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

Policy News 

Yet another Federal Judge has put a stop to the defunding of a regional Teen Pregnancy Prevention program. This time .a district court judge in Washington, DC has ruled that that HHS (Department of Health and Human Services) must process the grant for $3 million dollars which provides for 20 health educator jobs and provides for teen pregnancy prevention education.

Many voices have come out in opposition to proposed changes to Title X funding. Title X funding is meant to ensure access to reproductive health care. However, funds are due to be cut from any provider who mentions abortion even as an option. Proponents of the measure say parenting and adoption will also be promoted. Opponents say this is being sought to placate anti-abortion elements of the electorate as well as to close programs and clinics, thus decreasing federal health care spending for those on the lower end of the socioeconomic spectrum. 

Thirteen governors have signed a “ sharply worded letter” sent to HHS secretary Alex Azar opposing the proposed Title X changes. The letter cites “reckless policy” which “upends decades of bipartisan cooperation”. 

Texas which has struggled mightily with appalling maternal morbidity and mortality, has voiced particular concern that changes to Title X could undermine efforts to combat impact rampant maternal complications in the State. 

Medical News 

Newer gene testing is allowing doctors to better target therapies to individual patients. In particular, we are now gaining insight, through genetic analysis, about which tumors in which patients are likely to respond to chemotherapy, and conversely, which are not. Gene testing is allowing some patients to skip chemotherapy and the complications that that entails. 

Also in breast cancer news, immunotherapy is being brought to bear in the fight against breast cancer. In one case study a 49 year old woman who had failed all other therapies received immunotherapy with a large clone of her own best cancer killing immune cells. These were produced by identifying and removing theses cells, and then amplifying them to 100 billion then using them as a treatment. This patient, who had no further treatment options, is now three years with NED- No evidence of disease !!! 

In similarly encouraging news a pairing of new ovarian cancer drugs have shown themselves to be effective against heretofore drug resistant ovarian cancer. 

Zika virus is again upon us in the South and authorities in Florida are taking precautions. Thus far there have been cases noted, but none have been of local origin. Zika Virus is transmitted by certain mosquitoes and is prevalent in tropical and subtropical climates such as in Florida, Central and South America. Zika virus contracted in pregnancy can make serious birth defects in the central nervous system of the unborn. 

Many women are identified as having pregnancy associated diabetes. They may require medication or dietary modification in pregnancy. New research now indicates that such patients may benefit from a postnatal lifestyle intervention program. Such women with a history of gestational diabetes are at increased risk for diabetes later in life. 

In concerning news, a new meta-analysis has indicated that hypertensive disorders of pregnancy such as chronic hypertension and preeclampsia may be associated with a higher risk of autism spectrum disorders and ADHD (attention deficit hyperactivity disorder). Women with untreated chronic hypertension, over weight women, and others have a higher risk of having hypertensive disorders of pregnancy. Maintaining normal weight and fitness before pregnancy can decrease the incidence of hypertensive disorders during pregnancy. 

A new and encouraging study has shown that resistance training helps stave off depression. Most of the exercise literature now supports the combination of light resistance training women for women, especially older women as it preserves muscle and burns fat. The combination of cardio and light resistance is often called HIIT or high intensity interval training. Low hanging fruit ! 

Stay tuned for more news from the fascinating world of Obstetrics and Gynecology, here, next week on Medical Monday. 

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

It is no secret by now that the Trump administration is systematically enacting policies to ban abortion and limit access to contraception. Medical experts have indicated their concern all along, saying these policies are likely to backfire, increasing unplanned pregnancies and abortions overall. 

Legal challenges to Trump administration policies are now coming from many quarters. Mississippi and Louisiana have pending legislation to ban abortion after 15 weeks. Both laws will now go to Federal court to be tested. Meanwhile, New Jersey is suing the Federal government against the exemption which permits corporations to purchase insurance without contraception coverage if they object to it on “moral” grounds. Since when can a corporation have morality ? People, owners, and board members can have morality or the lack of it.

The Federal Courts are going to have a big role in determining how much of this Trump era law stands. For example, a federal judge in Washington struck down the decision by the HHS (Department of Health and Human Services) to withhold funds for the teen pregnancy prevention program. The judge called the cancellation of funds “capricious”.  HHS actions have been struck down by federal courts four times to date. 

A survey of various health care groups has shown the 95% have strongly criticized the Trump administrations efforts to weaken the ACA (Affordable Care Act). The American College of Physicians has published a paper calling for recognition and addressing of the discrimination against women in health care. Health care disparities include those pertaining to reproduction, family and medical leave, domestic and sexual abuse and inclusion in clinical trials. 

Elsewhere in the world, Ireland has voted to repeal the countries ban on abortion. The popular vote passed by a margin of 2 to 1. To put things in perspective in this historically Catholic country, divorce was only legalized in 1995. Gay marriage has also been ratified in Ireland, and an openly gay man has served as Prime Minister. 

Medical News

We all know that genes influence our physical health. But they also influence our mental health. They are a number of genes which are associated with the development of Schizophrenia. However, even if they are present, the odds of actually developing schizophrenia are low. New research has indicated that pregnancy complications such as gestational diabetes and preeclampsia increase the risk of schizophrenia in susceptible individuals, as can smoking. This is all thought to take place via epigenetics and the placenta. More research is needed. 

A new study indicates what we have often observed; that those women who introduce a bottle in the hospital are much more likely to give up breastfeeding. Breastfeeding is recommended as the sole food source for babies for six months. 

The Nurses Health Study has produced data about nutrition and healing loss. Turns out those who had a diet most closely resembling a Mediterranean or DASH (Dietary Approaches to Stop Hypertension) diet were 30% less likely to experience moderate or severe hearing loss later in life. 

You will hear all kinds of unscientific reasons from patients about why they will not get a certain vaccine. We all know vaccines stimulate the immune systems and we all know they can make you feel a bit flu like in the process- no fun. New research has now proven that HPV ( human papilloma virus) vaccine does not cause increased autoimmune activity in girls. This confirms two prior large cohort studies. Despite all this, there is still a lot of push back against vaccines. It is hard for a caregiver to persist when a patient or a parent declines a needed vaccine. However new research indicates that physician persistent leads to 94% of children being vaccinated against HPV. 

Many times I hear talk to the affect that obesity alone is not a problem. There must be other factors such as diabetes or hypertension for obesity to be a threat to health. FALSE.. Newer date now tells us that having obesity ALONE makes you 39% more likely to have heart disease. 

We have been finding a lot of vitamin deficiency up here in the North Country. This has been true in pregnancy. We have undertaken supplementation regimens with the input of Endocrinology and are tailoring better maintenance regimens for both diet and supplements. New research has now show some good news : that those who take vitamin D in pregnancy are 28 % less likely to have low birth weight babies or stillbirth. 

In other vitamin D related news, new research also indicated that women with sufficient levels of vitamin D are 10% more like to get pregnant after a miscarriage, and 15% more likely to have a live birth after a miscarriage. 

Folic acid is also important in pregnancy and is known to prevent birth defects such as spina bifida. New research indicates that poorer women rarely takeout before it during pregnancy. This is something that should have a really easy fix. 

Stay tuned for more news from the fascinating world of Obstetrics and Gynecology, here, next week on Medical Monday. 

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

POLICY NEWS

As reported last week, many States are starting to push back against the defunding of teen pregnancy prevention programs in their states. The latest such example is Minnesota, where in Hennepin County, HHS (Department of Health and Human Services) terminated a $214 million teen pregnancy prevention program. The grant had originally been obtained to last through 2020 and was cut as of 2018, and the suit filed asks that it be reinstated until 2020 again. Texas’ Teen Pregnancy Prevention Program is called Healthy Futures of Texas, and its Title X funds are slated to be cut. However, This organization and other Texas grant recipients are filing lawsuits to discontinue the termination of their grants. 

Title X is a federal grant program dedicated solely to providing funds for birth control and family planning. The Trump administration governs the awarding of such grant money. Of late, they have shifted their funding criteria to favor those organizations which promote abstinence rather than evidence based birth control. Several chapters of Planned Parenthood and the National Family Planning and Reproductive Health Association have filed suit against the Trump administration alleging that this strategy violates the mission statement of Title X. 

During the recent years of the Trump administration, the number of uninsured Americans rose by 4 million. These are those who slip through the cracks between the Affordable Care Act plans and private insurance, with a single income of $30,000 and a joint family income of about $61,000. The data comes from the Commonwealth Fund who warned that this trend is likely to continue. 

MEDICAL NEWS

We have known for some time now that women have been concerned about contraceptive access ever since Trump was elected. Long acting reversible contraceptives (LARCs) have been the strategy for many women. In one particular study out of UCLA David Geffen School of Medicine, uptake of LARCs nearly doubled in the two weeks following the election. 

All kinds of stereotypes exist about older people. Some have to do with sexual activity. A new study has shown that 40% of people ages 65-80 are sexually active, and of those, 73% are satisfied with their sex lives. In the subgroup of those with spouses or partners, a little over half are sexually active. Caregivers need to continue to bear all this in mind. 

ACOG (American College of Obstetricians and Gynecologists) recently held its annual meeting. One presenter there highlighted the medical benefits of vibrators, and called upon Gynecologists to identify patients who might benefit from them, and initiate discussions which normalize their use. 

ACOG president Dr. Hal Lawrence has termed the current health care climate a “battle” and “ one that is not going to end anytime soon”. They have called it a “fight to protect women’s health care”. The ACOG president has highlight the advocacy efforts of the organization this past year, along with like minded others, the “Gang of Six” consisting of  internists, pediatricians, family doctors, psychiatrists, ob/gyns, and osteopaths. 

Menopause. It is the cessation of ovarian function and all that results from that. We cease to ovulate and become infertile. Then our hormone production quits, and we may have symptoms of estrogen deprivation, like hot flashes and vaginal dryness. The average age of menopause is 51, but the range is considerable and it takes about two years to get completely through. A new study has highlighted a little know fact, that women with a poor diet, i.e. diets high in refined carbohydrates, get menopause much sooner than those with high quality diets, such as those with lots of whole foods and fish. 

The postpartum period or so called fourth trimester, is getting some much needed attention. A new study has illuminated the prevalence of perinatal depression. Turns out it affects 1 in 7 women. Indeed, a related study found that maternal suicide takes more women than hemorrhage and hypertensive disorders combined, and accounts for 1 in 5 postpartum deaths. The study has also shown that only about a fourth of postpartum moms suffering from depression get treatment. Both the US Preventive Services Task Force and ACOG recommend mental health screening during pregnancy. Pregnant moms take note: Your postpartum visit should cover mood, emotions, infant care, sexuality , contraception, sleep, and health maintenance, to name a few. 

The opioid crisis has brought many problems for pregnant women and their children. However, one such problem can go under the radar: Hepatitis C.The opioid epidemic is driving an increase in Hepatitis C among mothers and children and neither the screening protocols for mothers or infants has kept up. Hepatitis C is transmitted by blood, and thus by needles, and infrequently, from mother to child. There is no vaccine, but just recently, there is a fairly good treatment. 

Stay tuned for more news from the intense world of Obstetrics and Gynecology, here, next week, on Medical Monday.