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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_288"
                     title="SSRIs Affect Breast Milk Production (CME/CE)"
                     score="0.004"
                     href="http://www.medpagetoday.com/Endocrinology/GeneralEndocrinology/tb/18149?impressionId=1265753243173"
                     
      &lt;p&gt;Women taking selective serotonin reuptake inhibitor (SSRI) antidepressants may experience delays in postpartum breast milk production, researchers said.&lt;/p&gt;
&lt;p&gt;Delayed secretory activation occurred in 87.5% of a small group of women taking SSRIs, compared with 43.5% of those not taking the drugs (RR 2, 95% CI 1.51 to 2.67, &lt;em&gt;P&lt;/em&gt;=0.02), according to Aaron M. Marshall, PhD, of the University of Cincinnati.&lt;/p&gt;
&lt;p&gt;The relative risk of delayed activation remained significantly higher (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) among SSRI users after adjustment for maternal age, obesity, cesarean delivery, infant gestational age, and infant breastfeeding behavior, the researchers reported online in the &lt;em&gt;Journal of Clinical Endocrinology and Metabolism&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;An early breastfeeding difficulty faced by many women, particularly those who are primiparous, is milk secretion delayed beyond 72 hours postpartum.&lt;/p&gt;
&lt;p&gt;These women also are at risk of early cessation of breastfeeding. In fact, only 11% of mothers in the U.S. breastfeed exclusively for the recommended six months.&lt;/p&gt;
&lt;p&gt;Studies in animal models and cell cultures suggested that serotonin (5-HT) is an important local regulator of lactation homeostasis, and the 5-HT transporter is expressed in mammary tissue at the apical membrane of epithelial cells.&lt;/p&gt;
&lt;p&gt;Serotonin is controlled intracellularly by a balance between synthesis and degradation, while extracellularly its availability is controlled through recycling by the 5-HT transporter.&lt;/p&gt;
&lt;p&gt;The 5-HT transporter also is the target for the most commonly prescribed class of antidepressants in the U.S. and other developed countries. These SSRI antidepressants are typically used to treat postpartum depression.&lt;/p&gt;
&lt;p&gt;The investigators conducted in vitro and animal studies to establish that the 5-HT transporter is expressed in breast tissue, particularly in the apical membranes of mammary epithelial cells, and that pharmacologic inhibition of the transporter disrupts tight junctures leading to a local involution-like effect.&lt;/p&gt;
&lt;p&gt;To examine the potential effect of SSRI inhibition on milk production in women, Marshall and colleagues enrolled 431 mothers as part of a longitudinal cohort study examining barriers to early lactation success.&lt;/p&gt;
&lt;p&gt;All were expecting their first live-born infants, had no known absolute contraindication to breastfeeding, and were at least 19 years old.&lt;/p&gt;
&lt;p&gt;Women taking SSRIs were more likely to have scored higher on a depressive symptom scale (as expected), and were somewhat more likely to be obese or to have had a cesarean delivery.&lt;/p&gt;
&lt;p&gt;Participating mothers were visited between 72 and 96 hours after giving birth to assess their breastfeeding experience and to determine the timing of secretory activation, and then seen again one week later.&lt;/p&gt;
&lt;p&gt;Delayed secretory activation was defined as initiation more than 72 hours postpartum.&lt;/p&gt;
&lt;p&gt;Median onset of secretory activation among the SSRI-treated mothers was 85.8 hours compared with 69.1 hours in mothers not using the drugs (&lt;em&gt;P&lt;/em&gt;=0.004).&lt;/p&gt;
&lt;p&gt;Eight women reported regular use of an SSRI medication. Seven experienced definite delayed secretory activation, and the eighth reported activation at 72 hours and therefore did not meet the defined cutoff for delayed activation.&lt;/p&gt;
&lt;p&gt;All women taking SSRIs had experienced secretory activation by their second visit a week after the first interview.&lt;/p&gt;
&lt;p&gt;The researchers noted that most studies on the effects of SSRI use during pregnancy and lactation have focused on the risks for developmental defects or whether the drugs passed into milk during lactation.&lt;/p&gt;
&lt;p&gt;This study, they said, is the first to report data on another important aspect of SSRI use during the peripartum, the effect on milk production.&lt;/p&gt;
&lt;p&gt;They concluded that the risk of delayed secretory activation was twice as great among primiparous women using an SSRI medication, and although the fraction of women taking the drugs was small, the risk was significant and remained so after adjustment for potential confounding factors.&lt;/p&gt;
&lt;p&gt;Further examination of this relationship is needed in larger groups of mothers, the researchers said, and in studies to determine if there are differences among the antidepressant medications.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;This work was supported by the National Institutes of Health, the USDA Cooperative State Research, Education, and Extension Service, and the Department of Health and Human Services.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_235"
                     title="Congenital Anomalies Linked to Mom&apos;s Diabetes (CME/CE)"
                     score="-0.001"
                     href="http://www.medpagetoday.com/OBGYN/Pregnancy/tb/18065?impressionId=1265753243173"
                     
      &lt;p&gt;Pregestational maternal diabetes was associated with an increased risk of a major congenital anomaly, but obesity itself was not, a cross-sectional study found.&lt;/p&gt;
&lt;p&gt;In a multivariable logistic model, the major contributor to a rising rate of congenital anomalies was maternal pregestational diabetes (OR 3.8, 95% CI 2.1 to 6.6), according to Joseph R. Biggio, Jr., MD, and colleagues from the University of Alabama at Birmingham.&lt;/p&gt;
&lt;p&gt;&quot;Because hyperglycemia is a major contributor to developmental malformations, interventions to address obesity and identify women at risk for diabetes and hyperglycemia should be considered in efforts to reduce the occurrence of congenital anomalies,&quot; they wrote in the February issue of &lt;em&gt;Obstetrics &amp;amp; Gynecology.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;Maternal obesity has been linked with numerous problems, including preeclampsia, gestational diabetes, fetal and neonatal death, and birth trauma, but scientists have disagreed over whether it also contributes to the risk of fetal malformations, the researchers noted.&lt;/p&gt;
&lt;p&gt;To help settle the issue, Biggio and colleagues used a perinatal database in their university health system that included all women with singletons delivered between 1991 and 2004.&lt;/p&gt;
&lt;p&gt;They divided the cohort into three time periods  --  1991 to 1994, 1995 to 1999, and 2000 to 2004, with a total of 41,902 pregnancies.&lt;/p&gt;
&lt;p&gt;For their primary analysis, they defined maternal obesity as a first prenatal visit weight greater than 200 lb, because during the earlier epochs many women did not have body mass index (BMI) calculated. For their secondary analyses they used BMI greater than 29 kg/m&lt;sup&gt;2&lt;/sup&gt; as the criterion for obesity.&lt;/p&gt;
&lt;p&gt;In each epoch, there were increases in mean maternal weight, mean BMI, the proportion of women weighing more than 200 lb, the proportion with a BMI greater than 29 kg/m&lt;sup&gt;2&lt;/sup&gt;, and the prevalence of pregestational diabetes (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for all).&lt;/p&gt;
&lt;p&gt;Univariable analysis determined that the rate of major anomalies, particularly involving the cardiac and pulmonary systems, also increased during each time period.&lt;/p&gt;
&lt;p&gt;But there was no independent association between congenital anomalies and maternal obesity using either definition, during any of the three time periods or during the study overall.&lt;/p&gt;
&lt;p&gt;Although no direct association was seen between congenital malformations and maternal obesity, the investigators reported that the proportion of anomalies that could be attributed to obesity increased from 0% to 23% during the overall study period.&lt;/p&gt;
&lt;p&gt;The proportion of anomalies that could be attributed to diabetes ranged from 58% to 76%.&lt;/p&gt;
&lt;p&gt;Moreover, for obese women with diabetes the proportion of anomalies attributed to diabetes increased sharply, from 48% in the first epoch to 74% in the third epoch.&lt;/p&gt;
&lt;p&gt;In contrast, for the obstetric population as a whole, the population-attributable risk of congenital malformation related to obesity rose from near zero in the first epoch to 6.1% in the third epoch, while that related to diabetes increased from 3.3% to 9.2%, the investigators reported.&lt;/p&gt;
&lt;p&gt;During the course of the study there was a nearly 15-lb increase in maternal weight and a 30% increase in the proportion of women whose BMI exceeded 29 kg/m&lt;sup&gt;2&lt;/sup&gt;.&lt;/p&gt;
&lt;p&gt;There also was a nearly twofold increase in the rate of major anomalies  --  and a 250% increase in the prevalence of diabetes.&lt;/p&gt;
&lt;p&gt;The authors observed that there has been much interest in the effects of maternal obesity on birth defects.&lt;/p&gt;
&lt;p&gt;Although the pathophysiologic basis for this possible association have not been identified, hypotheses have included increased serum insulin, lower levels of folic acid, chronic hypoxia, and increased inflammatory mediators.&lt;/p&gt;
&lt;p&gt;&quot;Our study provides evidence that the defects may not be due solely to the maternal obesity per se but may be due to undiagnosed diabetes,&quot; the investigators wrote.&lt;/p&gt;
&lt;p&gt;From a public health standpoint, the study findings suggest that efforts to reduce the prevalence of congenital anomalies should be focused less on obesity and aimed more closely at correcting hyperglycemia.&lt;/p&gt;
&lt;p&gt;&quot;If euglycemia could be achieved before pregnancy, or at least embryogenesis and organogenesis, the majority of these anomalies could potentially be avoided,&quot; they observed.&lt;/p&gt;
&lt;p&gt;They also suggested that even women of normal weight, but with other diabetes risk factors, could benefit from closer attention to glycemic control.&lt;/p&gt;
&lt;p&gt;A weakness of the study was the fact that detailed data on glycemic control was not available in the perinatal database, &quot;and therefore we cannot comment on the association between glycemic control and anomaly rates,&quot; the investigators wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported in part by the National Institute of Child Health and Human Development.&lt;/p&gt;&lt;p&gt;The authors did not report any potential conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_212"
                     title="No Need for Most Moms to Fast During Labor (CME/CE)"
                     score="-0.002"
                     href="http://www.medpagetoday.com/OBGYN/Pregnancy/tb/18059?impressionId=1265753243173"
                     
      &lt;p&gt;Although conventional wisdom has long held that women shouldn&apos;t eat or drink during labor, the scientific evidence suggests there&apos;s no reason for the prohibition, according to a new meta-analysis.&lt;/p&gt;
&lt;p&gt;&quot;Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labor for women at low risk of complications,&quot; Mandisa Singata, MBA, RM, RN, of the University of the Witwatersrand in East London, South Africa, and colleagues concluded in a Cochrane review.&lt;/p&gt;
&lt;p&gt;They identified five studies involving 3,130 women that examined whether food and drink during labor affected outcomes such as rates of cesarean section, operative vaginal births, or Apgar scores. No significant advantage was found for restricting access to food or liquids on any outcome, Singata and colleagues found.&lt;/p&gt;
&lt;p&gt;Until the 1940s, women were generally encouraged to eat and drink during labor  --  often specific foods and fluids  --  to keep up their strength.&lt;/p&gt;
&lt;p&gt;But a 1946 paper and other publications by Curtis Lewis Mendelson suggested that access to food increased the risk that women under anesthesia would aspirate acidic stomach contents during labor, potentially causing serious lung injury and even death.&lt;/p&gt;
&lt;p&gt;Mendelson&apos;s work persuaded many obstetricians to urge that women fast until after delivery, according to Singata and colleagues.&lt;/p&gt;
&lt;p&gt;The researchers cited a 1988 survey of U.S. hospitals that found almost half allowed only ice chips, although more recent trends suggested that access to food and liquids had increased, at least in Great Britain.&lt;/p&gt;
&lt;p&gt;They noted that some women in labor don&apos;t feel like eating but others regard restrictions as &quot;unpleasant and sometimes harrowing.&quot;&lt;/p&gt;
&lt;p&gt;One reason for revisiting Mendelson&apos;s research is that anesthesia procedures have changed markedly since the 1940s, with regurgitation of stomach contents now considered very rare.&lt;/p&gt;
&lt;p&gt;&quot;The policy of routine restriction of foods and fluids in labor in many hospitals across the world generally does not reflect women&apos;s preferences or cultural expectations,&quot; Singata and colleagues wrote. &quot;It is critical that any policy should be based on evidence of overall benefit to women and babies.&quot;&lt;/p&gt;
&lt;p&gt;Searching the literature, Singata and colleagues found five randomized trials that had compared more versus less restrictive nutrition regimens.&lt;/p&gt;
&lt;p&gt;Only one of the trials tested free access to any kind of food and drink against restriction to ice chips or sips of water. The other four examined particular classes of nutritive foods or drinks.&lt;/p&gt;
&lt;p&gt;Two tested electrolyte-carbohydrate sports drinks and two others evaluated low-fat and/or low-residue foods, all against water or ice chips.&lt;/p&gt;
&lt;p&gt;Pooling data from the five studies, Singata and colleagues calculated relative risks for three major adverse outcomes for allowing access to nutrition, versus water or ice chips: &lt;ul&gt; &lt;li&gt;Cesarean section: RR 0.89, 95% CI 0.63 to 1.25&lt;/li&gt; &lt;li&gt;Operative vaginal birth: RR 0.98, 95% CI 0.88 to 1.10&lt;/li&gt; &lt;li&gt;Apgar scores &amp;lt;7 at five minutes: RR 1.43, 95% CI 0.77 to 2.68&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The meta-analysis also examined eight other outcomes, such as maternal ketosis and nausea and vomiting, infant admission to intensive care, and augmentation of labor. There were no significant differences in any of these outcomes between allowing and restricting access to nutrition.&lt;/p&gt;
&lt;p&gt;The sole study comparing unlimited access to food and drink to water or ice chips, which had 330 participants, also found no effects on either primary or secondary outcomes in either direction.&lt;/p&gt;
&lt;p&gt;None of the studies examined women&apos;s perceptions of the labor experience based on whether or not they had access to nutrition.&lt;/p&gt;
&lt;p&gt;Singata and colleagues called the overall quality of evidence &quot;reasonable.&quot; But they noted that none of the studies enrolled women at increased risk of needing general anesthesia, so the conclusions should be interpreted as applying only to women at low risk of complications.&lt;/p&gt;
&lt;p&gt;The studies also left some questions unanswered. For example, one of the two sports drink studies found that C-section rates were lower in participants who drank plain water, but no such result was seen in the other.&lt;/p&gt;
&lt;p&gt;&quot;It would be worth comparing the use of carbohydrate drinks ... with freedom to eat and drink at will during labour to see if this really is a problem,&quot; Singata and colleagues wrote.&lt;/p&gt;
&lt;p&gt;Moreover, they suggested, &quot;a better approach&quot; to the rare problem of inhaling regurgitated material while under anesthesia during labor may be to test treatments intended to reduce acidity and volume of stomach contents, now used during elective C-sections.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;External funding for the study came from the World Health Organization and the U.K. National Institute for Health Research.&lt;/p&gt;&lt;p&gt;One author of the review was principal author of one of the studies included in the meta-analysis, but did not participate in decisions regarding data from that study. No other potential conflicts were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_872"
                     title="Thyroid Removal Prevents Hereditary Cancer"
                     score="-0.005"
                     href="