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Women’s Health

In the News, Parenting, Pregnancy, Public Health, Public Safety, Women's Health

Exploring new recommendations to diagnose prenatal and postpartum depression

Exploring new recommendations to diagnose prenatal and postpartum depression

Although having a child is usually considered a happy event, an estimated 10 to 15 percent of women living in the U.S. develop some form of maternal depression. In response to new research and increased awareness about the problem, the U.S. Preventive Services Task Force revised their 2009 recommendations for screening procedures to diagnose and treat prenatal and postpartum depression.

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The guidelines, published last week in the Journal of the American Medical Association, now recommend screening for depression in the general adult population and they highlight the potential benefits of screening for pregnant and postpartum women.

Earlier this week, KQED Forum delved into the basis and potential implications of these new recommendations by exploring the topic with a panel of experts including Katherine Williams, MD, director  of Stanford’s Women’s Wellness Clinic.

Williams (who begins speaking at the 10:25 mark) stated that one of the most important aspects of the revised recommendations is its discussion of psychotherapy and how it can and, as Williams says, should be used as the first form of treatment for pregnant or nursing moms who are suffering from depression. The entire hour-long discussion is worth a listen.

Previously: A telephone lifeline for moms with postpartum depression“2020 Mom Project” promotes awareness of perinatal mood disordersAh…OM: Study shows prenatal yoga may relieve anxiety in pregnant women and Helping moms emerge from the darkness of postpartum depression
Photo by Sarah Zucca

Autoimmune Disease, Pregnancy, Research, Stanford News, Women's Health

The latest on the pregnancy risks for women with lupus

The latest on the pregnancy risks for women with lupus

2892182827_accf82f274_zWomen with lupus, an autoimmune disorder that can attack a variety of tissues, were once counseled to avoid pregnancy. Now, physicians tailor their advice to each patient’s case. In many instances, however, it’s difficult for physicians to gauge what types of risk their patient might be facing.

A new study designed to clarify those risks found that women with lupus during pregnancy — and even women who may soon be diagnosed with lupus — are more likely to experience preeclampsia, stroke and infection than women without lupus. Infants born to mothers with lupus or pre-lupus are also more likely to be born preterm, have infections, or be small for gestational age, according to the paper, which was published today in Arthritis Care and Research.

“We’ve confirmed previous findings while strengthening the data to show that lupus is associated with a variety of adverse pregnancy outcomes both to the mother, and to the infant,” said senior author Julia Simard, ScD, assistant professor of health research and policy at Stanford.

The research team, which included collaborators in Sweden and at several U.S. universities, examined data from population-based Swedish registers. That data set allowed the researchers to identify patients who had babies several years before being diagnosed with lupus.  From 13,598 single, first-time births, the team identified 551 women with existing lupus and 198 who presented with lupus within five years after giving birth.

For women who have not yet been diagnosed, it’s possible that autoantibodies implicated in the disease may lead to some of the adverse outcomes, but the exact mechanisms remain unknown, Simard said.

She and others are also working to clarify the clinical ramifications of the work, which may help refine physicians’ recommendations and care of pregnant women with lupus, and may lead to earlier diagnoses.

This is a descriptive study, Simard cautioned. Lupus is a challenging condition to study, because it can manifest differently in every patient. As with other chronic diseases, it’s also difficult to distinguish between conditions that could strike anyone, and conditions that might be caused by lupus, she said.

Previously: Empowered is as empowered does: Making a choice about living with lupus, Women and men’s immune system genes operate differently, Stanford study shows Lupus and rheumatoid arthritis may mean fewer children for female patients and Why some autoimmune diseases go into remission during pregnancy
Photo by J.K. Califf

Ask Stanford Med, Pregnancy, Women's Health

A look at hypertension in pregnancy

A look at hypertension in pregnancy

Most people know that hypertension, or high blood pressure, is a common condition. What many might not know is that it’s also one of the most common complications in pregnancy: It is prevalent in 5-10 percent of pregnant women.

In a recent Q&A session, Sandra Tsai, MD, MPH, spoke with BeWell at Stanford about this condition and its effects:

Hypertension in pregnancy — especially the more severe forms (preeclampsia and eclampsia) — increases the risk for complications such as placenta abruption, acute kidney injury, and death. Longer-term, women diagnosed with hypertension in pregnancy are at risk for future cardiometabolic diseases — including hypertension, diabetes, stroke, and heart attacks.

Tsai also delved into ways to prevent hypertension and discussed her own work in this area:

Lifestyle behaviors — such as a healthy diet, regular exercise, starting pregnancy with a normal weight — may reduce, but may not entirely prevent, a woman’s risk for developing hypertension in pregnancy.

I am interested in helping women maintain a healthy weight throughout pregnancy. Women who start their pregnancy with excess weight are at increased risk for gaining more weight than the Institute of Medicine recommends. If these women can remain within the weight gain guidelines, they may be at less risk of developing pregnancy complications such as gestational hypertension and preeclampsia.

Alex Giacomini is a social media intern in the medical school’s Office of Communication and Public Affairs. 

Previously: Attending to signs of preeclampsia in late-stage pregnancy and The importance of knowing your blood pressure level in preventing hypertension

Fertility, Pregnancy, Sexual Health, Women's Health

Fertility quiz: How well do you know your body?

Fertility quiz: How well do you know your body?

2364734203_937bfdfe48_zRemember all the rumors that you heard about sexuality and fertility as a teen (or even a 20-something or a 30-something)? It’s hard to sort fact from fiction.

According to the Institute for Reproductive Health (IRH) at the Georgetown University Medical Center, an accurate understanding of sexuality and fertility is surprisingly low around the world. That’s why IRH has created an online quiz to probe fertility awareness, called “Know Your Bod,” which poses the challenge: “You live with your body everyday. Do you really know it? Find out.”

The online quiz asks ten questions including the true-or-false query, “A woman will get pregnant only if she has sex on the same day she ovulates? ” After you select an answer, the quiz provides a simple educational summary that explains the correct answer. At the end, it shows your score and how you compare to the general population.

The quiz was officially introduced this week at the International Conference on Family Planning in Indonesia. It was developed as part of IRH’s Fertility Awareness for Community Transformation Project, which strives to increase fertility awareness and the use of family planning.

Victoria Jennings, PhD, director of IRH, explained in a recent Georgetown press release:

Accurate understanding and awareness about human fertility is surprisingly low around the world, regardless of age, sex or education level. If we could lift the taboos and improve fertility awareness, would people be informed and empowered to make better sexual and reproductive health decisions? At IRH, we believe the answer to this question is ‘yes.’

So why not take the challenge? How well do you know your bod?

Jennifer Huber, PhD, is a science writer with extensive technical communications experience as an academic research scientist, freelance science journalist, and writing instructor.

Previously:Ask Stanford Med: Expert in reproductive medicine responds to questions on infertilitySex without babies, and visa versa: Stanford panel explores issues surrounding reproductive technologies, and Med students want more sexual-health training
Photo by Scott Maxwell

Cancer, Events, Stanford News, Women's Health

There’s something about Harry: Harry Connick Jr. sings in support of women’s cancer research

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The heavy rain started just as the salad plates were taken away (“How appropriate,” I thought – given the name of the event I was attending), but few people inside the Sharon Heights Golf and Country Club in Palo Alto were paying attention to what was happening outside. Most eyes, including those of Stanford President John Hennessy, PhD, and Lloyd Minor, MD, dean of the medical school, were instead directed to a small stage at the front of the room holding a sleek black piano, several brass-holding men clad in suits, and Harry Connick Jr.

The acclaimed vocalist/pianist was in Palo Alto for Under One Umbrella, an annual event benefiting the Stanford Women’s Cancer Center, and he wowed the crowd with his commanding voice, big smile, and charming personality.

“I wrote this song for my wife, but there are so many attractive people here that you should consider it yours,” he told the largely female audience with a grin before launching into his 2013 song “One Fine Thing.” And later, he jokingly scolded the appreciative crowd when they gave him an enthusiastic standing ovation: “You’re not supposed to act like that at a damn luncheon.”

Moments earlier, Connick had been introduced with great fanfare by Jonathan Berek, MD, director of the center, who called the crooner not only an “internationally celebrated” entertainer but an “active philanthropist” and a “special guy.” (“I’ve never received so many compliments in my life,” Connick later laughed. “I’m going to make him my ringtone.”) And Connick also has a personal connection to what brought the roughly 300 people together on that rainy afternoon: As he shared during a serious moment between songs, his mother died of ovarian cancer when he was 13.

“Man, do we get it,” he said of those who have been affected by cancer. “It’s so nice to be among people who know what it’s all about.”

Connick took a few moments on the stage to call out Berek on his accomplishments – “It’s not often that you’re humbled sitting next to someone,” he said of the pre-performance time they spent together – and the work of others here, which was nicely highlighted in a 8-minute, Berek-produced film shown at the event.

During the piece, Beverly Mitchell, MD, director of the Stanford Cancer Institute, called the women’s cancer center “one of the jewels in our crown.” And Berek, before introducing Connick, noted the “tremendous expansion” of the “innovative and extensive” research programs that has occurred since the first Under One Umbrella event in 2008. (Much of this is, of course, thanks to Under One Umbrella, which has raised more than $26 million over seven years for the center.)

Berek also reminded attendees of the importance of patients – “They are both our benefactors and our inspiration” – but it was evident that most in the room also took inspiration from our researchers and clinicians. “I’m glad I can be a small part of this, but know how honored I am to be among the people who will eradicate” these diseases, Connick told the crowd.

Previously: Country music stars thank Under One Umbrella for supporting Stanford Women’s Cancer Center, Stanford Women’s Cancer Center: Peace of mind and advanced care under one umbrella and Garth Brooks and Trisha Yearwood help fundraising effort for Women’s Cancer Center at Stanford
Photo by Drew Altizer

Global Health, Health Policy, In the News, Pediatrics, Pregnancy, Women's Health

Ending preventable stillbirth: A Q&A with Stanford global-health expert Gary Darmstadt

Ending preventable stillbirth: A Q&A with Stanford global-health expert Gary Darmstadt

Today, prominent medical journal The Lancet publishes “Ending Preventable Stillbirth,” a series of articles calling for global efforts to greatly reduce fetal deaths that occur late in pregnancy or during labor. The series brings much-needed attention to a medical and societal problem that often goes ignored.

“Millions of women and families around the world have suffered the pain of stillbirth in silence,” said series adviser Gary Darmstadt, MD, a Stanford global-health expert who studies how to improve medical care for pregnant women, infants and children in developing countries.

Darmstadt recently answered my questions about why we should break the silence and work to lower stillbirth rates. “Many of the interventions that avert stillbirths also avert deaths of mothers and newborns,” he said. An edited version of his responses is below.

What’s the biggest misconception about stillbirth?

Perhaps the biggest misconception is that stillbirths don’t matter. There is a tradition of social stigma and lack of awareness of stillbirths that makes it easy to keep them out of sight and out of mind. But an estimated 1.2 million women around the world every year have an intrapartum stillbirth: They enter into labor after a normal pregnancy, with great expectations for a healthy baby and one of the most joyous experiences of a lifetime, only to face sudden devastation when the baby dies during birth. Their experiences matter.

A related misconception is that nothing much can be done to prevent stillbirth, or that prevention will divert scarce resources from other important issues. In fact, three fourths of intrapartum stillbirths around the world could be prevented through means that we take for granted in high income societies — such as skilled medical care before and during delivery — and that also benefit mothers, surviving newborns and children.

Why did the scientists involved in The Lancet’s new series think it was important to break the common pattern of silence, stigma and fatalism around stillbirth?

Stillbirth is a taboo topic in many societies, or worse yet, mothers are blamed for failing to deliver a healthy baby and feel intense social pressure to keep quiet about stillbirth. Their sense of loss and isolation may lead to depression, which in turn has many adverse consequences, including for subsequent pregnancies. On the other hand, many women who have the opportunity to talk about their experience with stillbirth and work through their grief express great relief and renewed hope. When the last Lancet stillbirth series came out five years ago, and women shared their experiences online or in parent support groups — often the first time they had ever shared their experience with stillbirth with anyone — many found this to be immensely healing and empowering. Thus, it was both the science showing the adverse effects of unexpressed and unresolved grief, and the testimonials of women who had experienced the benefits of breaking the silence that I believe influenced the scientists involved in The Lancet series to highlight this issue.

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Pregnancy, Public Health, Women's Health

Reducing cesarean delivery rates, without jeopardizing safety

Reducing cesarean delivery rates, without jeopardizing safety

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Approximately one-third of all babies born in the United States are currently delivered by cesarean section, according to the Centers for Disease Control and Prevention. Although cesarean delivery can be life saving for both the mother and child, the rapid increase in the cesarean birth rate between 1996 and 2011 raised significant concern that cesarean delivery is being overused.

This concern has led to initiatives to lower the c-section rates, including a new plan funded by the Oakland-based California HealthCare Foundation (CHCF) to lower California’s c-section rate for low-risk mothers to 23.9 percent in the next five years — in alignment with the federal government’s Healthy People 2020’s national target.

A recent KQED Science article describes these efforts to reduce the state’s c-section rates. The story also explores the controversial issue that a healthy pregnant woman’s likelihood of having a cesarean birth varies depending on the hospital, based on a recent analysis of maternity care. For instance, the CHCF’s assessment report found that Lucile Packard Children’s Hospital Stanford has a c-section rate of 23.0 percent and the Coastal Communities Hospital in Santa Ana has a rate of 42.9 percent.

Deirdre Lyell, MD, professor of obstetrics and gynecology, clarified the issue in a recent email:

Nationally and internationally, there is concern that cesarean rates as a whole are too high. CHCF and others have shown a wide range in cesarean rates by hospital around the country, and even within hospitals among individual physicians. Hospitals with very high rates should examine the underlying reasons. However, the “ideal rate” depends on the characteristics of the patient population, and it would be inappropriate to apply one goal to all women. For example, a non-obese 25-year old who has had a prior vaginal delivery has a better likelihood of delivering her baby vaginally than does an obese 45-year old first-time mom.

At Stanford, we follow the “Safe Prevention of the Primary Cesarean Delivery” guidelines outlined by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. We care for a higher risk maternal and higher risk fetal population, and share with our patients a common goal for delivery: a safe mom and a safe baby, while not performing cesareans unnecessarily. Avoidance of the first cesarean helps reduce the potential risks in the future.

Jennifer Huber, PhD, is a science writer with extensive technical communications experience as an academic research scientist, freelance science journalist, and writing instructor.

Previously: C-section rates up to 19 percent help save women and their newborns, global study findsUnneeded cesareans are risky and expensive, and  “The mama Sherpas”: Exploring the work of nurse-midwives and their collaborations with doctors
Photo by Salim Fadhley

Health Policy, In the News, Women's Health

Breast screening recommendations — finalized?

Breast screening recommendations — finalized?

mammogramThe simmering national debate over how often and at what age women should get mammograms has come to a full boil once again.

This week, the U.S. Preventive Services Task Force reaffirmed its 2009 guidelines that said women in their 40s with an average risk of breast cancer should discuss mammography with their clinicians and make individual decisions about whether to have the screening.

The panel members said their final recommendation is that women 50 and older only get the screening every other year.

This has provoked an outcry from some medical associations and cancer-awareness advocates who fear the advice would lead some women to delay having mammograms and put them at greater risk of death. A task force editorial explains:

In 2015, contentious discussions about breast cancer screening and prevention continued, with physicians, advocates, lawmakers, and scientists all lending their voices to the debate.

Many of these stakeholders focused on the need for women to be able to make more informed health care choices about when to start screening without having to worry about the cost of an insurance copayment.

Douglas Owens, MD, director of the Center for Health Policy and the Center for Primary Care and Outcomes Research, is a member of the task force.

The task force determined that while screening mammography in women aged 40 to 49 may reduce the risk for breast cancer death, the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger.

The balance of benefits and harms is likely to improve as women move from their early to late 40s, the task force said.

Breast cancer is the second-leading cause of cancer death among women in the United States, according to the National Cancer Institute. In 2015, an estimated 232,000 women were diagnosed with the disease and 40,000 women died.

Previously: A new way of reaching women who need mammograms, Education reduces anxiety about mammography and Screening could slash number of breast cancer cases
Photo by Getty iStock

Cancer, Imaging, In the News, Medicine and Society, Women's Health

This breast cancer is mine: When doctors get sick

This breast cancer is mine: When doctors get sick

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As the death last year of neurosurgeon Paul Kalanithi, MD, reminded us all, successful physicians aren’t protected from the onslaught of medical maladies that can strike anyone at any time.

Take Kimberly Allison, MD, a breast cancer researcher whose personal experience with the disease is featured in a recent Newsweek article and whose own breast cancer cells are shown above.

In 2008, Allison found a “shelf-like formation” under her arm. Only 33, she calls the experience “completely disorienting.” One minute she’s a doctor. The next, a patient.

As a pathologist, she was equipped to examine her own cells, as described in the article:

Slow-growing cancers appear almost like normal cells under a microscope’s lens. But then, Allison says, there are “big, bad and ugly” aggressive cancers. Instead of being neatly arranged into structures, these cancer cells swell and lose their tidy alignment. That’s what Allison saw when she peered through the microscope at her own cells.

This story has a happy ending. Allison penned a book on her experience, and she is now advancing the science on the particular type of breast cancer that struck her.

For more on Allison’s experience, check out this 1:2:1 podcast with Allison and Paul Costello, chief communications officer at the School of Medicine.

Previously: “You have cancer”: On being a doctor and receiving the news, Stanford neurosurgeon/cancer patient Paul Kalanithi: “I can’t go on. I will go.” and Stanford neurosurgeon Paul Kalanithi, who touched countless lives with his writing, dies at 37
Image courtesy of Kimberly Allison

Cancer, Imaging, Women's Health

Education reduces anxiety about mammography

Education reduces anxiety about mammography

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My close childhood friend Kelly died from breast cancer when she was only 32 years old. This inspired me to choose a research position at Berkeley Lab to help develop new breast-imaging scanners to improve early detection. Given my expertise in this field, my friends come to me with their confusion and ask, “At what age and how frequently should I get a mammogram?”

There has been a lot of debate surrounding mammography screening since 2009 when the United States Preventive Services Task Force revised the guidelines for average-risked women, limiting routine screening to biennial mammography for women 50 to 74 years of age.

The researchers recommended increasing the screening age in part because of the harmful anxiety caused by false-positive results, which are more common in younger women. The American Cancer Society recently released a new set of guidelines that recommends yearly mammograms starting at age 45, but they also considered the pain, anxiety and other potential side effects of mammography.

A recent article published in the Journal of the American College of Radiology describes a successful intervention to reduce this anxiety. The authors organized interactive one-hour educational sessions on mammography, which were led by a trained breast radiologist.

Before the lecture, a questionnaire was administered to the participants to identify their anxiety and previous mammography experience — 117 responded. Those respondents who reported having anxiety about mammography screening indicated “unknown results” and “anticipation of pain” as the primary sources of their anxiety.

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