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    <recommendedItem id="20100101_19_328"
                     title="Novel Contraceptive Matches Plan B (CME/CE)"
                     score="0.007"
                     href="http://www.medpagetoday.com/OBGYN/Pregnancy/tb/18201?impressionId=1265739244690"
                     
      A novel emergency contraceptive is as effective as levonorgestrel when taken within three days of unprotected intercourse, researchers said.&lt;br&gt;
&lt;br&gt;And ulipristal acetate was significantly more effective than the older drug when taken between 72 and 120 hours after intercourse, according to Anna Glasier, DSc, MD, of National Health Service Lothian in Edinburgh, and colleagues.&lt;br&gt;
&lt;br&gt;The finding, from a large randomized single-blind study, establishes ulipristal as an effective alternative to levonorgestrel, which is available in more than 140 countries, Glasier and colleagues said online in &lt;em&gt;The Lancet&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The study is the second in recent days to report that ulipristal is effective up to 120 hours after unprotected sex, about two days longer than levonorgestrel is expected to work. (See &lt;a href=&quot;http://www.medpagetoday.com/OBGYN/Pregnancy/18091&quot; mce_href=&quot;http://www.medpagetoday.com/OBGYN/Pregnancy/18091&quot; target=&quot;_blank&quot;&gt;Novel &apos;Morning-After&apos; Pill Works for Five Days&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Ulipristal is made by HRA Pharma of Paris, which supported the study. Ulipristal has been given marketing authorization in Europe (under the brand name ellaOne) but is not yet approved in the U.S. Levonorgestrel is marketed here as Plan B One-Step.&lt;/p&gt;
&lt;p&gt;The study enrolled 2,221 women who came to one of 35 participating family planning clinics, requesting emergency contraception within five days after unprotected intercourse.&lt;/p&gt;
&lt;p&gt;The primary endpoint was the pregnancy rate in women who received emergency contraception within the first 72 hours.&lt;/p&gt;
&lt;p&gt;Analysis excluded women lost to follow-up, those over 35, women with unknown follow-up pregnancy status, and those who had re-enrolled in the study  --  leaving a total of 1,696 participants in the so-called efficacy-evaluable population.&lt;/p&gt;
&lt;p&gt;In that group, the researchers found, there were 37 pregnancies  --  15 among those getting 30 milligrams of ulipristal and 22 among those given 1.5 milligrams of levonorgestrel.&lt;/p&gt;
&lt;p&gt;The proportions  --  1.8% for ulipristal versus 2.6% for levonorgestrel  --  differed by 0.8 percentage points, less than the preset noninferiority margin of a one percentage-point difference between the groups, Glasier and colleagues said.&lt;/p&gt;
&lt;p&gt;Outside the primary efficacy-evaluable population, there were 203 women who were treated between 72 and 120 hours after unprotected intercourse.&lt;/p&gt;
&lt;p&gt;Among those women, there were three pregnancies, all in the levonorgestrel group. The difference was significant at &lt;em&gt;P&lt;/em&gt;=0.037.&lt;/p&gt;
&lt;p&gt;Adverse events were reported by 54% of women in the ulipristal group and 56% in the levonorgestrel group, with headache, dysmenorrhea, and nausea being most common, but not significantly different, between the groups.&lt;/p&gt;
&lt;p&gt;Two serious events were thought to be possibly related to medication  --  a case of dizziness in the ulipristal group that cleared up within a day, and a molar pregnancy in the levonorgestrel group.&lt;/p&gt;
&lt;p&gt;The researchers also conducted a meta-analysis, combining the groups in this study with those from a previous head-to-head test of the two drugs to get a combined dataset of 3,445 women, in which there were 60 pregnancies.&lt;/p&gt;
&lt;p&gt;The analysis showed ulipristal prevented more pregnancies at all time points than the older drug. Specifically: &lt;ul&gt; &lt;li&gt;For the first 24 hours, the odds ratio was 0.35 in favor of ulipristal, (95% CI 0.11 to 0.93,&lt;em&gt; P&lt;/em&gt;=0.035).&lt;/li&gt; &lt;li&gt;For the first 72 hours, the odds ratio was 0.58 (95% CI 0.33 to 0.99, &lt;em&gt;P&lt;/em&gt;=0.046).&lt;/li&gt; &lt;li&gt;And for the first 120 hours, the odds ratio was 0.55 (95% CI 0.32 to 0.93, &lt;em&gt;P&lt;/em&gt;=0.025).&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The researchers cautioned that the findings might not generalize to all groups of women. The study took place, they noted, in settings where emergency contraception is available without prescription.&lt;/p&gt;
&lt;p&gt;Also, women on hormonal contraception were excluded from the study, but emergency contraception is often used to treat women who have missed oral contraceptive pills, they noted.&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 by HRA Pharma, which was involved in study design, data collection, data analysis, data interpretation, and writing of the report. Glasier reported lecture honoraria from HRA Pharma. Several authors are employees of the company.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <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=1265739244690"
                     
      &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_1_335"
                     title="The Pill Called Okay After All for Women With Stable Lupus"
                     score="-0.005"
                     href="