ob/gyn

Study reveals no increase in risks for women who eat and drink during labor

At most US maternity units, women in labor are put on nil per os (NPO) status -- they're not allowed to eat or drink anything, except ice chips. But new nursing research questions that policy, showing no increase in risks for women who are allowed to eat and drink during labor.

At most US maternity units, women in labor are put on nil per os (NPO) status — they’re not allowed to eat or drink anything, except ice chips. But new nursing research questions that policy, showing no increase in risks for women who are allowed to eat and drink during labor. The study appears in the March issue of the American Journal of Nursing, published by Wolters Kluwer.

“The findings of this study support relaxing the restrictions on oral intake in cases of uncomplicated labor,” write Anne Shea-Lewis, BSN, RN, of St. Charles Hospital, Port Jefferson, N.Y., and colleagues. Adding to the findings of previous reports, these results suggest that allowing laboring women to eat and drink “ad lib” doesn’t adversely affect maternal and neonatal outcomes.

No Increase in Complications with ‘Ad lib’ Oral Intake During Labor

The researchers analyzed the medical records of nearly 2,800 women in labor admitted to one hospital from 2008 through 2012. At the study hospital, one practice group of nurses and doctors had a policy of allowing laboring women to eat and drink ad lib (ad libitum, or “as they please”). Another four practice groups kept all patients NPO (nil per os, or “nothing by mouth”).

Recommendations to restrict oral intake during labor reflect concerns over the risk of vomiting and aspiration (inhalation) in case general anesthesia and surgery are needed. However, with advances in epidural and spinal anesthesia, the use of general anesthesia during labor has become rare (and, if needed, much safer than before).

The study compared maternal and child outcomes in about 1,600 women who were kept NPO (except for ice chips) with 1,200 who were allowed to eat and drink ad lib during labor. The two groups were “sufficiently equivalent” for comparison. The women’s average age was 31 years. Before delivery, a “preexisting medical condition” complicating pregnancy was identified in 14 percent of the NPO group compared with 20 percent of the ad lib group.

Even though the women in the NPO group started out with fewer medical problems, they had a significantly higher incidence of complications during labor and birth, compared with the ad lib group. The women in the NPO group were also significantly more likely to give birth via unplanned cesarean section.

Other outcomes — including requiring a higher level of care after delivery and the newborns’ condition as measured by Apgar score — were not significantly different between groups. Analysis using a technique called propensity score matching, comparing groups of women with similar risk factors, yielded similar results.

The findings add to those of previous studies suggesting that restrictions on eating and drinking during labor could be safely relaxed in uncomplicated cases. “Yet in keeping with current guidelines, most obstetricians and anesthesiologists in the United States continue to recommend restrictions on oral intake for laboring women,” Anne Shea-Lewis and colleagues write.

“Our findings support permitting women who are at low risk for an operative birth to self-regulate their intake of both solid food and liquids during labor,” the researchers add. They note some limitations of their study, especially the fact that the women weren’t randomly assigned to NPO or ad lib groups.

The authors hope their study will lead to reconsideration of current recommendations to keep women NPO during the “often long and grueling” process of labor and delivery. “Restricting oral intake to a laboring woman who is hungry or thirsty may intensify her stress,” Anne Shea-Lewis and colleagues conclude. “Conversely, allowing her to eat and drink ad lib during labor can contribute to both her comfort and her sense of autonomy.”

Story Source:

Read this article on Science Daily: Wolters Kluwer Health. “Ice chips only? Study questions restrictions on oral intake for women in labor.” ScienceDaily. ScienceDaily, 23 February 2018. www.sciencedaily.com/releases/2018/02/180223151852.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

Risk of heart disease goes up with breast cancer treatment

Some breast cancer therapies can damage the heart and healthcare providers should carefully monitor breast cancer treatment effects on the heart. Breast cancer survivors, especially older women, are more likely to die from cardiovascular diseases such as heart failure rather than breast cancer.Some breast cancer therapies can damage the heart and healthcare providers should carefully monitor breast cancer treatment effects on the heart. Breast cancer survivors, especially older women, are more likely to die from cardiovascular diseases such as heart failure rather than breast cancer.

Breast cancer patients may be at an increased risk of cardiovascular diseases including heart failure and may benefit from a treatment approach that weighs the benefits of specific therapies against potential damage to the heart, according to a new scientific statement from the American Heart Association published in its journal Circulation.

The statement is an overview of what we currently know about risk factors common to both heart disease and breast cancer, the potential heart damage from some breast cancer treatments, and suggested strategies to prevent or minimize the damage. Breast cancer survivors, especially older women over the age of 65, are more likely to die from cardiovascular disease than breast cancer, underscoring the importance of effectively managing heart disease risk factors during and following cancer treatment.

“Any patient who is going to undergo breast cancer treatment, whether they have heart disease at the beginning or not, should be aware of the potential effects of the treatments on their heart,” said Laxmi Mehta, M.D., chair of the writing group for the new scientific statement. “This should not deter or scare patients from undergoing breast cancer treatment, but should allow them to make informed decisions with their doctor on the best cancer treatment for them.”

During cancer treatments, patients should pay attention not only to their breast health, but also to their general health, including their heart, said Dr. Mehta, who is director of the Women’s Cardiovascular Health Program and an associate professor of medicine at The Ohio State University in Columbus, Ohio.

For example, some cancer treatments, such as HER-2 targeted therapies, can cause weakening of the heart muscle, a condition known as heart failure. HER-2 is a specific type of breast cancer. In some cases, the reduction in heart function is temporary and cessation of the treatment and/or the addition of heart medicines can improve function. But in some breast cancer patients, heart failure can be permanent. Because of this, the early development of heart failure can signal a need to slow down and/or alter a patient’s breast cancer treatment because of the risk for worsening the condition or the development of permanent heart failure.

Some small studies suggest that administering common chemotherapy agents in new ways may reduce heart disease risks. Doxorubicin is a chemotherapy drug used in breast cancer therapy that can lead to the damage of heart cells. Studies have shown that when doxorubicin is administered slowly, rather than all at once, patients may have a lower risk of heart failure.

In addition, a drug called dexrazoxane that could reduce cell damage has recently been approved for patients with metastatic breast cancer who receive high doses of doxorubicin. More studies will need to be done to confirm whether the results of the smaller studies are seen in larger groups of patients.

Other treatments, such as radiation, can affect the heart arteries and cause the development of coronary artery disease or blockages. Some breast cancer treatment agents, such as anthracyclines, can result in abnormal heart rhythms that in some patients are benign but in others can lead to life-threatening heart rhythms. And, some treatments — like antimetabolites — can cause spasm of the heart arteries, which can cause chest pain symptoms but could lead to heart attacks as well.

Heart disease and breast cancer share a number of risk factors, including advanced age, poor diet, family history, physical inactivity and tobacco use. The fact that these diseases share some risk factors suggests that there are lifestyle choices, primarily diet and exercise, that could help decrease the risks of developing both diseases. Healthcare providers should monitor a woman’s heart health before, during and after breast cancer treatment.

Adherence to a number of ideal heart health behaviors or factors from the American Heart Association’s’ Life’s Simple 7 is associated with a trend towards a lower incidence of breast cancer. Life’s Simple 7 includes being physically active, achieving and maintaining a healthy body weight, eating a healthy diet, avoiding tobacco, maintaining healthy levels of blood pressure, cholesterol and blood sugar.

“Fortunately, with the advances in breast cancer treatment, there has been a growing number of survivors. However, during and after the treatment of breast cancer, having optimal control of heart disease risk factors is important, because older breast cancer survivors are more likely to die of heart disease than breast cancer,” Dr. Mehta said. “And that’s why Life’s Simple 7 is important for all patients with and without breast cancer.”

Although there are an estimated 47.8 million women in the U.S. who are living with cardiovascular diseases and approximately 3 million breast cancer survivors, many people regard breast cancer as the primary threat to women’s health. It is important to recognize the overlap of heart disease and breast cancer as both entities impact survival.

Story Source: Read this article on Science Daily: American Heart Association. “Breast cancer treatments may increase the risk of heart disease: American Heart Association scientific statement.” ScienceDaily. ScienceDaily, 1 February 2018. www.sciencedaily.com/releases/2018/02/180201085812.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

Mothers over 40 more at risk of preterm birth

Maternal age over 40 is associated with an increased risk of preterm birth Mothers aged 30-34 years old may have the lowest risk of preterm birth
Pregnant mothers aged 40 and over may have an increased risk for preterm birth, regardless of confounding factors, according to a new study.
Pregnant mothers aged 40 and over may have an increased risk for preterm birth, regardless of confounding factors, according to a study published January 31, 2018 in the open-access journal PLOS ONE by Florent Fuchs from CHU Sainte Justine, Canada and colleagues.

Maternal age at pregnancy has been increasing worldwide and so has the risk for preterm birth. However, the association between maternal age and preterm birth remains a topic of ongoing research.

Fuchs and colleagues sought to investigate the impact of maternal age on preterm birth in a large cohort. The researchers analyzed the previously-collected data from the QUARISMA randomized controlled trial, which had taken place in 32 hospitals in Quebec, Canada, from 2008 to 2011.

The researchers identified five different age groups among the 165,282 pregnancies included in the study, and compared them based on maternal characteristics, gestational and obstetric complications, and risk factors for prematurity. Some of the known risk factors identified more commonly in older mothers (40 and over) included placental praevia, gestational diabetes, medical history, use of assisted reproduction technologies and occurrence of an invasive procedure. On the other hand, nulliparity, past drug use and smoking were more prevalent in younger mothers (30 and under).

Even after adjusting for confounding factors, the researchers found that advanced maternal age (40 or over) was associated with preterm birth. Meanwhile, a maternal age of 30-34 years was associated with the lowest risk of prematurity.


Read this article on Science Daily:  “Maternal age over 40 is associated with an increased risk of preterm birth: Mothers aged 30-34 years old may have the lowest risk of preterm birth.” ScienceDaily. ScienceDaily, 31 January 2018. www.sciencedaily.com/releases/2018/01/180131160346.htm.


About Women’s OB/GYN 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. Call for an appointment today: (707) 579-1102. Visit our website: www.womensobgynmed.com

Start the New Year Right: Quit the nicotine habit using the latest research model for success

In addition to lowering the effects of nicotine withdrawal, exercise is by far the best thing women can do to improve health.The Women’s OB/GYN Medical Group shares insight into how women who have a nicotine habit can take advantage of the latest research trends for quitting that might just guarantee success; starting an exercise routine.

Smoking is a bad habit for anyone and for women it poses very specific problems, particularly for pregnant women and women who are considering pregnancy. “Now is the perfect time for women of all ages to make a commitment to stop smoking,” says Dr. Lela Emad Obstetrician & Gynecologist. “In light of the latest research, we’re asking all of our patients who smoke or use nicotine products, to make the commitment to change this one lifestyle habit, and start the New Year on a better track toward health.”

The Study 

Experts at St George’s University of London set out to understand the underlying mechanism that seems to be exercise’s way of supporting the body against nicotine dependence and withdrawal. The study revealed that even moderate exercise noticeably reduces the severity of nicotine withdrawal symptoms. The findings help to validate the protective effect of exercise during smoking cessation; against the development of physical dependence, which may help smokers in giving up the habit by reducing the severity of withdrawal symptoms.

The Impact of Smoking

According to the Center of Disease Control and Prevention cigarette smoking remains the leading cause of preventable death and disability in the United States, despite a significant decline in the number of people who smoke. More than 16 million Americans have at least one disease caused by smoking.

“If exercise works to decrease the symptoms associated with nicotine withdrawal, then taking up an exercise routine and quitting the habit go hand in hand,” Dr. Emad says. “Statistics show that only 30 percent of women quit smoking when they find out they are pregnant, if we could make a dent in that number, it will have a positive impact on the well-being of both mothers and their children.”

Cigarette smoking alone kills more than 480,000 Americans each year. It causes direct damage to the body, which can lead to long-term health problems. We’ve all heard that smoking causes cancer, lung and heart disease, and stroke, but smoking also causes specific problems for women’s health including:

  • Decreased bone density
  • Rheumatoid arthritis
  • Cataracts
  • Gum disease
  • Ulcers
  • Depression
  • Menstrual problems
  • Low birth-weight
  • Pre-term delivery

In addition to lowering the effects of nicotine withdrawal, exercise is by far the best thing women can do to improve health. Exercise has been found to increase a person’s overall energy level and it releases endorphins—which in turn increases a person’s happiness quotient. Ongoing research suggests that as little as 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.

“What a great resolution for women of all ages to make for this New Year; stop smoking, start exercising,” Dr. Emad said.

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.