Health News, Round 1: Reproductive Health

I subscribe to a bunch of RSS feeds for medical, health, and science news, so I thought I'd take this opportunity to share with you a batch of articles dealing with reproductive health.

Treatment: Flu vaccine for pregnant women is 2 for 1, Nicholas Bakalar, NY Times, Oct. 6
Flu season is here! Everyone should get their flu shot! (More will be discussed about this in a later post.)

Diabetes is a risk in pregnancy that carries risks beyond, Jane E. Brody, NY Times, Oct. 27
Can't stress this fact enough: glycemic control is very, very important, for everyone. I have a burning desire to get my own hemoglobin A1C checked, just for curiosity's sake, even though I know I have never had an abnormally high fasting blood glucose. I have a suspicion our thresholds for diabetes is going to be lowered for everyone -- pregnant or not -- in the coming years.

Pre-birth defects, William Saletan, Slate.com, Oct. 29
First-trimester screening is one thing, and we already have to counsel women who are unsure about whether to get it. We generally say, if you would continue with the pregnancy even if you had a positive (meaning bad) test result, and you're unsure whether to get the tests, then you don't need to. If the result of the test would influence your decision, then get the tests. Now, we are about to have all of this genetic data that we don't know what to do with. I'd rather get my own genomic analysis first before I get my fetus's done. I do love the irony of pro-life groups pushing for ultrasound laws on the one hand and railing against genetic testing on the other, though.

Our vote to end cervical cancer, by Lance Armstrong and John Seffrin, Washington Post, Oct. 30
The GAVI vote has been postponed until the spring, but still, I support all efforts to increase HPV vaccination both in the United States and around the world.

Risks: Extra pregnancy weight tied to big baby, Nicholas Bakalar, NY Times, Nov. 3
Gaining the right amount of weight during pregnancy is very important, but can be tricky. And if you think it's dangerous for a man to pause a second to long when asked, "Does this make me look fat?" just try telling a pregnant, super-hormonal woman that she's gained too much weight. Think talking about risks to the baby will help convince her? You haven't met all the women I have who smoke, drink, and use cocaine while they're pregnant. Of course, the cocaine users aren't generally gaining too much weight...

Having a baby: Depression linked to premature deliveries, Nicholas Bakalar, NY Times, Nov. 3
This is interesting. We know a lot about postpartum depression and its effects on maternal and infant health and maternal-infant bonding, but I haven't seen any prospective studies linking intrapartum depression to poor outcomes. I will say, though, that two of the three reported results in the study were not statistically significant, so I will remain skeptical of the study's outcomes (of course, there's no harm in screening for and treating intrapartum depression, so that's a moot point when it comes to individual physician practice).

Pregnancy..., Tamoeh Murakami Tse, Washington Post, Nov. 4
Ugh, vomiting. Even worse? Morning sickness. Even more worse? Hyperemesis gravidarum.

The Checkup, Washington Post, Nov. 11. This article has a few news briefs. Among them:
Caffeine, your baby, and you. In this brief, the results of a BMJ study are reviewed. The conclusion was that increased caffeine consumption during pregnancy was associated with higher rates of fetal growth restriction. I take issue with a couple of the statistical conclusions, but overall, this basically says that pregnant women should limit their caffeine intake to less than 100 mg/day, which is roughly one cup of coffee per day.
Improving a woman's love life. I think we knew this already, but another study has shown that a woman can experience an increased libido and sexual pleasure if she takes testosterone. Not too much, though, now!

HPV vaccine may prevent genital warts in males, AP, published in NY Times, Nov. 13
This isn't surprising news. This is why Merck included the warts strains in its vaccines, unlike GlaxoSmithKline. I had no doubts the studies would prove successful in men. By the way, the plural of "man" that should be used in this headline is "men," not "males." "Male" is an adjective, not a noun. The AP would be scolded by the UofL surgery department, which refers to its patients not just as "men" and "women," but as "gentlemen" and "ladies." Old-school style. Anyway, there's no reason not to vaccinate boys for HPV, too. Just like rubella -- boys can get rubella all they want with no problems, but we vaccinate them to protect the girls and their fetuses. With HPV, the boys actually get their own benefit -- preventing genital warts (which, yes, may be benign, but trust me, you still don't want them even if they aren't cancer) -- and the girls will get a double benefit -- preventing cervical cancer and genital warts.

Children of the clones, William Saletan, Slate.com, Nov. 20
This is just wacky. And cool. But still wacky. I'm definitely in that group of women who "want to get the degree, save a little money and buy the nice flat" before getting pregnant, plus I have that pesky medical residency to complete, so maybe I'll set my ovaries aside for a few years and get them reimplanted into me. By the way, the biggest irony of becoming an Ob/Gyn? It takes you so long to become one and it's so not ideal to have a baby during residency that you end up having to see one of your colleagues to get pregnant when it finally is time.

Foes of stem cell research now face tough battle, Kevin Frekking, Nov. 23, originally seen in Washington Post but now found via Google
I absolutely think stem cell research is important, and the current bans are ridiculous. One thing I found very interesting was that when I interviewd at UMDNJ-Robert Wood Johnson, they told us the Ob/Gyn department was in the process of starting up a stem cell research lab. I realized they're able to do that because New Jersey has approved funding of such research and is promoting it. (The department also had a division of epidemiology, which was pretty cool.) It's a good place to do research!

A hard choice, Patricia Meisol, Washington Post, Nov. 23
I linked to this article before, but it belongs here by subject matter, so here you go again. This was a really good article about the factors that go into deciding to be an abortion provider. To be honest, I think there are other points of view that are important too, like that of an Ob/Gyn resident. Do you opt out of termination training? Do you figure that out before you apply to residency, or do you just try to go to the best program and deal with it later? They're interesting questions.

Lose-lose on abortion: Obama's threat to Catholic hospitals and their very serious counterthreat, Melinda Henneberger, Slate.com, Nov. 24
This is interesting. My feelings on healthcare practitioners who have moral reasons for not participating in certain procedures or activities are as follows: That's fine, but you still have to take care of the patient. An ER physician I used to work with was Catholic and didn't believe in birth control. He sighed and moaned as he and his wife had son after son after son, and when a patient asked for birth control pills, he simply asked a colleague to write the prescription for him. No lectures, no outright refusals, just doing his job in a way that he could agree with and that didn't affect patient care. I worked with a nurse anesthetist in Whitesburg this spring who "didn't believe in tubal ligation," so he refused to anesthetize patients for them. The hospital was able to accommodate him and find another person to staff those cases. What would have happened if he were the only one and there was no one else? I'm not sure. Did he make his feelings known when he interviewed for the job? I'm not sure. It could definitely be a problem. Pharmacists refusing to fill Plan B prescriptions themselves? Sure. Refusing to then return the prescription to the patient and refusing to refer them to another pharmacy? Big problem. The guy in my class who fully intends to practice primary care medicine in the middle of the state AND who refuses to assist a woman in any way with finding an abortion practictioner? Big problem. Don't want to deal with reproductive health issues? Go into orthopedic surgery, not family medicine. As I'm interviewing for residencies, I and the other applicants question the Catholic hospitals a lot. I didn't even bother with Georgetown because of it, and I grilled University of Maryland (which has an affiliation with Mercy in Baltimore) about how my training and medical practice might be affected. I'm not even talking about going so far as pregnancy termination; I strongly believe that birth control pills, IUDs, and tubal ligation are perfectly normal and every patient should have a right to receive them if they want. Close the Catholic hospitals? Yes, it would make things easier for pregnancy prevention options. But they serve a lot of other patients, too, I can't deny that. I'm happy enough with the odd relationship that exists right now; just please don't screw it up in either way.

Couple's Wish: A better heart for baby, Part 1 and Part 2, John Kelly, Washington Post, Nov. 26 and Nov. 27
This is more about the baby, but even as a future Ob/Gyn, I think that's important. One of the things I like about obstetrics is the interface between prenatal and natal care, the chance to work with neonatologists, pediatricians, and pediatric surgeons. Everyone's working together to make sure the baby that is brought into the world is as healthy as possible. It's a nice feeling.

Having a baby: Exercise may reduce need for an epidural, Nicholas Bakalar, NY Times, Dec. 1
I have to start by emphasizing that there is absolutely nothing wrong with getting an epidural during labor. Epidurals come in very small doses and can be adjusted throughout labor. If you're otherwise healthy, you can walk with an epidural, and you can feel every one of your contractions and can definitely still push adequately. If you tear, then guess what -- you're already numb for the repair! Some of the worst tears I've seen are in women who choose natural childbirth and who simply aren't prepared for it, so they can't handle the pain and bust the baby out through their perineum, destroying everything in the way in the process. And then they jump through the roof when you have to numb them with local anesthesia to sew them up. Not pleasant. But if you're really motivated and mentally prepared, natural childbirth can be a great thing, too. I won't advocate either way. But this is pretty cool, if regular exercise can help a woman manage her labor better. Plus, it's good all around for her and the baby.

Parents torn over fate of frozen embryos, Denise Grady, NY Times, Dec. 4
This is another area of medicine I think could be improved upon. We create new technologies that are great, but don't put enough thought into the emotional implications ahead of time. I like the idea of giving embryos back to couples if they want them; I also don't care if a mother wants to keep her placenta if she wants to. I might think she doesn't know what she's asking for, but yeah, I'll give it to her, and help her fight the hospital if that's what it takes (there was a news story about that a while back). I'm pretty sure I know what I would do if I were in this situation, but I absolutely understand how tough a decision it must be.

Nursing grudges: Why do we protect the moral convictions of only some health care workers?, Dahlia Lithwick, Slate.com, Dec. 6
You already know how I feel about this. I refuse to give my patients false information, plain and simple, so the South Dakota law is absolutely ridiculous. And Bush/HHS's new proposed regulation? Completely and utterly ridiculous and aggravating. I can't think about it too much or I'll get really, really pissed off.

The Checkup, Washington Post, Dec. 9. Two news briefs this time.
Abortion's impact. It turns out that the best designed studies of abortion's emotional impact tend to find neutral results, while those with poor study design find abortion to have a negative emotional impact. Frankly, I'm not surprised. Study design is very, very important and can seriously affect study conclusions. (The second news brief is about physicians choosing not to stock or provide vaccines, and I'll touch on that in another post.)

Motherhood at 70: Meet the world's newest oldest mom, William Saletan, Slate.com, Dec. 9
Congratulations, technology, and I guess, to the new parents. You won't find me inseminating any 70-year-olds just because I can, though.

So there you go, an installment of health news. Hope you found it interesting; I definitely enjoyed sharing!