Fighting Preeclampsia in May and Beyond
Posted on May 3, 2012
This is my last blog post as ACOG president (I continue as immediate past president for another year), so I'd like to finish where it all began, with my Issue of the Year: preeclampsia. It's a condition that affects up to 7% of pregnant women, and in my opinion, it's the most important medical complication of pregnancy. It's potentially life-threatening to mother and baby during pregnancy and can signal health problems for the mother later in life. Unfortunately, this serious and common condition is understudied and largely misunderstood.
As part of my President's Program on Monday, May 7, at The College's Annual Clinical Meeting, I invited three of my esteemed colleagues at the forefront of preeclampsia research to share what we know, what's new, and the advances that may be coming soon in preventing and treating preeclampsia. This session will help educate ob-gyns about the condition. It's imperative that physicians appreciate a patient's experience of preeclampsia. It's also extremely important to raise awareness of the signs and symptoms of preeclampsia among women.
High blood pressure and protein in the urine can both signal preeclampsia. Because these changes are hard—if not impossible—for women to spot, blood pressure and urine tests are routinely checked at each prenatal visit. Other symptoms may arise, especially in the last three months of pregnancy, including sudden weight gain, headaches, swelling of the face or hands, blurred or altered vision, chest pain or shortness of breath, pain in the upper right abdomen area, and nausea and vomiting. These symptoms may seem normal, but because preeclampsia can worsen quickly, it's important that pregnant women alert their doctor immediately if they occur.
Preeclampsia Awareness Month (PAM) in May is an excellent time to educate women and spread the word about this condition. The Preeclampsia Foundation's website has a page devoted to the signs and symptoms of preeclampsia and what women can do to monitor themselves for preeclampsia-related changes. The foundation also has great news and information about risk factors, resources, and local PAM events. The more we know, the safer we can make pregnancy for women and their families.
Two Must-Sees in San Diego
Posted on April 26, 2012
I talked recently about the excitement leading up to ACOG's upcoming Annual Clinical Meeting (ACM). As in every year, attendees can look forward to a thoughtful and comprehensive scientific program. I wanted to share two of the sessions that have particularly piqued my interest from this year's line-up.
While I admit to being a stargazer, the special session on maternal and child mortality headlined by Christy Turlington Burns and Tonya Lewis Lee promises to offer much, much more than a celebrity sighting. Both are activists and documentary filmmakers who have used their star power to raise awareness about maternal and child health in the US and around the world. Maternal and infant mortality is an issue that ACOG continuously works to address and improve. With all the advances in medicine and obstetrics available to us, it is a travesty that mothers and babies around the world are still dying every day. In fact, the US has the highest rate of maternal mortality among industrialized nations. Ms. Turlington Burns and Ms. Lewis Lee will share the insights that they have gained from their time spent on the front lines with at-risk women and children.
Switching gears, the second session I won't miss addresses cosmetic gynecology—a hot topic in ob-gyn. We are a society preoccupied with appearances, and procedures that promise to give our looks a boost generally receive a lot of attention. Some ob-gyns have stepped into the cosmetic surgery arena, performing cosmetic gynecologic procedures such as labioplasty, "revirgination," and other forms of vaginal "rejuvenation" as well as aesthetic procedures such as injecting Botox. A four-expert panel will discuss the pros, cons, and ethics of ob-gyns performing these surgeries and the controversies that surround some of these procedures.
These are just two highlights in a scientific program studded with clinical pearls. Check back from May 5-9 to hear more about the happenings at the ACM.
Meetings Matter — The Importance of Our Annual Clinical Meeting
Posted on April 20, 2012
The ob-gyn community is abuzz in anticipation of our 60th Annual Clinical Meeting (ACM), just over two weeks away in San Diego. You read that right. We're excited over an annual meeting. I've been an ob-gyn since the 1970s and I've had many reasons for attending the ACM over the years. In my opinion, each meeting gets better and more relevant to my daily practice.
The ACM is the best place to gather with other ob-gyns to learn about and discuss a wide array of new findings in research and in clinical practice. The phenomenal poster sessions—where more than 260 research abstracts will be presented—help physicians get a pulse on emerging areas in ob-gyn research and of the breakthroughs that may be coming soon. The ACM also provides an excellent opportunity to meet up with colleagues, collaborators, and friends from the US and abroad. It has been the birthplace of countless projects and initiatives that support our mission of providing the highest quality women's health care and eliminating obstacles and health disparities our patients may face.
Of all the times I've attended, this particular ACM holds special significance. It marks the sunset of my tenure as president of ACOG. It has been an amazing and transformational year for our organization. One of the highlights of my presidency has been shining a national spotlight on preeclampsia, a leading cause of maternal and infant sickness and death in the US that is both understudied and misunderstood. Unfortunately it is also an area of reproductive research that is woefully underfunded especially with regard to clinical trial undertakings. The 2012 ACM will kick off with my President's Program on preeclampsia. I'm very excited to have James M. Roberts, MD, giving the historical and current perspective on the condition; John Barton, MD, reporting on the findings of ACOG's Preeclampsia Task Force and some of the implications for our clinical practice; and Eleni Z. Tsigas of the Preeclampsia Foundation discussing how it affects women and families.
So for the next few weeks, I'll be looking forward to all that awaits me at the ACM. There's still time to register for what promises to be an informative, fun, and comprehensive meeting. Hope to see you in San Diego!
The Original Organic Baby Food
Posted on April 13, 2012
Breastfeeding—it's a woman's built-in system for nourishing her baby. It provides complete nutrition, and it's an inexpensive and convenient feeding option. ACOG recommends that infants be breastfed for the first six months. Unfortunately, people in the US have not whole-heartedly embraced breastfeeding, making it a constant source of debate, controversy, and awkward pauses. But I say enough already. It's time to move beyond thinking that breastfeeding is odd, taboo, or indecent.
Breastfeeding helps babies build strong digestive and immune systems and may protect against respiratory infections, some childhood cancers, and obesity. Breastfed babies often have less gas, constipation, and diarrhea, fewer feeding problems, and less illness than do formula-fed babies. Women who breastfeed may lose weight faster, experience less stress during the postpartum period, build stronger bonds with their babies, and have a decreased risk of breast and ovarian cancer in the future. Exclusive breastfeeding can also temporarily stop ovulation, lowering the risk of pregnancy. However, it is not a foolproof method of contraception. Women who want to avoid pregnancy should discuss birth control options with their ob-gyn to be on the safe side.
Overall, the benefits of breastfeeding are great, and the vast majority of women are able to breastfeed. But even though breastfeeding is a natural process, it's not always intuitive. That's why it's a good idea to let your doctor and health care team know your breastfeeding plans before you deliver. They will help you start and support your breastfeeding once the baby is born. For some, learning how to nurse takes time, patience, and practice.
Women may also face logistical or workplace-based obstacles to breastfeeding. ACOG continues to advocate for employers to provide designated spaces to facilitate breastfeeding moms. In the meantime, it's a good idea to talk to your coworkers and other moms who have breastfed and share strategies for how you can make breastfeeding work at work.
If you're pregnant, consider giving breastfeeding a try. If it's not the best choice for you and your baby, that's OK. But who knows? You may be surprised to find that it comes... naturally.
The Truth About Growing Up
Posted on April 5, 2012
The teenage years can be among the most challenging in the human experience. It's a time of unparalleled physical and emotional growth when new, interesting, and sometimes frightening events happen in quick succession. Peer pressure to experiment with drugs and alcohol, have sex, be popular, figure out what to say and wear and do—the list goes on and on.
Today's teens may have it harder than ever before. The new documentary "Bully" gives us a glimpse into what typical teens face at school every day—the content is so mature that it garnered an "R" rating, ironically prohibiting many of those who most need to see the movie from viewing it without an adult present.
In a perfect world, teens would consult their parents for advice on navigating the sometimes turbulent process of growing up. But we all know that's not how it usually plays out. Many teens would rather avoid awkward conversations with their parents or other adults, instead turning to friends who are just as confused about the facts. The consequences of misinformation—such as teen pregnancy, substance abuse problems, or suffering in silence—are too steep.
As an ob-gyn, I remind my young patients that my door is always open if they need help working through difficult times. But, in case they're not quite ready to have a conversation with me, their parents, or another trusted adult, there are some great online resources available:
- www.girlsmarts.org: This website is devoted to helping teens work through tough scenarios such as meeting new friends in chat rooms; experimenting with smoking, alcohol, and drugs; and weight issues and eating disorders. Girlsmarts features polls, blog posts written by teens, and video content related to teen issues.
- www.stopbullying.gov: The Centers for Disease Control and Prevention recently relaunched its anti-bullying website. The resources and information provided encourages teens, parents, schools, and communities to find solutions to prevent and respond to bullying and foster a safe environment for all members of the community.
- Patient Fact Sheets: ACOG has developed a series of fact sheets for teens on a variety of topics such as body art and piercings, body image, stress and trauma, internet safety, plastic surgery, and pregnancy options. Corresponding fact sheets for parents are also available.
Share these resources with teens you know and see what happens. They just might spark a healthy conversation too important to miss.
Access to Contraception Is Every Woman's Right
Posted on March 29, 2012
You'd have to be living under a rock to have missed the recent political and culture debates about contraceptive access and coverage. Having practiced ob-gyn since the early 1970s, I can tell you that contraception is a fundamental part of women's health care, just as important as Pap screening, prenatal care, and breast exams. ACOG has long advocated for the right of women to obtain contraception, expanded access to and coverage of it, and a doctor's ability to prescribe contraception to his or her patients.
More than 80% of reproductive-age women will use contraception for a wide variety of reasons, not just for birth control. Hormonal contraceptives can help with gynecologic problems such as endometriosis, menstrual cycle irregularities, fibroids, and premenstrual syndrome. They also treat acne, improve bone density, help with perimenopausal symptoms, and reduce the risk of certain cancers.
Of course, many women use contraception to avoid pregnancy. However, not enough do, because roughly half of the pregnancies in the US are unintended. Unplanned pregnancies often cause undue strain on women, their families, and society. Lack of access and affordability of contraception deprives a woman of her right to plan a pregnancy at a time that makes most sense for her. Clearly, any campaign to reduce unintended pregnancy must be coupled with a comprehensive program of sex education and easily accessible options for contraceptive health.
I take pride in the fact that my patients turn to me for advice and guidance about medical issues, healthy lifestyle, screenings, immunizations, and their contraceptive needs. I trust that women know what's best for their lives and their bodies. I also know that contraception is a basic necessity used to protect and improve women's health. And I am not alone. I stand with ACOG in putting women first. I fully support the right of all women to unimpeded contraceptive access.
What Is Endometriosis?
Posted on March 22, 2012
March is Endometriosis Awareness Month. Do you know what endometriosis is?
If your answer is no, you’re not alone. Although it is a common disease affecting up to 10% of reproductive-age women and is the culprit in many cases of chronic pelvic pain, painful periods, and infertility, most people are largely unfamiliar with what it is and how this condition impacts women.
Endometriosis occurs when the cells that line the uterus migrate to other parts of the pelvic region, attaching where they don’t belong, which leads to a recurring cycle of bleeding and healing and the eventual development of scar tissue. The scar tissue can cause mild to severe pelvic pain before and during menstruation; pain during sex, urination, or bowel movements; and menstrual bleeding more than once a month. In some women, endometriosis causes no symptoms at all and they may be first diagnosed when they have trouble getting pregnant. It’s most often seen in women in their 30s and 40s, but it can occur in women of any age. Women who have never had children and those who have a mother, sister, or daughter with endometriosis may be at increased risk.
Endometriosis can only be diagnosed through surgery, so if you have symptoms or risk factors, talk to your doctor. Laparascopy—a surgical procedure that uses a lighted scope to view the pelvic organs—is often used to detect endometriosis. If scar tissue is found, it can often be removed during the procedure. Your doctor may also recommend medication, such as ibuprofen or naproxen, for pain relief or prescribe birth control pills to control the menstrual cycle and shrink areas of endometriosis. In severe cases, there are other medications that may be potentially beneficial, or hysterectomy may be an option.
For more information, click here.
What's Up, Doc?
Posted on March 15, 2012
Sometimes it seems you can't go more than a few weeks without hearing about a medical organization changing recommendations about a particular health screening regimen or a tried-and-true treatment. From mammograms to prostate exams—not to mention the endless advice on which new or old medicines to take or avoid—it happens in every area of health and medicine. Just this week, two organizations released new advice on how often women should be screened for cervical cancer.
Each time a standard recommendation changes, I can expect a flurry of questions from my patients. The most common question is "Why should I switch from doing something that I know (eg, get a Pap test every year) to something that's so different (eg, wait three to five years between cervical screenings)?" The answer will vary depending on the specific test or the recommendations involved, but it often comes down to the same concept: evidence-based medicine.
Evidence-based medicine combines research findings on how a disease works with real-life data and feedback on how that disease—and patients—respond to certain prevention and treatment strategies. This evidence provides a more complete picture of how a disease is best handled. Medical organizations like ACOG use it to develop practice recommendations and physicians rely on it as the foundation for how we treat patients.
Because new information is always being discovered, health recommendations need to be routinely updated. This is all part of the process of providing the patient with the best, most effective, and up-to-date care available.
If news of new recommendations leaves you feeling confused or frustrated, talk to your doctor. He or she can explain the changes. And because every guideline does not apply to every patient, only you and your doctor can determine what impact, if any, it will have on you. It's always ok to ask: "What's up doc?"
Colonoscopy — It's Not As Bad As You Think
Posted on March 7, 2012
If I were to ask you about the screening test that you dread the most, what would it be? For many people, the resounding answer would be a colonoscopy. The prep, the exam itself, the area being examined…it can all seem very strange and uncomfortable.
While you may be skittish about the idea of the exam, colonoscopy is truly a procedure in which the end justifies the means. Colon cancer remains the third leading cause of cancer death among women, and an estimated 70,000 women will be diagnosed with the disease this year. Colonoscopy detects precancerous growths (polyps) and cancers early on, when they are most treatable—especially important because colon cancer often shows no symptoms. A recent study published in the New England Journal of Medicine reported that the procedure cuts the rate of death in half. And the preparation itself has gotten easier—the cleansing preparation can now be performed with pills and water instead of gallons of unpleasant liquid.
ACOG recommends that all women should be screened regularly for colon cancer beginning at age 50. Earlier screening is suggested for African American women and those at increased risk, including women who have a first-degree relative younger than age 60 or two or more first-degree relatives of any age with colorectal cancer or polyps; had colorectal cancer or polyps themselves; had bowel disease, such as chronic ulcerative colitis, inflammatory bowel disease, or Crohn’s disease; or a family history of certain types of colon problems or colon cancer.
During Colon Cancer Awareness Month in March, maybe it’s time to put your fears and anxiety aside. Once the procedure is done, you can ease your mind knowing you’ve done the right thing and that you have roughly 10 years before having to do it again. Considering that it could save your life, a colonoscopy is time minutes well spent.
Staying Healthy After Cancer Treatment
Posted on March 1, 2012
If you're one of the 2 million breast cancer survivors in the US today, you know that battling cancer is no small feat. But after cancer goes into remission, you might think the hard part's over, right? Not always.
Although the tools we use to fight cancer—from chemotherapy to surgery—can be life-saving, they also can affect fertility, sexual function, body image, and contraceptive needs. Some anti-cancer medications can also increase the risk of osteoporosis.
Symptoms such as vaginal dryness, decreased sex drive, and hot flashes are common, but compared with cancer, they may not seem worthy of a complaint. And even if you felt strong and didn't lean heavily on others for emotional support during the initial cancer treatments, the long-term effects of "being an island" can erode relationships and lead to depressive symptoms. All of these treatable symptoms can have a very real effect on your quality of life. You've been through enough, and there's no need to suffer in silence.
Talk to your doctor about your symptoms. He or she can recommend lubricating creams or gels to combat vaginal dryness, or suggest relaxation and dietary changes to help reduce hot flashes. You and your doctor should discuss your contraceptive options to prevent pregnancy or talk about fertility concerns if you're considering getting pregnant in the future. Reduce your risk of bone loss or fractures through lifestyle changes such as weight-bearing and muscle-strengthening exercise, quitting smoking, and consuming less alcohol. If you are depressed, your doctor can refer you to counselors or support groups.
No matter the problem, your doctor should know about it and may be able to help. Keep an open line of communication after your treatment ends, and speak up. You'll be glad you did.
Protecting Teen Girls from Violence
Posted on February 23, 2012
Approximately one out of every 10 high school teenage girls in the US reported experiencing physical violence from their dating partners in the previous year. This is not abstract—this could be happening to someone you know. A girl in your family or community may have recently been slapped, punched, kicked, pushed or grabbed, sexually coerced or raped, called names online, threatened, or screamed at in public—all by the person she is in an intimate relationship with.
Throughout February, ACOG and other organizations have been raising awareness as part of Teen Dating Violence Awareness Month. It’s important that we educate young girls—and women—that unsafe relationships are not only about physical violence. Those who monitor cell phone use, stalk or humiliate online, or control their partner’s wardrobe, choice of friends, or contraceptive use are abusive.
As a father and grandfather, I want to do everything in my power to make sure my children and grandchildren are safe. This feeling extends into my practice as well. As an ob-gyn, I am in a unique position to reach out to my patients, letting them know my office is a safe environment in which they can seek help. ACOG recommends that physicians screen all women for intimate partner violence at periodic intervals. Recognizing violence in a teenage girl’s relationship can be especially critical because adolescent violence can lead to intimate partner violence when she grows up.
To get help for yourself or someone you love, call the National Domestic Violence Hotline at 800-799-SAFE. Teens can also learn about healthy relationships at loveisrespect.org or get teen-specific help through the Dating Abuse Helpline at 866-331-9474.
Heart Month Pop Quiz: Which is Better, HDL or LDL?
Posted on February 16, 2012
Quick—which type of cholesterol do you want more of, HDL or LDL?
Answer: HDL, or the "Happy" or "Healthy" type.
A lot of people can't remember which type of cholesterol is the ‘"good" one and which is the "bad" one, but it's an important distinction. High cholesterol is one of the main culprits in heart disease, the leading killer of women in the US.
LDL (low-density lipoprotein) is the "bad" cholesterol that causes buildup and blockages in the arteries, which leads to heart attacks and strokes. The healthiest LDL level is less than 130 mg/dL.
HDL (high-density lipoprotein) is the "good" cholesterol that helps keep the "bad" LDL cholesterol from sticking to your arteries. You want a high HDL number (60 mg/dL or higher) to help lower your heart disease risk. Your ideal goal is a total cholesterol level (HDL+LDL combined) of less than 200 mg/dL.
As women move past menopause, their overall cholesterol level tends to rise. Estrogen levels prior to menopause raise HDL cholesterol; this benefit is lost after menopause. But there are things you can do to raise your HDL level and lower your bad LDL cholesterol: Lose weight, reduce foods with saturated fats in your diet, stop smoking, and exercise regularly. Medication may also be needed to lower your cholesterol levels.
Know your cholesterol levels and get tested every five years. Do it for your heart.
Heart Disease in Women
Posted on February 9, 2012
For many years, heart disease was thought of as a man's disease. Most heart disease awareness efforts and research dollars focused on recognizing heart problems in men. But today we know different. Heart disease kills more women annually than all cancers combined, and more women than men have died from it every year since 1984.
While awareness efforts among women are improving, it's time for heart disease research in women to catch up. We need more people like Barbra Streisand—who recently discussed her personal efforts to raise money for Cedars Sinai Women's Heart Center in pause® magazine—to invest in heart disease prevention and treatment for women.
More clinical study is key in the fight against heart disease, but it's also important to remember that you are your own first line of defense. Family history, high blood pressure, high cholesterol, diabetes, being overweight, and smoking increase your heart disease risk. To that end, the tried-and-true health trilogy of eating right, exercising, and avoiding smoking still applies. In addition, you can protect your heart health by lowering salt intake, controlling diabetes, keeping blood pressure and cholesterol levels low, managing stress in a healthy way, and visiting your doctor regularly.
Your heart supports you and everything you do every minute of every day. Repay the favor by committing to treating it right.
Why I Wear Red
Posted on February 2, 2012
I'll be wearing red tomorrow, and it's not because it's my favorite color or because I was born on Valentine's Day. February 3 is National Go Red for Women Day, raising awareness of heart disease in women. As an ob-gyn, my career has centered on keeping women well, especially when they are pregnant. Heart disease is a formidable enemy for my patients and me, and its impact is hard to deny. Speaking of pregnancy, did you know that heart disease has become one of the major causes of maternal mortality in this country?
An estimated 42 million women in the US are living with heart disease, the no. 1 killer of American women. But despite its prevalence, heart disease in women can be hard to spot. Feeling tired (even after a full night's rest) or anxious, having an irregular heartbeat, or having trouble breathing or sleeping can all signal heart disease, but are often overlooked or attributed to other problems.
Many times, the first symptom of a heart problem is a major cardiac event like a heart attack. Chest pain or discomfort is the main symptom of heart attack in both women and men. However, other more subtle cues—such as nausea; lightheadedness; shortness of breath; pain in the back, jaw, neck, or arms; and breaking out in a cold sweat—are more common in women. These symptoms may not seem to warrant special attention, but if you are experiencing them, consider it an emergency and seek medical attention right away. Brushing off these signs delays timely care and hampers recovery.
By donning red tomorrow, I'll show my support for my patients and the fight against heart disease. So, go ahead and ask about my outfit. It's an easy way to spark a conversation that could save a life.
The Real Recipe for Good Health
Posted on January 26, 2012
Last week's announcement that Paula Deen, the reigning queen of rich and decadent Southern cooking, has type-2 diabetes caused some controversy in the public and in the health community. The fact that Ms. Deen signed on as a spokesperson for a diabetes drug further fueled the debate. But in arguing about the rightness of Ms. Deen's cooking style in light of her health issues, we may be missing the most important point: it is far easier to prevent diabetes than to make it go away once you've got it.
To avoid diabetes—a chronic and potentially life-threatening disease—diligence is key. You should know if your blood sugar level is within a normal range, so be sure to ask your doctor for a fasting blood glucose test at your next check-up. If your results come back high, or if you have a strong family history of diabetes, take steps to lower blood glucose levels through healthy diet and regular exercise. This is a far smarter plan than letting diabetes happen and trying to medicate it away. Additionally, making a preemptive investment in healthy habits now (eg, fresh fruits and vegetables, lean meats, and the occasional new pair of sneakers) is much cheaper in the long run than a lifetime of diabetes medication.
Though heredity and age play a role, for most people, diabetes is not a given. Don't let it happen to you. Do something now to prevent the disease later.
A Plan to Defeat HPV
Posted on January 19, 2012
In a recent blog post titled “HPV and a Vaccine: Why We Can Beat Cervical Cancer,” William Smith, executive director of the National Coalition of STD Directors, looks in depth at the conundrum of cervical cancer in the US today. On one hand, we can now classify cervical cancer as a largely preventable disease. On the other, more than 4,000 women in the US still die from cervical cancer each year. If we are to drive these numbers down, HPV vaccination must play an essential role.
The human papillomavirus (HPV) is a known cause of cervical, vulvar, vaginal, and anal cancers in women; penile and anal cancers in men; and throat, esophageal, and other head and neck cancers in both sexes. The HPV vaccine has the potential to protect young women—and men—from many, if not all, of these cancers. Recommended for girls and women ages 9–26 and boys and men ages 11–26, HPV vaccination works best if given before any exposure to HPV or the onset of sexual activity. But despite the recommendations of ACOG and other health organizations and women’s advocates, vaccination rates have remained low.
Many parents are sensitive to discussions regarding their young daughters (and sons) and sexually transmitted infections (STI). However difficult the concept, parents would be remiss in avoiding a potentially life-saving vaccine for these reasons. HPV vaccination is just another tool in a parent’s arsenal to shield their children and family from cancer. It’s no different than routinely vaccinating infants against hepatitis B—another STI that can increase the risk of liver cancer—which has been commonplace for roughly 30 years.
As a parent, some things just make good sense. And with the benefits that it provides, HPV vaccination is clearly one of those things. Protect your children; get them vaccinated.
Double Take: Where'd All These Twins Come From?
Posted on January 12, 2012
If you've been noticing more twins around lately, it's not just double vision. New data from the Centers for Disease Control and Prevention confirm that more twins are being born today than ever before. In fact, one in every 30 babies born in the US in 2009 was a twin.
Contrary to what some have said, oral contraceptive use is not a factor in the twin boom. The two main reasons for the increase: age of mother and fertility drugs. Women in their 30s—particularly those from 35 to 39—are more likely to ovulate more than one egg at a time, leading to historically higher rates of naturally conceived twins. With more than one-third of all US births occurring among women age 30 and older, the math adds up to more twins. Additionally, more couples of all ages are pursuing assisted reproductive technologies such as fertility drugs or in vitro fertilization, which increase the odds of a twin pregnancy.
While having twins can be twice as nice, there are some very real health concerns that come with carrying two or more embryos. Preterm labor is more common among twin pregnancies and frequently results in preterm birth. Roughly half of twins are delivered early, sometimes before they have fully developed. When compared to singleton babies, twins are more likely to be born small and require more hospitalization. Women carrying twins also have a higher likelihood of developing high blood pressure, preeclampsia, anemia, and other conditions. Efforts are ongoing to improve infertility treatments to avoid multiple gestation pregnancies.
With proper prenatal care and monitoring, it is possible to deliver a healthy pair of babies. However, women should be aware of the risks of carrying twins and work closely with their doctors to ensure a healthy pregnancy and delivery of two bundles of joy.
Put Your Cell Phone Down and Operate
Posted on January 5, 2012
Advances in technology have enabled us all to be connected in ways unimaginable just a few years ago. From practically anywhere, we can send and receive texts and emails, pull up websites, and use apps to access a wealth of information with a push of a button. A recent New York Times article highlighted how computer and smartphone technology has also made its way into the hospital setting and surgery room.
Admittedly, these technologies can be wonderful tools for improving the health and well-being of our patients. But we can quickly lose sight of the very real downside these gadgets can pose to our patients. It would seem to be common sense that personal calls, texts, and online surfing have no place in the operating room, in our clinics, or in hospital areas where patient care is ongoing.
As these devices become even more ubiquitous and the pressure to immediately respond and constantly check in can be great, we must recognize that we cannot focus on our patients if we are simultaneously glued to our smartphone or tablet. Just as there has been a great deal of awareness about the dangers of texting or talking on a cell phone while driving (or even walking!), we must focus awareness on the patient safety risks with the same technology-related problems.
As physicians, our priority is always the patient. To this end, we need to eliminate unnecessary distractions when we are taking care of our patients. Hospitals and medical practices should develop and institute firm policies about how and when these technologies can be used... and when they cannot.
A Little More, a Little Less...
Posted on December 29, 2011
This time every year many of us set goals for the following year that are ambitious, to say the least. Like quitting smoking cold turkey or losing 20 pounds in a month. Often these New Year’s Resolutions are daunting and are more apt to overwhelm us rather than inspire us to make meaningful changes.
Let’s try something different—how about setting small, specific goals such as eating more fresh fruits and vegetables (5–9 servings/day) and fewer processed foods, cutting down on salt (less than a teaspoon/day), going for a walk on most days of the week, or drinking more water? Give yourself a month or two to work on each one and by year’s end, you’ll have several concrete accomplishments. You might even get some added benefits, such as losing weight or lowering your disease risk.
For me, I’m going to try to exercise more, but stress less about not getting to the gym every day. I’m also going to make more time for visiting our children and grandchildren, be a better listener, and cultivate an attitude of gratitude.
This is an excellent time to take stock of what you’ve accomplished in the last 12 months and set goals for the next 365. Remember to give yourself a pat on the back for making an effort to focus on your well-being…and don’t give up!
On behalf of ACOG, I’d like to wish you a happy holiday season and a new year marked by fresh approaches, tenacity, and good health.
Wrong-Headed Decision on Plan B One-Step
Posted on December 15, 2011
For a decade, ACOG has supported making emergency contraception (EC) available over the counter (OTC) without an age restriction. So it was deeply troubling and disappointing to see HHS Secretary Kathleen Sebelius overrule the US Food and Drug Administration’s decision to remove the age restriction and make Plan B® One-Step accessible to all females capable of becoming pregnant.
The argument that 11- and 12-year-olds are not capable of understanding how to use EC isn’t true, based on the data, and it misses the point. The majority of girls this young are not sexually active and do not represent the bulk of adolescents who are at risk of an unwanted pregnancy. According to the Guttmacher Institute, nearly half of all high school students in the US have had sex at least once, and 85% of adolescent pregnancies are unintended. These high school students are the adolescents who would most benefit from OTC access to EC.
The overwhelming scientific evidence shows that EC is safe for teens and women and is highly effective in preventing unintended pregnancy. Ideally, all sexually active teens and women would use effective contraception each and every time they engaged in sexual intercourse to avoid an unplanned pregnancy. But, we don’t live in a perfect world—a condom tears or you miss a pill, for instance. Rapid access to EC is especially important for women that have been raped.
EC products contain the same hormones as oral contraceptives, only in a higher dose. EC works primarily by preventing ovulation, but it can also prevent fertilization or implantation. However, timing is critical: EC is most effective when taken within 72 hours after unprotected intercourse. This is why OTC access is so important. There’s no need to wait for a doctors’ appointment to get a prescription, or to have the prescription filled.
While EC does not replace the consistent use of reliable birth control, making it available without a prescription to all provides an important safety net. For this reason, ACOG will continue to advocate for removing this unnecessary age restriction to OTC EC.
Support Preeclampsia Awareness Month Today
Posted on December 14, 2011
In an effort to increase public awareness and research funding, ACOG is pleased to support the Preeclampsia Foundation’s petition to Congress to have the month of May officially designated as national “Preeclampsia Awareness Month.” Please take a moment to show your support by signing the petition today—the deadline is December 31, 2011.
The main focus of my ACOG presidential initiative is something that has consumed my professional career for more than 30 years: preeclampsia and hypertensive disorders during pregnancy. Over the past two decades, preeclampsia in particular has been a growing problem in the US, and it is a leading cause of maternal and infant death and illness. Yet despite decades of research, we still don’t know what causes it or how to prevent it.
What we do know is that certain women are at increased risk of developing preeclampsia, including women who are obese, carrying two or more babies, pregnant for the first time, older than 35 years, African American, or who have diabetes, lupus, or kidney disease, among a few factors.
Preeclampsia is high blood pressure that occurs only during pregnancy and usually starts sometime after the 20th week of gestation. Some of the warning signs include headaches, vision problems, rapid weight gain, and upper abdominal pain. Hypertensive disorders during pregnancy, including preeclampsia, often require very preterm delivery to protect the health of both mothers and infants and are a major contributor to the high prematurity rate.
Drop in Cesareans, Teen Births, Premature Babies Welcome News
Posted on December 8, 2011
The CDC recently released preliminary 2010 data on births in the US and there’s good news. For starters, preterm births declined for the fourth straight year. Although the rate is still high, it’s clear that progress is being made in preventing premature births.
The other good news is that the cesarean delivery rate also decreased. I’d like to believe that ACOG’s concerted efforts to educate physicians and the public that there are increased risks associated with cesarean birth, as well as our efforts to encourage vaginal birth after cesarean (VBAC), has something to do with this. We’ve also educated doctors and patients about not inducing labor or scheduling a cesarean before 39 weeks of pregnancy without a pressing medical need to do so. A full term pregnancy is 40 weeks and babies need these last few weeks to gain weight and fully develop lung function.
Births to teens fell again for the third straight year, hitting a record low. Fewer teens are having sex and more of them are using contraception when they do.
This new data is encouraging, but we must keep the momentum up on driving these rates down further and in the process, improving maternal and infant health outcomes.
Today—World AIDS Day—we celebrate the great strides we’ve made in the treatment of HIV/AIDS. But we also recognize that over one-fifth of the estimated 1.1 million people in the US living with HIV don’t know they have the disease, which means they are missing vital opportunities to receive life-prolonging treatment and protect their sexual partners.
Approximately 25% of people with HIV are female, and the majority of them were infected through heterosexual contact. However, many sexually active women have never been tested, whether because of stereotypes about who’s at risk, stigma and fear of knowing their status, or because they’ve never been offered an HIV test.
ACOG recommends that all women ages 19–64, regardless of risk status, be routinely offered HIV screening. It is so important for women to know their HIV status, especially if they are planning a pregnancy or become unexpectedly pregnant. One of the HIV success stories is that with proper treatment, the risk of a mother passing along HIV to her baby is less than 1%.
Americans who are HIV positive are living longer and healthier lives thanks to antiretroviral medications. But you must know your status first. Ask your doctor today about getting an HIV test.
Opening Our Office Doors to the Transgender Community
Posted on November 23, 2011
As ob-gyns, our goal is to provide the very best health care for our patients, regardless of age, race, ethnicity, religion, marital status, immigrant status, handicap, sexual orientation, or gender identity. Unfortunately, there are segments of our population that, for a variety of reasons, have problems getting necessary health care, whether due to poverty, a lack of health insurance, living in a rural setting, or fear of discrimination.
One group that often experiences problems with access to health care includes transgender individuals. That’s why ob-gyns are being encouraged to do more to provide for their care. The fact is that transgender people share many of the same health care needs as everyone else. By instituting non-discrimination policies, ensuring confidentiality, and referring to patients by their preferred name, physicians can help make transgender individuals feel welcome in their offices.
We want the transgender community to know that we care about their health and can provide screenings, preventive care, and other appropriate services. Many transgender individuals who were assigned female sex at birth but live as male will need breast and reproductive organ screening. Male-to-female individuals who have had genital reconstruction may need cancer screening of the neovagina and breast cancer screening if they take hormones.
By working together, we can ensure that our transgender patients receive the health care that they need.
Today, November 17th, is the Great American Smokeout—a perfect time for physicians to become reenergized and recommitted to helping our patients quit.
According to the American Cancer Society, 75% of women say they want to stop smoking. However, with one in five Americans still lighting up, the reality is clear: quitting smoking is hard. The average smoker will make several quit attempts before kicking the habit for good. This can be frustrating for the smoker and the physician. But, as ob-gyns, we must remain sensitive and engaged with our patients who attempt to quit smoking.
Pregnant smokers increase their risk of preterm birth, placental abruption, low birth weight, asthma, and SIDS. But quitting early in pregnancy greatly minimizes these risks.
We should make it our business to follow up with patients who have expressed interest in quitting and help them find resources that can improve their chances of success, including medication, support groups, and help lines (such as 800-QUIT-NOW). Studies show that people who use telephone counseling are twice as likely to quit smoking as those who don’t get use this type of intervention. There is even a new smoking cessation app for smart phones to help smokers stay tobacco-free.
Let’s pledge to walk with them along the path to healthier and longer lives.
Did you know that prematurity is a leading cause of infant morbidity and mortality in the US? In fact, about 12% of all babies in the US—roughly 500,000—are born preterm each year. According to the March of Dimes, there is some hopeful news: Preterm birth rates improved in nearly every state between 2006–2009.
A pregnancy is considered full term at 40 weeks. Any birth before 37 weeks gestation is considered premature. In the majority of premature births, preterm labor starts spontaneously. In other cases, the baby is delivered early because of health problems with the mother or the baby, or both, and it’s safer to get the baby out. Additionally, women should not be induced or delivered by cesarean before 39 weeks gestation unless there is a medical indication.
Preterm babies have a high risk of serious problems with their vision, hearing, breathing, and nervous system development. Sadly, some don’t survive. Unfortunately, despite the advances in medicine, we don’t yet know what causes preterm labor nor can we prevent most preterm births.
If you have uterine contractions, vaginal bleeding or discharge, leaking amniotic fluid, pelvic pressure, mild abdominal cramps, or any unusual symptoms before 37 weeks of pregnancy, call your obstetrician. Medication can help your baby’s lung development if preterm labor is caught in time.
We continue educating physicians and patients about this national problem and are committed to finding ways to reduce preterm births.
Raising a family is an expensive proposition. The estimated cost of raising a child born in 2010 until age 17 is almost $287,000. So it came as no surprise when the Pew Research Center released a recent report showing a decline in birth rates since the recession began in December 2007. Since then, the rate has dropped from 69.7 births per thousand women aged 15 to 44 to 66.7 births in 2009.
The drop was most pronounced among Hispanics. Between 2008 and 2009, the birth rate among Hispanics fell almost 6% compared with African-Americans who experienced a 2.4% decline, and whites who had a 1.6% drop. Experts say people are postponing having children because they don’t have the necessary financial resources. But regardless of the economy—planning a pregnancy always makes sense.
Unintended pregnancies can have significant health consequences for both mother and baby, especially if women don’t get prenatal care early and often. Decisions about family planning are at the core of a woman’s wellbeing and will have lasting repercussions over her entire lifespan. In good times and bad, it’s important to use a method of birth control that’s right for you. Take charge of your health now.
The number of women prisoners—many of them pregnant—has soared over the past decade but most states have failed to institute adequate policies to address their health care. Ob-gyns are committed to ensuring that incarcerated women receive the same prenatal and postpartum health care as other women.
Many women inmates have unplanned, high-risk pregnancies and need HIV testing, mental health screening, and drug and alcohol abuse treatment. It’s important that they receive nutritious food, along with prenatal supplements, be assigned bottom bunks during pregnancy to avoid falls, and have 24/7 access to obstetric care.
Inmates should deliver their babies in licensed hospitals, preferably with high-risk facilities. However, no woman should be shackled during labor or delivery—it’s unnecessary and risks harming her and her baby. If restraint is used, it should be the least restrictive as possible and should never interfere with leg movement.
Maintaining prison nurseries allows mothers to bond with their infants and breastfeed. It also helps prevent foster care placement and reduces recidivism rates. Prenatal care is important for all women, including those in prison. ACOG will continue advocating for better prenatal care for incarcerated women—every woman has the right to a healthy pregnancy.
Back in the 1940s and until 1971, women took a synthetic estrogen called diethylstilbestrol (DES) to prevent miscarriages and other pregnancy complications. As a result, millions of babies were exposed to DES in utero with profound health consequences.
Now, a new study in the New England Journal of Medicine quantifies the magnitude of that impact. Government researchers analyzed data from three studies that began in the 1970s, looking at 12 health risks in 4,600 women who were exposed to DES in utero and compared them to 1,900 women who were not.
Investigators found that exposed women had higher rates of infertility (33% vs. 16%), miscarriage (50% vs. 39%) and premature delivery (53% vs. 18%) than unexposed women. In addition, they were more likely to develop preeclampsia (26% vs. 14%), miscarry in the second trimester (16% vs. 2%), and experience early menopause (5% vs. 2%). DES daughters also had a slightly higher risk for breast cancer after age 40 (4% vs. 2%).
Little can be done now to undo this public health disaster. Researchers plan to follow these women through menopause and study their daughters to see whether the impact will affect future generations.
The leaves are turning and the holidays are just around the corner. It’s easy to get caught up in all the busy preparations in the coming months, but remember: The flu season is also upon us, and one of the things you need to do now is to get your flu shot.
The CDC recommends that everyone over the age of six months be vaccinated against the flu each year. As ob-gyns, we are reminding all pregnant women, regardless of trimester, to get the flu vaccine. Although flu vaccination rates are improving for pregnant women, only 49% of them were vaccinated last season—which is far too low.
If you are pregnant, the flu vaccine is a crucial part of your prenatal care. Your immune system is lowered during pregnancy and you’re at increased risk of serious complications if you get the flu. The vaccine is safe during any trimester and protects both you and your baby since you pass along protective antibodies. While the flu shot is recommended, pregnant women should NOT use the nasal mist version of the flu vaccine.
Schedule your flu vaccination with your ob-gyn now.
Spotlight on Breast Cancer
Breast cancer consistently tops the list of health concerns for many women and fear of developing the disease can be a tremendous source of anxiety. During National Breast Cancer Awareness Month in October, I urge women to move beyond fear and into action by reducing personal breast cancer risk factors, having regular mammograms, and tuning in to breast changes that warrant further assessment.
There’s still a lot more to be done in the fight against breast cancer, but we have come a long way. The 2.5 million breast cancer survivors in the US serve as proof that more women are beating breast cancer than ever before. Women diagnosed with breast cancer also have a wider variety of breast-conserving treatments and reconstruction options to consider.
There’s a reason why so many doctors preach the gospel of living a healthy lifestyle. Almost 40 percent of the breast cancer cases in the US—about 70,000 cases a year—could be prevented if women maintained a healthy weight, exercised, and limited the amount of alcohol they drink.
In some instances, women who’ve done everything that they can to avoid breast cancer still develop the disease. This is why regular mammography screening is so critical. Mammograms are central to early detection before the cancer has spread to other parts of the body. The five-year survival rate for cancer caught at this stage is 98 percent, a compelling reason to get screened.
To learn more about taking control of your breast health, read ACOG’s “Spotlight on Breast Cancer.”