Kaiser Daily Women's Health Policy Report Highlights Recently Released Reports

The following highlights recently released reports on women's health issues.

Pregnancy & Childbirth
"Decision-to-Incision Times and Maternal and Infant Outcomes," Obstetrics and Gynecology: Steven Bloom, chair of the department of obstetrics and gynecology at the University of Texas Southwestern Medical Center, and colleagues analyzed data on 2,808 women who had emergency caesarean sections at one of 13 university hospitals over a two-year period to measure "decision-to-incision" times and maternal and infant outcomes. The American College of Obstetricians and Gynecologists in 1989 issued a guideline that a hospital providing obstetric care should be able to begin an emergency c-section within 30 minutes of a decision to perform the procedure. The study finds that 98% of primary c-section deliveries performed for emergency reasons begin before 30 minutes have elapsed. "Our findings indicate that obstetrical providers are exercising good judgment as to which [c-sections] must actually commence within 30 minutes of the decision to operate," Bloom said. Among the c-sections that were performed outside the 30-minute window, "95% did not experience a measure of newborn compromise," the researchers said (Rauscher, Reuters Health, 7/3).

"Brief Maternal Depression Screening at Well-Child Visits," Pediatrics: Ardis Olson, a professor of community and family medicine at Dartmouth Medical School, and colleagues examined 1,398 mothers at their well-child screenings for depression by asking them two questions (Olson et al., Pediatrics, 7/1). The two-question survey asked whether the woman had become apathetic about certain activities and whether she had been feeling unhappy (Goldberg, Boston Globe, 7/5). According to the study, 17% of the mothers screened had one symptom of depression, and 6% were recorded as being at risk for a major depressive disorder. In addition, 5.7% of the participants thought they might be depressed, and 4.7% thought they were experiencing stress, but not depression, the study finds. The researchers reported that "routine, brief, maternal depression" screening during visits is "feasible and detect[s] mothers who [are] willing to discuss depression and stress issues with their pediatrician" (Olson, Pediatrics, 7/1).

"In Utero Exposure to Dichlorodiphenyltrichloroethane (DDT) and Dichlorodiphenyldichloreothylene (DDE) and Neurodevelopment Among Young Mexican American Children," Pediatrics: Brenda Eskenazi, a professor of maternal health and epidemiology at the University of California-Berkeley, and colleagues measured levels of DDT and DDE in 360 pregnant women in the U.S. to determine the relationship between DDT and DDE and the neurodevelopment in the children of Mexican farmworkers in California (Eskenazi et al., Pediatrics, 7/1). The study finds that infants exposed to the pesticide DDT in utero experienced neurological effects that in some cases were severe enough to cause mental and physical developmental delays (Cone, Los Angeles Times, 7/5). In addition, the researchers found that the longer women breast-fed their infants, the better the infants scored on mental development tests, even though DDT is transmitted through breastmilk (BBC News, 7/5).

Stem Cells, Wayne State University: Graham Parker, a pediatrics researcher, and colleagues gathered umbilical cord blood from women who delivered by c-section to determine whether nicotine and alcohol affect the development of stem cells in the umbilical cord blood. They isolated the stem cells that make infants' and adults' blood and exposed the cells to alcohol, caffeine and nicotine. The study, which was presented at a stem cell conference in Toronto, Canada, finds that stem cell growth is not significantly affected by low doses of alcohol but high doses destroy the cells. The researchers also reported that adding nicotine to cells previously exposed to alcohol appeared to prevent the cells from dying. Parker said this might be a negative result because it might mean that damaged cells are left alive, which could prevent a fetus that should miscarry from doing so thereby increasing the risk of birth defects (Washington Post, 7/1).

Public Health
"Are Predictors for Myocardial Infarction the Same for Women and Men When Evaluated Prior to Hospital Admission?" International Journal of Cardiology: Johan Herlitz of Sahlgrenska University Hospital in Goteborg, Sweden, and colleagues examined the records of 433 people, 45% of whom were women, who were transported to the hospital because of a possible heart attack. The study finds that the women taken to the hospital were older in age and had a lower prevalence of previous heart attacks than the men. In addition, about 22% of women who had initial, abnormal ECG drops were diagnosed with heart attack, compared with 54% of men, according to the researchers (Reuters Health, 6/29). The study finds that "early prediction of [heart attack] might differ between women and men with acute chest pain" (Herlitz et al., International Journal of Cardiology, 5/10).

"Mortality and Cardiac and Vascular Outcomes in Extremely Obese Women," Journal of the American Medical Association: Kathleen McTigue of the University of Pittsburgh School of Medicine and colleagues followed for about seven years more than 90,000 women ages 50 to 79 from the Women's Health Initiative Observational Study (Srikameswaran, Pittsburgh Post-Gazette, 7/5). Women who had a body mass index of greater than 30 were considered obese, and these women were divided into three subclasses: obesity 1, with a BMI of 30-34.9; obesity 2, with a BMI of 35-39.9; and extreme obesity, with a BMI of greater than 40 (McTigue et al., JAMA, 7/5). The more obese women are, the higher their risk is for premature death, coronary heart disease, diabetes and hypertension, the study finds (Belden, Bloomberg/Arizona Republic, 7/5).

"Association of Breast Cancer Outcome With Status of p53 and MDM2 SNP309," Journal of the National Cancer Institute: Stefan Ambs of the National Cancer Institute in Bethesda, Md., and colleagues examined whether the interaction between a variation of a cancer-causing gene called SNP309 and an anticancer gene called p53 influenced a woman's odds of surviving breast cancer. The researchers found that SNP309 alone does not affect the odds of surviving breast cancer, and when the gene interacts with p53, the odds of surviving breast cancer are reduced (Boggs, Reuters Health, 7/5).

"Premature Menopause in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study," Journal of the National Cancer Institute: Charles Sklar of Memorial Sloan-Kettering Cancer Center in New York City and colleagues compared 2,819 women who survived childhood cancer and were older than age 18 with 1,065 female siblings of the cancer survivors to determine whether childhood cancer affects menopause (Sklar et al., Journal of the National Cancer Institute, 7/5). The study finds that 8% of the cancer survivors experienced early menopause, compared with less than 1% of the sisters, the AP/Washington Post reports. The study also finds that the risk of experiencing early menopause was 30% for cancer survivors who had received radiation to the lower abdomen and "alkylating" chemotherapy drugs, the AP/Post reports. Wendy Chen and JoAnn Manson of Brigham and Women's Hospital and Harvard Medical School in an accompanying editorial said that the 30% might underestimate the risk of those women experiencing early menopause because most of the study participants were women younger than age 40 (AP/Washington Post, 7/4).

Trafficked Women, London School of Hygiene & Tropical Medicine: Cathy Zimmerman, a researcher in public health policy, and colleagues examined 207 women ages 15 to 45 from 14 countries who were released after being trafficked for sexual or domestic work to determine the long-term effects of trafficking. The study finds that girls and women who have been trafficked experience symptoms consistent with post-traumatic stress disorder, such as anxiety, back pain, depression, dizziness, fatigue, headaches and memory problems. Zimmerman said that women need both immediate and long-term health and support services after being trafficked (Reuters/CNN, 6/28).

Reproductive Health
"Plan B, Reproductive Rights and Physician Activism," New England Journal of Medicine: Rebekah Gee -- an ob-gyn, a fellow of public policy and health care research at the University of Pennsylvania and one of three women who filed a complaint with the Massachusetts Board of Registration in Pharmacy against Wal-Mart after the company failed to fill her prescription for Barr Laboratories' emergency contraceptive Plan B -- in a perspectives piece describes her experience advocating for access to Plan B. She says that in the past 10 years, physicians' roles have been expanded because they "are all patient advocates in the examination room, the research laboratory, the media and Congress." Gee concludes, "We may not choose such embroilments for ourselves, but more and more, our engagement in them is what our patients require" (Gee, NEJM, 7/6).

"Roe Versus Reality -- Abortion and Women's Health," NEJM: Alexi Wright, a hematology-oncology fellow at the Dana Farber Cancer Institute in Boston and an editorial fellow at NEJM, and Ingrid Katz, an infectious disease fellow at the Beth Israel Deaconess Medical Center in Boston and an editorial fellow at NEJM, in a perspectives piece profiled LeRoy Carhart, an abortion provider, and examined abortion, the reasons some women undergo the procedure, so-called "partial birth" abortion and the potential ramifications of a fall Supreme Court case that could result in a decision banning the procedure (Wright/Katz, NEJM, 7/6).















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