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Women’s Health

Pregnancy, Stanford News, Women's Health

Attending to signs of preeclampsia in late-stage pregnancy

preeclampsiaAs recently written about on Scope, the California Quality Care Collaborative organized a task force and produced a toolkit of recommendations for treating preeclampsia, a pregnancy complication marked by hypertension that can kill pregnant women and new mothers.

An article in the San Francisco Chronicle details one woman’s health emergency and stillbirth experience owing to the condition. “I wish I had known more about preeclampsia,” Elizabeth Barnett, the 33-year-old mother, told Stephanie M. Lee. “Not that the outcome necessarily could have been that much different because of how severe I had it, but I definitely would have gone into the hospital earlier and would have been more on top of it.”

The piece emphasizes why recognizing and treating preeclampsia and eclampsia – which may induce deadly seizures – is paramount for expectant mothers and their health care providers.

From the Chronicle:

“Nobody realizes it’s a problem. Preeclampsia is the most common medical complication of pregnancy essentially,” said [Maurice Druzin, MD], an obstetrics and gynecology professor at Stanford University School of Medicine and an attending physician at Lucile Packard Children’s Hospital. Druzin helped lead the group of clinicians that wrote the guidebook.

From 2002 to 2004 in California, 25 women died of preeclampsia or eclampsia, making up 17 percent of all pregnancy-related deaths in the state during that time, according to an analysis of the most recent data. The number of maternal deaths in California, in general, is relatively small. The numbers had, in fact, been declining for years, but increased between 1999 and 2010 because of chronic conditions among pregnant women, variety in quality of pre- and postnatal care and other factors.

Previously: New preeclampsia toolkit will help prevent maternal deaths and Could exercise before and during early pregnancy lower risk of pre-eclampsia?
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Clinical Trials, Fertility, NIH, Research, Women's Health

Testosterone therapy not effective for primary ovarian insufficiency-related depression, study finds

Testosterone therapy not effective for primary ovarian insufficiency-related depression, study finds

Primary ovarian insufficiency (POI), a condition affecting approximately 1 percent of women and teenage girls in the U.S., is characterized by ovaries that stop functioning normally before a woman is 40. POI may be a cause for irregular periods, reduced fertility, or health problems such as osteoporosis, and women with POI may also be at risk for depression and decreased quality of life. Treatments for POI may include hormone replacement therapy to restore estrogen and progesterone levels.

A recent study from the National Institutes of Health Clinical Center has examined the effect in women with POI of one year of hormone treatment that included testosterone.

From a release:

In the randomized, double-blind, placebo controlled study, 61 women used placebo patches and 67 women used patches that delivered 150 micrograms of testosterone a day, similar to the Intrinsa patch that was rejected by FDA as a treatment for low sexual desire in women.

After 12 months, testosterone levels were back up to normal for the women who got the treatment. The investigators saw no detrimental effects of testosterone, but they found no significant improvement either in measurements of quality of life, self esteem and mood compared with placebo.

Bringing testosterone back to normal doesn’t help these aspects of life, suggesting that it’s something other than testosterone that plays a role in mood problems for women with POI, concluded the researchers.

“This study makes an important contribution toward understanding what testosterone can and cannot do. With all the hype about testosterone and aging, it is important that the public have the facts,” NAMS Executive Director Margery Gass, MD, said in the release.

The study was published online in the journal Menopause.

Previously: An in-depth look at fertility and cancer survivorshipAsk Stanford Med: Expert in reproductive medicine responds to questions on infertility, Researchers describe procedure that induces egg growth in infertile women and Oh, baby! Infertile woman gives birth through Stanford-developed technique

Health and Fitness, Pregnancy, Public Health, Research, Women's Health

Group sessions shown to help women maintain healthy pregnancy weight

Group sessions shown to help women maintain healthy pregnancy weight

pregnant_012214More than 50 percent of pregnant women, myself included, gain more weight than the recommended national guidelines. Personally, I had grand ambitions of maintaining my pre-pregnancy workout routine, or at least a modified version, and sticking to my usual healthy eating habits for the entire 40 weeks. But then I was sidelined for several months by unrelenting fatigue and an odd form of morning sickness where only Mexican cuisine agreed with my stomach. Although I resumed exercising and eating a more diverse diet, I wasn’t able to keep my weight gain within the suggested range.

Perhaps I would have been more successful if my prenatal check-ups had been structured as meetings with other women of similar gestational ages, rather than the traditional doctor visit. According to a growing body of research, women who received group prenatal care benefitted in a number of ways, including weight management. Futurity reports:

Researchers found that women who participated in prenatal care delivered in a group setting as opposed to the traditional approach—which typically involves a series of regular one-on-one visits with a healthcare provider—saw a 22 percent reduction in the risk of excessive gestational weight gain.

The beneficial effect of group prenatal care was even more pronounced for women who were overweight prior to pregnancy, who saw a 28 percentage points reduction in the risk of excessive gestational weight gain.

The post also notes that past studies have shown prenatal group check-ups can reduce the risk of infants being born with very low birth weights and increase the odds that  mothers will breastfeed their babies.

Previously: Eating nuts during pregnancy may protect baby from nut allergies, What’s in YOUR blood? A simple blood test may change the face of prenatal care and From womb to world: Stanford Medicine Magazine explores new work on having a baby
Photo by hugrakka

Patient Care, Pregnancy, Public Health, Stanford News, Women's Health

New preeclampsia toolkit will help prevent maternal deaths

New preeclampsia toolkit will help prevent maternal deaths

pregnant woman holding bellyCalifornia hospitals have a new tool to help reduce maternal deaths. Today, the California Maternal Quality Care Collaborative released a toolkit for the treatment of preeclampsia, a pregnancy complication that can kill pregnant women and new mothers. Although, fortunately, few women die in California during pregnancy or birth, preeclampsia is among the leading causes of such deaths. Importantly, many deaths caused by this disease can be prevented if doctors know what to do.

Preeclampsia is characterized by high blood pressure in late pregnancy. It can escalate without warning to full-blown eclampsia, in which the woman experiences potentially deadly seizures. The only cure is delivery of the baby.

To help California hospitals handle this obstetric emergency, the CMQCC convened a task force that reviewed scientific literature on the disease. The task force, c0-led by Stanford’s Maurice Druzin, MD, developed a package of materials that includes care guidelines, such as identification of clinical “triggers” that require immediate evaluation; a compendium of relevant research on the disease; and educational materials for physicians and patients.

From the CMQCC’s announcement about the toolkit:

The primary aim of the Toolkit is to guide and support obstetrical providers, clinical staff, hospitals and healthcare organizations to develop methods within their facilities for timely recognition and an organized, swift response to preeclampsia. “Every hospital that provides obstetric care should have current guidelines on early recognition and response to preeclampsia,” says Dr. Druzin. An expert in the field, Dr. Druzin also served on a national committee that made recommendations to the American College of Obstetrics and Gynecology on how to diagnose and treat preeclampsia.

I spoke with Druzin when the toolkit was in development, and he stressed that sharing this information could prevent tragic outcomes for women and their families. “The good news is that with a modern treatment approach, most women and their babies can have safe, healthy outcomes,” he said.

Previously: Could exercise before and during early pregnancy lower risk of pre-eclampsia?
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Aging, Chronic Disease, Health and Fitness, Men's Health, Research, Women's Health

More evidence that prolonged inactivity may shorten life span, increase risk of chronic disease

More evidence that prolonged inactivity may shorten life span, increase risk of chronic disease

sitting_deskIf you have a lengthy daily commute, spend hours at a desk clacking on the computer, or sit for a prolonged period for other reasons, a pair of recent studies may have you leaping to your feet.

The first study, conducted by researchers at Cornell University, examined the effects of sitting for a long period of time each day over a 12-year period. Results showed that individuals who were inactive for more than 11 hours had a 12 percent higher mortality rate than those who sat for four hours or less. And don’t think you’re not at risk because you occasionally hit the gym. Cornell researcher Rebecca Seguin, PhD, explained in a Futurity post:

The assumption has been that if you’re fit and physically active, that will protect you, even if you spend a huge amount of time sitting each day… In fact, in doing so you are far less protected from negative health effects of being sedentary than you realize.

While this study focused on postmenopausal women, additional research from Kansas State University shows that the health risks of being sedentary affect both both genders. The study analyzed data on nearly 200,000 men and women ages 45 to 106 taken from a large Australian study of health and aging. The research showed that both exercising and reducing sitting time were key to improving health. MedicalXPress reports:

Even standing throughout the day—instead of sitting for hours at a time—can improve  and quality of life while reducing the risk for  such as , diabetes, heart disease, stroke, breast cancer and colon cancer, among others.

Sitting for prolonged periods of time—with little muscular contraction occurring—shuts off a molecule called lipoprotein lipase, or LPL, [Sara Rosenkranz, PhD,] said. Lipoprotein lipase helps to take in fat or triglycerides and use it for energy.

“We’re basically telling our bodies to shut down the processes that help to stimulate metabolism throughout the day and that is not good,”  [Rosenkranz] said. “Just by breaking up your , we can actually upregulate that process in the body.”

Previously: Exercise is valuable in preventing sedentary deathIs standing healthier than sitting?How sedentary behavior affects your health and Stanford hosts conference on the science of sedentary behavior 
Photo by Danny Choo

Infectious Disease, Pregnancy, Public Health, Women's Health

Text message reminders shown effective in boosting flu shot rates among pregnant women

Text message reminders shown effective in boosting flu shot rates among pregnant women

pregnant_textingInfluenza is now widespread in 35 states across the country. Changes to the immune system during pregnancy make expectant moms more susceptible to the flu, and these women also face a particularly high risk for complications if they get sick. But despite this, roughly half of pregnant women fail to get a seasonal flu shot.

In an effort to increase adherence rates among moms-to-be, Columbia University researchers recently examined the effectiveness of using text message reminders. Psych Central reports:

Women in the intervention group received five weekly text messages about the importance of the vaccine starting in mid-September 2011 and two text message appointment reminders.

Both the intervention group and a control group received standard automated telephone appointment reminders.

The results showed that text messaging was successfully used to increase vaccination coverage.

Adjusting for gestational age and number of clinic visits, women who received the intervention were 30 percent more likely to be vaccinated.

A subgroup of women early in the third trimester had the highest intervention effect – 61.9 percent of the intervention group was vaccinated versus 49 percent for the control group.

The study adds to a growing body of work that shows how mobile health initiatives can help improve public health.

Previously: Ask Stanford Med: Answers to your questions about seasonal influenza, Flu shots for moms may help prevent babies from being born too small and Examining the effectiveness of text4baby service
Photo by niXerKG

Cancer, Health and Fitness, Stanford News, Women's Health

Ironman of Stanford Women’s Cancer Center

Ironman of Stanford Women’s Cancer Center

ironmanOliver Dorigo, MD, PhD, loves training. The associate professor of obstetrics and gynecology has trained in medicine, surgery, gene therapy, molecular biology, laboratory research and clinical trials management. And that’s just for his day job(s), directing Stanford’s Division of Gynecologic Oncology and the gynecologic oncology program at the Stanford Women’s Cancer Center.

In his spare time Dorigo’s training has included enough running, biking and swimming to compete in 19 Ironman distance triathlons, the most recent being the 2013 Ironman World Championship, held in Kona, Hawaii in October. (For those keeping score, “Ironman distance” means a 2.4-mile swim, a 112-mile bicycle ride and a 26.2-mile run.)

Dorigo says the physical and psychological rigors of triathlon training have helped him professionally to overcome challenges and find solutions for success in difficult situations. And they are lessons he imparts to his patients. As he told me:

In every race, there is a moment when making another step forward seems almost impossible. However, with persistence and the right attitude, this step and all others necessary to reach the finish line will eventually happen. There’s just no giving up. And that’s exactly the attitude I convey to my cancer patients. Don’t give up; keep fighting! Otherwise, how does one ever know whether one could have reached the finish line?

Dorigo and his primary medical passion – ovarian cancer – are discussed in the latest edition (.pdf) of the Stanford Cancer Institute News.

Michael Claeys is the senior communications manager for the Stanford Cancer Institute.

Previously: Frontiers in the fight against ovarian cancer and Ovarian cancer biomarkers may enable personalized treatment, say Stanford scientists
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Cancer, Stanford News, Videos, Women's Health

Stanford Women’s Cancer Center: Peace of mind and advanced care under one umbrella

Stanford Women's Cancer Center: Peace of mind and advanced care under one umbrella

Flamingo-pink carpet lined the path to the Sharon Heights Golf and Country Club in Palo Alto, Calif. – the location of the fifth annual Under One Umbrella benefit for the Stanford Women’s Cancer Center. As I walked into the reception hall, I thought of the phone call that was my introduction to the center several months before.

In March, I tested positive for the HPV virus that can cause cervical cancer and I was scared. Cervical cancer claimed the life of my best friend, and the memory of the day she mentioned that she needed “some testing” is etched in my mind. My phone call to the Stanford Women’s Cancer Center gave me the information and courage I needed to schedule additional testing. “We hope you never need our services,” the receptionist said, “but if you do, we’re here if you need us.”

I ultimately didn’t need the services of the center, but many of the nearly 340 guests in the fundraiser’s reception hall did. For these people, and for many others, the center is a source of medical treatment and hope.

Yet, the center is more than a cancer care facility, as Nicole Kidman, Academy Award-winning actress and honorary chair of the Under One Umbrella committee, explains in the short film above. The center unites medical treatment with cancer research and prevention.

The Under One Umbrella committee supports the cancer center’s efforts, and the annual benefit is a big part of that support. “It brings together an amazing group of people who are interested in furthering research of women’s cancer,” Lloyd Minor, MD, dean of the Stanford medical school told me. “It highlights the talents of Stanford researchers and the wonderful job that Jonathan Berek, MD, [the center's director] has done with the center. It also gives us the opportunity to rededicate our commitment to the cause.”

A crucial step of this commitment and care begins when a patient first learns she has cancer. As social worker Jordan Chavez explains in the film, “When patients come in and have a diagnosis of cancer there’s pandemonium, either internal or external. I think a lot of what I do is to provide, hopefully, some stability and some calm amidst a lot of chaos and to normalize what is a very scary experience for patients and for families, and to help them understand that they will not be alone.”

This sense of camaraderie pervaded all aspects of the benefit. As the fundraiser came to a close, the guest of honor, country music star Keith Urban, gave an (outstanding) unplugged, solo concert. As he sang, the cancer survivors, their family members and friends, and the center’s medical experts forgot themselves. They were simply a crowd of fast friends.

As I left the event, I wondered how I could explain the importance of the women’s cancer center to someone who wasn’t a woman with cancer. The answer came to me in the form of an umbrella I carry with me rain or shine.

I know that I won’t need an umbrella most days, but it’s comforting to know that if I do, it will be there to shelter me from the storm.

Holly MacCormick is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a graduate student in ecology and evolutionary biology at University of California-Santa Cruz.

Previously: Garth Brooks and Trisha Yearwood help fundraising effort for Women’s Cancer Center at StanfordStanford expert weighs in on ovarian-cancer screening recommendationWhat’s 1,454 feet tall, glows pink and sounds like country music?Stanford Women’s Cancer Center opens Monday and Wellness after cancer: Stanford opens clinic to address survivors’ needs
Video, Embracing the Challenge, from Friday’s Films

Pregnancy, Research, Stanford News, Women's Health

Stanford-developed fertility treatment deemed a “top medical breakthrough” of the year

Stanford-developed fertility treatment deemed a "top medical breakthrough" of the year

‘Tis the season for end-of-the year top 10 lists. (Just wait – we have some of our own to post soon on Scope.)  TIME.com recently published its “Top 10 of Everything of 2013″ lists, and a Stanford fertility development was included as a top medical breakthrough.

From writer Alice Park:

Poor quality eggs are one of the reasons that some American women struggle to get pregnant. But researchers at Stanford University developed a technique that helps women with ovarian insufficiency to produce healthy, mature eggs again. The process, called in vitro activation, involves removing an ovary or piece of ovarian tissue and treating it in a lab with proteins and other factors that help the immature follicles it contains to develop into eggs. The recharged tissue is then reimplanted near the fallopian tubes. So far, of the 27 women who volunteered to test the technique, five produced viable eggs, one woman is pregnant and another gave birth to a healthy baby.

Previously: Image of the Week: Baby born after mom receives Stanford-developed fertility treatment, Oh, baby! Infertile woman gives birth through Stanford-developed technique and Researchers describe procedure that induces egg growth in infertile women

FDA, Health Disparities, Sexual Health, Women's Health

Female sexual health expert responds to delay in approval for “Viagra for women”

Female sexual health expert responds to delay in approval for "Viagra for women"

As announced yesterday, Sprout Pharmaceuticals, manufacturer of flibanserin, dubbed a “female Viagra,” is appealing the Food and Drug Administration‘s decision requesting more information on the drug before approving it for use in the U.S. Leah Millheiser, MD, director of Stanford’s Female Sexual Medicine Program, writes an appeal of her own on her blog, DrLeahM.com, in response to the FDA’s delay.

From the post:

Many of us in the field of female sexual medicine felt that Flibanserin had the best shot at being the first FDA-approved “Viagra for Women” – the holy grail for women with persistent low sexual desire in whom other treatments have failed (relationship therapy, sex therapy, off-label medications,etc). With this latest rejection, I ask you to consider the following: 43% of women in the US compared to 31% of men suffer from a sexual function complaint. There are currently 2 drugs that are FDA-approved for female sexual dysfunction (both for the treatment of postmenopausal painful intercourse due to vaginal dryness) compared to over 10 FDA-approved treatments available to men.

Previously: Speaking up about female sexual dysfunctionYoung, single, dating – and a breast-cancer survivorAsk Stanford Med: Director of Female Sexual Medicine Program responds to questions on sexual health and Shining the spotlight on women’s sexual health

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