Great Neck OBGYN

Obstetrics and Gynecology

Acupuncture For Depression During Pregnancy
NIH Panel Convenes Committee On VBAC
Pregnancy Weight Gain Increases Diabetes Risk
Retracting A Medical Journal's Autism Study
Dark Chocolate is Linked to Less Maternal Anemia
Staples Tied To Increase In C section Wound Complications
Cochrane Date: Food, Water In Labor OK In Low-Risk Women
Novel Biomarker May Quickly Confirm Ectopic Pregnancy
In Vitro Fertilization & Ovarian Cancer Risk Study
Increased Pregnancy Loss Rate in Thyroid Antibody Negative Women
Effect of Alcohol Consumption On In Vitro Fertilization
Placebo-controlled Trial Of Indole-3-Carbinol In Treatment Of CIN
Dr. Anita Sadaty Quoted In Parents Magazine

Dr. Anita Sadaty Quoted In Parents Magazine

Here are some highlights from the article: Expecting Cold Weather — Stay safe and healthy all season long with these winter-wise strategies in the January 2012 issue of Parents magazine

A big belly can get in the way of a seat belt, but wearing one is a must, especially when icy roads make even the best of drivers somewhat unpredictable. How to wear it right? Place the horizontal strap across your hips and under your belly, and the diagonal strap over your shoulders and between your breasts, says Anita Sadaty, M.D., an ob-gyn at North Shore University Hospital, in Manhasset, New York. If it's stormy out, or road conditions are hazardous, don't drive unless it's necessary."

During pregnancy your center of gravity shifts, which increases your risk of falling — especially on icy sidewalks. To help avoid taking a spill, Dr. Sadaty advises wearing ﬂat, rubber-soled footwear with a tread (avoid leather-soled shoes, which are especially slippery). Hold on to handrails whenever they're available, and try not to carry anything in front of you, which throws o! your balance and occupies your hands, making it more di"cult to cushion a fall.
If you do slip, take your time getting up. Gently turn to one side, then get to your hands and knees, and if possible, use something for stability — such as a car-door handle or a stair rail — as you bring yourself upright. Then give your doctor a quick call, just to be safe. "Luckily your baby is extremely wellprotected in the womb," Dr. Sadaty assures.

Winter is cold-and-ﬂu season, and pregnant woman are especially at risk because the body naturally suppresses the immune system in order to protect the baby, which is essentially foreign tissue. So wash your hands frequently and avoid anyone who's sick. Get plenty of zzz's too. "Studies suggest that the number of infection-ﬁghting T-cells goes down when you don't sleep enough," says Dr. Sadaty. The American College of Obstetricians and Gynecologists also recommends getting an inﬂuenza vaccination during ﬂu season, as women are more prone to serious complications from the ﬂu during pregnancy. (Just avoid the nasal spray ﬂu vaccine, which isn't recommended for moms-to-be.)
If you do get sick, you can safely treat your symptoms with acetaminophen, throat lozenges, pseudoephedrine, saline nasal sprays, and cough medicine, according to Dr. Sadaty. Stay away from cold-and-ﬂu combos, which may contain drugs that aren't safe while you're expecting. You can also relieve stuffiness by adding a few drops of lavender oil to hot water and breathing in the vapors. Other remedies: sipping warm tea with honey and lemon to soothe your throat and eating chicken soup, which is thought to have anti-inﬂammatory and mucus-thinning e!ects, Dr. Sadaty says.

Read the entire article.

Placebo-controlled Trial Of Indole-3-Carbinol In Treatment Of Cervical Intraepithelial Neoplasia (CIN)

A double-blind placebo-controlled study of indole-3-Carbinol. Thirty women with biopsy-proven cervical intraepithelial neoplasia (CIN) received placebo, 200 or 400 mg/day of I3C for 12 weeks. None of the patients in the placebo arm had complete regression of CIN, whereas 4 of 8 (p=0.023) from the 200 mg/day arm and 4 of 9 (p=0.032) from the 400 mg/day arm had complete regression after 12 weeks. The ratio of 2-hydroxyestrone to 16-alpha-hydroxyestrone changed in a dose-dependent fashion. The results of this study show promise for the use of I3C as a nonsurgical option for the treatment of CIN, although the data needs to be confirmed in a large multicenter trial.

Physician commentary: Indole 3 carbinol is a potent anti-oxidant that is a concentrated form of the cancer fighting agents found in cruciferous vegetables. According to this study, intake of I3C was associated with a significant increase in regression of cervical pre-cancerous cell changes. This is particularly exciting given the high incidence of pre-cancer of the cervix in the United States and gives women an opportunity to avoid any procedures on the cervix to treat these abnormalities.

Effect of Alcohol Consumption On In Vitro Fertilization

A study out of brigham and women's hospital published in the January 2011 Obstetrics and Gynecology concludes that consumption of as few as 4 drinks per week is associated with a decrease in IVF live birth rate.

MD commentary: It is well known that alcohol use in pregnancy is linked to birth defects however the effects on fertility are not so well studied. Women who drank at least 4 drinks per week had a 16 percent lower likelihood of live birth compared to women who drank less. Interestingly the odds of having a live birth were 21% lower among COUPLES in which both members drank more than 4 drinks per week. We conclude that alcohol use at the time of IVF cycle start can have a negative effect on fertilization and live birth, and that men and women should modify this behavior to enhance their chances of a successful conception.

Increased Pregnancy Loss Rate in Thyroid Antibody Negative Women With TSH Levels Between 2.5 and 5.0 in the First Trimester of Pregnancy

The study reports pregnancy outcomes in 4123 women who had their TSH (thyroid stimulating hormone) levels measured at the first medical visit during pregnancy. All pregnancies were singleton and spontaneously conceived. Two groups were created on the basis of TSH levels: < 2.5 mIU/l (n = 3481) and 2.5-5.0 mIU/l (n = 642). Age and parity were comparable. The mean gestational age for the first prenatal visit was also similar (between 8-9 weeks).

The pregnancy loss rate was 3.6% in women with a TSH level of < 2.5 mIU/l, and 6.1% in women with TSH levels between 2.5 and 5.0 mIU/l. This difference was statistically significant. Within the 2 TSH groups, age, obstetric history, and thyroid function test did not differ between those who miscarried and those who did not. The risk for miscarriage increased by 15% for each 1 mIU/l elevation of the TSH level on the basis of logistic regression analysis. The risk for preterm delivery and very preterm delivery did not differ on the basis of TSH levels.

MD commentary: This study underscores the need for optimization of thyroid function in women who are already diagnosed with underactive thyroid and also points to an additional screening tool for evaluating women with miscarriages not associated with chromosomal abnormalities.

In Vitro Fertilization & Ovarian Cancer Risk Study

In a paper published in the journal Human Reproduction just a month ago, a very large database was examined. More than 24,000 women who had been treated with in vitro fertilization were studied, and the data show rather convincingly that although there is clearly an association between infertility and the development of ovarian cancer, women who had undergone in vitro fertilization compared with women who had infertility and had not undergone in vitro fertilization, there was in fact no increase in the risk for ovarian cancer. These are very important data, particularly for women who have experienced infertility and are considering in vitro fertilization — and all the benefits that clearly provides in terms of being able to have children — and this is very reassuring information that there is no increased risk for the development of ovarian cancer following this procedure.

MD commentary: It is often of concern for patients who have undergone infertility treatment with powerful hormone therapy that they may be increasing their long term risks for ovarian cancer. This large database supports the currently held opinion that the infertility treatment does NOT increase the risk for developing ovarian cancer above the background risk.

Novel Biomarker May Quickly Confirm Ectopic Pregnancy

A new biomarker may result in earlier diagnosis of ectopic pregnancy, according to a study published recently in the Journal of Clinical Endocrinology & Metabolism.

Investigators proposed that ectopic pregnancies, or pregnancies that implant outside of the uterus (most commonly in the fallopian tube), may release smaller or different amounts of a placental tissue specific hormone than pregnancies that implant in the uterus. They conducted a small study of 40 women comparing the amount of PGIF, placental growth factor, found in the serum of women undergoing surgery for either pregnancy termination, miscarriage or removal of ectopic pregnancy. The investigators found that serum PIGF levels were not detected in tubal ectopic pregnancies and were limited or undetectable in miscarriage compared with terminated viable pregnancies.

This could be very useful in determining whether or not a pregnancy is normal very early in the process compared to current techniques that rely and serial ultrasound exams and serial bhcg pregnancy levels. Researchers recommend larger scale studies to determine if this would be helpful in the clincial setting.

Staples Tied to Increase in C section Wound Complications

Staple closure at cesarean delivery was associated with more than a fourfold increased risk of wound separation compared with subcuticular closure according to a large prospective randomized study. The wound separation rate in the staple group was 17% compared to the suture group 5%. There were however similar rates of wound infection in both groups.

MD commentary: It is reassuring to know that a closure method that we have adopted as a group has been shown to result in fewer complications for our patients. The study did remark that more women in the staple group had more prior c sections, and a higher incidence of chorioamnionitis, which may be independent risk factors for wound separation to begin with...

Cochrane Date: Food, Water in Labor OK In Low-Risk Women

In women at low risk of needing general anesthesia during childbirth, there was no significant association with eating and drinking during labor and the rate of cesarean delivery, operative vaginal birth, or Apgar scores of less than 7 at 5 minutes. A Cochrane database review of 5 studies comprising 3,130 women, concludes that women at low risk of complications during childbirth should be allowed to take food and water as they desire during the active phase of labor.

MD commentary: I applaud the move to open the discussion regarding such strict guidelines for the majority of low-risk women in labor. I think it is certainly reasonable to begin allowing a more flexible clear fluid drinking schedule and light eating in the early phases of labor. However, during active labor, it is difficult to predict which patient may turn into a high risk situation. It will be interesting to hear if ACOG begins to relax their recommendations given this analysis.

Dark Chocolate is Linked to Less Maternal Anemia

A daily dosage of 30 grams of dark chocolate during pregnancy was associated with a lower blood pressures and a reduced risk of anemia. Yale University investigators reported that in a study including 2,291 pregnant women, dark chocolate consumption was associated with a lower risk of pre-eclampsia as well.

MD commentary: It's an appealing concept that a pleasure food actually may be associated with health benefits for pregnant moms.

Acupuncture For Depression During Pregnancy

In March 2010 issue of Obstetrics and Gynecology, a study of 150 pregnant women randomized to acupuncture specific for depression or either a control acupuncture or massage group for 8 weeks demonstrated a significant decrease in depressive symptoms in the treatment arm. This may be a safe option or alternative for women experiencing depression in pregnancy who prefer to avoid medication exposure.

NIH Panel Convenes Committee On VBAC

The NIH Consensus Conference on Vaginal Birth After Cesarean has just released its findings offering strong support for a far more liberal policy regarding vaginal birth after C-section (VBAC). In 1980, after reviewing the scientific literature, an NIH panel recommended offering a trial of labor to women who had had a previous C-section. As a result, VBAC became popular. Many women had successful vaginal deliveries. Only a very small proportion of women had serious complications, almost exactly what was predicted. Yet the VBAC rate peaked in 1997 and has declined precipitously since.

Why did VBACs decline despite the fact that the benefits and risks were exactly as predicted? The answer can be summed up in one word: lawsuits. Although women offered VBAC were counseled about the small risk of uterine rupture (opening of the uterine scar during labor) and the attendant risk that the baby might die in the event of a rupture. Nonetheless, when a baby died after a uterine rupture, many mothers sued, and claimed that they had not "understood" the risks, even though those risks were clearly explained. Juries were moved by these emotional appeals, and large judgments were paid out.

The American College of Obstetricians (ACOG) stepped into the breach and, attempting to make things better, made them far worse. Unfortunately, the ACOG guidelines were so strict (unreasonably strict in the eyes of most obstetricians) that most obstetricians could not meet them. ACOG mandated that VBAC should only be attempted when both an anesthesiologist and obstetrician were present so that anyone who experienced a uterine rupture could be treated immediately. Most medium sized and small hospitals cannot afford to have an anesthesiologist in the hospital around the clock. Most obstetricians cannot afford to sit for hours while a patient labors. Therefore, many hospitals and anesthesiologists stopped offering VBAC.

The latest NIH panel reviewed the scientific literature and confirmed their earlier stance. VBAC should be offered to eligible women because the chance of success is high and the risk of complications is low. Furthermore, the conference report urged ACOG to re-evaluate their VBAC guidelines, presumably to eliminate the need for continuous presence of both anesthesiologist and obstetricians. In addition, the panel recommended that policy makers review the medico-legal strictures on VBAC, since liability concerns are driving the restriction of VBACs.

So doctors, patients and NIH are in agreement that VBAC should be offered to many more women. Too bad the lawyers don't agree, since they seem to be in charge of making the decision, and they recommend C-section.

Great Neck Obstetrics and Gynecology offers our patients the option to attempt Vaginal Birth After Cesarean if they are appropriate candidates for VBAC. We are able to offer 24 hour anesthesiology and OR availability at North Shore University Hospital in Manhasset, in the unlikely event of a uterine rupture in labor. Hopefully with a national committment to continue to investigate this health issue and with continued efforts to educate patients, doctors and hospitals alike, we may be able encourage doctors and hospitals to offer patients this option,and begin to see an appropriate increase in VBAC rates in our country.

Pregnancy Weight Gain Increases Diabetes Risk

Pregnancy Weight Gain Weight gain during pregnancy, especially in the first trimester, could increase women's risk of developing diabetes later in their pregnancy, according to a new study. The study by the Kaiser Permanente Division of Research appears online in the current issue of Obstetrics and Gynecology.

The three-year study of 1,145 pregnant women from an ethnically diverse population found that women who gained more weight than is recommended by the Institute of Medicine had a 50 per cent increased risk of developing gestational diabetes mellitus.

Retracting A Medical Journal's Autism Study

Autism Study Last week, the highly regarded medical journal, The Lancet, retracted a much debated 1998 study that had linked the measles, mumps and rubella vaccine to autism.

The study was retracted after concerns about ethical breaches by one of the study authors. In addition, 10 of the 13 co-authors have disavowed the study's conclusions. "We fully retract this paper from the published record," The Lancet editors said in a statement.

But the damage has been done. The paper has fueled fears about the risks of childhood vaccinations and autism, particularly the M.M.R. vaccine, despite numerous studies showing no link.

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