Greetings from the heart of Silicon Valley. Please excuse the blog silence over the last few days as, believe it or not, I have suffered from sporadic Internet connection. I have been attending a very busy conference, Stanford MedX, on which I will fully brief you later. I could not blog at the conference but I took a lot of notes and pictures and they will serve as the basis for my reports to you sometime late on Wednesday. Where I stayed was a beautiful residence deep in a grove of old-growth trees so dense that it interfered with us cellular and local Wi-Fi coverage. So I right now without pictures, I will make this dispatch to you because I think medical Monday is so important. Text will go, but pictures will have to wait.
Some continue to doubt the association of the Zika virus infection with the development of microcephaly. However this latest study should put this to rest. The Journal Lancet Infectious Disease reported work that studied newborn Zika babies both with microcephaly and without. It turns out that babies with microcephaly we're 55 times more likely to have been infected with the Zika virus in utero. However, none of the 62 newborns in the comparison group who appeared normal showed any sign of infection.
Of chilling significance is another story published the Journal of Emerging Infectious Diseases. Those authors note that "for infants about four months and up to eight months of age" babies were "born on average on measures of weight length and head circumference" but "fell even further below average as time passed".
The CDC (Centers for Disease Control and Prevention) has now indicated that Zika virus can spread through "contact with bodily fluids such as tears, discharge from infected eyes, saliva, vomit, urine or stool." This has obvious implications for those living with and caring for those affected by the Zika virus.
Florida may offer free Zika virus testing, but that does not mean women are getting results. Apparently results that take a private lab a few days to report are taking weeks for the state run service. Time is of the essence when inquiring about Zika virus infection in pregnancy, since many women consider the option of abortion if there is evidence that their baby could be or is infected. Access to abortion is more restricted in what now could be called the Zika belt of our country. Women consider this drastic measure because central nervous system manifestations of Zika virus in pregnancy are often devastatingly severe. We now know they're also potentially progressive even after the baby is born.
A recent poll suggests that the risks of Zika virus to pregnant women have caused some Americans to soften their view on abortion. 62% of voters living in the 10 battleground states in the south and along the Gulf Coast have said that they "support abortions after 24 weeks if a doctor believes there is a serious possibility that a woman's fetus could have severe birth defects from the Zika virus."
As of this writing the funding to combat the Zika virus is virtually spent. The Obama administration as well as the CDC, the American College of Obstetricians and Gynecologists and others have appealed to Congress to put aside partisan politics and fund the fight against the crisis
It is worth reiterating news from last week coming to us from the Zika belt state of Texas. Texas maternal mortality spiked from 18.6 maternal deaths per 100,000 live births in 2010 two more than 30 per 100,000 into thousand and 11 and remains at that level through 2014. This statistic may not seem huge but it has increased dramatically and is a higher rate than anywhere else in the country. It is also higher maternal mortality rate than in most other industrial countries. Numerous writers, ACOG and the State Heath Services of Texas maternal mortality task force all recommend an increase in health care services to women as the solution.
Global maternal mortality rates are not where they should be. The United Nations sustainable development goals (SDG) indicate the rate would have to fall by nearly 70% to meet the target globally of 70 maternal deaths per 100,000 live births. It is felt that this should be accomplished by adding an estimated 18 million Women's Health workers including midwives and obstetricians.
A new study by the Urban Institute has indicated that only 31% of women know about the most effective forms of birth control, the LARCs, the long acting reversible contraceptives. ACOG has said that such IUDs and implants are the most effective reversible contraceptives available and are safe to use by almost all women of reproductive age. Of note, weeks ago it was reported that Puerto Rico, which is greatly affected by the Zika virus, had been given a large supply of IUDs but was unable to fully utilize them due to the lack of providers trained to insert them. LARC use in Texas is on the rise.
The rest of the news in brief:
US preventive services task force recommend screening all nonpregnant adults and adolescents at risk for syphilis, which is on the rise.
The British medical Journal reports that pregnant women with higher ambient glucose levels who are not meeting the criteria for gestational diabetes still have an increased risk of complications. These complications would include preeclampsia and overly large infants (macrosomia). Additionally, related complications are noted, such as shoulder dystocia, which is the condition where babies are dangerously difficult to deliver due to a larger girth at the shoulders.
The national Cancer institute is once again encouraging all children adolescents and young adults 26 years of age or younger to obtain the vaccine against the human papilloma virus, HPV. Only 40% of eligible girls and 21% of eligible boys have received the vaccine. Vaccination rates in Australia and the United Kingdom are in the range of 75 to 92%
In the good news and we already knew this department, an article in the Annals of Oncology has reminded us that use of oral contraceptives decreases ovarian cancer risk by 50%. For the record, having children and breast-feeding them also decreases this risk.
In the good news department, The number of Americans without health insurance has fallen to a recent level of less than 10%. This is attributed to people buying insurance on the Affordable Care Act (ACA) exchange.
Stay tuned for more exciting news from the world of Obstetrics , Gynecology, and Women's Health, next week on Medical Monday.