Pregnancy and Birth

When used properly, oral contraceptives are extremely effective in preventing unintended pregnancies, yielding only 3 pregnancies per 1000 users in the first year of use. In reality, however, women may not be as adherent as necessary to obtain this ideal rate-studies have shown that about 50% of women regularly miss at least 1 pill per cycle.

News of KV Pharmaceutical’s plan to sell Makena (hydroxyprogesterone caproate injection) at up to $1500 per injection is receiving some serious backlash. The drug-perhaps best known to physicians as 17P-has been used for years to prevent preterm deliveries. Before Makena’s FDA approval last month, 17P had an “orphan drug” designation; forms of the medication were custom-compounded in pharmacies, which were then provided to patients at a cost of around $10.

Makena (hydroxyprogesterone caproate) has been approved by the U.S. Food and Drug Administration to help prevent birth before 37 weeks of pregnancy in women who have had at least one prior early delivery.

The American Heart Association (AHA) has compiled a series of evidence-based recommendations for the diagnosis, management, and treatment of cerebral venous thrombosis (CVT), and specifically for its management during pregnancy and postpartum, detailed in a statement published online Feb. 3 in Stroke.

The U.S. teenage birth rate has resumed its decline, reaching a historic low in 2009, according to a report published in the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) February Data Brief.

Sex during pregnancy is generally safe, and abstinence should be recommended only for women at risk of preterm labor or antepartum hemorrhage due to placenta previa, according to a primer published online Jan. 31 in CMAJ, the journal of the Canadian Medical Association.

Overnight closed-loop insulin delivery appears to be safe among pregnant women, according to a study published in the February issue of Diabetes Care.

Is there a way to predict which patients will have the best outcomes following an assisted reproductive intervention? Dr William Gibbons, director of the Family Fertility Program at Texas Children’s Hospital and professor of obstetrics and gynecology at Baylor College of Medicine, and colleagues examined birth weight and gestational age of singleton pregnancies from in vitro fertilization, donor egg, and gestational carrier cycles to determine which factors most influence outcomes.

Progesterone support during the luteal phase is needed to allow for implementation in medically assisted cycles. To date, available options have not met all of the ideals of the “perfect” progesterone strategy-easy to administer, safe with minimal adverse effects, and effective in producing pregnancies.

The fertility field has seen incredible successes with in vitro fertilization and intracytoplasmic sperm injection. However, the resulting successes have yielded concern over the high rates of multiple pregnancies, which can result in increased maternal and perinatal morbidity and mortality as well as increased health care utilization and costs.

One serum blood test is sufficient to diagnose hyperprolactinemia, and dynamic testing of prolactin secretion should be avoided, according to new guidelines published in the February issue of the Journal of Clinical Endocrinology & Metabolism.

Injectable terbutaline should not be used for prevention or prolonged treatment of preterm labor in pregnant women because of the potential for serious maternal heart problems and death, according to a warning issued by the U.S. Food and Drug Administration. The agency also warned that oral terbutaline should not be used for prevention or any treatment of preterm labor because of similar safety concerns and the fact that it has not been shown to be effective.

Evidence shows that combined oral contraceptives are contraindicative in women who have migraines with auras (MA) due to increased risk of ischemic stroke. So what can these women do?

Despite the wide range of contraceptives available, almost 50% of pregnancies in the United States are unintended, with the highest rates among women aged 18 to 24 years. Meanwhile, few studies have explored contraceptive responsibility and no studies since the 1980s have looked at female college students’ perceptions of such. Without this data, physicians and health educators are unable to adequately and effectively address STD and pregnancy prevention among this patient population.

Adequate breast-feeding of a baby exposed to diabetes in utero may protect against childhood adiposity, according to a study published in the March issue of Diabetes Care.

Emotional distress some women experience prior to undergoing fertility treatment appears to have no bearing on the likeihood that the treatment will result in a successful pregnancy, according to a literature analysis published Feb. 23 in BMJ.

Patients with type 2 diabetes who are treated with bupropion (BU) for major depressive disorder (MDD) show significant improvement in sexual function, according to a study published in the February issue of Diabetes Care.

Although mothers with type 1 diabetes are less likely to partially or exclusively breast-feed at two months, diabetes is not an independent risk factor for the initiation and maintenance of breast-feeding, according to a study published in the February issue of Diabetes Care.

The U.S. Food and Drug Administration has notified health care providers that the Pregnancy section of drug labels include additional and consistent information regarding the potential risk for abnormal muscle movements (extrapyramidal signs [EPS]) and withdrawal symptoms among newborns whose mothers received the drugs in the third trimster of pregnancy.

Interpreting a high volume of mammograms ma not lead radiologists to find more cancers but my help them to better distinguish between malignant and non-malignant lesions, according to research published online Feb. 22 in Radiology.

Women who are extremelly obese may not need to gain as much weight during the second and third trimesters of pregnancy as current guidelnes recommend, according to research presented at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting, held from Feb. 7 to 12 in San Francisco.

In utero and early infancy exposure to diagnostic X-rays may increase the risk for childhood cancers, according to research published online Feb. 10 in BMJ.

Women who administer their own analgesia (patient-controlled epidural analgesia [PCEA]) during labor as compared to being administered a continuous epidural infusion (CEI) use less analgesia but experience similar levels of satisfaction, according to research presented at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting, held from Feb. 7 to 12 in San Francisco

Consumption of folate prior to or during pregnancy does not appear to protect women from spontaneous preterm delivery, according to data presented at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting, held from Feb, 7 to 12 in San Francisco

Public-sector research institutions (PSRIs) appear to play a bigger role in drug discovery than was previously thought, contributing to the discovery of about 10 to 20 percent of drugs approved for new drug applications since 1990, according to research publisted in the Feb. 10 issue of the New England Journal of Medicine.

Prenatal surgery for myelomeningocele decreases the need for shunting and improves motor outcomes at 30 months, though it is linked to an increased risk of preterm delivery and uterine dehiscence at delivery, according to a study published online Feb 9 in the New England Journal of Medicine.

Infants exposed to HIV in the womb, but not infected at birth, have lower infant-specific antibody responses against some diseases, compared to infants not exposed to HIV, according to a study published in the Feb. 8 issue of the Journal of the American Medical Association

To ascertain if levobupivcaine can serve as a safe and effective option for women undergoing elective cesarean-section, Dr. I Gunusen, Department ofAnesthesiology and Reanimation at Egee University Faculty of Medicine, Turkey, and colleagues a randomized study of 120 pregnant women.

I was recently asked by WebMD to comment on a newly published study that highlights a possible link between epilepsy, its treatment, and infertility, but a finding in the study has broader implications for all patients trying to conceive. First, a little about the study, and afterwards I will show how it applies to everyone trying to build a family.

Modern medicine recognizes the potential impact of stress on physical well-being, but can stress pass through the mother to the fetus? Indeed, it has been hypothesized that maternal chronic stress can alter the uterine environment and may affect length of gestation, fetal growth, birth weight, and spontaneous preterm birth. Similarly, research on cortisol levels in fetuses and mothers has found that anxiety in mothers can affect the function of the placenta. With so much evidence pointing to the interaction between maternal psychological well-being and fetal wellness, there has become an increased need to find effective, nonpharmacological interventions for pregnant women.