In the United States, there has been a recent dramatic rise in the number of children classified as obese and diagnosed with obesity-related diseases, such as type 2 diabetes and nonalcoholic fatty liver disease (NAFLD). One factor thought to contribute to this rise is obesity of the mother during pregnancy.
However, a team of researchers, at Oregon Health and Science University, Beaverton, and the University of Colorado School of Medicine, Aurora, have found the offspring of both lean and obese nonhuman primate mothers chronically consuming a high-fat diet exhibited an increased risk of developing NAFLD.
Importantly, if mothers fed a high-fat diet were reverted to a low-fat diet during a subsequent pregnancy, this second offspring exhibited fewer signs of NAFLD. The team, led by Kevin Grove and Jacob Friedman, therefore suggests that a developing fetus is highly susceptible to maternal consumption of excess fat, whether or not the mother is obese, and that a healthy maternal diet is most important for the obesity-related health of a developing fetus.
TITLE: Maternal high-fat diet triggers lipotoxicity in the fetal livers of nonhuman primates
AUTHOR CONTACT:
Kevin L. Grove
Oregon Health and Science University, Beaverton, Oregon, USA.
Phone: (503) 690-5380; Fax: (503) 690-5384; E-mail: grovek@ohsu.edu.
Jacob E. Friedman,
University of Colorado School of Medicine, Aurora, Colorado, USA.
Phone: (303) 724-3983; Fax: (303) 724-3920; E-mail: jed.friedman@ucdenver.edu.
View the PDF of this article at: https://www.the-jci.org/article.php?id=32661
Retinoid cream associated with death in clinical trial, but relationship does not appear causal
Patients using a cream containing tretinoin, and retinoid commonly used to treat acne and other conditions, appeared more likely to die than those using a placebo in a clinical trial that was halted early as a result, according to a report in the January issue of Archives of Dermatology, one of the JAMA/Archives journals. However, evidence does not suggest these excess deaths were caused by the therapy.
"The potential of retinoid compounds to prevent cutaneous malignant lesions [skin cancers] has been of considerable interest, and some are effective for this purpose," the authors write as background information in the article. In 1998, the Veterans Affairs Topical Tretinoin Chemoprevention (VATTC) Trial was launched to assess whether high-dose therapy with a cream containing one such retinoid, tretinoin, could prevent cancer. A total of 1,131 veterans (97 percent men, average age 71) were randomly assigned to apply either a cream containing 0.1 percent tretinoin or an unmedicated cream daily to their face and ears. They were then examined by a dermatologist every six months, with a planned study end date of Nov. 15, 2004.
A report prepared for one of the study's several oversight committees in 2004 identified a statistically significant increase in the number of deaths among study participants in the group using tretinoin. The trial was therefore halted six months early, in May 2004. Martin A. Weinstock, M.D., Ph.D., of the VA Medical Center and Brown University, Providence, R.I., and colleagues assessed the data collected during the study to assess the relation of the medication to death risk.
Because death was not an end point in the original study, additional efforts were made to identify study participants who had died and gather more information about cause of death, including accessing the VA master death file. Through these records and original study data, researchers identified 108 patients in the tretinoin group and 76 in the control group who died before the end of the intervention period and an additional 14 in each group who died before the end of the study period (November 2004). After considering other factors that might increase the risk of death—including smoking, age and co-occurring illnesses—there was still a significantly higher risk of death in the treatment group.
However, additional analyses did not support tretinoin as a cause of death. For example, there was no clear association between the number of tubes of cream used and death. There was no consistency in the causes of death among participants. However, in the treatment group, 15 patients died of non-small cell lung cancer, 12 of vascular disorders and 15 of respiratory and other chest disorders—causes associated with smoking, which some previous studies have suggested interacts with compounds in some ways similar to tretinoin, but administered systemically, to produce additional health risks. Participants were asked whether they smoked, but their smoking status was not verified, potentially affecting the detected associations.
"The biological implausibility, lack of specificity of causes of death, inconsistency with previous experience, weakness of other supportive evidence in our data and weak statistical signal cast doubt on a potential causal association of topical tretinoin with death in the VATTC Trial," the authors write. "We do not conclude that this trial provides appropriate grounds for hesitating to use topical tretinoin in clinical practice in the absence of additional evidence."
(Arch Dermatol. 2009;145[1]:18-24. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported by the Cooperative Studies Program (CSP) of the Office of Research and Development, U.S. Department of Veterans Affairs, and the American Cancer Society. OrthoNeutrogena, a division of Ortho-McNeil Pharmaceutical Inc., provided the tretinoin, 0.1 percent, and the vehicle creams. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Physicians Should Discuss Results With Patients
"Public health ideally uses the precautionary principle—that possible harm should be avoided before harmful effects are unquestionably proven," write Lisa M. Schilling, M.D., M.S.P.H., and Robert P. Dellavalle, M.D., Ph.D., M.S.P.H, of the Department of Veterans Affairs Medical Center, Denver, in an accompanying editorial.
"At a minimum, this principle should cause prescribing physicians to discuss the results of the VATTC with elderly men using topical tretinoin," they write. "More circumspect practitioners may wish to discuss the results of the VATTC with all patients using topical tretinoin. This dialogue should include that the results of the VATTC may have been due to chance, but also that the outcome of death was not initially anticipated, and owing to the ad hoc analysis, various important risk factors, such as smoking status, might not have been completely ascertained. These discussions provide an opportunity for all health care providers prescribing tretinoin to emphasize tobacco prevention and cessation with their patients."
(Arch Dermatol. 2009;145[1]:76. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported in part by Colorado Health Informatics Collaboration Academic Enrichment Funds from the University of Colorado Denver School of Medicine and a Cancer Prevention and Control Career Development Award grant. Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
Adelaide researchers have made a world breakthrough in treating premature babies at risk of developmental disorders.
A six-year study led by Dr Maria Makrides from the Women's & Children's Health Research Institute and Professor Bob Gibson from the University of Adelaide has demonstrated that high doses of fatty acids administered to pre-term infants via their mother's breast milk or infant formula can help their mental development.
The findings were published Wednesday in the Journal of the American Medical Association (JAMA).
Researchers found that a major lipid in the brain - the omega-3 fatty acid known as Docosahexaenoic acid (DHA) - is not developed sufficiently in babies born before 33 weeks' gestation, leading to possible impaired mental development.
To counter this, increased doses of DHA (1000mg per day) were administered to lactating mothers with pre-term infants, in the form of tuna oil capsules. If required, infants were given supplementary formula with matching DHA levels.
Of 657 premature babies tested in a trial involving five Australian hospitals, about 50% fewer infants on high-DHA diets had significantly delayed mental development compared with low DHA diets.
Premature girls in particular who were exposed to DHA-rich diets showed much better mental development than girls fed the low DHA diet.
Professor Gibson said his team was at a loss to explain why premature male babies - who are more susceptible to cognitive problems - did not respond to the same extent, with no obvious differences in mental development between the control group and those administered high doses of DHA.
"Boys may have a faster metabolic rate than girls and need higher doses of DHA to make a difference," he said. "We need to do a lot more work in this area to find out why."
Infants weighing less than 1250gm (about a third of a full-term baby's weight) who were fed a high-DHA diet also scored better on the mental development scale, with a 40% reduction in the incidence of mild mental delay.
The project was primarily funded by the National Health and Medical Research Council, with the University of Adelaide and Women's and Children's Health Research Institute (WCHRI) now in the process of formalising a joint venture agreement in the area of food, nutrition and health.
Dr Makrides is the Deputy Director of the WCHRI and Professor of Nutrition at the University of Adelaide. Professor Gibson is a Professor of Functional Food Science in the School of Agriculture, Food & Wine.
Research aims to help doctors in counseling prospective patients
BOSTON -- Thirty years ago last summer, the world's first "test-tube" baby was born, and since then more than 1 million infants have been successfully conceived through in vitro fertilization (IVF), the technique in which a woman's eggs and man's sperm are fertilized in a laboratory and then implanted in the mother's womb.
When deciding whether or not to pursue IVF treatment, the obvious question of most patients is, "What is the chance that this therapy will result in a baby?" They now have an answer.
In the largest study of IVF patients to date, researchers at Boston IVF and Beth Israel Deaconess Medical Center (BIDMC) followed more than 6,000 women through six IVF cycles. Their findings, described in tomorrow's issue of The New England Journal of Medicine (NEJM) demonstrate that the chances of a successful live birth following IVF therapy range between 65 and 86 percent in younger women and between 23 and 42 percent in women aged 40 and older.
"This shows that, overall, IVF is extraordinarily effective and largely overcomes infertility, especially in younger women," explains lead author Beth Malizia, MD, a clinical fellow at Boston IVF and in the Division of Reproductive Endocrinology and Infertility at BIDMC.
Infertility affects more than 6 million women in the U.S. between ages 15 and 44, according to figures from the National Center for Health Statistics. The authors embarked on the study in order to provide doctors and their patients with accurate, evidence-based estimates of the likelihood that a pregnancy resulting from IVF would result in a live birth.
"Traditionally, IVF has been reported as pregnancies per IVF cycle," explains Malizia. "These calculations can not only be difficult to comprehend, but can also be misleading since they don't take into account the difference in success between the first-time patient and the patient who did not become pregnant in previous IVF attempts. Our goal in conducting this study was to provide information that would answer the patient's primary question – What is the chance that I will walk away with a baby?"
Each IVF cycle consists of four steps: First, the patient takes a course of fertility medication to encourage egg development. Eggs are then retrieved through a minor surgical procedure. The retrieved eggs are then fertilized in the laboratory and approximately three to six days following egg retrieval, fertilized embryos are implanted in the woman's uterus.
Malizia, together with senior author Alan Penzias, MD, a reproductive endocrinologist at Boston IVF and BIDMC and coauthor Michele Hacker, ScD, MSPH, followed 6,000 couples undergoing IVF therapy between 2000 and 2005. Using a longitudinal analysis method – which makes use of repeated observations of the study group over time and provides a more accurate estimate of a woman's history over multiple IVF cycles – they calculated the cumulative live birth rate of their population. All IVF patients were included without excluding for age, ovarian reserve or other prognostic factors. And, explains Malizia, because the success of embryo cryopreservation has nearly doubled over the past decade, frozen embryo cycles were also included in the analysis.
To account for patients who did not return for further IVF treatment, the authors reported the cumulative live birth rate as both optimistic (best-case) and conservative (worst-case) estimates. They also reported multiple live births (twins, triplets, etc.), which says Malizia, is another important issue when counseling patients prior to IVF treatment.
"Our results showed that among 6,164 patients who underwent 14,248 cycles of IVF, the overall cumulative live birth rate after six cycles was 72 percent with the optimistic analysis and 51 percent with the conservative analysis," notes Malizia, adding that the chance of a live birth for women under the age of 35 was between 65 and 86 percent, while the figures were between 23 and 42 percent for women over age 40. And, she notes, of the 3,126 live births, the majority were "singletons" while 27 percent were twin births and 2 percent were triplet births. There were no multiple births beyond triplets, a finding consistent with a national decline in multiple births [greater than twins] resulting from IVF treatment over the past decade.
"IVF treatment has come of age," notes the study's senior author Alan Penzias. "Although we continue to address the challenge of age-dependent decline in fertility, with these successful results, we have shown that fertility can be restored to the majority of young women who want to have a baby."
Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School and consistently ranks in the top four in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of the Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.harvard.edu.
Implications for new blood disorder therapies
PHILADELPHIA -- A research team led by Nancy Speck, PhD, Professor of Cell and Developmental Biology at the University of Pennsylvania School of Medicine, has identified the location and developmental timeline in which a majority of bone marrow stem cells form in the mouse embryo. The findings, appearing online this week in the journal Nature, highlight critical steps in the origin of hematopoietic (or blood) stem cells (HSCs), says senior author Speck, who is also an Investigator with the Abramson Family Cancer Research Institute at Penn.
Because HSCs, found in the bone marrow of adult mammals, generate all of the blood cell types of the body, unlocking the secrets of their origin may help researchers to better manipulate embryonic stem cells to generate new blood cells for therapy.
“The ultimate goal for stem cell therapies is to take embryonic stem cells and push them down a particular lineage to replace diseased or dead cells in human adults or children,” says Speck. For instance, in theory embryonic stem cells could be tweaked in a lab to provide a patient with bone marrow failure a fresh supply of compatible HSCs.
To date, however, Speck says scientists have been unable to coax embryonic stem cells to become HSCs without significant genetic manipulations that are too risky for clinical therapies. First things first, Speck says: “You have to understand what's happening in the embryo.”
Previous studies hinted that HSCs originated from a small population of cells lining the blood vessels, called endothelial cells. But, it was unclear how endothelial cells transitioned to blood stem cells during early development.
Before joining Penn in September 2008, Speck, then at Dartmouth Medical School, led a team that confirmed that HSCs in bone marrow were originating from the endothelial cells and determined whether the activity of a protein called Runx1, which is known to be critical in the formation of blood cells, was responsible for this important transition.
First, the researchers inactivated the gene that codes for the protein Runx1 in the endothelial cells of mouse embryos. During development, some endothelial cells express Runx1, signaling the production of grapelike clusters of HSCs along the interior walls of several major blood vessels. Upon release from the vessel walls HSCs enter the blood circulation and travel to the fetal liver, and upon birth they relocate to the bone marrow.
By selectively blocking the ability of endothelial cells to express Runx1 during embryo development, the researchers halted HSC production, demonstrating that Runx1 is vital to the endothelial cell to HSC transition.
Next, Speck’s team shut off Runx1 expression in mouse embryos at day 11.5 of gestation -- a time when most newly born HSCs have detached from the vessel wall and migrated to the fetal liver. The researchers found that blocking Runx1 expression had no effect on HSC formation, suggesting while Runx1 is required for the transition from endothelium to HSCs, the process is complete by the end of the 11th day of gestation.
The researchers also showed that at least 95 percent of all adult HSCs (and therefore almost all adult blood) originate in the endothelium, during this short window of time during development.
“This study helps illustrate a very important step in the transitional stage from embryonic stem cells to HSCs – the need to move through endothelial cells as an intermediary,” Speck says.
Understanding the location and developmental timeline of the origin of blood stem cells will help guide future efforts to coax embryonic stem cells to produce mature blood cells, she says.
Co-authors include Michael Chen and Brandon Zeigler from Dartmouth Medical School (Departments of Biochemistry and Genetics) and Tomomasa Yokomizo and Elaine Dzierzak from Erasmus Medical Center in Rotterdam, Netherlands.
This work was funded by the National Institutes of Heart, Lung and Blood and Diabetes and Digestive and Kidney Diseases
PENN Medicine is a $3.6 billion enterprise dedicated to the related missions of medical education, biomedical research, and excellence in patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System.
Penn's School of Medicine is currently ranked #4 in the nation in U.S.News & World Report's survey of top research-oriented medical schools; and, according to most recent data from the National Institutes of Health, received over $379 million in NIH research funds in the 2006 fiscal year. Supporting 1,700 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.
The University of Pennsylvania Health System (UPHS) includes its flagship hospital, the Hospital of the University of Pennsylvania, rated one of the nation’s top ten “Honor Roll” hospitals by U.S.News & World Report; Pennsylvania Hospital, the nation's first hospital; and Penn Presbyterian Medical Center. In addition UPHS includes a primary-care provider network; a faculty practice plan; home care, hospice, and nursing home; three multispecialty satellite facilities; as well as the Penn Medicine at Rittenhouse campus, which offers comprehensive inpatient rehabilitation facilities and outpatient services in multiple specialties.
Scientists have tricked bone marrow into releasing extra adult stem cells into the bloodstream, a technique that they hope could one day be used to repair heart damage or mend a broken bone, in a new study published today in the journal Cell Stem Cell.
When a person has a disease or an injury, the bone marrow mobilises different types of stem cells to help repair and regenerate tissue. The new research, by researchers from Imperial College London, shows that it may be possible to boost the body's ability to repair itself and speed up repair, by using different new drug combinations to put the bone marrow into a state of 'red alert' and send specific kinds of stem cells into action.
Cell Stem Cell new study, researchers tricked the bone marrow of healthy mice into releasing two types of adult stem cells – mesenchymal stem cells, which can turn into bone and cartilage and that can also suppress the immune system, and endothelial progenitor cells, which can make blood vessels and therefore have the potential to repair damage in the heart.
This study, funded by the British Heart Foundation and the Wellcome Trust, is the first to selectively mobilise mesenchymal stem cells and endothelial progenitor cells from the bone marrow. Previous studies have only been able to mobilise the haematopoietic type of stem cell, which creates new blood cells. This technique is already used in bone marrow transplants in order to boost the numbers of haematopoietic stem cells in a donor's bloodstream.
The researchers were able to choose which groups of stem cells the bone marrow released, by using two different therapies. Ultimately, the researchers hope that their new technique could be used to repair and regenerate tissue, for example when a person has heart disease or a sports injury, by mobilising the necessary stem cells.
The researchers also hope that they could tackle autoimmune diseases such as rheumatoid arthritis, where the body is attacked by its own immune system, by kicking the mesenchymal stem cells into action. These stem cells are able to suppress the immune system.
Dr Sara Rankin, the corresponding author of the study from the National Heart & Lung Institute at Imperial College London, said: "The body repairs itself all the time. We know that the skin heals over when we cut ourselves and, similarly, inside the body there are stem cells patrolling around and carrying out repair where it's needed. However, when the damage is severe, there are limits to what the body can do of its own accord.
"We hope that by releasing extra stem cells, as we were able to do in mice in our new study, we could potentially call up extra numbers of whichever stem cells the body needs, in order to boost its ability to mend itself and accelerate the repair process. Further down the line, our work could lead to new treatments to fight various diseases and injuries which work by mobilising a person's own stem cells from within," added Dr Rankin.
The scientists reached their conclusions after treating healthy mice with one of two different 'growth factors' – proteins that occur naturally in the bone marrow – called VEGF and G-CSF. Following this treatment, the mice were given a new drug called Mozobil.
The researchers found that the bone marrow released around 100 times as many endothelial and mesenchymal stem cells into the bloodstream when the mice were treated with VEGF and Mozobil, compared with mice that received no treatment. Treating the mice with G-CSF and Mozobil mobilised the haematopoietic stem cells – this treatment is already used in bone marrow transplantation.
The researchers now want to investigate whether releasing repair stem cells into the blood really does accelerate the rate and degree of tissue regeneration in mice that have had a heart attack. Depending on the outcome of this work, they hope to conduct clinical trials of the new drug combinations in humans within the next ten years.
The researchers are also keen to explore whether ageing or having a disease affects the bone marrow's ability to produce different kinds of adult stem cells. They want to investigate if the new technique might help to reinvigorate the body's repair mechanisms in older people, to help them fight disease and injury.
This work was funded by the British Heart Foundation, the Wellcome Trust, a European Community INNOCHEM grant and CNPq, Brazil.
Research paper: Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: A Swedish prospective screening study in 39,821 newborns
Routine screening of blood oxygen levels before discharge from hospital improves the detection of life threatening congenital heart disease in newborns and may save lives, according to a study published on bmj.com today.
The low false positive rate of pulse oximetry screening* and the reduced need for treatment because of a timely diagnosis also makes this a cost effective intervention, say the authors.
About 1 babies per 1000 live births have an immediately life threatening heart abnormality, because a fetal blood vessel called the ductus arteriosus - which bypasses the baby's non-functioning lungs when in the uterus and normally closes off soon after birth - remains partly open. The current screening technique of a routine clinical examination shortly after birth fails to detect many of these babies because duct-dependent heart disease often lacks heart murmurs. Indeed, 30% of such infants leave hospital without their condition being diagnosed, which leads to higher rates of complications such as circulatory collapse with organ damage and sometimes death.
Pulse oximetry screening has been suggested for early detection of congenital heart disease, but its effectiveness is unclear.
Professor Östman-Smith and colleagues assessed the introduction of universal oximetry screening in one region of Sweden (West Götaland) and examined the diagnostic accuracy for detection of duct dependent heart disease compared to other regions using clinical examination alone. Nearly 40,000 babies born between 1 July 2004 and 31 March 2007 were screened with a pulse oximeter before routine physical examination.
The authors found that in apparently well babies ready for discharge a combination of clinical examination and pulse oximetry screening had a detection rate of 82.8% for duct-dependent heart disease. The detection rate of physical examination alone was 62.5%. Pulse oximetry also had a substantially lower false positive rate (0.17%) compared to physical examination alone (1.90%).
However, some babies had been detected before discharge examination, meaning that the introduction of pulse oximetry screening in West Götaland improved the total detection of duct dependent heart disease to 92%. This was significantly higher than the 72% detection rate in other regions not using the screening technique. Thus the risk of leaving hospital with an undiagnosed duct dependent circulation was 8% in West Götaland versus 28% in the other regions.
Babies discharged from hospital without diagnosis had higher mortality than those diagnosed in hospital (18% v 0.9%). In addition, no babies died in West Götaland from undiagnosed heart disease, but there were five deaths in the other regions.
Interestingly, improved detection was achieved by a maximum of just five minutes of extra nursing time per baby.
The authors conclude: "Such screening seems cost neutral in the short term, but the probable prevention of neurological morbidity and reduced need for preoperative neonatal intensive care suggest that such screening will be cost effective long term."
In an accompanying editorial, Professor Keith Barrington from the University of Montreal in Canada, says that in light of this new evidence on the effectiveness of universal pulse oximetry screening as a low risk and low cost strategy for improving the detection of critical congenital heart disease, "serious consideration should be given to its introduction wherever neonatal cardiac surgery is available."
Notes to Editors:
*Pulse oximetry is a quick and non-invasive method of measuring the concentration of oxygen in the blood of newborns using a sensor placed on a hand, and in this study on a foot as well, for a few minutes before the baby leaves hospital. A low concentration of oxygen could signal a heart problem and would require further investigation.
BERKELEY -- Two new studies led by researchers at the University of California, Berkeley, suggest that taking maternity leave before and after the birth of a baby is a good investment in terms of health benefits for both mothers and newborns.
One study found that women who started their leave in the last month of pregnancy were less likely to have cesarean deliveries, while another found that new mothers were more likely to establish breastfeeding the longer they delayed their return to work.
Both papers were part of the Juggling Work and Life During Pregnancy study, funded by the Maternal and Child Health Bureau of the U.S. Health Resources and Services Administration and led by Sylvia Guendelman, professor of maternal and child health at UC Berkeley's School of Public Health. The research takes a rare look into whether taking maternity leave can affect health outcomes in the United States.
"In the public health field, we'd like to decrease the rate of C-sections (cesarean deliveries) and increase the rate of breastfeeding," said Guendelman. "C-sections are really a costly procedure, leading to extended hospital stays and increased risks of complications from surgery, as well as longer recovery times for the mother. For babies, it is known that breastfeeding protects them from infection and may decrease the risk of SIDS (Sudden Infant Death Syndrome), allergies and obesity. What we're trying to say here is that taking maternity leave may make good health sense, as well as good economic sense."
The study on the use of antenatal leave - time off before delivery with the expectation of returning to the employer after giving birth - and the rate of C-sections is the first examination of birth outcomes in U.S. working women, the researchers said. It will appear in the January/February print edition of the journal Women's Health Issues.
The researchers analyzed data from 447 women who worked full-time in the Southern California counties of Imperial, Orange and San Diego, comparing those who took leave after the 35th week of pregnancy with those who worked throughout the pregnancy to delivery. Only women who gave birth to single babies with no congenital abnormalities were included in the analysis. They adjusted for sociodemographic factors such as income, age and type of occupation, as well as for various health measures such as high blood pressure, body mass index, amount of self-reported stress and average number of hours of sleep at night.
Using a combination of post-delivery telephone interviews and prenatal and birth records, the researchers found that women who took leave before they gave birth were almost four times less likely to have a primary C-section as women who worked through to delivery.
The study authors pointed out that the United States falls behind most industrialized countries in its support for job-protected paid maternity leave. The federal Family and Medical Leave Act provides for only unpaid leave of up to 12 weeks surrounding the birth or adoption of a child.
The bulk of studies on leave-taking and health outcomes from other countries suggest that taking leave prior to birth can be beneficial. The authors point to a macroanalysis of 17 countries in Europe that linked failure to take such leave with low birthweight and infant mortality. Rates of pre-term delivery were lower among female factory workers in France if the women took antenatal leave, and a study conducted in several industrialized countries found that paid leave, but not unpaid leave, significantly decreased low birthweight rates.
According to the U.S. Census, among working women who had their first birth between 2001 and 2003, only 28 percent took leave from their jobs before giving birth while an additional 22 percent quit their jobs. Twenty-six percent of women took no leave before birth.
"We don't have a culture in the United States of taking rest before the birth of a child because there is an assumption that the real work comes after the baby is born," said Guendelman. "People forget that mothers need restoration before delivery. In other cultures, including Latino and Asian societies, women are really expected to rest in preparation for this major life event."
The authors added that financial need may also deter women from taking leave in the last month of pregnancy. Only five states - California, Hawaii, New Jersey, New York, Rhode Island - and the territory of Puerto Rico offer some form of paid pregnancy leave, and none offer full replacement of the woman's salary.
The study on maternity leave and breastfeeding is in the January issue of the journal Pediatrics. Using data from 770 full-time working mothers in Southern California, researchers assessed whether maternity leave predicted breastfeeding establishment, defined in this study as breastfeeding for at least 30 days after delivery. Phone interviews were conducted 4.5 months, on average, after delivery.
In this study, women who had returned to work by the time of the interview took on average 10.3 weeks of maternity leave. Overall, 82 percent of mothers established breastfeeding within the first month after their babies were born. Among women who established breastfeeding, 65 percent were still breastfeeding at the time of the interview.
Researchers found that women who took less than six weeks of maternity leave had a four-fold greater risk of failure to establish breastfeeding compared with women who were still on maternity leave at the time of the interview. Women who took six to 12 weeks of maternity leave had a two-fold greater risk of failing to establish breastfeeding.
Having a managerial position or a job with autonomy and a flexible work schedule was linked with longer breastfeeding duration in the study. After 30 days, managers had a 40 percent lower chance of stopping breastfeeding, while those with an inflexible work schedule had a 50 percent higher chance of stopping.
Overall, the study found that returning to work within 12 weeks of delivery had a greater impact on breastfeeding establishment for women in non-managerial positions, with inflexible jobs or who reported high psychosocial distress, including serious arguments with a spouse or partner and unusual money problems.
"The findings suggest that if a woman postpones her return to work, she'll increase her chances of breastfeeding success, especially if she's got a job where she's on the clock and has less discretion with her time," said Guendelman. "Also, women who are in jobs where they have more authority may feel more empowered with how they use their time."
The American Academy of Pediatrics (AAP) recommends that babies be breastfed for at least the first year of life, and exclusively so for the first four to six months.
According to the AAP, increased breastfeeding has the potential for decreasing annual health costs in the U.S. by $3.6 billion and decreasing parental employee absenteeism, the environmental burden for disposal of formula cans and bottles, and energy demands for production and transport of formula.
The study authors noted that just having maternity leave benefits offered by an employer was not helpful in breastfeeding establishment unless the leave was actually used, indicating the importance of encouraging the use of maternity leave and making it economically feasible to take it.
"These new studies suggest that making it feasible for more working mothers to take maternity leave both before and after birth is a smart investment," said Guendelman.
Other co-authors of the paper in Women's Health Issues are Michelle Pearl and Steve Graham, senior research scientists at the Sequoia Foundation, a California-based non-profit organization focused on public health research; Alan Hubbard, UC Berkeley assistant professor of biostatistics; Dr. Nap Hosang, lecturer at UC Berkeley's Maternal and Child Health program and a practicing obstetrician; and Martin Kharrazi, research scientist supervisor in the California Department of Public Health Genetic Disease Screening Program.
In addition to Guendelman, Pearl, Graham and Kharrazi, the Pediatrics paper was co-authored by Jessica Lang Kosa, research associate, and Julia Goodman, former graduate student, both at UC Berkeley's School of Public Health.
The study published in Women's Health Issues received additional funding from the Center for Health Research at UC Berkeley. The paper in Pediatrics also received support from the UC Labor and Employment Research Fund and the UC Berkeley Institute for Research on Labor and Employment.
NOTE: Sylvia Guendelman will be out of the country through Tuesday, Jan. 6. She will have periodic access to her e-mail, sylviag@berkeley.edu, while she is out of town. Starting on Wednesday, Jan. 7, she can be reached by e-mail and at (510) 64
WASHINGTON -- Adults with diabetes experience a slowdown in several types of mental processing, which appears early in the disease and persists into old age, according to new research. Given the sharp rise in new cases of diabetes, this finding means that more adults may soon be living with mild but lasting deficits in their thought processes.
A full analysis appears in the January issue of Neuropsychology, which is published by the American Psychological Association.
Researchers at Canada's University of Alberta analyzed a cross-section of adults with and without adult-onset Type 2 diabetes, all followed in the Victoria Longitudinal Study. At three-year intervals, this study tracks three independent samples of initially healthy older adults to assess biomedical, health, cognitive and neurocognitive aspects of aging. The Neuropsychology study involved 41 adults with diabetes and 424 adults in good health, between ages 53 and 90.
The research confirmed previous reports that diabetes impairs cognition and added two important findings. First, it teased out the specific domains hurt by diabetes. Second, it revealed that the performance gap was not worse in the older group. Thus, the reductions in executive function and processing speed seem to begin earlier in the disease.
Healthy adults performed significantly better than adults with diabetes on two of the five domains tested: executive functioning, with significant differences across four different tests, and speed, with significant differences or trends across five different tests. There were no significant differences on tests of episodic and semantic memory, verbal fluency, reaction time and perceptual speed.
When researchers divided participants into young-old and old-old, with age 70 as the cutoff, they found the same pattern of cognitive differences between young-old and old-old in the diabetes and control groups. Thus, the researchers concluded, the diabetes-linked cognitive deficits appear early and remain stable.
"Speed and executive functioning are thought to be among the major components of cognitive health," says co-author Roger Dixon, PhD. With Type 2 diabetes a growing concern among adults of all ages, but especially those above age 30, Dixon says that public health programs could check the cognitive status of people with more advanced or severe cases; ensure that diet and medications are effectively employed in all early diagnosed cases; and enact possible cognitive monitoring or training programs for people with diabetes. According to the U.S. Centers for Disease Control and Prevention, new cases of diabetes nearly doubled in the past decade, with nearly one new case for every 100 adults between the years 2005 and 2007.
The normal age-related slowing of thought processes could be exacerbated by diseases such as Type 2 diabetes, says Dixon. But, he continues, "There could be some ways to compensate for these declines, at least early and with proper management." The level of impairment detected, he adds, should not make it hard for people to manage their condition.
Diabetes is a known risk factor for late-life neurodegenerative diseases such as Alzheimer's. Although the deficits detected in the current sample were not clinically significant, they appear (according to subsequent research by the authors) to foreshadow additional deficits. Only further study would reveal whether it's possible to "connect the dots" between mild early deficits in speed and executive function, and later signs of a progressive cognitive impairment.
Article: "Exploring Effects of Type 2 Diabetes on Cognitive Functioning in Older Adults," Sophie E. Yeung, PhD, Ashley L. Fischer, PhD, and Roger A. Dixon, PhD, University of Alberta; Neuropsychology, Vol. 23, No. 1.
(Full text of the article is available from the APA Public Affairs Office and at http://www.apa.org/journals/releases/neu2311.pdf)
Roger Dixon can be reached by e-mail at rdixon@ualberta.ca or by phone at 780-492-5850.
The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 148,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.
CLEVELAND -- Researchers from Case Western Reserve University and Yale University have made a significant advancement in understanding the cause behind why some pregnant women suffer from inflammations in the inner womb without any signs of an infection.
Using gene-cloning techniques, researchers discovered that approximately 60 percent of the bacteria present in women with intra-amniotic inflammations were missed by traditional culture testing — considered the gold standard for finding bacterial infections.
The findings were reported in the January issue of the Journal of Clinical Microbiology.
For the first time, the researchers identified a comprehensive list of microbial species in intra-amniotic infections by using new DNA methods to track down the presence of bacteria. To increase their accuracy the investigators used a combination of analyses including proteomics results of amniotic fluid and histological analysis of the placenta to corroborate the infection and inflammation.
Intra-amniotic inflammation is known to set off spontaneous births of preterm babies at less than 32 weeks, said Yiping Han, associate professor of dental medicine at Case Western Reserve University and lead investigator on the study of 46 women of which 44 experienced preterm births. Han has previously done a number of research projects examining the link between oral bacteria and preterm birth.
In the present study, bacteria levels from the amniotic fluids of pregnant women with signs or symptoms of preterm births were compared to those from a control group of 16 women without such manifestations and who delivered at term. The amniotic fluid of the control group came from amniocenteses for genetic screenings or analyses to check fetal lung maturity and showed no signs of bacteria even by DNA methods.
"Because culturing is not finding all bacteria present in the amniotic fluid, this calls for new detection methods," Han said. "It is also important to identify which germ is causing the infection and inflammation leading to preterm birth so that antibiotics are initiated early in this pathophysicological chain of events."
In addition to the bacteria identified by cultures by using a new detection process which amplifies the 16SrRNA bacterial gene and clones it in order to identify its sequence, the researchers were able to identify a number of harmful bacteria not detected by cultures of which some have not been previously linked with preterm birth.
"By employing 16s rRNA gene-based polymerase chain reactions (PCR) followed by the clone analysis, we stand to determine the identity and true relationship between intra-amniotic bacterial infection and the onset of preterm birth," said Han.
The researchers also found it was not just one bacterial species causing the inflammation but an abundance of different species in the sample. "Unrecognized, uncultivated or difficult-to-cultivate species may play a key role in initiating spontaneous preterm births," said Han.
These bacteria either reach the placenta through the genital tract or through the blood to the placenta. Han suspects some originate in the mouth which has hundreds of dozens of bacteria present. Among the oral bacteria is Fusobacterium nucleatum, which is ubiquitous in the mouth. Once it enters the blood stream, however, it has been linked to a number of health issues.
Other members of Han's research team included Tao Shen and Peter Chung from Case Western Reserve's Department of Periodontics and Irina Buhimschi and Catalin Buhimschi from the Department of Obstetrics, Gynecology and Reproductive Sciences at Yale University The study was supported partially with funding from the National Institutes of Health.
Case Western Reserve University is among the nation's leading research institutions. Founded in 1826 and shaped by the unique merger of the Case Institute of Technology and Western Reserve University, Case Western Reserve is distinguished by its strengths in education, research, service, and experiential learning. Located in Cleveland, Case Western Reserve offers nationally recognized programs in the Arts and Sciences, Dental Medicine, Engineering, Law, Management, Medicine, Nursing, and Social Work.
Commonly used pneumococcal polysaccharide vaccines do not appear to be effective for preventing pneumonia, found a study by a team of researchers from Switzerland and the United Kingdom http://www.cmaj.ca/press/pg48.pdf.
In many industrialized countries, polysaccharide pneumococcal vaccines (PPVs) are currently recommended to help prevent pneumococcal disease in people aged 65 and over and for younger people with increased risk due to conditions like HIV. Studies have shown conflicting results regarding the efficacy of PPV.
The study, a systematic review and meta-analysis, looked at 22 clinical trials, reviews and meta-analyses and more than 100,000 participants from countries in North America as well as India, Africa, Latin America and the Caribbean. Unlike other similar studies the authors examined the reasons why different clinical trials produced different results. They found that the quality of the studies substantially affected the results. When only high quality trials were included, there was no evidence that PPVs could prevent pneumonia. The study adds to the ongoing debate around effectiveness of the vaccine.
"Policy makers may therefore wish to reconsider their current recommendations for PPV, especially where routine pneumococcal conjugate immunization has been introduced," conclude Dr. Matthias Egger from the University of Bern, Switzerland and coauthors.
However, in a related commentary http://www.cmaj.ca/press/pg18.pdf, Dr. Ross Andrews and coauthor from the Menzies School of Health Research, Darwin, Australia state that the researchers' conclusions exceed the evidence presented. They caution that there should be no change in vaccine policy in countries that recommend PPV to prevent invasive pneumococcal disease.