qualified researchers. UC Davis Health System administers the program, which is funded by a $2 dollar fee on birth certificate copies.

“The main goal of this program is to expand the diversity of publicly available cord blood by making it easy and convenient for new mothers to donate,” said Suzanne Pontow, co-director of the program and a scientist at the UC Davis Institute for Regenerative Cures in Sacramento. “Only a tiny fraction of cord blood is collected and preserved right now, so this is the beginning of an important effort to enable parents around the state to voluntarily and easily donate cord blood at no cost.”

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Young mother delivers baby, develops heart disease


UC San Diego Sulpizio Cardiovascular Center among first in region to implant cardiac device.

Amanda and her husband, Nathan, doting on their beautiful daughter, Kassidy, minutes after her arrival.

Three weeks after delivering her first child, Amanda began to suffer from extreme fatigue, headaches, a tight chest and stomach pain. An initial diagnosis of pneumonia changed for the worse: Amanda was experiencing heart failure. The 28-year-old’s life was at risk. She was quickly transferred to UC San Diego Sulpizio Cardiovascular Center (SCVC) where a multidisciplinary team implanted a novel cardiac device under her skin, leaving the heart untouched, to prevent sudden cardiac arrest.

“When Amanda first arrived at SCVC, she was in critical condition. It became clear within 24 hours that she needed emergency surgery or she would not survive,” said Eric Adler, M.D., director of cardiac transplant and mechanical circulatory support at UC San Diego Health System.

The new mother was diagnosed with peripartum cardiomyopathy, a rare disorder in which a woman develops heart disease within the final month of pregnancy or within five months after delivery. Adler adds that one in 2,000 women suffers from the condition, the cause is not exactly known and it can be hard to correctly diagnosis.

“I knew I had to fight for my daughter,” said Amanda. “I am not a quitter and always strive for success. I wasn’t going to let heart failure beat me.”

A left ventricular assist device (LVAD) – a mechanical heart of sorts that helps pump oxygen-rich blood throughout the body – was first implanted in Amanda.

“The patient’s heart was failing. She was in a dire situation and needed the LVAD device immediately implanted to support her heart function and restore blood circulation,” said Victor Pretorius, M.B.Ch.B., cardiothoracic surgeon at UC San Diego Health System, who implanted the LVAD in Amanda.

Amanda was also a candidate for the new Boston Scientific Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) System. The device is used for the treatment of patients at risk for sudden cardiac arrest. To date, more than 3,000 devices have been implanted in patients around the world.

The S-ICD System monitors cardiac activity and shocks the heart when it goes into a dangerous rhythm, a function not performed by the LVAD. The S-ICD does not use traditional wires, called “leads,” threaded to the heart through blood vessels. Rather, the device is implanted just under the skin near the breastbone, and heart patients who require an ICD may be candidates.

“Leads in standard ICDs have been known to fracture or disconnect at times. The S-ICD has fewer long-term complications, an easier removal process and puts the patient at less risk for infection,” said Ulrika Birgersdotter-Green, M.D., director of pacemaker and ICD services at UC San Diego Health System, who implanted the device in Amanda. “It is an advancement in defibrillation technology that is simple to implant and can be life-saving.”

Amanda was the first patient at UC San Diego Health System to receive the S-ICD. The procedure took about an hour, and she was able to walk around the next day. As she continues to heal, she will be closely monitored to see if her heart function improves. If not, she will be placed on a heart transplant list.

“As part of the region’s only academic hospital, we are dedicated to using a team approach to treat high risk patients, who five to ten years ago, may not have survived,” said Adler.

Amanda is now sharing her story to raise awareness about heart disease.

“Knowledge and early detection for heart disease, especially peripartum cardiomyopathy, are key. I hope my story helps others to understand the warning signs and the technology available for treatment,” said Amanda. “The first time I was able to hold my daughter after the procedure, I became very emotional after the journey I had just been through. Because of the team at SCVC, I am able to embrace my family every day.”

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Researchers one step closer to ovarian cancer marker


UC Davis researchers verify that glycans can be used to detect ovarian cancer.

Gary Leiserowitz, UC Davis

The hunt is on to find biomarkers that detect cancer, but it’s a challenging process. Early successes often are followed by heartbreaking failures. But now, researchers at UC Davis have verified that glycans (sugars attached to proteins) can be used to detect ovarian cancer. The study was published online in the journal Cancer Epidemiology, Biomarkers & Prevention.

“This is one of many papers we’ve done to see if glycans can distinguish between women who have ovarian cancer and those who don’t,” said senior author Gary Leiserowitz, chief of the Division of Gynecologic Oncology. “So far, the results have been consistent and promising.”

Creating a diagnostic tool that identifies ovarian cancer early through analysis of a blood sample would be an enormous benefit. Because the disease produces indistinct symptoms, such as bloating, ovarian cancer is often diagnosed late, making it difficult to treat.

The answer may be glycans, which are attached to over 50 percent of all proteins and often are altered when patients have cancer. By measuring these changes, the UC Davis team hopes to create a blood test that will find these cancers early.

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Know the risks: Kawasaki disease and pregnant women


UC San Diego researchers say risks are manageable, provided doctors recognize them.

Jane Burns, UC San Diego

In the first study of its type, researchers at the UC San Diego School of Medicine have looked at the health threat to pregnant women with a history of Kawasaki disease (KD), concluding that the risks are low with informed management and care.

The findings are published in today’s (March 6) online edition of the British Journal of Obstetrics and Gynaecology.

KD is a childhood condition affecting the coronary arteries. It is the most common cause of acquired heart disease in children. First recognized in Japan following World War II, KD diagnoses are rising among children in Asia, the United States and Western Europe. Predictive models estimate that by 2020 one in every 1,600 American adults will be affected by KD.

“A growing number of women with a history of KD are reaching child-bearing age, but there is little information available to guide their obstetrical care,” said study author Jane C. Burns, M.D., professor and director of the Kawasaki Disease Research Center at UC San Diego and Rady Children’s Hospital-San Diego. “By and large, KD is virtually unknown among working obstetricians.”

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Acetaminophen use during pregnancy linked to ADHD in children


UCLA study raises concerns about use of acetaminophen during pregnancy.

Beate Ritz, UCLA

Acetaminophen, found in over-the-counter products such as Excedrin and Tylenol, provides many people with relief from headaches and sore muscles. When used appropriately, it is considered mostly harmless. Over recent decades, the drug, which has been marketed since the 1950s, has become the medication most commonly used by pregnant women for fevers and pain.

Now, a long-term study by UCLA, in collaboration with the University of Aarhus in Denmark, has raised concerns about the use of acetaminophen during pregnancy.

In a report in the current online edition of JAMA Pediatrics, researchers from the UCLA Fielding School of Public Health show that taking acetaminophen during pregnancy is associated with a higher risk in children of attention-deficit/hyperactivity disorder and hyperkinetic disorder. The data raises the question of whether the drug should be considered safe for use by pregnant women.

ADHD, one of the most common neurobehavioral disorders worldwide, is characterized by inattention, hyperactivity, increased impulsivity, and motivational and emotional dysregulation. Hyperkinetic disorder is a particularly severe form of ADHD.

“The causes of ADHD and hyperkinetic disorder are not well understood, but both environmental and genetic factors clearly contribute,” said Dr. Beate Ritz, professor and chair of the department of epidemiology at the Fielding School and one of the senior authors of the paper. “We know there has been a rapid increase in childhood neurodevelopmental disorders, including ADHD, over the past decades, and it’s likely that the rise is not solely attributable to better diagnoses or parental awareness. It’s likely there are environmental components as well.”

“That gave us the motivation to search for environmental causes that are avoidable,” said the University of Aarhus’ Dr. Jørn Olsen, another senior author and former chair of the UCLA Fielding School’s epidemiology department. “Part of the neuropathology may already be present at birth, making exposures during pregnancy and/or infancy of particular interest. Because acetaminophen is the most commonly used medication for pain and fever during pregnancy, it was something we thought we should look at.”

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Drug prolongs survival in advanced cervical cancer, study finds


Results of UC Irvine-led trial already have changed treatment guidelines.

Krishnansu Tewari, UC Irvine

Women with advanced cervical cancer now have a new treatment option that could lengthen their lives. A trial led by UC Irvine gynecologic oncologist Dr. Krishnansu S. Tewari found that combining chemotherapy with bevacizumab, also known as Avastin, extended median survival to 17 months, compared to 13.3 months for those receiving chemotherapy without bevacizumab.

Furthermore, treatment with the anti-angiogenesis drug – which inhibits a tumor’s ability to form new blood vessels – caused no significant deterioration in quality of life. The results of the phase 3 randomized trial conducted by the Gynecological Oncology Group appear in today’s (Feb. 20) issue of The New England Journal of Medicine.

“This trial showed for the first time that a targeted agent could improve overall survival in a gynecologic cancer,” said Tewari, a professor of obstetrics & gynecology at the University of California, Irvine. “Women with metastatic or recurrent cervical cancer don’t have many options, and now we finally have a therapy that helps them live longer.”

Although a difference of 3.7 months may not seem like a long time, he said, it’s important to understand that this patient population responds very poorly to even one line of therapy and that those minimal responses tend to be short-lived.

“We do not have the luxury of treating women who have advanced cervical cancer with multiple lines of therapy over many years, as we do with more chemosensitive malignancies such as ovarian or breast cancer,” Tewari said. “However, these findings show that we may be on the cusp of converting this disease from a terminal to a chronic condition where the 3.7 months provides a window of opportunity in which patients might benefit from new therapies, including other anti-angiogenesis drugs and immunotherapies that are now being studied.”

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UCSF receives $50M gift for women’s health


Women’s hospital at Mission Bay named in honor of quality, safety leader Betty Irene Moore.

This rendering of the new UCSF Medical Center at Mission Bay shows the entrance to the women's hospital, which will be named in honor of Betty Irene Moore, a patient safety pioneer and advocate.

This rendering of the new UCSF Medical Center at Mission Bay shows the entrance to the women's hospital, which will be named in honor of Betty Irene Moore, a patient safety pioneer and advocate.

UCSF Medical Center will name its new women’s hospital at Mission Bay in honor of Betty Irene Moore, a patient safety pioneer and advocate.

The hospital has received a $50 million gift from Bay Area residents Gordon and Betty Moore to help fund the region’s first women’s hospital and to advance the innovative initiatives of the UCSF National Center of Excellence in Women’s Health. The gift is a private donation from the Moores, whose leadership and philanthropy have profoundly influenced health care practices in the United States.

Gordon Moore is a co-founder of Intel Corp. In 2000, he and his wife Betty established the Gordon and Betty Moore Foundation to support progress in science, nursing and patient care, as well as environmental conservation.

By bringing attention to such issues as medication safety, central line-associated bloodstream infections and ICU care, the Moore Foundation has helped patients avoid hundreds of thousands of hospital days, improved patient experiences and saved lives. And, thanks in large part to continued support from the Moore Foundation, UCSF has established itself as a national leader in patient safety and satisfaction.

“Gordon and Betty Moore have been amazing visionaries and philanthropists in so many fields, including health care, and we are so grateful for their support at UCSF. We are delighted to have Betty Irene Moore’s name permanently associated with our new women’s hospital,” said Chancellor Susan Desmond-Hellmann, M.D., M.P.H.

In recognition of the Moores’ outstanding generosity, UCSF will name its new women’s hospital the UCSF Betty Irene Moore Women’s Hospital. The specialty hospital is part of the new UCSF Medical Center at Mission Bay, a 289-bed state-of-the-art hospital complex for children, women and cancer patients that will open in February 2015.

“It is a privilege to have the Moore name associated with our women’s hospital. Betty is an icon, and her longstanding work as a patient advocate is inspiring,” said Mark Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospital. “The Moores are national leaders in improving the quality and safety of health care, and we are thrilled to partner with them as we work to better the lives of our patients at the UCSF Betty Irene Moore Women’s Hospital.”

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