Women’s Health News

BMI determines risk of heart disease in middle-aged women

A woman’s race and where on her body she packs on pounds at midlife could give her doctor valuable clues to her likelihood of having greater volumes of heart fat, a potential risk factor for heart disease, according to new research.

BMI determines risk of heart disease in middle-aged women

A woman’s race and where on her body she packs on pounds at midlife could give her doctor valuable clues to her likelihood of having greater volumes of heart fat, a potential risk factor for heart disease, according to new research led by the University of Pittsburgh Graduate School of Public Health.

The findings, published online today in the journal Menopause, show that black women who put on fat around their midsection during midlife are more likely to accumulate fat around their hearts, whereas white women’s risk of fatty hearts is higher when they add weight all over. The results echo the findings of a Pitt Public Health study three years ago in men.

BMI determines risk of heart disease in middle-aged women

“Excess fat around the heart, in both men and women, is an evolving risk factor for heart disease. But how can clinicians see it at a regular physical? They can’t without a special heart scan,” said senior author Samar El Khoudary, Ph.D., M.P.H., associate professor of epidemiology at Pitt Public Health. “This study, coupled with our previous study in men, gives doctors another tool to evaluate their patients and get a better sense of their heart disease risk. It also may lead to suggestions for lifestyle modifications to help patients lessen that risk.”

El Khoudary and her team evaluated clinical data, such as CT scans and blood pressure, on 524 women from Pittsburgh and Chicago enrolled in the Study of Women’s Health Across the Nation (SWAN). The women were in varying stages of menopause, averaged 51 years old and were not on hormone replacement therapy.

The bottom line on BMI and heart disease

After accounting for the potential health effects of lifestyle and socioeconomic factors, such as smoking, alcohol consumption and financial strain, the researchers determined that, not surprisingly, the more fat a women carries overall, the higher her risk for a fatty heart.

However, white women with higher body mass indexes, or BMI, which is a measure of overall body fat, had significantly more heart fat, as measured by a CT scan, than black women with the same BMI. BMI determines risk of heart disease in middle-aged women

For black women, the levels of heart fat were greater if they carried more fat in their midsection, as measured by a cross-sectional CT scan, compared with white women with the same volume of fat in their midsection.

El Khoudary’s team found that the heart fat black women with larger waistlines accumulate is closer to their hearts than the fat the white women with higher BMI’s accumulate. Fat close to the heart secretes inflammatory markers directly to the heart tissue and produces a greater detrimental effect as it expands.

“We’ve now come to very similar conclusions that show excess abdominal fat is worse for both black men and women, and a higher BMI is worse for white men and women when it comes to their odds of having more fat around their hearts,” said El Khoudary, who noted that the current analysis could not assess changes over time. “There is something going on here that warrants further investigation to determine why it is happening and what tailored interventions doctors may prescribe to help their patients lower their risk.”


Story Source: Materials provided by University of Pittsburgh Schools of the Health Sciences. Note: Content may be edited for style and length.

Read this article on ScienceDaily: University of Pittsburgh Schools of the Health Sciences. “Risk of a fatty heart linked to race, type of weight gain in middle-aged women.” ScienceDaily. ScienceDaily, 2 August 2017.


The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. Call for an appointment today: (707) 579-1102. Visit our website: www.womensobgynmed.com

Malaria drug may prevent Zika virus from infecting fetus

Studying pregnant mice, researchers at Washington University School of Medicine in St. Louis found that Zika virus manipulates the body's normal barrier to infection, and that hydroxychloroquine, a malaria drug related to chloroquine, interferes with this process, protecting the fetus from viral infection.Zika virus infects the fetus by manipulating the body’s normal barrier to infection, according to a new study of pregnant mice. Moreover, the study showed that a drug that interferes with this process protects the fetus from viral infection. That drug is already approved for use in pregnant women for other medical purposes.
Devastating consequences of Zika virus infection are suffered in the womb, where the virus can cause brain damage and sometimes death.

Studying pregnant mice, researchers at Washington University School of Medicine in St. Louis have learned that the Zika virus infects the fetus by manipulating the body’s normal barrier to infection. Moreover, they showed that a malaria drug that interferes with this process protects the fetus from viral infection. That drug already is approved for use in pregnant women for other medical purposes.

“We found that the malaria drug hydroxychloroquine effectively blocks viral transmission to the fetus,” said senior author Indira Mysorekar, PhD, an associate professor of obstetrics and gynecology, and of pathology and immunology. “This drug already is used in pregnant women to treat malaria, and we suggest that it warrants evaluation in primates and women to diminish the risks of Zika infection and disease in developing fetuses.”

The findings are published July 10 in The Journal of Experimental Medicine.

In late 2015, doctors in Brazil began to notice a surge in the number of babies born with microcephaly, or unusually small heads, an indicator of neurological damage. The epidemic soon was linked to the mosquito-borne Zika virus, which was spreading through the tropical parts of the Americas. Doctors advised pregnant women to avoid mosquito bites by wearing bug spray and long-sleeved clothing, but had little other advice to offer. There were, and still are, no drugs or vaccines approved for use in pregnant women to protect them or their fetuses from Zika infection.

The developing fetus is uniquely vulnerable to damage from infection, so the body mobilizes robust defenses to keep microbes from ever reaching the fetus in the first place. The placenta is the last line of defense. Mysorekar and others have shown that a process known as autophagy — the cellular waste-disposal pathway by which cells grind up debris, unwanted organelles and invading microbes — is an important part of the formidable placental barrier to infection. However, previous studies by Mysorekar and others have shown that Zika not only can invade the placenta, but multiply there.

To learn more about how Zika breaches the placenta, Mysorekar, postdoctoral fellow Bin Cao, PhD, and colleagues infected human placental cells with Zika virus. They found that exposure to the virus activated genes related to autophagy.

However, when the researchers treated the cells with drugs to ramp up the autophagy pathway, the number of cells infected with Zika virus increased. Drugs that suppressed autophagy resulted in fewer placental cells infected with Zika virus. In other words, the virus multiplied and spread more effectively when the researchers dialed up the barrier response, and performed more sluggishly when they dialed it down. The virus seemed to be doing a form of microbial martial arts, turning the body’s weapons to its own advantage.

Mysorekar and colleagues verified these findings using mice whose autophagy response was hobbled by low levels of a key autophagy protein. They infected two groups of pregnant mice with Zika: one in which the autophagy process was disrupted and the other in which it worked normally.

Five days after infection, the mothers with a weak autophagy response had about the same amount of virus in their bloodstreams as the mice with a normal response. However, in mice with a weak autophagy response, the researchers found 10 times fewer viruses in the placenta and the heads of the fetuses and less damage to the placentas.

“It appears that Zika virus takes advantage of the autophagy process in the placenta to promote its survival and infection of placental cells,” Cao said.

Since hydroxychloroquine suppresses the autophagy response, the researchers questioned whether it also could protect fetuses against Zika.

To find out, they repeated the mouse experiment using only mice with a normal autophagy response. Female mice at day nine of pregnancy were infected with Zika and then dosed with hydroxychloroquine or placebo every day for the next five days.

Following treatment, the researchers found significantly less virus in the fetuses and placentas from the mice that had received hydroxychloroquine. In addition, these placentas showed less damage and the fetuses regained normal growth. Both the untreated and the treated mothers had about the same amount of Zika virus in their bloodstreams, indicating that hydroxychloroquine was able to protect fetuses even when the virus was circulating through the mother.

Although hydroxychloroquine has been used safely in pregnant women for short periods of time, the researchers caution that further studies are needed before it can be used in pregnant women to fend off Zika. Pregnant women living in areas where Zika circulates may need to take the drug for the duration of their pregnancies, and the safety of hydroxychloroquine for long-term use is unknown.

“We would urge caution but nevertheless feel our study provides new avenues for feasible therapeutic interventions,” said Mysorekar, who is also co-director of the university’s Center for Reproductive Health Sciences. “Our study suggests that an autophagy-based therapeutic intervention against Zika may be warranted in pregnant women infected with Zika virus.”

The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. Call for an appointment today: (707) 579-1102. Visit our website: www.womensobgynmed.com


Story Source:

Materials provided by Washington University School of Medicine. Original written by Tamara Bhandari. Note: Content may be edited for style and length.


Journal Reference:

  1. Indira Mysorekar et al. Inhibition of autophagy limits vertical transmission of Zika virus in pregnant mice. The Journal of Experimental Medicine, July 2017 DOI: 10.1084/jem.20170957

Read this article on ScienceDaily: Washington University School of Medicine. “Malaria drug protects fetuses from Zika infection: Treatment prevents virus from crossing placenta to infect fetus, mouse study shows.” ScienceDaily. ScienceDaily, 10 July 2017. www.sciencedaily.com/releases/2017/07/170710091702.htm.

Diet that includes vegetable protein may protect against early menopause

Eating more vegetable protein may protect against early menopause: Study shows modest but significant lower risk in older women, linking diet menopause.Results of a new study from epidemiologists at the University of Massachusetts Amherst and Harvard T.H. Chan School of Public Health suggest that long-term diet that includes a high intake of vegetable protein from such foods as whole grains, soy and tofu, may protect women from early menopause and could prolong reproductive function. Diet menopause.

Consuming enriched pasta, dark bread and cold cereal were especially associated with lower risk, while they observed no similar relation to eating animal sources of protein.

“A better understanding of how dietary vegetable protein intake is associated with ovarian aging may identify ways for women to modify their risk of early onset menopause and associated health conditions,” write first author and then-graduate student Maegan Boutot, with her advisor, professor Elizabeth Bertone-Johnson. Details appear in the current early online edition of the American Journal of Epidemiology.

Early menopause, the cessation of ovarian function before age 45, affects about 10 percent of women and is associated with higher risk of cardiovascular disease, osteoporosis and early cognitive decline, the authors note. Few studies have evaluated how protein intake is associated with menopause timing, they add, and to their knowledge this is the first to look specifically at early menopause.

Boutot, Bertone-Johnson and colleagues in the School of Public Health and Health Sciences at UMass Amherst, with others, evaluated the relationship between diet and risk of early menopause among members of the Nurses’ Health Study II (NHS2), an ongoing prospective study of 116,000 women aged 25-42 when they entered it in 1989.

Participants were asked to report how often they ate a single serving of 131 foods, beverages and supplements over the previous year, from “never or less than once a month” to “6+ per day.” They observed that women consuming approximately 6.5 percent of their daily calories as vegetable protein had a significant 16 percent lower risk of early menopause compared to women whose intake was approximately 4 percent of calories.

Diet Menopause

For a woman with a 2,000 calorie per day diet, the authors explain, this is equal to three to four servings of such foods as enriched pasta, breakfast cereal, tofu and nuts, or about 32.5 grams a day. They adjusted for age, smoking, body mass index and other possible confounding factors.

Boutot and Bertone-Johnson add, “Though relatively few women in our study consumed very high levels of vegetable protein and our power for analyses of more extreme intake levels was limited, women consuming 9 or more percent of their calories from vegetable protein had a hazard ratio of 0.41 (95 percent confidence interval = 0.19-0.88)” compared to those eating less than 4 percent.

Others on the study team were from Brigham and Women’s Hospital and Harvard Medical School. The study was supported by a grant from NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.

For the NHS2, follow-up questionnaires have assessed nurses’ lifestyle behaviors and medical conditions every two years. Nearly 90 percent have continued to participate in followup. Diet was assessed five times over the 20-year study, allowing the researchers to capture within-person variation in changes in food and nutrient intake over times, Boutot explains. Participants in the study contributed more than 1 million person-years of follow-up, during which 2,041 women experienced early menopause.

Boutot and Bertone-Johnson suggest that more prospective studies of their findings are warranted, including studies that compare soy-based and non-soy vegetable proteins.

Story Source:

Materials provided by University of Massachusetts at Amherst. Note: Content may be edited for style and length. University of Massachusetts at Amherst. “Eating more vegetable protein may protect against early menopause: Study shows modest but significant lower risk.” Read this article on ScienceDaily:  ScienceDaily, 26 June 2017. www.sciencedaily.com/releases/2017/06/170626093604.htm.


The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. Call for an appointment today: (707) 579-1102. Visit our website: www.womensobgynmed.com

Menstrual cycle has no impact on how a woman’s brain functions

Levels of estrogen, progesterone and testosterone in one's system have no impact on the working memory, cognitive bias or ability to pay attention to two things at once.A new study published in Frontiers in Behavioral Neuroscience is setting out to change the way we think about the menstrual cycle. While it’s often been assumed that anyone who’s menstruating isn’t working at top mental pitch, Professor Brigitte Leeners and her team of researchers have found evidence to suggest that that’s not the case. They examined three aspects of cognition across two menstrual cycles, and found that the levels of estrogen, progesterone and testosterone in your system have no impact on your working memory, cognitive bias or ability to pay attention to two things at once. While some hormones were associated with changes across one cycle in some of the women taking part, these effects didn’t repeat in the following cycle. Overall, none of the hormones the team studied had any replicable, consistent effect on study participants’ cognition.

Professor Leeners, team lead, said: “As a specialist in reproductive medicine and a psychotherapist, I deal with many women who have the impression that the menstrual cycle influences their well-being and cognitive performance.” Wondering if this anecdotal evidence could be scientifically proven — and questioning the methodology of many existing studies on the subject — the team set out to shed some light on this controversial topic.

The study published today uses a much larger sample than usual, and (unlike most similar studies) follows women across two consecutive menstrual cycles. The team, working from the Medical School Hannover and University Hospital Zürich, recruited 68 women to undergo detailed monitoring to investigate changes in three selected cognitive processes at different stages in the menstrual cycle. While analysis of the results from the first cycle suggested that cognitive bias and attention were affected, these results weren’t replicated in the second cycle. The team looked for differences in performance between individuals and changes in individuals’ performance over time, and found none.

Professor Leeners said, “The hormonal changes related to the menstrual cycle do not show any association with cognitive performance. Although there might be individual exceptions, women’s cognitive performance is in general not disturbed by hormonal changes occurring with the menstrual cycle.”

Professor Leeners cautions, however, that there’s more work to do. While this study represents a meaningful step forward, larger samples, bigger subsamples of women with hormone disorders, and further cognitive tests would provide a fuller picture of the way that the menstrual cycle affects the brain. In the meantime, Professor Leeners hopes her team’s work will start the long process of changing minds about menstruation.


Story Source:

Materials provided by Frontiers. Note: Content may be edited for style and length.


Journal Reference:

  1. Brigitte Leeners, Tillmann H. C. Kruger, Kirsten Geraedts, Enrico Tronci, Toni Mancini, Fabian Ille, Marcel Egli, Susanna Röblitz, Lanja Saleh, Katharina Spanaus, Cordula Schippert, Yuangyuang Zhang, Michael P. Hengartner. Lack of Associations between Female Hormone Levels and Visuospatial Working Memory, Divided Attention and Cognitive Bias across Two Consecutive Menstrual Cycles. Frontiers in Behavioral Neuroscience, 2017; 11 DOI: 10.3389/fnbeh.2017.00120

See this article on science daily:  Frontiers. “Menstruation doesn’t change how your brain works — period: Normonal changes during the menstrual cycle have no impact on aspects of cognition, study shows.” ScienceDaily. ScienceDaily, 4 July 2017. www.sciencedaily.com/releases/2017/07/170704093610.htm.

How to always look good at the beach with Laser Hair Removal

With the arrival of summer Dr. Lela Emad of Women’s OB/GYN Medical Group discusses the advantages offered by laser hair removal.

With a heatwave bearing down on Northern California pushing temperatures to the maximum, many people are heading to the beach or hanging out at the pool. Being swimsuit ready is easy with laser hair removal.

The process of summer waxing and constantly shaving unwanted hair, then repeat – and repeat again can be a burdensome routine when all you want to do is get out, dive in and cool off. There is a way to be swimsuit ready all summer long with laser hair removal.  “Traditional methods for removing hair like shaving, tweezing and waxing can be very cumbersome and time consuming for women,” explains Dr. Lela Emad of Women’s OB/GYN Medical Group in Santa Rosa. “Laser hair reduction offers a safe and very effective medical procedure to permanently terminate hair growth from unwanted areas.”

What is Laser Hair Reduction?

Laser hair removal is actually a medical procedure that employs an intense, pulsating beam of light to remove unwanted hair. A focused laser beam passes through the skin to penetrate and essentially vaporize individual hair follicles. The intense heat of the laser damages the hair follicle without harming surrounding skin and tissue. This process acts to inhibit future hair growth and although it may not completely guarantee permanent hair removal, over the course of a few treatments, it can provide an extended hair-free period. Periodic follow-up maintenance treatments are recommended as well.

The procedure is extremely precise and takes only a few minutes to remove hair from small areas, such as the upper lip or chin, and about an hour to treat larger areas, such as the back or legs. Laser hair reduction may require up to five sessions for optimal outcomes, and when performed properly, the procedure successfully terminates hair growth from treated areas in the vast majority of (up to 90%) of women.

Does it work for everyone?

Although anyone can undergo laser hair removal, best results depend on a person’s hair color and skin type. For example, people who have light skin and dark hair have the best results overall due to how the laser beam targets the pigment (melanin) in the hair. Advances in technology over recent years have made laser hair removal an option even for people who have darker skin.

Laser hair removal isn’t always as effective for hair colors such as white, gray, blond or even red because it’s more difficult for the laser to target that range of color,” said Dr. Emad. “Although people with lighter color hair will see results, it may not be as obvious as those with darker hair color.”

While laser hair reduction is fast and easy for patients, it is still a medical procedure that requires an experienced technician to ensure it is performed safely and effectively. The physicians at Women’s OB/GYN Medical Group carry years of experience in performing laser hair reduction and they take care to attend to any discomfort or bad reactions patients may have to the procedure.

Best outcomes for laser hair removal

Laser hair removal leaves skin smooth and soft on the underarms, legs and arms, hands, back, face, bikini area. The results are always immediate and quite lasting. And since hair follicles are essentially transformed by laser light, hair typically will not grow back as quickly as prior to the treatment and occasional touch-ups are recommended to keep the skin smooth and hair-free.

“Patients who have experienced laser technology for hair removal tend to feel better about the look of their skin, and many report experiencing an improvement in body image that gives a boost of confidence,” says Dr. Email. “Above all else, patients appreciate the convenience it provides to the grooming routine.”

About Women’s OB/GYN Laser Hair Removal

Women’s OB/GYN physicians also offer expert advice and products for general skin care and treatment. Call (707) 579-1102 to schedule an appointment and for more information about laser hair reduction and skin care offered by the group. Visit the website to learn more.

May is the Month for Women – A good time to focus on Women’s Health

In honor of Mother’s Day and National Women’s Health Week Dr. Lela Emad of Women’s OB/GYN Medical Group offers timely insights for staying healthy.

With the goal of empowering women to make health a priority, the U.S. Department of Health and Human Services Office celebrates National Women’s Health Week beginning on May 14th – which is also Mother’s Day. This weeklong event is offered to encourage women to take steps to improve health with a focus on annual screenings, lifestyle choices and prevention.

“It is certainly important for women to be vigilant about testing for conditions that are most successfully treated when caught early, including breast cancer and colon cancer. And, another good way to stay healthy is to have routine check-ups to screen for the basic health concerns,” says Dr. Lela Emad obstetrician & gynecologist. “Heart disease is still the top killer of women in the U.S. therefore it is equally important for women to monitor blood pressure, cholesterol levels and to be aware of any potential for diabetes.”

Life expectancy in the U.S. for women now averages a full eight decades – barring accidents or major health issues. With all that living to look forward to, it’s a good idea to adopt healthy habits as early in life as possible. A look at the trends to better health reveals that there are some very simple ways to optimize health, and make life worth living.

Schedule an Appointment

One important step consists of scheduling a visit to a healthcare provider for a well-woman checkup that includes preventive screenings. Health professionals recommend adolescent girls and women start routine, annual gynecologic visits around the age of 14 unless otherwise indicated by their general practitioners. These important checkups give women an opportunity to discuss both gynecologic and general health concerns. This type of screening can include the following:

  • Blood pressure, Height, Weight
  • Lipid Panel (cholesterol and triglycerides)
  • Breast Cancer Screening
  • Cervical Cancer Screening
  • A hemoglobin test, an indicator for anemic
  • Pap & HPV tests

Exercise – Be more active!

Sitting for prolonged periods at a desk or in front of the computer may be a necessity for many a woman’s livelihood, but it’s not good for the body. Research shows that women who sit for more than six hours a day have a 40 percent higher risk of dying from any cause when compared to women who sit for fewer than three hours—regardless of their fitness levels.

Exercise is hands-down the best thing both men and women can do to improve health. And the best way to get fit and stay fit is to get moving. Exercise increases energy and releases endorphins—which in turn increases a person’s happiness quotient. Several recent studies indicate that staying active is associated with a longer life expectancy.

Exercise doesn’t need to be drudgery, a good way to incorporate a routine that endures the test of time is to choose activities that are fun. Simply going for a 20-minute walk with a friend is extremely beneficial to overall healthfulness. Just 2.5 hours weekly (about 20 minutes a day) of moderate aerobic exercise such as walking provides all the major health benefits a body needs to stay healthy.

Eating for Life

Research proves that eating more fresh vegetables is one of the simplest way to improve overall healthfulness. A vegetable-rich diet can help protect the body from arthritis, heart disease, stroke, dementia and a variety of cancers – and it might also slow down the aging process. In fact, one study found that people who consume at least seven portions of fresh vegetables and fruit each day have as much as 42 percent lower risk of dying from any cause, compared to those who eat one portion or less.

Breast Health

Routine breast exams and general awareness of how to maintain breast health are important elements in maintaining a healthy lifestyle for women. Screening methods such as regular self-breast exams, breast checks during routine gynecologic exams, and screening mammographies can all help to detect breast problems early-on.

For National Women’s Health Week, the office of Women’s Health US Dept. of Health & Human Services also recommends that women pay attention to mental health, get plenty of sleep and take steps every day to manage stress. And, of course avoid unhealthy behaviors, such as smoking, texting while driving, and not wearing a seatbelt or bicycle helmet.

About Women’s OBGYN Medical Group

The provider team of expert OB/GYN physicians, certified nurse midwives, family nurse practitioners, and medical assistants provides unmatched care to patients in our region. As women proudly serving women, we understand the needs and expectations of our patients. For more information call (707) 579-1102 or visit the Women’s OB/GYN website.

Good outcomes for older women who give birth at home or in a birth center

Women with some characteristics commonly thought to increase pregnancy risks — being over age 35; being overweight; and in some cases, having a vaginal birth after a cesarean section — tend to have good outcomes when they give birth at home or in a birth center, a new assessment has found.

However, women with some other risk factors, a breech baby and some other cases of vaginal birth after cesarean or VBAC, may face an increased risk of poor outcomes for themselves or their babies, researchers at Oregon State University have found. The study is believed to be the first to examine these risks and the outcomes. About 2 percent of all births in the U.S., and about 4 percent in Oregon, occur at home or in a birth center, rather than in a hospital setting. Generally, women who are considered “low-risk” are good candidates for home or birth center births, also referred to as community births, if they are attended by a midwife or other trained provider and timely access to a hospital is available.

However, there is little agreement among health providers on what should be considered low- or high-risk, and some women choose to have a community birth despite potential risks, said Marit Bovbjerg, a clinical assistant professor of epidemiology at Oregon State University and lead author of the study.

Medical ethics and the tenets of maternal autonomy dictate that women be allowed to decide where and how they wish to give birth. That’s why it’s important to have as much information as possible about potential risks, said Bovbjerg, who works in the College of Public Health and Human Sciences at OSU.

There are also risks associated with hospital births, such as increased interventions, which means there aren’t always clear answers when it comes to determining the best and safest place to give birth, said Melissa Cheyney, a medical anthropologist and associate professor in OSU’s College of Liberal Arts.

The goal of the research was to better understand the outcomes for women and babies with some of the most common pregnancy risk factors, to see how those risk factors affected outcomes.

“There’s a middle or gray area, in terms of risk, where the risk associated with community birth is only slightly elevated relative to a completely low-risk sample,” Cheyney said. “We’re trying to get more information about births that fall in that middle zone so that clinicians and pregnant women can have the best evidence available when deciding where to give birth.”

The findings were published recently in the journal Birth. Other co-authors are Jennifer Brown of University of California, Davis; and Kim J. Cox and Lawrence Leeman of the University of New Mexico. Using birth outcome data collected by the Midwives Alliance of North America Statistics Project, commonly referred to as MANA Stats, the researchers analyzed more than 47,000 midwife-attended community births.

They looked specifically at the independent contributions to birth outcomes of 10 common risk factors: primiparity, or giving birth for the first time; advanced maternal age, or mother over age 35; obesity; gestational diabetes; preeclampsia; post-term pregnancy, or more than 42 weeks gestation; twins; breech presentation; history of both cesarean and vaginal birth; and history of only cesarean birth.

The last two groups are both considered VBACs and hospital policies and state regulations for midwifery practice usually make no distinction between the two types. However, the researchers found a clear distinction between the two groups in terms of community birth outcomes.

Women who delivered vaginally after a previous cesarean and also had a history of previous vaginal birth had better outcomes even than those women giving birth for the first time. On the other hand, women who had never given birth to a child vaginally had an increased risk of poor outcomes in community birth settings.

“That finding suggests that current policies that universally discourage VBAC should be revisited, as the evidence does not support them,” Bovbjerg said. “Women who in the past have successfully delivered vaginally seem to do just fine the next time around, even if they have also had a previous C-section. That’s really important because some medical groups totally oppose VBACs, even in hospital settings, and many hospitals don’t offer the option of a VBAC at all.”

Researchers also found that women whose babies were in breech position had the highest rate of adverse outcome when giving birth at home or in a birth center.

There was only a slight increase in poor outcomes for women over age 35, or women who were overweight or obese, compared to those without those risk factors. In some categories, there were not enough births in the data set to properly evaluate a risk’s impact, such as with gestational diabetes and preeclampsia.

“As is appropriate, women who face high complication risks such as preeclampsia tend to plan for and choose a hospital birth, rather than a community birth,” Bovbjerg said. “But even for these women, it’s important to remember that they can choose a community birth if their faith, culture or other considerations dictate that is the best choice for them.”

The researchers emphasized that the new information about risks and outcomes can serve as an important tool in decision-making for families making very personal choices about where to give birth. “These findings help us to put information and evidence, rather than fear, at the center of discussions around informed, shared decision-making between expectant families and their health care providers,” Cheyney said.

Researchers next plan to examine how the healthcare culture and standards of care in different locations within the U.S. affect outcomes of home and birthing center deliveries.


Story Source:

Materials provided by Oregon State University. Note: Content may be edited for style and length.


Journal Reference:

  1. Marit L. Bovbjerg, Melissa Cheyney, Jennifer Brown, Kim J. Cox, Lawrence Leeman. Perspectives on risk: Assessment of risk profiles and outcomes among women planning community birth in the United States. Birth, 2017; DOI: 10.1111/birt.12288

Read this article on Science Daily: www.sciencedaily.com/releases/2017/04/170413154439.htm.

Inadequate sleep may increase risk of bone loss in women

Insufficient sleep, a common problem that has been linked to chronic disease risk, might also be an unrecognized risk factor for bone loss. Results of a new study will be presented Saturday at the Endocrine Society’s 99th annual meeting in Orlando, Fla.

The study investigators found that healthy men had reduced levels of a marker of bone formation in their blood after three weeks of cumulative sleep restriction and circadian disruption, similar to that seen in jet lag or shift work, while a biological marker of bone resorption, or breakdown, was unchanged.

“This altered bone balance creates a potential bone loss window that could lead to osteoporosis and bone fractures,” lead investigator Christine Swanson, M.D., an assistant professor at the University of Colorado in Aurora, Colo., said. Swanson completed the research while she was a fellow at Oregon Health & Science University in Portland, Ore., with Drs. Eric S. Orwoll and Steven A. Shea.

“If chronic sleep disturbance is identified as a new risk factor for osteoporosis, it could help explain why there is no clear cause for osteoporosis in the approximately 50 percent of the estimated 54 million Americans with low bone mass or osteoporosis,” Swanson said.

Inadequate sleep is also prevalent, affecting more than 25 percent of the U.S. population occasionally and 10 percent frequently, the Centers for Disease Control and Prevention report.

The 10 men in this study were part of a larger study that some of Swanson’s co-authors conducted in 2012 at Brigham and Women’s Hospital in Boston, Mass. That study evaluated health consequences of sleep restriction combined with circadian disruption. Swanson defined circadian disruption as “a mismatch between your internal body clock and the environment caused by living on a shorter or longer day than 24 hours.”

Study subjects stayed in a lab, where for three weeks they went to sleep each day four hours later than the prior day, resulting in a 28-hour “day.” Swanson likened this change to “flying four time zones west every day for three weeks.” The men were allowed to sleep only 5.6 hours per 24-hour period, since short sleep is also common for night and shift workers. While awake, the men ate the same amounts of calories and nutrients throughout the study. Blood samples were obtained at baseline and again after the three weeks of sleep manipulation for measurement of bone biomarkers. Six of the men were ages 20 to 27, and the other four were ages 55 to 65. Limited funding prevented the examination of serum from the women in this study initially, but the group plans to investigate sex differences in the sleep-bone relationship in subsequent studies.

After three weeks, all men had significantly reduced levels of a bone formation marker called P1NP compared with baseline, the researchers reported. This decline was greater for the younger men than the older men: a 27 percent versus 18 percent decrease. She added that levels of the bone resorption marker CTX remained unchanged, an indication that old bone could break down without new bone being formed.

“These data suggest that sleep disruption may be most detrimental to bone metabolism earlier in life, when bone growth and accrual are crucial for long-term skeletal health,” she said. “Further studies are needed to confirm these findings and to explore if there are differences in women.”


Story Source:

Materials provided by The Endocrine Society. Note: Content may be edited for style and length.


Read this article on Science Daily: The Endocrine Society. “Prolonged sleep disturbance can lead to lower bone formation.” ScienceDaily. ScienceDaily, 2 April 2017. <www.sciencedaily.com/releases/2017/04/170402111317.htm>.

Most Women of Child Bearing Age Lack Knowledge of Healthy Diet Says New Study

Dr. Lela Emad of the Women’s OB/GYN Medical Group discusses the latest findings on diet and nutrition among women and offers some guidelines for women planning for pregnancy.

A new study by the University of Pittsburgh Schools of the Health Sciences uncovers a national trend toward a less than optimal diet among women prior to pregnancy. “This information is particularly concerning for women who intend to conceive,” says Dr. Lela Emad of the Women’s OB/GYN Medical Group of Santa Rosa. “It’s imperative that prior to pregnancy, women follow a higher standard of nutrition for several reasons; to ensure healthy growth of the fetus, to reduce risks associated with premature birth, and to avoid the possibility of preeclampsia and maternal obesity – both of which carry added risks to the mother and baby.”

The study, published in the Journal of the Academy of Nutrition and Dietetics, assessed more than 7,500 women participants using the Healthy Eating Index-2010, measuring quality of diet including the intake for key food groups, while also measuring the consumption of less desirable aspects of a typical American diet such as refined grains, salt and calories from solid fats and sugars from food as well as from alcohol consumption.

Ultimately, more than a third of the calories the women in the study consumed came from ‘empty calories’ from such things as;

  • sugar-sweetened beverages,
  • pasta dishes
  • grain desserts
  • Soda
  • beer, wine and spirits

“This list consists of just about everything we would recommend a woman who was in a preconception phase to avoid,” Dr. Emad points out. “A healthy diet goes a long way toward ensuring a healthy pregnancy, and planning ahead for pregnancy by participating in a Preconception Healthcare Plan is one of the best things a woman can do both for her baby and for herself.”

What is Preconception Healthcare

Preconception healthcare describes medical care provided to a woman that is designed to increase the chances of having a positive pregnancy experience and a healthy baby. Preconception healthcare is uniquely designed for every individual, customized for personal needs and circumstances. It typically offers an introduction to guidelines for a healthy diet as part of the overall education and planning process.

“We encourage parents – that is, both parents – to begin making healthy lifestyle changes up to one full year prior to trying to get pregnant,” explains Dr. Emad. “This process improves a woman’s chances of becoming pregnant and prepares her body so it can provide the best environment for her infant.” During a preconception care visit, the OB/GYN healthcare provider will focus on lifestyle, medical and family history, previous pregnancies and currently prescribed medications. In addition to diet and exercise, topics may include alcohol, tobacco, and caffeine use; recreational drug use, birth control, family histories, genetics as well as health issues and other concerns (diabetes, high blood pressure, depression, obesity, etc.)

Healthy Diet and Supplements

“We also encourage our patients and their families to adopt a nutrient rich and calorie conscious diet prior to and during pregnancy. This is the best way to prevent excessive weight gain and cut the potential risk of obstetric complications,” says Dr. Emad. “Planning ahead and taking steps to ensure optimal pre-pregnancy health is a great way to create a healthy family.”

Learning how to make smart food choices as well as being mindful about food preparation is important, as is knowing which foods to avoid or limit during pregnancy. Foods that contain sources of folic acid (vitamin B9) are important nutritional elements to incorporate into both the preconception and pregnancy diet. Folic acid helps to prevent some birth defects – particularly those affecting the brain and spinal cord. Folic acid is best taken before pregnancy and in the very early stages of pregnancy.

Although the bulk of nutrients should ideally come from eating fresh healthy foods, it is generally recommended that women start taking a prenatal vitamin supplement before pregnancy. Prenatal vitamin supplements are specifically formulated to contain all the recommended daily vitamins and minerals needed before and during pregnancy.

About Women’s OBGYN Medical Group

The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. To learn more about these fine physicians and the many services provided by the Women’s OB/GYN Medical Group visit the website. Call for an appointment at (707) 579-1102.

Can eating soy products affect breast health?

Georgetown Lombardi Comprehensive Cancer Center researchers have used animal models to reveal new information about the impact — positive and negative — that soy consumption could have on a common breast cancer treatment.

The scientists have uncovered the biological pathways in rats by which longtime soy consumption improves effectiveness of tamoxifen and reduces breast cancer recurrence. But they also show why eating or drinking soy-based foods for the first time while being treated with tamoxifen can, conversely, reduce effectiveness of the drug, and promote recurrence.

The study, published in Clinical Cancer Research, uncovers the molecular biology behind how soy consumption, especially its most active isoflavone, genistein, affects tamoxifen — both positively and negatively.

It also mirrors what has been observed in breast cancer patients, says the study’s senior investigator Leena Hilakivi-Clarke, PhD, professor of oncology at Georgetown Lombardi.

“There has long been a paradox concerning genistein, which has the similar structure as estrogen and activates both human estrogen receptors to a degree. Estrogen drives most breast cancer growth, yet high soy intake among women in Asian countries has been linked to a breast cancer rate that is five times lower than Western women, who eat much less soy,” she says. “So why is soy, which mimics estrogen, protective in Asian women?”

More than 70 percent of the 1.67 million women diagnosed with breast cancer worldwide in 2012 was estrogen-receptor positive, and tamoxifen and other endocrine therapies meant to reduce the ability of estrogen to promote cancer growth, are the most common drugs used for these cancers. Although endocrine therapies can be highly effective in preventing or treating breast cancer, about half of patients who use them exhibit resistance and/or have cancer recurrence.

Employing a more advanced rat model of breast cancer and tamoxifen use than has been used in past studies, the researchers found that the timing of genistein intake is the central issue.

Longtime sustained use of genistein before development of breast cancer improves overall immunity against cancer, thus protecting against cancer development and recurrence, says the study’s lead researcher, Xiyuan Zhang, PhD.

“It also inhibits a mechanism called autophagy that would allow cancer cells to survive, which explains why it helps tamoxifen work,” says Zhang, a member of Hilakivi-Clarke’s laboratory when this study was conducted. She is currently a postdoctoral researcher at the National Institutes of Health.

Previous studies in women show no evidence of adverse effects of soy intake on breast cancer outcome, the researchers say, adding that research has also shown that Asian and Caucasian women who consumed as little as 1/3rd cup of soymilk daily (10 mg. of isoflavones) had the lowest risk of breast cancer recurrence.

The animal studies suggest it is a different story when soy consumption begins after breast cancer develops.

Starting consuming genistein in a diet after breast cancer develops in the animals did not trigger anti-tumor immune response to eliminate cancer cells, Zhang says. “We do not know yet why this made the animals resistant to the beneficial effects of tamoxifen and increased risk of cancer recurrence,” she continued.

Animals consuming genistein as adults on had a 7 percent chance of breast cancer recurrence after tamoxifen treatment, compared with a 33 percent recurrence with rats exposed to genistein only after breast cancer developed.

“We have solved the puzzle of genistein and breast cancer in our rat model, which perfectly explains the paradox seen in earlier animal studies and patients,” says Hilakivi-Clarke. “While many oncologists advise their patients not to take isoflavone supplements or consume soy foods, our findings suggest a more nuanced message — if these results hold true for women. Our results suggest that breast cancer patients should continue consuming soy foods after diagnosis, but not to start them if they have not consumed genistein previously.”


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Materials provided by Georgetown University Medical Center. Note: Content may be edited for style and length.


Read this article on ScienceDaily: Georgetown University Medical Center. “Understanding when eating soy might help or harm in breast cancer treatment.” ScienceDaily. ScienceDaily, 1 February 2017. www.sciencedaily.com/releases/2017/02/170201092711.htm.