Medical Monday: Breaking News from the World of Obstetrics and Gynecology

Policy News:

Medical and civil rights organizations have come together to oppose the detention of pregnant women by the agency on Immigration and Customs Enforcement (ICE). They have cited harmful effects on the health of these individuals due to lack of access to proper prenatal care and due to the high risk of rape while detained. 

Senator Tammy Duckworth (D-Illinois) has been the first Senator to have a baby while in office. Adequate lactation rooms were ensured through a measure by Senator Nancy Pelosi in 2008 so that breastfeeding Senators could comply with breastfeeding recommendations from the American Academy of Pediatrics. However, the post partum senator may have more difficulty attending votes unless the current rules barring children from the Senate floor are modified. 

The Trump administration has added two new exemptions to the individual mandate which is the rule that says people must carry individual health insurance or pay penalties. One is an exemption for those who live in a place with only one ACA (Affordable Care Act) insurance carrier whose coverage includes abortion services. On the basis of paying into a fund whose services include abortion, they can be exempted. I can see why people feel such consumers should not be obligated to use such a plan. I believe, however, that same anti-abortion consumer should be obligated to follow through with their execution of conscience and be required, under pain of penalty to buy private health insurance so that the rest of society does not end up footing the bill for their conscience driven but unfunded health care.  

The second exception the the individual mandate is nonsense. It is a “hardship” exemption. Who more than those under hardship need quality health care ? This particular exemption is a recipe for making the poor or those under hardship even poorer. And what does it gain? It gains political brownie points under the guise of freedom, and a better appearing Federal spreadsheet for this administration to tout to the voting taxpayers. We need to do a better job a making it clear to people that they stand to gain much more buying health insurance than they do forgoing it. 

Four abortion restricting laws have been passed by the 2017 Arkansas legislators. However, several influential groups have filed amicus briefs at the 8th Circuit Court of Appeals in St. Louis. One is the American College of Obstetricians and Gynecologists pertaining to the criminalization of “D & E”, the procedure dilation and curettage. This procedure is a safe and effective method for abortion, the safest in fact for the second trimester, and is used in many medically indicated cases where the patient’s life is at stake. 

The New York Times has reported that Scott Lloyd, the director of the Office of Refugee Resettlement keeps a spreadsheet of all detained unaccompanied minors who are pregnant and are requesting abortion. Lloyd has directed that this "captive audience" received non medical “counseling”  regarding their requests. Does anyone else view this as a misuse of power ? Does anyone else view this an incursion of a non-medical authority into the realm of medicine and counseling ?

Medical News: 

 Ever heard of the term “Previvor”? Me neither.  Previvors are those that know they carry a genetic mutation for cancer but have not yet developed cancer. Many are people who have discovered their mutation through non- medical genetic screening such as through the popular company “23 and me”. Others are those with family member with cancer who have been advised to do testing. Either way they are in a grey zone, and do not always get the care they need to address their relatively new predicament. Enter Dr. Heather Macdonald, an Obstetrician Gynecologist at Hoag Hospital in Newport Beach, California. She has created a special tailored program for these patients. It is called the “ Breast and Ovarian Cancer Prevention Program. In it she has outlined the possible ways to address risk, which may range from surgery, to medication to health maintenance strategies. 

The nation is finally mobilizing on the issue of maternal morbidity and mortality. Five states were in on the creation of the Alliance for Innovation on Maternal Health (AIM), California, Florida, Illinois ,Michigan, and Oklahoma. Texas, the nation’s worst offender, has now joined. The initial states have since seen significant decreases in maternal morbidity using protocols called “safety bundles”. 

Young women still suffer stigma even in the confines of an office visit. New research indicated fully half of teens and young women do not feel comfortable discussing sexually transmitted infections (STIs). Moreover, over a quarter lie to their caregivers about their sexual history. Separate research has shown that that the incidence of STIs is at a many decade high. Nonetheless, 62% of women under 25 do not consider themselves at risk for STIs. Only 40% use condoms. What might be a way to change all this ? 

A recent study published in Obstetrics and Gynecology indicates that marijuana does show up in the breastmilk of using mothers. Infants who breastfed exclusively ingested about 2.5 percent of the maternal dose and peaked one hour after smoking. ACOG’s position on marijuana in pregnancy and breastfeeding is as follows: 

There are “...concerns regarding impaired neurodevelopment, as well as maternal and fetal exposure to the adverse effects of smoking”. 

"There are insufficient data to evaluate the effects of marijuana use on infants during lactation and breastfeeding, and in the absence of such data, marijuana use is discouraged.”

Reference: 

https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Marijuana-Use-During-Pregnancy-and-Lactation

PCO or polycystic ovarian syndrome is a complex medical condition that comprises problems with ovulation, fertility, menstruation and excess male hormones, and problems with acne and unwanted hair growth. It also includes problems with carbohydrate metabolism and may lead to cardiovascular disease and diabetes. New research also indicates is is associated with a higher prevalence of several psychiatric conditions including depression and anxiety. 

Initial testing of a personalized vaccine against recurrent ovarian cancer cells is showing promise. A patient’s own dendrite cells (DC) are treated and given separately or together with other immunotherapy. The DC vaccine induced potent anti tumor T cell responses and was well tolerated, and was associated with a better prognosis. Further clinical testing is planned. 

New research in the Journal Menopause has unearthed a connection between the severity of menopausal symptoms and the risk of heart disease. The research found that increased symptoms such as hot flashes were associated with artery stiffness and dysfunction. This research may come to influence the way we think about postmenopausal hormone replacement therapy which reduces both symptoms and arterial dysfunction. 

The biggest news of the week may be that alcohol is not as safe as once previously believed. A new international study has shown that even one drink of beer or wine per day can increase the odds of hypertension, stroke and heart disease and significantly shorten life. Numerous national and international recommendations are likely to be changed based on this. 

Stay tuned this week for more exciting news from the world of Obstetrics and Gynecology. 

Medical Monday : Two Week Catch Up

Happy Easter and Happy Passover. We have two weeks to cover. Thanks for reading ! 

Policy News

Much of the National Health Policy News this week deals with contraception and reproductive health. Can anyone remember any time in this or any other country when these private matters were ever so much on the national stage ? The politically conservative aspects of my nature questions why this degree of government intervention in private lives is necessary. My medical qualifications and medico-legal experience cause me to classify some of this meddling as practicing medicine without a license. 

Title X is a federal grant program whose purpose it is to promote positive birth outcomes and healthy families. It provides grants for family planning and health services. So here’s my first question: Why is it not run by health care professionals ? Trump administration officials are now contemplating new wording which would add additional criteria for clinics to receive Title X funding, namely the provision of primary preventive services. Sounds good right ? Well many clinics offer only reproductive health services. These clinics would have to expand or close. This measure seems like just another way of closing family planning clinics.  Now whether pap smears would qualify as preventive health is unclear, or whether paps would be classified as reproductive health, I don’t know. 

Texas is challenging the federal government’s withholding of funds for its family planning programs. They were withheld several years ago based on the fact that these providers, many of them through Planned Parenthood, also provided abortions.

Planned Parenthood itself is challenging the Federal Government on its withdraws of funds from the teen pregnancy program. Between this and two other plaintiffs, the Department of Health and Human Services has partially and temporarily restored some of the funding until litigation can be completed. 

Idaho has failed to solve the problem of insurance for those whose income falls between Medicaid and the Affordable Care Act coverage criteria. A proposal called Plan First Idaho would have funded family planing services for women in the gap. My question is, what rocket scientist designed the State’s the two programs such that their income qualifying criteria do not meet seamlessly ? This is a problem of their own making and it needs solving. Republicans in the Idaho House stalled this measure. 

Idaho Governor “ Butch” Otter has approved a measure by which prospective abortion patients must a told about “ abortion reversal” a procedure that does not exist. Additionally, he has signed legislation which will require abortion providers to collect personal and demographic information which, in de-identified form they intend to make public. I don't know what they think this will accomplish, but I have a feeling it may backfire, since they will be able to see how many and how diverse a group of women utilize the procedure.

The Supreme Court is hearing a case between the State of California and a group of "crisis pregnancy centers”, an actual chain of 130 outlets run by “ The National Institute of Family and Life Advocates”. These centers are anti-abortion counseling facilities, however they are licensed as family planning providers. California has a law requiring that all licensed family planning facilities to post notices of the availability of free or low cost birth control and abortion services and they are challenging it. They are arguing that this posting requirement violates their free speech.  So far the Court has expressed concern that these clinics not be singled out from other clinics. California has argued that their staff, many of whom are not medically qualified, present medical misinformation as truth, all to the end of dissuading patients from abortion. Apparently theses non-credentialed counselors actually wear white coats. 

Along with the opioid epidemic has come a hepatitis C epidemic. Kentucky, having seen a surge of the disease, has passed a law now requiring all pregnant women to be tested for it. Hepatitis C used to be very hard to treat. However, patients have much more hope nowadays due to the availability of effective therapy. 

Missouri has expanded Medicaid for pregnant women in drug abuse treatment. Their continued coverage will be contingent upon them staying in treatment, and could under those conditions, be continued up to 12 months.  

And now for more of a purple to blue state review:

Florida is considering a bill requiring HPV (human papilloma virus) vaccination to be required as part of the vaccinations required of children attending public school. Human papilloma virus causes multiple illnesses most notably cervical cancer and genital warts, and the vaccine has not demonstrated any conclusive evidence of harm.

It is interesting to note that physicians are not prescribing HPV vaccine equally for female and male children. Doctors recommend the vaccine twice as often for girls as they do for boys. This puts the boys at increased risk for HPV disease, and puts all their future partners at increased risk too. 

Mississippi passed a law banning abortion after 15 weeks Of course this is unconstitutional based on Roe V. Wade which is still on the books. A Federal Judge over turned Idaho's ban. 

New Hampshire has passed a bill which will allow pharmacist to prescribe birth control. No doctors visit will be necessary. The medical establishment has concluded that vast majority of the birth control methods are safe for the vast majority of women. They certainly are when compared to pregnancy for those same women. Authorities believe this will eliminate yet one more barrier to contraception. Utah signed a similar law into place earlier in the week. 

On the other coastline, the state of Washington now has a bill that will require insurance to cover contraception, abortion and maternity care. Additionally, after the first of the year, all contraception has to be co-pay and deductible free. This includes voluntary sterilization. 

The new budget has failed to shore up the ACA ( Affordable care Act) marketplaces. States will have to tighten their belts and work on their budgets one by one. 

ProPublica has reported that the “US is the most dangerous country in which to give birth”. States all over the US are creating programs to quantify and address the problem of maternal morbidity and mortality, even as the Federal government under Trump is dismantling reproductive and maternal health care piece by piece. 

Do you ever get the feeling that the various States in America are becoming like the countries of the European Union with different values, cultures budgets and laws ? 

Medical News: 

Obstetrics: 

Striking research findings presented at Lancet Global Health conference have shown that the death risk is double among pregnant women who are anemic compared with those who are not. The lead study author also found the correcting anemia is not a sufficiently high enough priority among physicians. 

Research presented at Diabetes UK conference has shown that excess weight gain incurred during pregnancy by  gestational diabetics is associated with greater risk of cesarean section.

Women who exercise in pregnancy have shorter labors. This interesting news was published in the May issue of European Journal of Obstetrics and Gynecology and Reproductive Biology. The study group attended a professionally led session of moderate exercise three days per week. Labor was shortened about one hour, mostly in the first stage, or dilating phase. ACTIONABLE ! 

Children who were breastfed exclusively for at least 6 mores were less likely to become overweight to obese than their counterparts. The conclusions were drawn by analyzing over 38,000 records from children South Korea. The finding were presented at the Endocrine Society Annual Meeting. 

Gynecology/General Medical News: 

There may be a male birth control pill on the horizon. Research at the Endocrine Society's annual conference has presented information on a new male birth control pill called DMAU. It contains androgen and progestin,  which is analogous to the contents of the female birth control pill, estrogen and progestin. Once daily tablets appear to be safe and effective. No period required. 

Menopause and aging in general is characterized by a loss of muscle mass and bone density as well as the deposition of fat. As suspected, the Mediterranean diet may have a positive impact on bone mineral density and muscle mass in postmenopausal women. The Mediterranean diet emphasizes the eating of high quality protein, large volumes of fruit and vegetables, healthy fats such as olive oil and a modest amount of complex carbohydrates such as whole grains. As a whole, the diet is lower in simple carbohydrates than the typical American diet and is also higher in protein and antioxidants.

There are now over 400 cases of a rare lymphoma which are linked, epidemiologically, to breast implants. Breast implants are not new. Lymphoma is not new. However our ability to collect and parse data is better than it has ever been. The FDA it's taken this ability and created a meaningful database for this type of information. While an association between breast implants and this rare lymphoma is being established through data collection, a causality between the two is not necessary implied. That said, nothing is more likely to lead us to understand the causes of this problem than amassing quality data about it. 

Federal funding support for cancers is disproportionately low for gynecologic cancers if you rank them by lethality. Cancer of the ovary and the uterus ranked near the bottom of the funding list. Contact your elected officials ! 

A new modification of the current device used for pap smears can identify cells from endometrial (uterine lining) and ovarian cancer. The investigational PapSEEK uses an analysis of 18 genes and analysis similar to that used in prenatal screening for Down’s syndrome to identical the genetically abnormal cancer cells. THIS IS SO COOL ! 

A new study on postmenopausal hormone therapy has shown that it does help maintain thinking and memory skills. This is the case IF it is initiated shortly after the onset of natural menopause. This study was presented in the Journal Neurology and was a high quality randomized controlled trial of 75 women between the ages of  42 and 56. 

In my mountain state, there is not a great deal of sunlight or seafood. As a result we have a high prevalence of vitamin D deficiency. New research indicates that vitamin D deficiency increases a post menopausal women’s risk of metabolic syndrome. Metabolic syndrome includes the unholy triad of diabetes, high blood pressure, and abnormal serum lipids ( cholesterol and triglycerides) which together increase cardiovascular risk. Vitamin D levels are checked by a simple blood test. Ask your doctor about this ! 

Stay tuned for more news from the exciting world of Obstetrics an Gynecology, next week, here on Medical Monday ! 

Medical Monday: Breaking News from the World of Obstetrics and Gynecology

After a season of crisis with the Zika virus, the director of the CDC, (Centers for Disease Control) Dr. Thomas Frieden, has stated that the Zika virus is not “ controllable with current technologies.”. He has also indicated that he believes Zika "will become endemic in this hemisphere.” He states a Zika vaccine is probably 2-3 years away. 

Delays in public funding to combat the Zika virus in Florida have motivated private and corporate donors to step up. Pfizer, contributed $4.1 million, and Community Health Charities and March of Dimes will contribute and fund raise. 

The CDC (Centers for Disease Control) and ACOG (The American College of Obstetricians and Gynecologists) have identified use of long acting lot reversible contraceptive, or LARCs, inserted in the immediate postpartum period as key in curbing unintended pregnancy. Happily, many states are changing Medicaid regulations to cover IUDs inserted immediately after delivery. LARCs are highly effective safe methods of birth control which require little in the way of maintenance or remembering on behalf of the patient. The complication rate is low but not zero. Complications that do exist are well described and manageable.

At my institution, we practice evidence-based medicine. Moreover, Obstetrics and Gynecology is a very highly studied and regulated field. Because of all of this, many of our practices for example on the labor unit our policy driven. For example, we permit and encourage laboring in water because the literature shows that has clear benefits and no known side effects.. Others have also advocated, In the absence of any supporting data, for birth in water as well mistakingly assuming that amniotic fluid is similar to water. Indeed, as regular water is irritating to your respiratory passageways, so it is as well to the respiratory passageways of a newborn. Based on this,we do not endorse water birth. Updated guidelines from ACOG indicate that the first stage of labor may take place in water but when it comes time to push women should get out.

American College of Obstetricians and Gynecologists sponsored a special briefing last week in Washington DC on the subject of us maternal mortality rates. United States overall maternal mortality rates are actually increasing in contradistinction to the rest of the world. They are increasing disproportionately among minority women particularly African American women.

A recent study by Harvard researcher Dr. Julie Silver indicates that female physicians are still chronically underrepresented as healthcare leaders. She indicates that this may contribute to the persistent salary gap that exists between male and female physicians.

While women and men are still not equal in many ways, equality has been gained in one category. The British Medical Journal recently presented research which indicated women are now drinking as much alcohol has men. The differences between men and women in three categories, any alcohol use, problematic alcohol use, and alcohol-related harms, are diminishing.

We have two items in the "We are already knew this” department. First, education and support may help women stick with breast-feeding. This groundbreaking research was supported by your tax dollars through the Department of Health and Human Services Agency for healthcare research and Quality through the US Preventive Services Task Force. Were we unwilling to provide education and support to potentially breast-feeding mothers before the dawn of this research conclusion? I think not.

Secondly, scintillating new conclusions published in the Journal Menopause indicate that women experiencing menopause symptoms may do better in a comfortable workplace. They break this down and indicate that the workplace should be comfortable. Moreover the patient’s boss should be supportive. Another victory for common sense and human decency !

In the possibly actionable department, a new study finds that good pain relief during labor may be associated with lower postpartum depression scores. An observational study presented at the annual meeting of the American Society of Anesthesiologists has found this result after evaluating 201 postpartum women. Studies of this nature are suggestive but not conclusive.

Here are a couple Halloween party food pictures that I promised. Have a happy and safe Halloween.

Medical Monday : Breaking News from the World of Obstetrics and Gynecology

As per recent precedent and priority, we start with the Zika news. 

Three of nineteen traps in the Miami area have trapped mosquitos which have tested positive for the Zika Virus. New readers will note that this virus is transmitted to humans through mosquitos bites and sex. If a pregnant women acquires the virus, it often leads to severe brain damage to the baby most notably in the form of microcephaly, which means small brain. It also leads to hearing loss. Dr. Anthony Fauci of the National Institute of Allergy and Infectious Disease Control and Prevention warned that microcephaly may be “ the top of the iceberg” and that the full impact of Zika may not be apparent until they grow older. Thus it is of paramount public health important especially with regards to the care of pregnant and potentially pregnant women. 

Zika virus infection can also increase the risk of post viral paralysis,Guillain-Barre syndrome, in those who are infected. New research published in the New England Journal of Medicine has confirmed the association with Guillain-Barre in seven different countries.

The FDA has recommended that all donated blood be screened for Zika, even in places where the virus is not present. Zika testing is currently expensive and time consuming, but officials feels this is necessary, given the seriousness of the infection and the fact that many Zika infections are asymptomatic. 

The mosquito vector which carries the Zika virus has a territory spanning only part of the United States. For this reason, officials believe the sexual route of transmission may become more important here that mosquito transmission. 

The director of the CDC (Centers for Disease Control) has stated that federal funds to fight the Zika virus will be exhausted by the end of September. It has already spent $194 million of the $222 million it was allocated. Congress must then act to provide funding to fight the virus effectively.

Postmenopausal hormone therapy is back in the news. Current practice is largely dictated by a landmark study called the Women’s Health Initiative (WHI), which was released in 2002. One of the principal investigators of the WHI, Dr. JoAnne Manson, said the “ WHI findings have been seriously misunderstood and misinterpreted. She indicated that the benefits still outweigh the risk for women of average risk for breast cancer." Aye there’s the rub. To calculate risk, you will need to have a good history taken, including a family history, a physical exam, a mammogram, and maybe even a visit to the genetics counselor. The plot thickens. 

Texas maternal mortality rates have doubled in the last four years and no one knows why. Numerous commentators have now published about this, and most have noted the political and funding challenges to women’s health care there and in the whole bible belt. There is serious speculation as to whether slashing funding for women’s health and the increase in maternal mortality is related.  Some would say that amidst the ardor to defund clinics which provide reproductive health care services like abortion and contraception, that Texas has also weakened its ability to care for pregnant women. In effect, Texas may have shot itself in the foot. It is believed that family planning clinics are an entry point into health care for many women of modest means. It is often the place where pregnancy is diagnosed. Without these clinics, prenatal care is delayed or absent. An editorial in the Dallas Morning News indicated that if were Texas a country, it would rank 31st in the OEC (Organization for Economic Cooperation and Development) for maternal mortality.

Unpacking this further we see that this jump in mortality is predominantly occurring in black women. Heart problems, prescription drug overdoses, and hypertensive disorders of pregnancy like preeclampsia (aka toxemia) are the leading causes of death in these women. I can tell you that to properly follow a women with cardiovascular or blood pressure problems in pregnancy is big undertaking. It involves frequent if not weekly visits, fetal monitor strips, serial Ultrasounds, and social support so the patient can rest. Maternal mortality is the worst complication one can imagine. Complications can happen anywhere, but deaths should be a rarity if care is adequate. According to research in the Journal Obstetrics and Gynecology, Texas maternal mortality rates are the worst in the nation and among the worst in the developed world. Truthfully it’s a disgrace. 

In the practicing medicine without a license department, Ohio passed a law in 2011 stipulating that providers of medical abortion had to use a FDA ( Food and Drug Administration) protocol for the doses of the 2 medications involved, mifepristone and misoprostol. Basically the law required them to follow the package insert, or “ the labelling”. This protocol was developed in 2000. By 2003, specialist organizations such as the American College of Obstetricians and Gynecologists and the World Health Organization, found shortcomings with the protocol and recommended changes in the package insert, allowing for the simpler and more effective dosing protocol, but also the evidence based extension of the gestational age for which the drug would be effective, and the ability for women to take the medication at home. However these changes weren’t made due to political reasons.  It now appears that since the law was enacted, women taking the suboptimal dose are more than three times more likely than before to have complications requiring additional intervention, often surgical. In other states without this law, medical providers would simply follow the most up to date recommendations of their professional governing body, including an up to date dosing protocol, regardless of the FDA labelling. This is called “ off-label use” of FDA approved medications. In many cases, in many fields of medicine, off label use is common and necessary to take the best care of patients. Up until May of this year, however, it was illegal to do so in Ohio. I wonder what they did to the rebel caregivers who gave the correct doses ? It would be tough to be a doctor in this climate. If the law didn't get you for off label use of meds, the lawyers could for knowingly giving a potentially unsafe dose of a medication to a patient. 

In May of this year, the FDA corrected the package labeling to reflect the most up to date science on the subject. Regardless of how you feel about abortion, you would not want to give a patient part of a dose of medication to only evacuate her uterus partially, since this can cause hemorrhage and infection !  Dangerous !

You may recall that a few weeks past I reported on the decline in teen pregnancy. At that time we were not precisely sure why. However, now, parsed the data and we have nailed it down. Drum roll please…..It’s…. you guessed it…. contraception !!! It turns out sexual activity did not vary in that time frame. Use of contraception did. It increased from 86% use from 78%. Science !

Perform labor is in the news. The causation of preterm labor has remained a bit of a mystery. To show you how nascent is our science, I present the findings of two recent studies, both retrospective. The first, published in the Maternal and Child Health Journal examined 400,000 births. Resistance to preterm labor seemed to be conferred by three things: birth spacing, optional weight at the beginning of pregnancy, and appropriate weight gain in the pregnancy. Pretty vague, I grant you. Next, is an NIH(National Institute of Health) study of 200,000 women. In this group  they were able to unearth the uncanny fact that women exposed to extremes of temperature early in pregnancy were more likely to deliver preterm. OK. What if they wore appropriate clothing and used climate control devices ? Gosh that is unhelpful information. Whereas, any old crusty Obstetrician can spot preterm labor risk as it walks through the door. She or he might notice the frenzy with which the patient blew in, the smell of cigarettes, the poor nutritional status, or poor dentition (teeth). We need studies which tell us about factors we can change - not the weather ! 

Stay tuned for more breaking news from the world of Ob/Gyn next week on Medical Monday. 

Medical Monday: Breaking News from the World of Obstetrics and Gynecology

Zika again dominates the news in Ob/Gyn. As of Friday, a storm system was approaching the subtropical state of Florida, where 43 are confirmed infected with the Zika Virus. Authorities think the storm may help spread the virus which is transmitted by mosquitos and sex. Meanwhile, the CDC (Centers for Disease Control) does not have enough Zika testing resources. I myself experienced this last week when I was told a specimen we sent to the CDC would take “weeks” to result. We Ob/Gyns are not able to effectively work in time frames like this, and so this week we will have being having some words with the powers that be. 

A new study published in Radiology has shown that Zika can cause many other brain defects besides microcephaly. They have thus far identified 8 major defects. One of the most common was ventriculomegaly, or enlarged ventricles and thinning cortex. 

Thus far the Florida outbreak has been clustered around Miami. However Thursday, an isolated case showed up some 250 miles to the north in Tampa Bay, Pinellas county. It is still unclear how this occurred. On the bright side, modeling done by researchers at the University of Florida has indicated that the total outbreak should limited to under 400 individuals or less, considering all the southern states. They also believe winter will stop the outbreak, which would then recur next summer the same way. It is estimated that 20,000 pregnant women in the Miami area are taking extreme measures such as confinement indoors or moving to avoid Zika infection. 

NewYork officials are noting that travel restrictions to Zika affected area not being properly observed by pregnant or pre conceptual women. How do they expect people to take these restrictions seriously when they gave full sanction to people traveling to the Olympics in Rio? 

Dr. Kristyn Brandi writes that Zika is spreading more rapidly than anticipated in Puerto Rico, and that resources of information and contraception are not adequately available. 

The chair of ACOG (American College of Obstetricians and Gynecologists) has written a strongly worded piece which has criticized how politics has prevented the funding of an adequate Zika response. He and co author, Dr. Didi Saint Louis of Morehouse School of Medicine have called for the full funding of comprehensive reproductive health care to allow women to avoid or delay pregnancy. They have called on Congress to reconvene to deal with this. 

In the non-Zika news, HPV virus is in the spotlight. This virus is responsible for abnormal paps, and cervical cancer, among other things. It has an effective vaccine which is meant for young people between the ages of 9 and 26. However parents remain wary to give it to their children. Research is being done regarding the prospect of putting it on the list of already mandatory vaccines which must be done before school entry. Surveys show that parents would accept this as long as there was an opt out provision. As of 2014, only 40% of girls and 20% of boys were vaccinated. It will be interesting to see if there will be those who decline the Zika vaccine once it gets developed. 

Breastfeeding is practiced by about 80% of all American women when they leave the hospital. However less than a third keep it up for the recommended time. The American Academy of Pediatrics has recommended that infants should get nothing but breast milk for six months, and that breastfeeding should continue one year. 

Co-sleeping beyond six  months has been shown to produce significant stress on women. Researchers at Penn State note this may be related to fragmented sleep and less time with partner. Perhaps this is related to the falloff in breastfeeding. 

In the everyone-already-knows-this department, researchers at UCLA have discovered that menopause accelerates aging. In all fairness, what they have determined is that methylation increases in menopause, accelerating cellular aging about 6 %.

And in the we-should-have-known department, the “ baby simulator” program in high schools designed to deter teen pregnancy may actually be encouraging it. Graduates of the program with over third more like to have a teen pregnancy. 

Stay tuned next week for more news from the amazing world of Obstetrics and Gynecology.  

Medical Monday: Breaking News from the World of Obstetrics and Gynecology

About 1.6 million pregnant women are at risk for Zika virus infection in South and Central  America. Now, health officials are concerned that local transmission of Zika virus has begun in southern Florida. This means the virus was acquired in Florida, instead of being acquired elsewhere while a person was traveling. This means that some of the mosquitos in Florida carry the virus.

In related news, the blood supply in South Florida is now considered to be potentially contaminated with Zika virus. The FDA ( Food and Drug Administration) has asked that all blood donations from South Florida halt until all donations can be screened for Zika virus.

In even more striking news, the CDC ( Centers for Disease Control)  is recommending that all pregnant women be screening for the Zika virus. 

As most of you know, Congress left for its seven week vacation without coming to an agreement on Zika funding. The President of the American College of Obstetricians and Gynecologists has written a strongly worded letter to Congress on this matter. 

http://www.acog.org/About-ACOG/News-Room/Statements/2016/ACOG-Statement-on-Congress-Failure-to-Take-Action-on-Zika

Proceedings from the National Academy of Sciences include research that indicates that women who enter menopause early age faster than other women. They were able to quantify this, saying that menopause speeds up cellular again about 6 %. They also indicated that poor sleep can trigger similar aging type changes. 

In related news, women who start menstruation late and who have menopause late compared to average are more likely to achieve 90 years of age. Information like this is useful in that it helps identify factors tied to longevity. 

Research from the Journal Circulation has indicate that only 2.5 hours of moderate exercise per week has measurable effects on heart disease risk in women. Let’s see, taking one day off per week leave six days for exercise. Divide that into 2.5 hours to get the time per day needed for exercise. Only 25 minutes per day needed to reduce cardiac risk ! 

Stay tuned next week for more breaking news from the world of Ob/Gyn and women’s health.

Wellness Wednesday: Wellness in Menopause

More and more of us will be in menopause as time passes by. Our lifespans are increasing along with the quality of our health care and our knowledge about fitness, nutrition and health in general. So get rid of old stereotypes about menopause and menopausal women and learn the facts HERE. 

Menopause Monday: Menopause Basics

Thinking about menopause ? I didn't think so. But chances are, you or someone you care about is in menopause or will be facing it someday. Menopause is a natural life transition. At its essence, it means the cessation of reproductive functioning. It need not mean the loss of health, intellect or vibrancy. On the contrary, it can be a time for better self care and creativity. Click HERE to learn more.