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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=1265777945744"
                     
      &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="20090101_19_3832"
                     title="Childbirth May Slow MS Progression (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Neurology/MultipleSclerosis/tb/17164?impressionId=1265777945744"
                     
      Pregnancy not only appears safe for women with multiple sclerosis (MS), but also may help slow the disease&apos;s long-term progression, researchers said.&lt;br&gt;
&lt;br&gt;A cross-sectional analysis of 330 women with MS suggested that the time from disease onset to requiring assistance in walking was significantly longer in those who bore children, reported Marie D&apos;hooghe, MD, of the Nationaal MS Centrum in Melsbroek, Belgium, and colleagues.&lt;br&gt;
&lt;br&gt;The finding applied to women who developed MS after childbirth as well those already diagnosed with the disease when they became pregnant, the researchers wrote online in the &lt;em&gt;Journal of Neurology, Neurosurgery &amp;amp; Psychiatry&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Just last week, another research group had reported that pregnant women with MS were only slightly more likely to carry babies that develop slowly in the womb and require cesarean deliveries. (See &lt;a href=&quot;http://www.medpagetoday.com/Neurology/MultipleSclerosis/17097&quot; mce_href=&quot;http://www.medpagetoday.com/Neurology/MultipleSclerosis/17097&quot; target=&quot;_blank&quot;&gt;Pregnancy Generally Safe for Women with MS&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;In the current study, D&apos;hooghe and colleagues reported the following median intervals between disease onset and reaching an Expanded Disability Scale Score of 6.0, indicating a need for intermittent or unilateral assistance, such as a cane, to walk 100 meters without resting, for patients younger than 30 at disease onset: &lt;ul&gt; &lt;li&gt;No children ever: 8 years (interquartile ratio 5.0 to 15.5)&lt;/li&gt; &lt;li&gt;Children only before MS onset: 16 years (IQR 10.5 to 23.0)&lt;/li&gt; &lt;li&gt;Children only after MS onset: 21 years (IQR 14.8 to 27.8)&lt;/li&gt; &lt;li&gt;Children before and after MS onset: 21.5 years (IQR 14.3 to 20.0)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Findings were similar for the entire patient sample, which included those with later disease onset, except that the median interval to EDSS score of 6.0 was shorter in those who had children only before disease onset (median 10 years).&lt;/p&gt;
&lt;p&gt;The mechanism by which pregnancy may delay MS progression was unclear, D&apos;hooghe and colleagues said  --  if indeed there is one.&lt;/p&gt;
&lt;p&gt;&quot;Patients with a more aggressive disease, not related to age at onset, may be less inclined to become pregnant and have children,&quot; they pointed out.&lt;/p&gt;
&lt;p&gt;Some earlier studies had also indicated that MS progression was slower in mothers than in childless women, though others had failed to identify a long-lasting effect.&lt;/p&gt;
&lt;p&gt;The authors of the current study said several causal mechanisms were possible.&lt;/p&gt;
&lt;p&gt;&quot;The most obvious candidates in this respect are sex hormones, which are supposed to play a role in immunomodulation,&quot; D&apos;hooghe and colleagues wrote.&lt;/p&gt;
&lt;p&gt;They said human as well as animal studies have shown that hormones such as estriol can affect immunological activity.&lt;/p&gt;
&lt;p&gt;For example, one study they cited found that nonpregnant female MS patients given estriol showed decreased inflammatory activity in an MRI analysis.&lt;/p&gt;
&lt;p&gt;Alternatively, D&apos;hooghe and colleagues suggested, childbirth may lead to beneficial lifestyle alterations in diet, vitamin intake, and exercise.&lt;/p&gt;
&lt;p&gt;Their study was based on 330 women seen at a multiple sclerosis referral center from 2005 to 2007. Their records were analyzed for data on age at MS onset and age at which an Expanded Disability Scale Score &lt;strong&gt;(&lt;/strong&gt;EDSS)&lt;strong&gt; &lt;/strong&gt;of 6.0 was reached, along with MS subtype at onset and at their most recent evaluation.&lt;/p&gt;
&lt;p&gt;Just under half had their first symptoms before age 30.&lt;/p&gt;
&lt;p&gt;Overall, after adjusting for age at onset, the researchers found that childbirth in women with active MS reduced the risk of reaching EDSS scores of 6.0 by nearly 40%, compared with nulliparous patients (hazard ratio 0.61, 95% CI 0.37 to 0.99).&lt;/p&gt;
&lt;p&gt;The risk was also reduced among all women who had children irrespective of the time of MS onset, compared with those who did not have children (HR 0.66, 95% CI 0.47 to 0.95).&lt;/p&gt;
&lt;p&gt;A Kaplan-Meier survival curve, plotting the proportion of patients not reaching EDSS scores of 6.0 versus age, suggested that the apparent protective effect of childbirth ended at about age 60.&lt;/p&gt;
&lt;p&gt;That was where the stairstep lines representing childless versus childbearing patients crossed, with about 80% of women in both groups having reached the EDSS 6.0 level of disability.&lt;/p&gt;
&lt;p&gt;The study had several limitations: &lt;ul&gt; &lt;li&gt;Only live births were counted, not miscarriages or abortions.&lt;/li&gt; &lt;li&gt;Patients at their referral center may not be representative of MS patients elsewhere.&lt;/li&gt; &lt;li&gt;Detailed data on prior disease course were lacking.&lt;/li&gt; &lt;li&gt;No adjustments were made for treatments patients had received.&lt;/li&gt; &lt;li&gt;As a retrospective analysis of patient records, unmeasured confounding factors could account for the results.&lt;/li&gt; &lt;/ul&gt;&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;No external funding for the study was reported.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_870"
                     title="Oral Contraceptives May Also Prevent MS"
                     score="-0.005"
                     href="