West Australian Women: Drinking Before, And During, Pregnancy

* In a survey of non-indigenous West Australian women, 79.8 percent reported drinking alcohol in the three months before becoming pregnant.


* Nearly half of the women (46.7%) surveyed reported that their pregnancy was unplanned.
* More than half (58.7%) drank alcohol during pregnancy despite recommendations of abstinence.



Complications due to drinking during pregnancy can range from the very serious Fetal Alcohol Syndrome to the less severe and possibly greater-occurring Fetal Alcohol Spectrum Disorders. The timing of alcohol consumption, its frequency, the beverage size and type, all appear to be crucial elements of identifying risk. A new survey has found that nearly 80 percent of non-Indigenous West Australian women consumed alcohol during the three months before pregnancy; nearly half had not planned their pregnancies; and more than half drank alcohol during pregnancy despite recommendations of abstinence.



Results are published in the February issue of Alcoholism: Clinical & Experimental Research.



"There is a lack of information as it relates to the measurement of alcohol consumption during the periconceptional period of pregnancy," said Lyn Colvin, a researcher at the Telethon Institute for Child Health Research at The University of Western Australia and corresponding author for the study. "In particular, information on specific alcoholic beverage consumed, frequency, timing during pregnancy, and volume in standard drinks are rare."



Colleen O'Leary, a research associate at the Telethon Institute for Child Health Research, concurs. "The most vulnerable period for the fetus is during the first trimester," she said, "although there is potential risk to the baby from drinking throughout pregnancy. It is important to know how much alcohol women are drinking both during the periconceptional period and throughout pregnancy, as well as more about the relationship between alcohol consumption during the periconceptional period and unplanned pregnancy. This information is important for women and men, policy makers and researchers."



Researchers analyzed data from a survey of 4,839 women 12 weeks after delivery. The women had agreed to participate in the 1995 - 1997 West Australian Pregnancy and Infancy Survey, created from a 10-percent random sample of all non-Indigenous women giving birth in Western Australia. Each participant was asked questions about alcohol consumption during four time periods: the periconceptional period, and each trimester of pregnancy. Questions were designed to measure the volume and type of alcoholic beverage consumed, as well as frequency of consumption.



* Nearly 80 percent reported drinking alcohol in the three months before becoming pregnant.



"Of those 3,860 women consuming alcohol in the three months before pregnancy," said Colvin, "the majority (55.6%) drank more than one type of alcoholic beverage. Once pregnant, the majority (65.5%) drank only one type of alcoholic beverage."
















* Nearly half of the women (46.7%) surveyed had not planned their pregnancy.



"These data are in agreement with other Australian studies, and studies from the United States and Britain," said O'Leary. "It is concerning, however, that with the range of contraceptive options available to women that such a high proportion of pregnancies are unplanned." Furthermore, she added, the women who had planned their pregnancies were significantly less likely to drink alcohol during the first trimester than women who did not plan their pregnancy. "This would indicate that many pregnancies may be exposed to high levels of alcohol during the periconceptional period, prior to pregnancy awareness."



* More than half of the women (58.7%) drank alcohol during pregnancy despite the recommendation at the time of the study (1995-1997) of abstinence.



"It is interesting to note that the number of women who consumed alcohol during the 2nd trimester (42.4%) was similar to the number during the 1st trimester (42.1%)," said Colvin. "This probably indicates that the pregnant women were unaware of the recommendation of abstinence."



"Until 2001," added O'Leary, "the Australian guideline for alcohol consumption during pregnancy was abstinence. However, to my knowledge, there was no health promotion campaign in WA to educate women of this policy during or prior to the period these data were collected. Furthermore, a survey of health professionals conducted in WA during 2002 - 2003 found that fewer than half of health professionals surveyed routinely provided information to pregnant women about alcohol consumption during pregnancy."



'Despite what initially appears alarming, said Colvin, "it is actually encouraging that many women who drank alcohol reduced their consumption in the first trimester of pregnancy. With appropriate information, they and others may be able to further reduce or abstain from consuming alcohol when they are pregnant or might soon become pregnant. The challenge is to develop effective health promotion messages to reach women of child-bearing age before they consider pregnancy so they can make informed decisions." She added that involving health-promotion practitioners, medical practitioners and obstetricians would be key.



Both Colvin and O'Leary were concerned about "binge" drinking among women of childbearing age. "The findings that 14.2 percent of women surveyed consumed five or more standard drinks per occasion during the three months prior to pregnancy, and that almost half of the pregnancies were unplanned pregnancies, indicate that many women may have exposed their babies to high levels of alcohol before they were aware of their pregnancy," said O'Leary. In addition, she observed, "the percentage of Australian teenagers who binge drink has increased over the past decade since these data were collected. We need to find ways to reduce the very culture of binge drinking which is particularly concerning in young people as this is when drinking patterns are established."



O'Leary spoke of the need to educate both men and women. "We need to be careful how we frame our health-promotion messages since many women may have consumed alcohol prior to pregnancy awareness and unintentionally exposed their baby to alcohol," she said. "It is important not to generate undue fear and/or guilt. In addition, it is important not to place all the responsibility onto women alone: both women and men need to know about the risks to the baby from the consumption of alcohol during pregnancy; and many women and men need to take better precautions to prevent unplanned pregnancies."







Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Alcohol Consumption During Pregnancy in Non-Indigenous West Australian Women," were: Jan Payne, Deborah E. Parsons, and Carol Bower of the Telethon Institute for Child Health Research at The University of Western Australia; and Jennifer J. Kurinczuk of the National Perinatal Epidemiology Unit at the University of Oxford. The study was funded by the Health Promotion Foundation of Western Australia.



Contact:



Lyn Colvin, M.P.H.


Colleen O'Leary, M.P.H.



Telethon Institute for Child Health Research


Alcoholism: Clinical & Experimental Research

Ovarian Cancer Screening Does Not Appear To Reduce Risk Of Ovarian Cancer Death

In a clinical trial that included nearly 80,000 women, those who received ovarian cancer screening did not have a reduced risk of death from ovarian cancer compared to women who received usual care, but did have an increase in invasive medical procedures and associated harms as a result of being screened, according to a study in the June 8 issue of JAMA, a theme issue on cancer. The study is being published early online to coincide with its presentation at the American Society of Clinical Oncology 2011 Annual Meeting.



In the United States, ovarian cancer is among the 5 leading causes of cancer death in women. Most women with ovarian cancer are diagnosed with advanced stage disease, which has a 5-year survival of only 30 percent. The recognition that early detection of ovarian cancer may have the potential to improve prognosis prompted the development of randomized controlled trials to evaluate the efficacy of transvaginal ultrasound and serum cancer antigen 125 (CA-125) as screening tools to reduce ovarian cancer mortality, according to background information in the article.



Saundra S. Buys, M.D., of the University of Utah Health Sciences Center, Salt Lake City, and colleagues examined the ovarian cancer-specific mortality results from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial to evaluate the effect of screening for ovarian cancer. The randomized controlled trial included 78,216 women, ages 55 to 74 years, assigned to undergo either annual screening (n = 39,105) or usual care (n = 39,111) at 10 screening centers across the United States between November 1993 and July 2001. The intervention group was offered annual screening with CA-125 for 6 years and transvaginal ultrasound for 4 years. Participants and their health care practitioners received the screening test results and managed evaluation of abnormal results. The usual care group was not offered annual screening with CA-125 for 6 years or transvaginal ultrasound but received their usual medical care. Participants were followed up for a maximum of 13 years for cancer diagnoses and death until February 28, 2010.



Through the follow-up period, 212 ovarian cancer cases were diagnosed in the intervention group and 176 cases in the usual care group. There were 118 deaths caused by ovarian cancer in the intervention group and 100 deaths in the usual care group. Analysis of data indicated that the difference in survival between the intervention and usual care groups was not statistically significant.



"All-cause mortality (excluding deaths from ovarian, colorectal, and lung cancer) was similar in the 2 study groups; there were 2,924 deaths in the intervention group and 2,914 deaths in the usual care group. Mortality rates for the major causes of death were generally similar between the 2 study groups," the authors write.
















Of 3,285 women with false-positive results, 1,080 underwent surgery (32.9 percent for oophorectomy [surgical removal of one or both ovaries]) as part of the diagnostic workup. Of these 1,080 women, 163 (15 percent) experienced a total of 222 distinct major complications, which yielded a rate of 20.6 complications per 100 surgical procedures. A total of 1,771 women in the intervention group (7.7 percent) and 1,304 in the usual care group (5.8 percent) reported oophorectomy, with women in the intervention group having a higher rate of oophorectomy than women in the usual care group.



Regarding the outcomes of this trial, the researchers suggest that although the screening tests as used in this study did not reduce mortality, it is possible if used differently that CA-125 and transvaginal ultrasound may have the potential to be beneficial. For example, assessing the changes in CA-125 over time rather than a single CA-125 value as used in this study may allow detection of cancers at an earlier stage when cure is possible. However, there is no evidence from other clinical trials to support this approach at this time. The authors also suggest that even an optimized program of annual screening may be insufficient to detect cancers early enough to reduce mortality. "Evidence from modeling suggests that aggressive cancers progress rapidly through the early stages, limiting the ability to detect these cancers with yearly screening. In contrast, more ovarian cancers were diagnosed in the screened group than in the usual care group (212 vs. 176), suggesting that some of the additional cancers detected by screenings were not clinically important and, if left undetected, may never have caused any symptoms or affected the women during their life-limes (i.e., overdiagnosis)."




"We conclude that annual screening for ovarian cancer as performed in the PLCO trial with simultaneous CA-125 and transvaginal ultrasound does not reduce disease-specific mortality in women at average risk for ovarian cancer but does increase invasive medical procedures and associated harms," the authors write.


JAMA. 2011;305[22]2295-2303.

Low Complication Profile For Pelvic Floor Repair - New Restorelle™ Series Demonstrates Near Zero Mesh Erosion Rate

Mpathy Medical, a rapidly growing medical device company which specializes in restoring pelvic health to women, today announced the findings of a retrospective cohort study carried out by Red Alinsod, MD, FACOG, FACS, ACGE, Laguna Beach, CA. This study demonstrates a low complication profile for Restorelle™, the company's pelvic floor restoration product line, which is constructed with its ultra lightweight Smartmesh™.


In a series of 201 patients and 360 total mesh implantsi, carried out from November 2005 to October 2008, the results report that the use of Restorelle™ is associated with a 0.28% erosion rate and a 99.5% cure rate based on POP-Q assessment of the enrolled patients. The follow up time for this series ranged from 36 months to 2 months, resulting in a mean follow up of 22 months. Important factors regarding patient quality of life were measured and included:


-- No new occurrence of dyspareunia (painful intercourse) attributable to prolapse repair.


-- Non-palpability of the mesh throughout - neither the patient nor partner could feel the implant postoperatively in uncomplicated repairs.


-- 93% patients reporting that their quality of life was "good" or "very good" postoperatively compared to "poor" or "fair" preoperatively.


"The results from this substantial series clearly demonstrate the low complication profile associated with Mpathy Medical's ultra lightweight mesh material when used to surgically manage pelvic organ prolapse," stated Dr. Red Alinsod, South Coast Urogynecology, Laguna Beach, CA. "I have been extremely pleased with the fully functional and restored anatomy which Restorelle™ products help me to deliver to my patients. I have consistently been able to achieve these positive results without my patients or their partners experiencing dyspareunia, which was often present after using previous surgical solutions."


The Food and Drug Administration recently issued a public health notification which reported serious complications associated with transvaginal placement of mesh in the repair of urinary stress incontinence (USI) and pelvic organ prolapse (POP). This announcement came following over 1,000 reports of adverse events associated with mesh from nine manufacturers. These complications ranged from issues that negatively affect the patient's quality of life, such as dispareunia or narrowing of the vaginal wall, to more serious problems that can include chronic pain and require additional surgery to correct.


"We are pleased to share the results from Dr. Alinsod's study," stated Ian Stevens, Chief Executive Officer, Mpathy Medical. "We believe that the recent FDA announcement raises important issues relating to the use of mesh for this type of surgery. We are very confident that Smartmesh™ is the right solution for women and their surgeons, since it is the only product which has been designed specifically with the female anatomy and physiology in mind."















To review the abstract from Dr. Alinsod's series, click here.


Facts on Pelvic Health Conditions:


-- The prevalence of USI and POP increases with ageii.


-- USI affects approximately 1 in 4 women while POP affects up to half of all women over the age of 50.


-- Approximately 20% of women who have symptoms of POP also experience USI.


-- Approximately 200,000 procedures are performed each year to correct USI and POPiii.


-- Women who are obese have a 40-75% increased risk of POPiv.


-- Many women who suffer from USI or POP are unaware of the procedures that are available to correct these problems. A recent study indicated 2/3 of women were not aware of sling procedures to treat USIv.


-- Depression is a common resulting factor of pelvic health conditions. The risk of depression is 40% higher for incontinent women. Women with severe incontinence are 80% more likely to experience depressionvi.


About Mpathy Medical


Mpathy Medical is a rapidly growing medical device company which has developed and brought to market a range of surgical solutions used to restore pelvic health to women. Mpathy Medical's core product lines - Minitape® and Restorelle™ - are used by surgeons specializing in urogynecology, gynecology, and urology to treat female urinary stress incontinence and pelvic organ prolapse. Founded in 2003 by a surgeon, Dr. James Browning, Mpathy Medical supplies the only mesh solutions designed specifically for the female anatomy and physiology. The mesh - branded Smartmesh™ - is a physiologically compatible, ultra lightweight polypropylene mesh which encourages superior collagen growth and works in concert with the patient's own natural tissue for optimum safety and results. The company is headquartered in Glasgow, Scotland with US operations in Raynham, MA and has received 510(k) clearance to market by the FDA in the US and CE marking in the UK for all its medical devices. To learn more about Mpathy Medical, visit www.mpathymedical.


i Many patients received a multi-compartment vaginal repair; therefore, requiring more than one piece of Restorelle™ mesh.


ii Nygaard, I. et al (2008). Prevelance of Symptomatic Pelvic Floor Disorders in US Women. Journal of American Medical Association; 300, 1311-1316.


iii American Urogynecologic Society.


iv American Urogynecologic Society.


v American Academy of Gynecologic Laparoscopists.


vi Nygaard, I. et al (2003). Urinary Stress Incontinence and Depression in Middle-Aged United States Women. The American College of Obstetricians and Gynecologists; 101,149-156.

Sen. Menendez Introduces Bill That Would Increase Postpartum Depression Research

Sen. Robert Menendez (D-N.J.) on Friday said he would introduce a bill (S 1375) that would increase postpartum depression research at NIH and would provide grants to state and local health care workers to increase screening and treatment of the condition, CQ HealthBeat reports (Webber, CQ HealthBeat, 5/11).

The House Energy and Commerce Health Subcommittee earlier this month debated similar legislation (HR 20), sponsored by Rep. Bobby Rush (D-Ill.), that would "expand and intensify" research at the National Institute of Mental Health and other agencies on postpartum depression and postpartum psychosis. The bill also would provide grants through HHS for the "establishment, operation and coordination of effective and cost-efficient systems for the delivery of essential services" for women with the conditions and their families. Some Republicans on the House panel indicated that the measure should be amended to include language on "postabortion depression" (Kaiser Daily Women's Health Policy Report, 5/2).

Menendez's bill includes a provision from Rush's bill requiring NIMH to increase research on postpartum depression and postpartum psychosis. The measure, which is supported by several psychiatric and women's health organizations, does not specify funding amounts for grants or research, but it would authorize "such sums as may be appropriated," Menendez said.

Menendez said the legislation is modeled after a 2006 New Jersey law that provides $4.5 million annually for postpartum depression education and screening and requires health care workers to inform pregnant women about postpartum depression. According to CQ HealthBeat, versions of Rush's and Menendez's measures have been introduced for several years but have never seen action. About 10% to 20% of women experience postpartum depression after giving birth to their first infant, according to NIH estimates (CQ HealthBeat, 5/11).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

China To Augment Fines For Couples Who Violate One-Child Policy According To Income Level

The Chinese government recently ordered local authorities to check incomes and financial statements before issuing fines for couples who violate the national one-child-per-family policy, the South China Morning Post reports (Pinghui, South China Morning Post, 9/15). China's one-child-per-family policy seeks to keep the country's population, now 1.3 billion, at about 1.7 billion by 2050. Methods of enforcing the policy, such as fines and work demotions, vary among Chinese provinces and cities (Kaiser Daily Women's Health Policy Report, 8/27).

According to the Morning Post, the National Population and Family Planning Commission and 10 other ministries and bureaus in a joint statement released on NPFPC's Web site said that fines will be adjusted according to income level. The policy was approved five years ago, but local authorities have not enforced it effectively, the Morning Post reports. The statement said that people who violate the policy will be recorded in the People's Bank of China's credit system, but it did not say how the information would be used, the Morning Post reports.

The statement said influential people and public figures should "set a good example" by following the law. The "relevant authorities must make obeying the family planning regulation a basic requirement of hiring or promoting a cadre," the statement said, adding, "It should be a key factor in deciding whether a person is qualified to be a delegate to the party congress at all levels or as a deputy to the National People's Congress and the Chinese People's Political Consultative Conference." According to the statement, "Any public figure who deliberately violates the policy will be publicly denounced and severely punished according to the law."

According to Reuters, government media recently has released an increasing number of reports about officials, entertainers and business executives having more than one child, and some provinces have scaled up enforcement of the one-child policy (Reuters, 9/15).

Opinion Piece
To enhance China's "long-term economic outlook," the country must recognize that its one-child policy "has been a tragic and historic mistake" and must "abandon it, immediately," Nicholas Eberstadt, resident scholar at the American Enterprise Institute, writes in a related Wall Street Journal opinion piece. According to Eberstadt, the "superficial success" of the policy to reduce the country's fertility rate "comes with immense inadvertent costs and unintended consequences," including China's "incipient aging crisis, its looming family-structure problems and its worrisome gender imbalances."

Some Chinese officials might "worry that the end of the one-child policy might mean the return to the five-child family -- but in reality, modern China is most unlikely to return to preindustrial fertility norms," Eberstadt writes. He concludes, "Trusting China's people to act in their own self-interest ... may very well prove to be the key to whether China ultimately succeeds in abolishing poverty and attaining mass affluence in the decades and generations ahead." According to the Journal, Eberstadt's opinion piece is an excerpt he delivered at a World Economic Forum conference in Dalian, China, earlier this month (Eberstadt, Wall Street Journal, 9/17).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Morpace Inc. Reports: Hispanic American Women Unaware Of Heart Disease Threat

In a national survey
of adults, 60 percent of Hispanic American adult females indicated a lack
of awareness that heart disease is the #1 fatal disease among women.
Further, nearly half are unaware that Hispanic women's risk of heart
disease is greater than that of Caucasian women. Dania Rich-Spencer, Vice
President of Morpace's Health Care practice, said, "Programs such as the Go
Red For Women, founded by the American Heart Association (AHA), have made
great strides in raising awareness of heart disease's impact on women, but
the message apparently has not made its way into Hispanic communities." She
added, "Our research suggests that there is a real opportunity to target
this key ethnic group with educational efforts that raise awareness and
promote prevention strategies."



Rich-Spencer said that the heart disease awareness data comes from the
quarterly Morpace Omnibus Survey, conducted on the Internet in July, 2008,
on a variety of current topics.



About Morpace Inc.



Morpace is a full-service survey research and consulting organization
specializing in automotive, financial services, health care, retail and
technology. Morpace has global expertise in providing innovative
proprietary solutions to clients in four core areas: market definition and
segmentation; product development and pricing; brand and image positioning;
and customer satisfaction and loyalty.



Established in 1941, Morpace Inc., an ISO 9001:2000 certified
organization, is one of the largest privately held marketing research firms
in the United States. Headquartered in Farmington Hills, Michigan the
company has offices in Irvine, California; New York City; and London,
England.



Visit morpace for more information.


Morpace Inc.

morpace

'New And Improved Antiabortion Movement' Still Ignores Needs Of Women, Salon Opinion Piece States

A "new set of antiabortion actors" who are "anti-war, anti-capital punishment, pro-environment 'pro-lifers'" have "emerged as the face of a new and improved antiabortion movement," Salon columnist Frances Kissling writes. Although these advocates supported President Obama in the 2008 election, they "suffer from the same lack of understanding of women's nature and identity as do old-line anti-abortionists," Kissling writes. She notes that this group has "already decided that a political effort to make abortion illegal is hopeless, which helps the pro-choice cause." According to Kissling, "Taking legality off the table" increases the prospects for "rational public discourse about all the factors at play in women's decisions not to continue pregnancy and not to become mothers," but "[w]e are ... far from common ground between the new anti-abortionists and the pro-choice advocates."

Members of this new group believe that data suggesting that many women decide to have abortions for financial reasons prove that "better economic support" for pregnant women "will result in more continued pregnancies and more women embracing motherhood," Kissling writes. In addition, they "assert that if adoption policies were friendlier," more women would choose adoption over abortion, according to Kissling. "But facts have little place in their strategy," as the policies they support "are already in place in much of Europe," and "few women who face unintended pregnancies in those countries opt out of abortion," Kissling writes. She adds, "Something much deeper influences a woman's decision about what to do when she is pregnant and does not want to become a mother -- and the new anti-choicers don't seem to have a clue about what this might be." For this group, "the outcome [of pregnancy] -- the new person -- is obviously so much more valuable than whatever short-term loss or pain the women might experience," Kissling writes. Therefore, they believe it is "not asking much of a woman who faces an unwanted, difficult or unintended pregnancy to shift the plan she had for this time in her life and continue the pregnancy," according to Kissling.

Kissling lists four "positions taken by the new antiabortionists [that] illuminate this flawed thinking." The first is "[d]enying the 'need' for abortion," she writes. Secondly, their "same sense of pregnancy as no big deal influences the new antiabortionists' unwillingness to embrace contraception," Kissling says. She adds that "[i]f we really understood what it meant for women to consent to becoming mothers, we would want them to be able to meet their moral obligation to their own identity by avoiding becoming pregnant." The third position is an attempt to make "sex sacred," Kissling writes, adding that if "creating new life is sacred, then we want men and women to have the tools necessary to fulfill the obligation to create life responsibly and not create it when they cannot -- or choose not to -- bring it to fruition." The fourth position is "[r]edefining adoption," Kissling continues. She asks whether adoption is "now a process of finding children for needy parents," adding, "Might it not be more generous of us as a society to work harder to make it possible for women to keep their children if they so wish?"

Kissling writes that the "challenge to the new antiabortionists" is whether "women's perspectives on the meaning of pregnancy and motherhood will be considered in their project" or if "their ethical frame will remain focused on the fetus." She asks, "How many of these women's decisions will the new antiabortionists be able to say 'yes' to?" Kissling concludes, "So far it seems that it is far more than abortion that is a stumbling block to common ground" (Kissling, Salon, 7/20).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2009 The Advisory Board Company. All rights reserved.