The group Campaign Against Unwanted Pregnancy recently held a workshop in Ota, Nigeria, to educate the media about unintended pregnancies and unsafe abortions by discussing case studies of abortion-related complications, Nigeria’s Daily Champion reports.

According to the Daily Champion, about 760,000 abortions are performed annually in Nigeria, about 140,000 of which result in hospitalizations from complications. In addition, unsafe abortion is a main contributing factor to Nigeria’s high maternal mortality rate of 800 deaths per 100,000 live births annually, the Daily Champion reports. According to a recent study by CAUP, most women in Nigeria undergo at least one clandestine abortion by age 49.

CAUP Executive Director Boniface Oye-Adeniran at the conference said that a lack of sex education and availability of reproductive health care are contributing to the high number of abortions performed in the country. “These women … continue to die because the society is hypocritical, the laws are restrictive, and [there is] low use of contraceptives and family planning services.” Isaac Adewole, a professor in the Department of Obstetrics and Gynecology at the University of Ibadan, called on policymakers to review current abortion policies and for improved medical, reproductive and family planning services, the Daily Champion reports (Udoh, Daily Champion, 9/13).

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.

Researchers at the University of Texas Medical Branch at Galveston are trying to determine whether a drug already available to heart patients can also be used to delay delivery in expectant mothers with severe preeclampsia. If so, this groundbreaking study would give hope to hundreds of thousands of women who experience this life-threatening disorder each year.

The drug, Digibind, has been prescribed for over 20 years to patients who overdose on a certain heart medication, but is not yet approved for preeclampsia, the most common and dangerous pregnancy complication affecting as many as eight in every 100 pregnant women. The disorder is characterized by high blood pressure, protein in the urine and multi-organ dysfunction, all of which can seriously harm both mother and fetus.

“Preeclampsia is the No. 1 killer of pregnant women in the world, and there is no cure except delivery,” said Dr. George Saade, chief of maternal-fetal medicine at UTMB. “When it is severe and occurs early in the pregnancy, delivery in order to protect the mother results in a premature baby. That’s why this study is important, because if the medication works, then we can protect the mom while allowing the baby to grow and develop without delivering early.”

The clinical trial will test whether Digibind reverses or prevents the abnormalities that occur with preeclampsia and allows the fetus to remain in the womb longer. This would give doctors more time to administer steroids to prevent respiratory complications in premature births and reduce the need for costly and lengthy neonatal intensive care.

“Right now, there is no treatment for preeclampsia, so this is truly groundbreaking,” said Dr. Nicole Ruddock, the study’s principal investigator and an instructor in UTMB’s Department of Obstetrics and Gynecology.

###

UTMB will continue enrolling participants at least through the end of this year. The study is sponsored by Protherics and is taking place in eight states around the country.

The University of Texas Medical Branch at Galveston
Public Affairs Office
301 University Boulevard, Suite 3.102
Galveston, Texas 77555-0144
utmb.edu/

Source: Kristen Hensley

University of Texas Medical Branch at Galveston

A study published on bmj
suggests that it is possible for proponents of euthanasia legalization
and advocates of better palliative care services to work together for a
common good.

Researcher Jan Berheim (End-of Life Care Researcher Group of
the Vrije Universiteit Brussel) and colleagues write that the
two prevailing schools of antagonistic and differing attitudes
regarding palliative care and euthanasia fail to recognize that they
are, “Both based on medical and ethical values of patient autonomy and
caregiver beneficence and non-maleficence.”

Euthanasia is the practice of using medicine to assist death, and
palliative care is an approach to treatment designed to reduce the
severity of disease symptoms instead of curing the disease or delaying
its progression.

The researchers conducted a historical review of regulatory and
epidemiology evidence from Belgium – the second country to
decriminalize the practice of euthanasia (in 2002). Belgium also places
third, after Iceland and the UK, in rankings of the best palliative
care systems.

Berheim and colleagues point out that in Belgium, euthanasia and
palliative care practices have actually helped each other. In one
direction, the political and social movement to legalize euthanasia
prompted the development of palliative care. In the other direction,
the fact that sufficient palliative care was obtainable led to ethical
and political acceptance that enabled then legalization of euthanasia.

The development of these two movements, according to the authors,
developed coincidentally with shared workers, and this is one reason
that the debate in Belgium was not caustic. The debate about euthanasia
grew side-by-side with provisions for palliative care.

The researchers failed to find evidence of increased harm to vulnerable
patients or disabled people due to the legalization of euthanasia. In
addition, although The
European Association for Palliative Care expressed concern,
legalization did not stop the development of palliative care in
Belgium. As the law became closer to being enacted, reports of secret
physician-assisted dying and other ethically disputable
practices actually
declined.

The view among advocates of euthanasia in Belgium was that palliative
care complements euthanasia instead of competing with it. Euthanasia is
seen as an option at the end of the palliative care pathway, focusing
on the preferences of the patient.

Support for palliative care is seen in the euthanasia law that was
passed in Belgium. The law mandates that patients who are interested in
euthanasia must be informed about potential palliative care,
and at the same time the law was passes, a second Act was passed that
doubled public funding for palliative care and guaranteed the right to
palliative care in every hospital, nursing home, and even
at home.

The researchers argue that, “The process of legalisation of euthanasia
was ethically, professionally, politically, and financially linked to
the development of palliative care.”

“The societal debates made clear that most values
of palliative care workers and advocates of euthanasia are shared. If
Belgium’s experience applies elsewhere, advocates of the legalisation
of euthanasia have every reason to promote palliative care, and
activists for palliative care need not oppose the legalisation of
euthanasia,” conclude the authors.

Development of Palliative Care and Legalisation of Euthanasia:
antagonism or synergy?
Jan L Bernheim, Reginald Deschepper, Wim Distelmans, ArsГЁne Mullie,
Johan Bilsen health scientist
BMJ. Vol 336. pp 864. (April 2008)
Click
Here to See Article Online

: Peter M Crosta

Cook Medical, the world’s largest private medical device company, and Gynecor, a global anatomic pathology laboratory devoted to gynaecology, announce their partnership to provide the Tao Brush™ to obstetricians and gynaecologists across the country, offering a fast and gentle method of endometrial biopsy with minimal patient discomfort. The Tao Brush is designed and manufactured by Cook Medical, and this partnership makes Gynecor the exclusive distributor of the Tao Brush in the UK and the US.

The Tao Brush is an integral part of Gynecor’s TruTest™ endometrial biopsy kit, which incorporates a gentle brushing technique to collect a uterine biopsy from a patient. The brush is enclosed in a sheath that protects the bristles from contamination during insertion and protects all collected biopsy tissue during removal. The brush and the tissue specimen are then sent to the Gynecor laboratory for processing and interpretation.

Every year more than 6,400 cases of uterine cancer are diagnosed in the UK, leading to 1,650 deaths. With this new device, the diagnosis of such uterine cancer will become much easier and less painful for the patient. Unlike other forms of endometrial biopsy that incorporate suction or cutting to remove multiple pieces of uterine tissue, the Tao Brush uses soft bristles to procure an adequate representative sample of the patient’s endometrium, facilitating early detection of abnormal cells.

Tissue collection with the brush minimises patient discomfort, potential damage to the uterus and the potential for cancer cells being missed. The Tao Brush is able to sample up to sixty percent of the endometrial lining, as compared to roughly four percent with the most commonly used suction-based device.

In addition to the brush, Gynecor’s TruTest kit contains a proprietary fixative that allows pathologists to evaluate both the tissue and the cells the Tao Brush collected. No other current diagnostic test provides both tissue and cell testing from one specimen. STD results such as HPV, Chlamydia and gonorrhoea can also be ordered as part of the TruTest.

In announcing the partnership, Christina AnnГ©, Cook Women’s Health strategic business unit leader, emphasised Cook’s focus on quality of life for the female patient: “The strategic partnership between Cook and Gynecor helps meet two of our important objectives. First, TruTest with the Tao Brush improves the quality of life of the female patient by providing a more gentle procedure that minimises the pain from conventional uterine biopsies, while providing specimens that can be better tested. The test’s fast turnaround time may also help stem the patient’s anxiety. Secondly, together, our partnership provides physicians with a state-of-the-art diagnostic test that can effectively detect early signs of endometrial cancer. As we know, early detection most often means early treatment and potentially better outcomes.”

Alison Lippincott, vice president of marketing for Gynecor, adds: “Cook’s objectives align with Gynecor’s core value of putting the patient first. No woman should have to go through a painful procedure, wait over a week for results, and risk not getting a clear diagnosis. Our goal is to address these issues by offering a comprehensive picture of the patients’ uterine health with less discomfort and a more definitive result in the shortest amount of time possible.”

About Cook Medical

Cook Medical was the first company to introduce interventional devices in the United States. Today, the company participates in all global markets, integrating device design, biopharma, gene and cell therapy and biotechnology to enhance patient safety and improve clinical outcomes. Cook won the prestigious Medical Device Manufacturer of the Year for 2006 from Medical Device and Diagnostic Industry magazine.

cookmedical

About Cook Women’s Health

The Cook Women’s Health Strategic Business Unit specialises in interventional and biodesigned technologies that support assisted reproduction, pelvic reconstruction, incontinence, high-risk obstetrics and gynaecologic procedures.

About Gynecor™

Gynecor is the only full-service anatomic pathology laboratory devoted exclusively to gynaecology with a special focus on the diseases of the female tract. Its exceptional staff includes board-certified pathologists and cyto-pathologists, an international sales force, and a dedicated client services team. Gynecor’s mission is to deliver fast and accurate testing results. Gynecor’s unique TruTest kits are currently processed in its Orlando, Fla. and Phoenix, Ariz., facilities and will soon to be added to the Gynecor facilities in Richmond, Va., Uniondale, N.Y .and London, England.

gynecor

Although prescription medications that may increase the risk of birth defects are commonly used by women in their childbearing years, only about half receive contraceptive counseling from their health care providers, according to a large-scale study from the University of Pittsburgh School of Medicine reported in the Sept. 18 issue of the Annals of Internal Medicine.

“We found that over the course of a year, one in six women of reproductive age filled a prescription for a medication labeled by the Food and Drug Administration as increasing the risk of fetal abnormalities,” said Eleanor Bimla Schwarz, M.D., assistant professor in the departments of medicine and obstetrics, gynecology and reproductive medicine at the University of Pittsburgh School of Medicine and first study author. “Unfortunately, many women filling prescriptions that can increase risk of birth defects remain at risk of pregnancy.”

Half of pregnancies in the United States are unintended, according to national estimates. While regular use of contraception can prevent unplanned pregnancies, women filling prescriptions that can increase the risk of birth defects are no more likely to use contraception than other women, the study authors note.

For this investigation, Dr. Schwarz and colleagues studied patient data related to all prescriptions filled by 488,175 reproductive-aged women enrolled with a large managed health care plan during 2001. Prescriptions involved drugs considered safe for use in pregnancy and those labeled as posing a fetal risk.

The researchers examined use of contraception and results of pregnancy tests. When they compared medications labeled as increasing the risk of birth defects to safer medications, the researchers found little difference in rates of contraceptive counseling, use of contraception or subsequent pregnancy test results.

“Many women — and perhaps their physicians — may be unaware of the risks associated with the use of some medications, the chance that women may become pregnant, or both,” said Dr. Schwarz, who also is an assistant investigator at the Pitt-affiliated Magee-Womens Research Institute. “The scary thing is that we know women in other primary care health care settings are even less likely to get information about birth control.”

While about half of the women in this study had received contraceptive counseling, other studies have shown that nationwide, only about 20 percent of women are advised to use birth control when they receive potentially dangerous medications.

“While efforts are needed to ensure that women get information about birth control and the risk of medication-induced birth defects, it also is important to realize that different birth control methods are not equally effective,” she said. “Women who were using the most effective methods of contraception, such as the intrauterine device or IUD, were least likely to have a positive pregnancy test after filling a prescription for a potentially dangerous medication.”

The researchers found that internists and family practitioners prescribed the largest proportion (48 percent) of riskier medications to women of childbearing age. Psychiatrists prescribed 15 percent of these drugs; dermatologists, 12 percent; obstetrician/gynecologists, 6 percent; and pediatricians, 3 percent, according to the study.

“Women should not avoid using prescription medications, but clinicians need to remember that sometimes birth control is needed until a woman is ready to have a healthy pregnancy and a healthy baby,” Dr. Schwarz added.

###

This study was funded by the National Institute of Child Health and Human Development and an unrestricted grant from Duramed Pharmaceuticals.

In addition to Dr. Schwarz, other authors are Debbie A. Postlethwaite, R.N.P.; Yun-Yi Hung, Ph.D.; and Mary Anne Armstrong, M.A., of Kaiser Permanente Northern California.

Source: Michele Baum

University of Pittsburgh Schools of the Health Sciences

Repeated courses of a drug that is used to improve the survival of unborn premature babies also may increase the risk of cerebral palsy in those children, according to results from a multi center study, funded by the National Institutes of Health and led by Ronald Wapner, M.D., professor of obstetrics and gynecology, Columbia University Medical Center and attending obstetrician and gynecologist at NewYork-Presbyterian Hospital/Columbia.

Results of the study are published in the Sept. 20, 2007 issue of the New England Journal of Medicine.

The drug a corticosteroid called betamethasone is given to women at risk of premature delivery to hasten the development of their baby’s lungs. One course of steroids has been shown to reduce neonatal mortality and improve lung function with little risk to the infant (citation: NIH Consensus Panel on antenatal corticosteroids, 1994).

Up until the year 2000, obstetrician-gynecologists frequently repeated the course of steroids every week, up to 10 to 11 times, in women who remained pregnant after the first course. A NIH panel that year, concerned with the lack of safety data for this practice, suggested multiple courses should be strictly reserved for patients enrolled in clinical trials.

In one of the first such trials to examine the long-term effects of the treatment on the children, women who remained pregnant a week after the initial course of corticosteroids were randomly assigned to weekly courses of corticosteroids or placebo until their babies were born.

The study, performed by members of the NIH-sponsored Maternal-Fetal Medicine Network followed a total of 556 infants at the Morgan Stanley Children’s Hospital of NewYork-Presbyterian Hospital/Columbia and 12 other sites around the country, and found that by ages two to three, the two groups of children were physically and neurologically identical, except that six out of 248 children who received multiple courses of corticosteroids had been diagnosed with cerebral palsy, compared to only 1 out of 238 children in the placebo group. The mothers of all six children with cerebral palsy in the corticosteroid group had received four or more courses of the drug.

Although the difference in number of children with cerebral palsy was not statistically significant, Dr. Wapner says that since weekly courses had no long-term benefit and potentially may harm the child, doctors should not administer multiple weekly courses of corticosteroids.

This research was supported by the National Institute of Child Health and Human Development of the National Institutes of Health.

Columbia University Medical Center
701 W. 168th St., HHSC 206
New York, NY 10032
United States
cumclumbia.edu

Scientists in California are reporting an advance toward rapid testing for pre-natal detection of Down syndrome and other birth defects that involve an abnormal number of chromosomes.

In a study scheduled for the Oct. 1, 2007 issue of ACS’ journal, Analytical Chemistry, Stanford University bioengineering professor and Howard Hughes Medical Institute researcher Stephen R. Quake and his graduate student H. Christina Fan point out that most existing pre-natal tests depend on a technique termed karyotyping. It requires a two-week wait for anxious parents, while cells taken with amniocentesis or chorionic villus sampling are grown in laboratory culture and analyzed.

Laboratory studies with the new method produced accurate results within two hours. The test is a variation of the famed polymerase chain reaction (PCR) — the basis of the genetic engineering revolution — which produces thousands of identical copies of minute samples of DNA.

Using a technique known as the digital polymerase chain reaction, Quake and Fan replicated DNA from two cultures of cells growing in the laboratory. One consisted of a normal human cell line and the other had human cells with the Down variant. The digital PCR process allowed the researchers to count DNA molecules from the samples, substituting for the two-week cell culture process traditionally needed to produce enough DNA for karyotyping. With the precision derived from counting individual DNA molecules, researchers then were able to move ahead without delay and determine which samples had the extra chromosome that indicates Down syndrome.

The digital PCR was performed in a commercially available microfluidic chip. The samples were loaded onto the chip, and then partitioned into thousands of chambers by microscopic mechanical valves. While PCR was performed, fluorescent material in the compartments containing individual DNA molecules lit up like an array of LEDs, while those without DNA did not glow. The technique enabled researchers to confirm the presence of abnormal chromosomes typical of Down syndrome with great accuracy.

Rapid testing alternatives already exist, but they are either too labor-intensive or not applicable to the whole population. “The technique we present in this paper can overcome these limitations. It is rapid and simple. We estimate that the entire procedure from sample collection to result readout would take only a few hours, substantially reducing the anxiety of the expectant parents,” Quake said.

The test is also potentially cheaper than other available methods and semi-automated, reducing the workload of lab personnel. And since the digital PCR technique is based on commercially available lab equipment, any interested physician could use it.

“We are confident that it will work on clinical samples of amniotic fluid or chorionic villus,” Fran said. The next step is to begin clinical trials to evaluate the sensitivity and specificity of the new test. The authors believe the new test could be available in as little as one year.

In addition, Quake cited the possibility that the method could lead to a blood test for Down syndrome. It would involve capturing fetal cells, which leak through the placenta and circulate in the mother’s blood, and analyzing their DNA for abnormalities with digital PCR. Other research groups are also investigating a digital PCR-based Down syndrome test, he noted.

As a non-invasive test, it would be the safest approach to prenatal diagnosis of Down syndrome, since both amniocentesis and chorionic villus sampling pose risks to the fetus. Quake noted, however, that new techniques to separate the small fraction of fetal DNA in a mother’s bloodstream must be developed before a blood test could be developed and tested.

###

The American Chemical Society — the world’s largest scientific society — is a nonprofit organization chartered by the U.S. Congress and a global leader in providing access to chemistry-related research through its multiple databases, peer-reviewed journals and scientific conferences. Its main offices are in Washington, D.C., and Columbus, Ohio.

Paper:
“Detection of Aneuploidy with Digital Polymerase Chain Reaction”
ac0709394

Print publication date: Oct. 1, 2007 ASAP (online) date: Aug. 28, 2007

Researcher contact information:
Stephen R. Quake, Ph.D.
Department of Bioengineering
Stanford University
Howard Hughes Medical Institute
Stanford, CA 94305

Source: Michael Bernstein

American Chemical Society

Teens exposed to secondhand smoke at home are at increased risk of test failure in school, suggests a new study in the Journal of Adolescent Health.

“Our retrospective study suggests that in adolescents, secondhand smoke exposure could interfere with academic test performance,” said lead author Bradley Collins, Ph.D., assistant professor of public health and director of the Health Behavior Research Clinic at Temple University.

Taking other known risk factors into account for example, socioeconomic status, gender, prenatal exposure to smoking and active smoking during adolescence Collins and his colleagues found that exposure to secondhand smoke at home decreased the odds of passing standardized achievement tests by 30 percent in 16 and 18 year-olds. Surprisingly, the study found that when examining the effects of prenatal tobacco exposure and secondhand smoke together, prenatal exposure did not influence test performance.

These study results bolster growing evidence of academic-related secondhand smoke consequences beyond the known health consequences, and should further encourage efforts to reduce this environmental threat, the researchers stated.

“It’s important that we help smoking parents learn how to reduce their children’s exposure to secondhand smoke, a goal that can be achieved without requiring the parent to immediately quit smoking, although that’s the ultimate goal for the health of the entire family,” said Collins. Current smoking cessation success rates are low, ranging from 20 percent to 28 percent in the United States.

The researchers, who analyzed data from 6,380 pregnant women and children from the 1958 British National Child Development Study, initially were interested in the long term effects of prenatal exposure to smoking on adolescent achievement test performance when controlling for the effects of secondhand smoke exposure during adolescence. They found it interesting that secondhand smoke exposure trumped prenatal exposure.

The researchers note that the United States and the United Kingdom share similar statistics on smoking: Approximately one third of women in their childbearing years are smokers, 10 percent to15 percent of women report smoking during pregnancy, and up to 60 percent of children may be exposed to smoke at home.

The study did not reveal why secondhand smoke influenced failure, and the researchers were unable to include other known factors, for example, learning disabilities, that could also affect learning and academic test performance. However, prior research has linked exposure to prenatal smoke to a higher risk of cognitive and academic defects, learning disabilities and impulsivity. But few studies have looked simultaneously at the effects of both prenatal and environmental exposure to smoking on academic achievement beyond childhood and into adolescence.

Collins currently is conducting a smoking treatment research study that is focused on reducing young children’s exposure to secondhand smoke, breaking down behavior changes into smaller steps. He is one of a few researchers looking at smoking in underserved, high-risk populations and helping them find solutions that don’t require smoking abstinence as the first-step goal.

Coauthors on this study included Paul Wileyto from the University of Pennsylvania, Michael F.G. Murphy from Oxford University, and Marcus R. MunafГІ from the University of Bristol in the U.K.

Temple University
301 University Services Bldg.1601 North Broad St.
Philadelphia, PA 19122
United States
temple.edu

HIV-positive women who want to become pregnant should be informed that pregnancy is safer during the early clinical stages of the virus, when CD4+ T cell counts are higher, according to a study published recently in Tropical Medicine & International Health, Uganda’s Monitor reports.

Lieve Van der Paal of Uganda’s Medical Research Council and colleagues from the Uganda Virus Research Institute examined the medical records of 139 HIV-positive women of reproductive age residing in southwestern Uganda who were in a clinical group established in 1990. The researchers examined the effect of pregnancy on HIV progression and survival among HIV-positive women before the introduction of antiretroviral drugs.

The study found that women who became pregnant had higher CD4 counts when they enrolled in the study and that they had a slower decline of CD4 cells than those who did not become pregnant. The study also found that CD4 counts declined faster after pregnancy. The researchers concluded that the “initial comparative immunological advantage possessed by fertile women before they become pregnant is subsequently lost as a result of their pregnancy.” The researchers suggested that women taking antiretrovirals who have low CD4 counts wait until their CD4 counts have increased before becoming pregnant.

According to the study, HIV-positive women who want to become pregnant should be warned about the potential negative effect a pregnancy could have on their immune system’s ability to fight HIV and should be offered contraception. Pregnant women living with HIV who are eligible for antiretroviral therapy “should be offered such treatment as a priority group since they are at high risk for fast progression” of HIV and because the antiretrovirals will help prevent mother-to-child HIV transmission, the study said. The study also found that since the introduction of a program aimed at preventing mother-to-child transmission, less than 5% of HIV-positive mothers in southwest Uganda do not breast-feed (Kirunda, Monitor, 9/17).


An abstract of the study is available online.

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.

A new study may help put to rest fears that pregnancy accelerates progression to full-blown AIDS in women with HIV receiving antiretroviral therapy. The study, published in the October 1st issue of the Journal of Infectious Diseases and now available online, revealed that pregnancy may, in fact, slow disease progression in these women.

Before the advent of highly active antiretroviral therapy (HAART), many women with HIV infection or AIDS were told that becoming pregnant would be unwise because there was thought to be a 25 percent risk of transmitting the virus to the child and that the effects of pregnancy on disease progression were unclear. It is now clear that the use of HAART in pregnancy can reduce the HIV transmission to the newborn to approximately 1 percent, but the effects of pregnancy on the HIV-infected woman remain unknown.

To determine the effects of pregnancy on HIV disease progression in the HAART era, Timothy R. Sterling, MD, and colleagues at Vanderbilt University performed an observational study of HIV-infected women between 1997 and 2004. Disease progression was defined as experiencing an AIDS-defining event such as Kaposi’s sarcoma, Pneumocystis carinii pneumonia, or Candida fungal infection of the esophagus; or death. Of the 759 women studied, 71 percent (540) were receiving HAART. Eighteen percent (139) of women studied had one or more pregnancy during this study.

Based on the results of studies conducted before HAART, researchers had expected there might be no difference in HIV disease progression between pregnant and non-pregnant women. What Sterling and colleagues found was that women who became pregnant actually had a lower risk of HIV disease progression and were healthier than women who did not become pregnant. Women experienced a lower risk of disease progression both before and after pregnancy. This may be a result of the healthier immune status of women who become pregnant and/or a beneficial interaction between pregnancy and HAART.

Although the pregnant women in the study were younger than the non-pregnant women, had higher initial CD4+ lymphocyte counts (white blood cells that are attacked by HIV), and a smaller amount of HIV RNA in their plasma, their risk of disease progression remained lower even after factoring in these differences. Nor did it matter that the pregnant women also were more likely to receive HAART and more likely to attend clinic appointments.

Additionally, women with multiple pregnancies during follow-up tended to have a lower risk of disease progression than did women with only one pregnancy. Sterling notes, “This apparent dose-response relationship supports a possible protective effect of pregnancy on disease progression. Pregnancy is associated with a complex set of immunological changes during the gestation period, which may provide additional benefit to the mother’s health.”

In an accompanying editorial, Kathryn Anastos, MD, of the Albert Einstein College of Medicine emphasized that although understanding of this complexity is not complete,

Dr. Sterling’s study gives hope that correlative studies of the immune response to pregnancy and the influence of pregnancy on HIV disease may help to provide the needed information.

Dr. Anastos suggested that this information may be of particular significance to women in resource-limited communities, who generally bear more children than do those in higher-resource communities. She noted that “women can now have greater confidence that in addition to protecting their children from [mother-to-child transmission of HIV] with HAART, their own health will not be compromised by pregnancy, which would place their children at long-term risk…the findings by Sterling and coworkers suggest that at least for HIV disease progression, the odds may be in their favor.”

Fast facts:

1) Women who became pregnant had a lower risk of HIV disease progression and were healthier than women who did not become pregnant.

2) Women with multiple pregnancies during follow-up tended to have a lower risk of disease progression than women with one pregnancy.

3) Currently, nearly all mother-to-child transmission can be prevented by the administration of appropriate HAART regimens during pregnancy and delivery, with postnatal treatment for the infant.

###

Founded in 1904, The Journal of Infectious Diseases is the premier publication in the Western Hemisphere for original research on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune mechanisms. Articles in JID include research results from microbiology, immunology, epidemiology, and related disciplines. JID is published under the auspices of the Infectious Diseases Society of America (IDSA). Based in Alexandria, Va., IDSA is a professional society representing more than 8,000 physicians and scientists who specialize in infectious diseases. Nested within the IDSA, the HIV Medicine Association (HIVMA) is the professional home for more than 3,400 physicians, scientists and other health care professionals dedicated to the field of HIV/AIDS. HIVMA promotes quality in HIV care and advocates policies that ensure a comprehensive and humane response to the AIDS pandemic informed by science and social justice. For more information, visit idsociety/ and hivma/.

Source: Steve Baragona

Infectious Diseases Society of America