Science Friday: Recurrent miscarriage raises heart attack risk.

December 2, 2010

Recurrent miscarriage increases a woman’s chance of having a heart attack fivefold in later life, indicates research published online in the journal

Research indicates that miscarriage is one of the commonest complications of pregnancy, occurring in up to one in five pregnancies.

The authors base their findings on more than 11,500 women who were taking part in the Heidelberg arm of EPIC, a large European study that is tracking the impact of diet and lifestyle on disease, particularly cancer.

All the women had been pregnant at least once, and the authors were particularly interested in those whose pregnancies had ended prematurely, either as a result of miscarriage or abortion, or whose babies had been stillborn.

Among the entire group, almost one in four (25%) had had at least one detectable miscarriage, while almost one in five (18%) had had at least one abortion. A further 2% had experienced a stillbirth.

Of those 2876 women who had miscarried, 69 had done so more than three times. These women tended to weigh more; those who had experienced a stillbirth were less physically active and higher rates of diabetes and high blood pressure, all of which are independent risk factors for heart attack and stroke.

Over a period of around 10 years, 82 women had a heart attack and 112 had a stroke.

No significant association was found between any of the types of pregnancy loss and an increased risk of stroke. But strong patterns emerged for stillbirth and miscarriage.

But having at least one stillbirth increased the risk of a heart attack by 3.5 times. But those women who had had more than three miscarriages were nine times as likely to have a heart attack.

The magnitude of the risk fell after adjusting for influential factors, such as weight, smoking, and alcohol consumption but it was still high, being five times as great.

Each miscarriage increased heart attack risk by 40% and those women who miscarried more than twice were more than four times as likely to have a heart attack.

“These results suggest that women who experienced spontaneous pregnancy loss are at a substantially higher risk of [heart attack] later in life,” comment the authors.

“Recurrent miscarriage and stillbirth are strong gender predictors for [this] and thus should be considered as important indicators for monitoring cardiovascular risk factors and preventive measures,” they add.

Elham Kharazmi, Laure Dossus, Sabine Rohrmann, Rudolf Kaaks. Pregnancy loss and risk of cardiovascular disease: a prospective population-based cohort study (EPIC-Heidelberg). Heart, 2010; DOI: 10.1136/hrt.2010.202226

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Science Friday: Miscarriage and heart disease connection

Pregnancy loss, cardiovascular disease connected by new study

July 16, 2014

The Annals of Family Medicine published an article detailing research showing that women with a history of pregnancy loss are at higher risk for cardiovascular disease later in adulthood than other women, work completed by physicians in the Center for Primary Care and Prevention (CPCP) at Memorial Hospital of Rhode Island.
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The article “Risk of Cardiovascular Disease Among Postmenopausal Women with Prior Pregnancy Loss: The Women’s Health Initiative” stems from the analysis of data from the maternity experiences of a sample of 77,701 women, according to Donna Parker, ScD, director for community health and research with the CPCP. Of those, 30.3 percent reported a history of miscarriage, 2.2 percent a history of stillbirth, and 2.2 percent a history of both.

“We found that the adjusted odds for coronary heart disease in women who had one or more stillbirths was 1.27 (95 percent confidence interval (CI), which is a measure of reliability, 1.07-1.51) compared with women who had no stillbirths,” Dr. Parker says. “For women with a history of one miscarriage, the odds ratio was 1.19 (95 percent CI, 1.08-1.32). For women with a history of two or more miscarriages, the odds ratio was 1.18 (95 percent CI, 1.04-1.34) compared with no miscarriage.”

The researchers found no significant association of ischemic stroke and pregnancy loss, she adds. The association between pregnancy loss and coronary heart disease appeared to be independent of hypertension, body mass index, waist-to-hip ratio and white blood cell count.

“These findings contribute to the growing body of evidence that the metabolic, hormonal and hemostatic pathway alterations that are associated with a pregnancy loss may contribute to the development of coronary heart disease in adulthood,” Dr. Parker continues.

Women with a history of miscarriage or a single stillbirth should be closely monitored and receive early intervention from their primary care physician so risk factors such as diabetes, hypertension, cholesterol, obesity, smoking and diet can be closely monitored and controlled.

Journal Reference:

D. R. Parker, B. Lu, M. Sands-Lincoln, C. H. Kroenke, C. C. Lee, M. O’Sullivan, H. L. Park, N. Parikh, R. S. Schenken, C. B. Eaton. Risk of Cardiovascular Disease Among Postmenopausal Women with Prior Pregnancy Loss: The Women’s Health Initiative. The Annals of Family Medicine, 2014; 12 (4): 302 DOI: 10.1370/afm.1668

Science Friday: Which is better after miscarriage? Surgery or waiting?

In May 2014, the effectiveness and safety of expectant (waiting) management vs. surgical management of first trimester miscarriage were compared.

In surgical intervention, a dilation and curettage (D&C) is performed to evacuate the tissue from the uterus–most commonly in the case of a missed miscarriage (fetus with no heart activity) or incomplete miscarriage (part of tissue stays in body). The most common side effect of a D&C is infection.

Waiting it out, or expectant management, is a common surgical alternative that results in complete evacuation in 79% of cases. It is easy, effective, safe and cost-effective from a medical standpoint.

In the study, 217 women with missed miscarriage and incomplete miscarriage in their first trimester participated. They were randomly assigned to surgical or expectant management. The groups were demographically and conditionally equivalent. Women in the surgical management group underwent a D&C. Women in expectant management group were advised to use acetaminophen tablets to relieve pain.

81.4% of patients undergoing expectant management were successful with loss of uterine contents within 4 weeks. 18.6% had to have surgical uterine evacuation because products still remained in the uterus.

95.7% of women in the surgical group had successful D&Cs.  5.2% had emergency surgical uterine evacuation. 4.3% had second curettage due to incomplete evacuation in first procedure.

The average duration of bleeding was 11 days in expectant group and 7 days in surgical group. The average duration of pain was 8.1 days in the expectant group and 5.5 days in the surgical group. These differences were both statistically significant.

Both methods had the same complication rate, however, the pelvic infection was significantly lower in the expectant than the surgical group (1.9 vs 3.5 %, respectively).

So what does this mean? First of all, talk to your doctor about the pros and cons of expectant vs surgical management of miscarriage. It could be that your personal health situation points to one method over the other. You must also think about, and share, your personal feelings with your doctor. Some women want to eliminate the physical evidence of a miscarriage as soon as possible, and some are content waiting for the physical evidence to evacuate naturally.

Either way, this small study indicated that expectant management (waiting) is safe and effective, but that surgical management is ultimately more successful.

Want to read the paper? See below or go to http://www.ncbi.nlm.nih.gov/pubmed/24240972.

Expectant versus surgical management of first-trimester miscarriage: A randomised controlled study.

Al-Ma’ani W1, Solomayer EF, Hammadeh M.

INTRODUCTION:

The aim of this study is to compare the efficacy and safety of expectant management with surgical management of first-trimester miscarriage.

METHODS:

This randomised prospective study was conducted in the Gynaecology Department at University of Saarland Hospital, Germany between February 2011 and April 2012. A total of 234 women were recruited following diagnosis of the first-trimester incomplete or missed miscarriage and randomised into two groups: 109 women were randomised to expectant management (group I), and 125 women to surgical management (groupII). All women were examined clinically and sonographically during the follow-up appointments at weekly intervals for up to 4 weeks as appropriate. The outcome measures were: efficacy, short-term complications and duration of vaginal bleeding and pain.

RESULTS:

Of 234 eligible women, 17 were lost to follow-up, and the remaining 217 women were analysed. The baseline characteristics were similar in both groups. The total success rate at 4 weeks was lower for expectant than for surgical management (81.4 vs 95.7 %; P = 0.0029). The type of miscarriage was a significant factor affecting the success rate. For missed miscarriage, the success rates for expectant versus surgical management were 75 and 93.8 %, respectively. For women with incomplete miscarriage, the rates were 90.5 and 98 %. No differences were found in the number of emergency curettages between the two study groups. The duration of bleeding was significantly more in the expectant than the surgical management (mean 11 vs 7 days; P < 0.0001). The duration of pain was also more in the expectant than the surgical group (mean 8.1 vs 5.5 days; P < 0.0001). The total complication rates were similar in both groups (expectant 5.9 % vs surgical group 6.1 %; P = 0.2479). However, the pelvic infection was significantly lower in the expectant than the surgical group (1.9 vs 3.5 %, respectively; P = 0.0146).

CONCLUSION:

Expectant management of clinically stable women with first-trimester miscarriage is safe and effective and avoids the need for surgery and the subsequent risk of anaesthesia in about 81.4 % of cases, and has lower pelvic infection rate than surgical curettage. However, surgical management is more successful, and with a shorter duration of bleeding and pain. Therefore, the patient’s preference should be considered in the counselling process.

Science Friday: Women don’t need to delay getting pregnant after miscarriage, study suggests

Women who conceive within six months of an initial miscarriage have the best chance of having a healthy pregnancy with the lowest complication rates, according to a new study published on the British Medical Journal website.

Lead author, Sohinee Bhattacharya from University of Aberdeen, says that current World Health Organisation (WHO) guidelines recommending that women who experience a miscarriage should wait at least six months before getting pregnant again may need to be reviewed.

Women who experience a miscarriage are not only at an increased risk of a second miscarriage, says the study, but also of complications in a subsequent pregnancy. Around one in five pregnancies ends in miscarriage before 24 weeks.

But the length of time couples should wait before trying again to get pregnant are not consistent, say the authors, with some doctors saying there is no justification for asking women to wait and other bodies, such as the WHO, recommending a wait of at least six months. This study was based on women delivering in Scotland and while the findings are valid for this population, the original WHO guidelines may still be applicable to women in developing countries.

Delaying getting pregnant is particularly problematic in the western world, they add, because “women over 35 are more likely to experience difficulties in conceiving and women aged 40 years have a 30% chance of miscarriage which rises to 50% in those aged 45 years or more … any delay in attempting conception could further decrease their chance of a healthy baby.”

The researchers reviewed the data of over 30,000 women who attended Scottish hospitals between 1981 and 2000. The participants all had a miscarriage in their first pregnancy and subsequently had another pregnancy.

The results show that women who conceived again within six months were less likely to have another miscarriage, termination of pregnancy or ectopic pregnancy compared to women who got pregnant between six and 12 months after their initial miscarriage.

The women who conceived within six months were also less likely to experience a caesarean section, deliver prematurely or have low birth weight babies. This association wasn’t explained by social and personal factors or by other problems in pregnancy including smoking.

The authors conclude: “our research shows that it is unnecessary for women to delay conception after a miscarriage.” They add that when there are reasons to delay, for example if there are signs of infection, women should be advised about what to do to protect their health.

An accompanying editorial supports the view that women who conceive earlier may have better outcomes and fewer complications and calls for further research into this important area.

Journal Reference:

Eleanor R. Love, Siladitya Bhattacharya, Norman C Smith, Sohinee Bhattacharya. Research Effect of interpregnancy interval on outcomes of pregnancy after miscarriage: retrospective analysis of hospital episode statistics in Scotland. BMJ, 2010;341:c3967 DOI: 10.1136/bmj.c3967

BMJ-British Medical Journal. (2010, August 6). Women don’t need to delay getting pregnant after miscarriage, study suggests. ScienceDaily. Retrieved March 12, 2015 from http://www.sciencedaily.com/releases/2010/08/100805204001.htm

Science Friday: Steroids can prevent miscarriage?

New hope for women suffering from recurrent miscarriage

A team of researchers, led by the University of Warwick, have published new data that could prove vital for advances in care for women who suffer from recurrent miscarriage.

The recurrent loss of pregnancy through miscarriage causes significant distress to couples, often exacerbated by there being so few treatments available to clinicians.

The search for an effective treatment has been the cause of significant controversy in the field of medical research, centering on the role of natural killer cells (or NK cells) and the ability of steroids to prevent miscarriage.

Scientists have been uncertain about how these NK cells could contribute to a miscarriage and this has raised doubt over their importance in causing pregnancy loss.

Led by Professor Jan Brosens of Warwick Medical School, the team found that elevated uterine NK cells in the lining of the womb indicate deficient production of steroids. Deficient steroid production in turn leads to reduced formation of fats and vitamins that are essential for pregnancy nutrition.

This study, published in The Journal of Clinical Endocrinology & Metabolism, is the first of its kind to provide an explanation for why high levels of NK cells can cause miscarriage.

Siobhan Quenby, Professor of Obstetrics at Warwick Medical School, explained, “This work is really exciting because after years of controversy and doubt we have a crucial breakthrough. This means, quite simply, that we have excellent scientific justification for steroid based treatment to prevent miscarriage.”


Story Source:

The above story is based on materials provided by University of Warwick. Note: Materials may be edited for content and length.


Journal Reference:

  1. Keiji Kuroda, Radha Venkatakrishnan, Sean James, Sandra Šućurović, Biserka Mulac-Jericevic, Emma S. Lucas, Satoru Takeda, Anatoly Shmygol, Jan J. Brosens, and Siobhan Quenby. Elevated Periimplantation Uterine Natural Killer Cell Density in Human Endometrium Is Associated With Impaired Corticosteroid Signaling in Decidualizing Stromal Cells. The Journal of Clinical Endocrinology & Metabolism, September 2013
  2. University of Warwick. (2013, September 11). New hope for women suffering from recurrent miscarriage. ScienceDaily. Retrieved February 27, 2015 from http://www.sciencedaily.com/releases/2013/09/130911132042.htm

Science Friday: Infertile women want more support

Many women coping with infertility count on relatives or close friends for encouragement and assistance. But according to research at the University of Iowa, when it comes to support, women may not be receiving enough — or even the right kind.

“Infertility is a more prevalent issue than people realize. It affects one in six couples, and in almost all cases, women want more support than they are getting,” says Keli Steuber, assistant professor in communication studies at the UI and co-author of the paper, published this week in the print edition of the journal Communication Monographs.

The study comes on the heels of National Infertility Awareness Week, a movement started in 1989 by the National Infertility Association to raise awareness about infertility and to encourage the public to better understand their reproductive health.

Steuber and Andrew High, assistant professor in communication studies at the UI and the paper’s co-author, surveyed more than 300 women across the nation who were coping with infertility.

They found that infertile women want more support of all kinds — ranging from practical aid such as help with household chores, to advice and emotional reassurance like hearing a spouse say, “I love you.”

Without this support, women wrestling with infertility may become depressed or be less able to cope with stress, according to the researchers.

The good news is there are easy ways a spouse, relative, or friend can be more supportive, say Steuber and High. Though family and friends have the best of intentions, the study found they tend to dole out too much advice.

The researchers say it’s best to keep the advice to a minimum and instead focus on other ways to be supportive. That could be as simple as cooking a meal or connecting your loved one to other women with whom she can share her feelings.

“People are overwhelmed by unsolicited advice from family and friends,” says Steuber, who cites mom, female relatives, and other women with children as key perpetrators when it comes to doling out excessive information.

“Parents perceive themselves to be experts in having children, but they may not be well-informed. That puts women in an awkward position,” she explains.

As for spouses? High and Steuber found that while women cited their husbands as the strongest source of emotional support, many felt their spouses could provide more.

That’s not surprising, say High and Steuber, who note previous research has suggested that men feel uncomfortable talking about infertility issues. That can leave women feeling like some of their emotional needs are not being addressed.

“It’s a very real strain on the marriage,” says High.

The researchers suggest that husbands become a more active participant in their wives’ infertility treatments by attending appointments, advocating for their spouse, and helping them explore alternatives to pregnancy or other treatment options.

“Becoming more involved gives you the opportunity to be more emotionally invested,” says High.

And Steuber adds that couples who stick together through the infertility experience often have a stronger marital foundation moving forward. “If you can find effective, supportive ways to communicate with each other, you’re better equipped to handle stressors down the road,” she explains.

In addition to close friends and family, the researchers also looked at the support provided by doctors and nurses. “We found those in healthcare often see themselves as sources of information rather than someone who can provide emotional support or suggest a valuable network of contacts,” says High.

Though the researchers acknowledge there is no simple solution, they suggest doctors and nurses could help women feel better supported by spending additional face time with their patients, phrasing questions in an empathetic manner, and handing out resources tailored to individual needs.

The UI Office of the Vice President for Research and Economic Development funded the study.

Journal Reference:

Andrew C. High, Keli Ryan Steuber. An Examination of Support (In)Adequacy: Types, Sources, and Consequences of Social Support among Infertile Women. Communication Monographs, 2014; 81 (2): 157 DOI: 10.1080/03637751.2013.878868

University of Iowa. (2014, April 30). Infertile women want more support. ScienceDaily. Retrieved February 19, 2015 from http://www.sciencedaily.com/releases/2014/04/140430192529.htm

Science Friday: Fracking correlated with reproductive harm?

Chemicals released during natural gas extraction may harm reproduction, development

Unconventional oil and gas (UOG) operations combine directional drilling and hydraulic fracturing, or “fracking,” to release natural gas from underground rock. Recent discussions have centered on potential air and water pollution from chemicals used in these processes and how it affects the more than 15 million Americans living within one mile of UOG operations. Now, Susan C. Nagel, a researcher with the University of Missouri, and national colleagues have conducted the largest review to date of research centered on fracking byproducts and their effects on human reproductive and developmental health. They determined that exposure to chemicals released in fracturing may be harmful to human health in men, women and children and recommend further scientific study.

“We examined more than 150 peer-reviewed studies reporting on the effects of chemicals used in UOG operations and found evidence to suggest there is cause for concern for human health,” said Nagel. “Further, we found that previous studies suggest that adult and early life exposure to chemicals associated with UOG operations can result in adverse reproductive health and developmental defects in humans.”

The “weight of evidence” review of scientific literature and peer-reviewed publications, where studies are examined thoroughly for patterns and links, included international studies that focused on UOG chemicals. Reviewers say these chemicals have been measured in air and water near UOG operations, and have been associated with harmful effects in both animals and humans.

The reviewers concluded that exposure to air and water pollution caused by UOG operations may be linked to health concerns including infertility, miscarriage, impaired fetal growth, birth defects and reduced semen quality.

“There are far fewer human studies than animal studies; however, taken together, the studies did show that humans can be harmed by these chemicals released from fracking,” Nagel said. “There is strong evidence of decreased semen quality in men, higher miscarriages in women and increased risk of birth defects in children. There is a striking need for continued research on UOG processes and chemicals and the health outcomes in people.”

Nagel, an associate professor of obstetrics, gynecology and women’s health in the School of Medicine, and adjunct associate professor of biological sciences in the College of Arts and Science at MU, conducted the review with colleagues from the University of Missouri as well as researchers at the Institute for Health and the Environment and the Center for Environmental Health.


Story Source:

The above story is based on materials provided by University of Missouri-Columbia. Note: Materials may be edited for content and length.


Journal Reference:

  1. Ellen Webb, Sheila Bushkin-Bedient, Amanda Cheng, Christopher D. Kassotis, Victoria Balise, Susan C. Nagel. Developmental and reproductive effects of chemicals associated with unconventional oil and natural gas operations. Reviews on Environmental Health, 2014; 29 (4) DOI: 10.1515/reveh-2014-0057