iPads Often Used to Pacify Difficult Kids

MONDAY, Feb. 29, 2016 (HealthDay News) — Some parents use mobile phones and tablets to calm young children with behavioral problems, a new study finds.

“We know that parents of babies and toddlers with difficult behavior disproportionately use television and videos as calming tools. We wanted to explore whether the same might be true for mobile technology like phones and tablets,” lead author Dr. Jenny Radesky, of C.S. Mott Children’s Hospital at the University of Michigan, said in a university news release.

“We found that the less control and more frustration parents felt over their children’s behavior, the more likely they were to turn to mobile devices to help calm their kids down,” Radesky said.

The study included 144 children, aged 15 to 36 months, in low-income families. Their parents were asked how often they allowed use of mobile phones and tablets during different situations.

The devices were most likely to be used to “pacify” children with social and emotional difficulties, the researchers said.

But parents’ use of mobile technology was no different for children with social-emotional problems and other children in other situations, such as eating, being in public, doing chores or bedtime, according to the study. The findings are published Feb. 29 in the journal JAMA Pediatrics.

“We need to further study whether this relationship between digital technology and social-emotional development difficulties applies to a more general population of parents as well, and what effect it might have on kids’ longer-term outcomes,” added Radesky, who conducted the study while at Boston Medical Center.

Previous studies have shown that increased television time can hinder young children’s language and social development, partly because they reduce human-to-human interaction, Radesky said.

“Now that screens can be taken anywhere, they have become part of our interpersonal space,” she added. “We’re interested in identifying the ways that mobile devices sometimes interfere with family dynamics, but also how we can use them as a tool to increase parent-child connection.”

More information

The American Academy of Pediatrics has more on child behavior.

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‘Female Libido’ Pill May Not Be Worth It: Researchers

By Dennis Thompson
HealthDay Reporter

MONDAY, Feb. 29, 2016 (HealthDay News) — The much-touted “female libido” pill seems to cause a host of serious side effects while failing to spark much additional passion in a woman’s life, a new review suggests.

Addyi (flibanserin) quadruples the risk of dizziness and sleepiness, more than doubles the chances of nausea, and increases the risk of fatigue by more than half, according to the analysis.

For all that trouble, a woman taking Addyi can expect to gain one-half of one additional satisfying sexual event per month, on average, according to the report. It was published online Feb. 29 in the journal JAMA Internal Medicine.

“We found women had, on average, 2.5 satisfying sexual events per month before entering the study, and flibanserin added one-half additional satisfying sexual events per month,” said senior study author Ellen Laan, a professor of sexology and psychosomatic gynecology at the University of Amsterdam, in the Netherlands.

The side effects are troubling, said Dr. Mamta Mamik, an assistant professor of obstetrics, gynecology and reproductive science at Mount Sinai’s Icahn School of Medicine in New York City.

“The article is pretty comprehensive in addressing the issues. They raise valid concerns,” Mamik said. “I think we have to be careful when a drug is marketed before its safety profile is approved and proper trials have been conducted.”

The U.S. Food and Drug Administration approved Addyi last year after a contentious review process, making it the nation’s first drug designed to help women with low libido.

Only 227 prescriptions for the drug were filled in its first few weeks on the market, Bloomberg reported.

In the new review, Laan and her colleagues reviewed eight clinical trials conducted with Addyi, including five published and three unpublished studies involving almost 6,000 women.

The combined evidence showed that Addyi provides marginal benefit for women who are suffering hypoactive sexual desire disorder, a condition involving a persistent or recurrent lack of interest in sex.

For example, women taking the drug scored just 0.3 points higher on a 5-point sexual desire scale and experienced a minimal increase in satisfying sexual events each month, the review authors found.

However, Mamik noted that it’s hard to judge how well Addyi performs because female desire is difficult to assess.

“When you try to judge efficacy for a drug without an accurate measure of what the drug’s supposed to do, it becomes fairly difficult,” she explained. “It’s not like blood cholesterol levels, where there’s a number. How do you measure it? That’s where the problem lies.”

Whether or not Addyi works, it appears to greatly increase a woman’s risk of nausea, dizziness and fatigue. Mamik said that large-scale clinical trials that involve women from a wide range of backgrounds are needed to learn more about these side effects.

Addyi underwent three FDA reviews and two agency advisory committee meetings before its approval last August, said Dr. Steven Woloshin, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H. He wrote an accompanying editorial in the journal.

Woloshin argued that the FDA caved to public pressure from a manufacturer-sponsored advocacy campaign alleging that sexism had held up the drug’s approval. He noted that the agency approved the drug even though no new positive data had surfaced between the second and third reviews.

“All of the clinical reviewers, the people closest to the data, voted to reject the drug, but they were overruled by the senior administrative people,” he said.

The FDA approval did come with significant restrictions because the drug can cause severely low blood pressure and loss of consciousness. Addyi’s label includes a boxed warning saying the drug shouldn’t be taken while drinking alcohol and shouldn’t be used with certain other drugs. Also, it should not be used by women with liver problems.

Within 48 hours of FDA approval, Valeant Pharmaceuticals purchased the company that developed Addyi, Sprout Pharmaceuticals, for about $1 billion, Woloshin said.

Valeant officials said that all three Phase 3 trials of Addyi showed an increase in sexually satisfying events for participants.

“That data was affirmed by an FDA advisory panel and FDA approval,” Dr. Tage Ramakrishna, chief medical officer and president of research and development and quality at the Canadian company, said in a statement.

“The JAMA Internal Medicine meta-analysis confirmed those findings and provided little additional context,” Ramakrishna noted.

Valeant officials did tell The New York Times in December that logistical problems have hampered sales. Given Addyi’s potential side effects, the FDA requires doctors and pharmacists to be specially certified to prescribe and dispense the drug, creating a logjam of unfilled prescriptions.

However, the drug’s continued approval is contingent on a series of follow-up studies, including several that will examine Addyi’s interaction with alcohol, Woloshin said. When combined, the two can cause a dangerous decrease in blood pressure that might result in fainting, he explained.

These studies are supposed to be completed over the next one to three years, Woloshin added.

“The FDA always responds to new information, and sometimes drugs are pulled from the market if important harms come up,” he said. “These alcohol studies, the FDA will be paying close attention to them and it’s possible if the results are scary, that might prompt them to pull the drug.”

More information

Visit the U.S. National Institutes of Health for more on Addyi.

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Study Compares Drugs for Common Diabetic Eye Disease

MONDAY, Feb. 29, 2016 (HealthDay News) — People with diabetes are at risk for blurred vision or even a loss of vision from a condition called macular edema.

Three drugs for the disease — Avastin, Eylea and Lucentis — vary widely in price, but new research suggests all work equally well for patients with mild vision loss.

However, when diabetic macular edema leads to more severe vision loss, researchers found Eylea to be the better choice.

The study, funded by the U.S. National Eye Institute (NEI), “will help doctors and their patients with diabetic macular edema choose the most appropriate therapy,” study lead author Dr. John Wells said in an institute news release.

“The study suggests there is little advantage of choosing Eylea or Lucentis over [much cheaper] Avastin when a patient’s loss of visual acuity from macular edema is mild, meaning a visual acuity of 20/40 or better,” Wells explained.

“However, patients with 20/50 or worse vision loss may benefit from Eylea, which over the course of the two-year study outperformed Lucentis and Avastin,” said Wells, a retinal specialist at the Palmetto Retina Center in Columbia, S.C.

As the researchers explained it, diabetic macular edema can cause fluid to leak from abnormal blood vessels in the retina. This can result in blurry vision or vision loss. Drugs used to treat the condition are injected into the eye and work by blocking a substance that can trigger the leakage.

Cost is a factor, too. Although they work in similar ways, the three drugs vary dramatically in price. Based on Medicare’s pricing guidelines, the per-injection cost for Eylea is $1,850, $1,200 for Lucentis and only $60 for Avastin, the news release noted.

The two-year clinical trial compared the effectiveness of the three drugs in 660 patients with diabetic macular edema. Patients were treated at 89 sites across the United States.

The patients averaged 61 years of age and had type 1 or type 2 diabetes for an average of 17 years. None of the patients had vision better than 20/32.

Half of the patients had already experienced “mild to moderate” vision loss, the researchers said. The rest had moderate to severe vision loss — 20/50 or worse vision. Patients were randomly assigned to receive one of the three drugs, and were checked regularly over the next two years.

Most patients received monthly injections for the first six months. After that, they received additional injections of the drug they were assigned until their condition resolved or their vision stabilized and stopped improving.

Patients that experienced a relapse of macular edema after their treatment was suspended resumed receiving their injections. Any whose macular edema persisted after six month of injections were given laser treatment — the standard treatment before newer drugs for the condition became available.

According to Wells and colleagues, all three drugs performed similarly among participants with mild vision loss when the study began. On average, participants’ vision improved from 20/40 vision to 20/25, the study showed.

“This rigorous trial confirms that Eylea, Avastin, and Lucentis are all effective treatments for diabetic macular edema,” NEI director Dr. Paul Sieving said in the news release. “Eye care providers and patients can have confidence in all three drugs.”

Patients with moderate to severe vision loss also reported significant improvements in their ability to see. Halfway through the study, however, Eylea outperformed Avastin and Lucentis. By the two-year mark, Eylea and Lucentis produced similar gains in vision, the team found.

The researchers reported that the average visual acuity was 20/32 to 20/40 among participants in each treatment group by the end of the study.

Patients needed about the same number of injections over the course of the study, regardless of the type of drug taken, the study authors said. On average, the participants were given nine injections during the first year of the study and five more injections the following year.

The need for laser treatment varied. Of the patients taking Eylea, 41 percent needed laser treatment. In contrast, 64 percent of the patients in the Avastin group and 52 percent of those in the Lucentis group also needed laser treatment.

Two experts said the study provides important guidance for patients and physicians.

“There are 7.7 million diabetic patients in the United States with approximately 750,000 of those suffering from diabetic macular edema,” said Dr. Mark Fromer, an ophthalmologist at Lenox Hill Hospital in New York City. “This study will help both retina specialists and patients alike understand the benefits of choosing these drugs in the treatment of diabetic macular edema.”

Dr. Nazanin Barzideh is chief of vitreoretinal surgery at Winthrop-University Hospital in Mineola, N.Y. She said that the study findings were in line with her experience.

“I have seen my diabetic patients with macular edema having a better response to Elyea compared to other [similar] drugs available on the market, especially those patients with severe visual acuity,” she said.

The study was published online Feb. 27 in the journal Ophthalmology.

More information

The American Diabetes Association has more about eye complications associated with diabetes, including macular edema.

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Physically Fit May Bounce Back Better After Heart Attack

MONDAY, Feb. 29, 2016 (HealthDay News) — Physically fit people may be less likely to become depressed after a heart attack, a new study suggests.

Heart attack survivors are three times more likely to have depression than people who haven’t had a heart attack. But this study found that a history of regular exercise can reduce that risk.

“Physical activity protects people from depression after a heart attack,” study author Linda Ernstsen, an associate professor at the Norwegian University of Science and Technology, said in a university news release.

For the study, the researchers looked at 189 middle-aged and older people in Norway who had suffered a heart attack. On average, 11 percent of them suffered depression after their heart attack. But there were significant differences in risk depending on how much people had exercised before their heart attack, the investigators found.

Depression occurred in 17 percent of those who never exercised, 12.5 percent of those who once exercised but stopped before their heart attack, 9 percent of those who were inactive but began exercising before their heart attack, and 7.5 percent of those who were consistently physically active, the findings showed.

The researchers said that people who exercised regularly over several years were less than half as likely to become depressed after a heart attack than those who never exercised.

However, the study could not prove a cause-and-effect relationship between regular exercise and depression risk after a heart attack.

The study was published recently in The American Journal of Medicine.

More information

The American Heart Association has more about depression after heart attack.

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Fidgeting May Help Students With ADHD Learn

By Kathleen Doheny
HealthDay Reporter

MONDAY, Feb. 29, 2016 (HealthDay News) — Students who have attention deficit hyperactivity disorder (ADHD) often get into trouble for fidgeting in the classroom, but that fidgeting may help them learn, new research suggests.

“The prevailing view has been and continues to be that hyperactivity is a core deficit in ADHD,” said study author Michael Kofler, an assistant professor of psychology at Florida State University in Tallahassee. “When we think of it as a deficit, we are saying it’s a bad thing and it’s interfering [with schoolwork]. Our work has been challenging that thought.”

Kofler’s team gave 25 boys and girls with ADHD, aged 8 to 12, a series of working memory tasks, observing the amount of fidgeting as the children did them. In one set, the students had to remember where a series of dots appeared on a screen and then reorder them mentally, based on color. They had to then remember a series of numbers and letters, mentally reordering them, numbers first from smallest to biggest, then the letters.

In the easier test of dots on a screen, the children knew in advance how many items they would have to remember. In the more difficult test, the amount of items they would have to remember was random so they didn’t know in advance how many items they would have to remember.

The children fidgeted during all the tests, but fidgeted about 25 percent more when they couldn’t predict how many items they would have to remember. The tests were alike in every other way, so Kofler said this shows that demands on working memory affect the level of hyperactivity in ADHD students.

The fidgeting may increase “physiological arousal,” Kofler speculated, similar to what stimulant medication does for a child with the disorder. But the study didn’t prove that point, he said, and the researchers don’t know if the kids were fidgeting on purpose.

The study was published online this month in the Journal of Attention Disorders.

The findings echo some from a study published last year from the University of California, Davis. Researchers there looked at 26 children with ADHD and 18 without. They found that when the children with ADHD fidgeted more, they did better on a test. Fidgeting among kids without ADHD had no effect on test performance.

Dr. Trevor Resnick, a pediatric neurologist at Nicklaus Children’s Hospital in Miami, said, “We’ve known [intuitively] for many years that kids with ADHD often do better when they are fidgeting.”

However, Resnick said, the interpretation of why they fidgeted more has not been proven. “We don’t know whether they do it to help or because they are anxious, or whether it is helping,” he said.

Kofler agreed, saying his team next plans research “to link the movement with the arousal and the performance, to see if we are right about that is why the movement is helpful.”

Meanwhile, until more is known, students with ADHD should not have free rein to do what they want in the classroom, Kofler said.

But the new study does suggest that teachers and parents should focus less on whether a child is sitting still and more on whether the work is getting done, regardless of the movement level, he said.

More information

To learn more about ADHD, visit U.S. Centers for Disease Control and Prevention.

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Daredevil at 20, Scam Victim at 70? What Being a Risk-Taker May Mean to You

SUNDAY, Feb. 28, 2016 (HealthDay News) — Most adult risk-takers continue to take chances as they get older, and that can make them more susceptible to fraud when they’re seniors, new research suggests.

The study included more than 44,000 people in Germany, aged 18 to 85, who were followed for 10 years. The results showed that a person’s level of risk-taking tended to remain stable over time.

For example, this means that someone who went bungee jumping in their 20s may be more likely to ride a motorcycle later in life.

“The data suggests risk-taking is similar to a personality trait in that it remains relatively stable throughout most of adulthood,” study co-author Gregory Samanez-Larkin said in a Yale University news release. He is an assistant professor of psychology at Yale.

However, recreational risk-taking falls sharply after age 30, according to the study published recently in the Journal of Personality and Social Psychology.

“Overall, the stereotype is that we take less risks when we are older and, in general, the respondents in the survey are telling us that is true. The new and interesting part of this study is that the effect of age on risk-taking varies across a range of activities,” Samanez-Larkin added.

For example, a person’s willingness to take financial gambles remains steady until about retirement age, but there is no decline in social risk-taking, such as trusting other people, he explained.

This finding suggests that people who are trusting when they’re younger may be more vulnerable to fraud in old age, according to Samanez-Larkin and colleagues from the Max Planck Institute for Human Development in Germany and the University of Basel in Switzerland.

“This potentially has implications how we might better protect people from fraud,” he concluded.

More information

The U.S. Federal Bureau of Investigation has more about seniors and fraud.

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Tips for Traveling to the U.S. With Medications

SATURDAY, Feb. 27, 2016 (HealthDay News) — Traveling to the United States with medications? Here’s what you need to know to avoid problems.

Americans traveling abroad are not allowed to bring home foreign versions of medications approved by the U.S. Food and Drug Administration. The FDA warned that it can’t ensure these foreign drugs are safe and effective. There is also no way to confirm that medications are made properly using the same formulation as FDA-approved drugs.

“As a pharmacist at the FDA, I advise people to remember that we at FDA cannot ensure that medications approved in other countries are safe or effective, or have been manufactured properly,” Lindsay Wagner, an FDA pharmacist, said in an agency news release.

When someone with a serious medical condition needs treatment with a foreign drug for which there is no U.S. equivalent, the FDA will review an application to import the drug for personal use. A letter from a doctor explaining that the drug is part of ongoing treatment that began outside the United States, or the name and address of a licensed U.S. physician who will supervise use of the drug, is required.

Foreigners planning to carry medications into the United States should have a valid prescription in hand or a note from a doctor written in English explaining why the drug is necessary. It’s a good idea to keep medication in its original container with the doctor’s instructions printed on the label, the FDA said.

The FDA also advises against carrying more than a 90-day supply of a specific medication into United States, but very few American pharmacies can fill prescriptions from another country. Foreigners who stay longer than 90 days can arrange to have their medication delivered by mail or courier.

Medication sent through the mail may be detained until an FDA inspector screens it. To expedite this process, which could take up to a month, make sure the outside package states that it contains your doctor’s letter to a U.S. Customs and Border Protection (CBP) officer.

Anyone coming to the United States with medications should contact the FDA, CBP and U.S. Transportation Security Administration beforehand. These agencies may have different restrictions over various medications.

Anyone with questions should contact the FDA’s Division of Drug Information at 855-543-DRUG (3784) or send email to druginfo@fda.hhs.gov.

More information

More on the U.S. Food and Drug Administration’s Personal Importation Policy can also be found online.

Information on the U.S. Drug Enforcement Agency’s restrictions can be found here.

The U.S. Transportation Security Administration provides more about on traveling with medication.

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After Missing the Olympic Team By 65 Seconds, Kara Goucher Talks About Her Next Dream

Photo: Getty Images

When it comes to running, Kara Goucher is a boss. Period. So when I was offered the chance to take a class at Mile High Run Club, a boutique indoor treadmill studio in New York City, coached by the two-time Olympian, I pretty much dropped everything. But before I could pick her brain, I had to survive a fartlek—Swedish for “speed play”—workout first. (In case you are wondering, we did a ladder drill: 1 minute on, 1 minute off; 2 minutes on, 2 minutes off; 3 minutes on, 3 minutes off; and then back down the ladder. Plus a 5-minute warm-up and cool-down.)

It was super challenging, but nowhere near as tough as what the Queens native has recently endured. Between coming out against her former coach (he is being investigated by the U.S. Anti-Doping Association) and her fourth place Olympic Trials finish (2:30:24) at the LA Marathon in mid-February, missing the mark to make the team by a mere 65 seconds, she has every right to hole up somewhere. But not Goucher. She’s already planning her next move.

Post workout, the 37-year-old long-distance runner opened up about how she’s dealing with defeat (while fighting back tears), being a feminist, and the biggest lesson she has learned from running.

RELATED: 15 Runnings Tips You Need to Know

When you put your all into something, like making the Olympic team, and it doesn’t happen, how do you cope?

I did everything I could and unfortunately there were three women better. I was fourth, and only three go. I’d be lying if I [said] I don’t care. I mean I’m still crying about it because you just want something so bad and you work so hard for it. It’s that dream of making a third Olympic team that has gotten me through a lot, especially in the last year, and so it’s been hard. But there’s still one more opportunity to get there. I’m going to throw myself into the 10K and try to make the 10K [Olympic] team.

The Olympic track trails aren’t until July, are you going to jump right back into training?

Even though I know I really want to focus on the 10K, I just need two weeks where I run for happiness. I just want to run for the enjoyment of it. I never take a day off. I love it. I need it. I actually feel fine, but I’m not ready to work out yet.

RELATED: How to Train for a 10K Race

Speaking of workouts, is fartlek training your favorite running one?

I love a fartlek [run]. It gives you relief from the watch and the expectation of a goal time. You can just go on how you’re feeling. It’s more organic. Sometimes I’ll do 10 by 5 minutes—5 minutes on, 2 minutes off. Sometimes I’ll do something like how it was today where it’s just a ladder. A lot of times I’ll do it by heart rate actually, and I don’t even measure how far I’m going. It’s like 5 minutes at this heart rate and 3 minutes recovery.

When you are in the midst of a tough race or workout, what helps you push through?

One of the things that I was telling myself when I was training for the trials was, you can do anything in this moment. A moment is like not even a second, so I would just think when it got hard, Just survive it for one more moment. I also like to remind myself of hard times. I like to draw back on things I’ve survived and things I’ve done, because I don’t care how fit you are, you are going to have a moment where you are doubting yourself.

RELATED: The Best Running Shoes for Spring 2016

One of your coaches in a woman now, and one of the brands that sponsors you has a woman CEO. How does it feel to be working with women and being supported by women?

I like it. I mean I never shy away from the fact that I’m a feminist, so it’s good to have women in bigger roles in my life. There’s a certain understanding between women and it feels good to be a part of something where women are building each other up instead of always being competitive.

You have a six-year old son, Colt, and a brand new puppy, Freya. How does being a mom affect people’s perception of you as a runner?

I think it’s important for people to know I’m a mom, but sometimes it is overkill. Like I’m not weaker because I’m a mom. “She got fourth and she’s a mom.” Like yeah, I f*cking got fourth. Period. Why do you have to add that? I’m proud to be a mom. I love my son. I love that my life is a little more complicated. It’s almost like a qualifier: You got fourth, but you’re a mom. And I’m like, “No, but I’m a competitor.”

RELATED: 4 Things I Learned Training for My First Marathon

You’ve been running for several years now, what’s one lesson you’ve learned from your time on your feet?

I was such a shy kid. My father died when I was little. I wasn’t particularly good at anything. I was always by my mom. I could never picture going away to college. Running made me realize I’m really strong. I couldn’t even order pizza. I would be like mom can you just call? Running has just changed the direction of my life so much. I feel like a different person. I don’t feel like this timid person who needs my mom to make a decision. Running did that for me.

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Recovery From Ultramarathon May Take Up to 5 Days

FRIDAY, Feb. 26, 2016 (HealthDay News) — It takes ultramarathon runners about five days to recover from an event, a new study shows.

Ultramarathons are much longer and more physically demanding than the traditional 26.2-mile marathon. These races have become increasingly popular, according to the researchers.

Despite high levels of physical stress on the body, some runners compete in multiple ultramarathons a year. This makes it important to learn more about the recovery process, the researchers added.

They studied 72 people who took part in the 2015 Western States Endurance Run, a 100-mile race through the Sierra Nevada mountains of northern California. Runners climb approximately 18,000 feet during this race, the researchers said.

Typically, runners need 24 to 72 hours to recover from exercise-linked muscle pain and soreness, the researchers said. But, the runners in this study needed an average of five days to recover, the researchers noted. However, they said a longer recovery time is to be expected from such a physically demanding event.

But while the runners’ recovered from pain and fatigue within an average of five days, they didn’t regain their normal running speed within that time, the study found.

The researchers also found that older runners had slightly less muscle pain and soreness than younger runners. In addition, higher concentrations of a substance called plasma creatine kinase after the race were associated with more muscle pain and soreness.

The study was presented recently at the Association of Academic Physiatrists’ annual meeting in Sacramento, Calif. Findings presented at meetings are generally viewed as preliminary until they’ve been published in a peer-reviewed journal.

“This study sheds light on the factors that impact a person’s physical and functional recovery from running an ultramarathon. As athletes continue to push the boundaries of strength and endurance, it becomes more important to study the effects of these activities as well as measures that could aid in recovery,” Joseph Chin, who was with the VA Northern California Healthcare System at the time of the study, said in an association news release.

More information

The American Academy of Orthopaedic Surgeons offers tips for a safe running program.

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Zika Found in 9 U.S. Pregnancies, Outcomes Often Severe: CDC

By Dennis Thompson
HealthDay Reporter

FRIDAY, Feb. 26, 2016 (HealthDay News) — Five of nine pregnancies among U.S. women who were infected with the Zika virus have resulted in tragic outcomes, federal health officials said Friday.

All of the women contracted the mosquito-borne virus while traveling outside the United States, in regions experiencing Zika outbreaks, the officials said.

In four of the cases, the women lost their babies: Two to miscarriage and two to abortions after ultrasounds revealed birth defects, the U.S. Centers for Disease Control and Prevention reported.

A fifth woman gave birth in late 2015 to a child with severe microcephaly, a condition in which the brain and skull are significantly underdeveloped.

Since the Zika epidemic began last spring, it’s believed there have been more than 5,600 suspected or confirmed cases of microcephaly in Brazil, the World Health Organization reported Friday.

“Even though the [U.S.] numbers are small, they are of considerable interest,” CDC Director Dr. Tom Frieden said during a news conference Friday. “We understand that the occurrence of fetal malformation, fetal loss or miscarriage, or a child with a birth defect, is something that can be devastating to a family.”

The proportion of U.S. pregnancies that appear to have been harmed due to the mosquito-borne infection “is unexpected, and greater than we would have expected,” Dr. Denise Jamieson, co-lead of the Pregnancy and Birth Defects Team with the CDC Zika Virus Response Team, said during the news conference.

Of the remaining four women, two gave birth to apparently healthy babies and two pregnancies are continuing without known complications.

Those numbers reflect confirmed cases as of Feb. 17. Ten additional reports of Zika infection involving pregnant U.S. women are currently under investigation, the CDC added.

Genetic evidence of Zika virus was detected in tissue specimens from the two miscarriages. The CDC was careful to say it is not known whether Zika caused the miscarriages, but Frieden noted that the presence of the virus in fetal tissue is highly suspicious.

In January, the CDC advised pregnant women to consider postponing travel to areas where active transmission of Zika is occurring. The agency also issued guidelines for physicians, urging them to perform blood tests and regular ultrasounds on expecting mothers who have returned from a Zika-affected region.

Approximately half a million pregnant women travel to the United States annually from the 32 Zika-affected countries and U.S. territories with active transmission of Zika virus, the CDC said. The agency hopes those numbers will decrease due to its travel advisory.

There have been 147 U.S. cases of Zika reported to the CDC so far, Frieden said. Of those, 140 are related to travel to a Zika-affected region, and 40 have occurred in a U.S. territory like Puerto Rico. No instances of direct transmission via mosquito have yet taken place in the United States.

Only one out of every five people infected with Zika show any symptoms, and even those who fall ill usually do not suffer severe symptoms. The most serious risk from Zika seems to be to pregnant women and their developing fetus, Frieden said.

But a case report published this week in the journal PLOS Neglected Tropical Diseases suggests that Zika may cause even greater harm than previously suggested. The report concerned a stillborn Brazilian fetus that had almost no brain tissue and dangerous fluid buildup in other parts of its body.

The nine confirmed U.S. cases of Zika virus infection were reported among pregnant women who had traveled to one or more of the following nine areas: American Samoa, Brazil, El Salvador, Guatemala, Haiti, Honduras, Mexico, Puerto Rico and Samoa.

All nine women reported at least one of Zika’s four most commonly observed symptoms — fever, rash, conjunctivitis (pink eye) and joint pain.

Six of the women reported Zika symptoms during their first trimester, and their outcomes reflect expert opinion that early infection can be more devastating to the developing fetus than infection later in pregnancy. All four lost pregnancies and the single case of birth with microcephaly occurred in this group of women.

The CDC has also warned pregnant women to refrain from unprotected sex with a partner who has traveled to a Zika-affected region.

Zika virus infection has been confirmed in two non-traveling women whose only known risk factor was sexual contact with a male partner who had recently traveled to an area with ongoing transmission, the CDC said Friday.

CDC researchers also are investigating four probable cases of sexually transmitted Zika virus in non-traveling women.

Frieden admitted the CDC “did not anticipate that we would see this many sexually transmitted cases of Zika.”

The Zika virus has now spread to over 32 countries and territories in Latin America and the Caribbean. The World Health Organization estimates there could be up to 4 million cases of Zika in the Americas in the next year.

More information

For more information on Zika virus, visit the U.S. Centers for Disease Control and Prevention.

To see the CDC list of sites where Zika virus is active and may pose a threat to pregnant women, click here.

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