Prior C-Section Raises Risk of Complications With Home Birth

By Alan Mozes
HealthDay Reporter

WEDNESDAY, May 18, 2016 (HealthDay News) — Pregnant women who’ve had a cesarean delivery in the past should not plan a home birth because they face a higher risk for complications, researchers warn.

The finding stems from an analysis of roughly 2.4 million full-term births between 2007 and 2013. Of these, about 4,500 were midwife-assisted deliveries in a home setting.

The study found that home births among women with a history of C-section were associated with a greater risk for stillbirth and/or neurological complications in the baby.

“It’s rare,” acknowledged study author Dr. Amos Grunebaum, chief of labor and delivery at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City. “But when it happens, it’s devastating. And in a hospital, a cesarean is available very quickly, to save the mother and the baby. That’s just impossible at home.”

Grunebaum presented the findings Saturday at the American Congress of Obstetricians and Gynecologists (ACOG) annual meeting in Washington, D.C. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.

ACOG’s current advisory states that “hospitals and birthing centers are the safest setting for birth,” while acknowledging that women have the right to make their own medically informed decision about where to deliver their baby.

Still, home birthing remains the exception to the rule. But U.S. birth certificate data published earlier this year indicated that the number of babies born outside a hospital setting increased from less than 1 percent in 2004 to roughly 1.5 percent by 2014.

Dr. Evan Myers, a professor of obstetrics and gynecology at the Duke University School of Medicine in Durham, N.C., noted that a century of obstetric advances has made childbirth an increasingly safe experience, regardless of locale.

But, “women who have had a previous cesarean have a scar on the uterus that is at risk for rupture during labor,” Myers explained. “It’s still a low risk. But if it happens it can be very bad for the baby, and potentially for the mother as well, and you do want to be prepared.”

To explore the issue, Grunebaum’s team sifted through birth certificate data collected by the U.S. Centers for Disease Control and Prevention.

All the infants were carried to term, meaning 37 weeks or more, and all had a “normal” birth weight, meaning at least 5 pounds, 5 ounces.

All also underwent an Apgar exam at birth. This is a standard test — graded on a scale of 1 to 10 — that assesses a newborn’s breathing capacity, heart rate, muscle tone, reflexes and skin color. A score of 7 or higher is considered a sign of good health. Babies who are not breathing and have no heartbeat are given a score of 0.

The investigators determined that the risk for an Apgar of “0” was rare, but higher, in a home birth setting. Similarly, the risk that a newborn would experience a seizure or serious neurological complication was higher among home births.

Why? Grunebaum and his team said that a lack of adequate fetal monitoring in the home is part of the problem, as is the inability to quickly perform an emergency C-section when needed.

“Every woman has to decide for herself on the place of delivery,” stressed Grunebaum. “All I can say is that we must advise women that there is a significantly increased risk from home delivery, and therefore we don’t recommend that she do so.”

Marlene Goldman is director of the division of clinical research in the department of obstetrics and gynecology at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. She agreed that “the risks to mother and baby in this [home birth] situation outweigh the benefits.”

For those intent on a home birth, Goldman said having a back-up plan that provides for emergency transport to a hospital “would be advisable, but probably too late” to be of help.

More information

The American College of Obstetricians and Gynecologists has more about planned home birth.

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Super-Fit Pregnant Midwife Responds to Body Shamers on Instagram

This extremely toned mom-to-be is further proof that there’s no one-size-fits-all version of a healthy pregnancy:

Hannah Polites, a midwife and fitness expert from Australia, has been documenting her pregnancy with sweet selfies on Instagram, where she has more than 1.2 million followers. Like pics of fellow Aussie Chontel Duncan and L.A. model Sarah Stage, Polites’ photos showing her super-fit pregnant body have gone viral, and sadly, attracted a slew of criticism about her weight.

In an interview with the Gold Coast Bulletin, the 24-year-old Insta-star said that while she tries to ignore the body shamers, they can be hurtful: “It’s truly shocking to read some of the comments regarding my health and that of my unborn baby, especially at a time where women are particularly vulnerable and can be more sensitive to bullying,” she said. “I do not take the negative comments to heart, especially when I know I am making informed decisions when it comes to nutrition and exercise in pregnancy and motherhood.”

RELATED: This Mother-to-Be is 7 Months Pregnant and Still Has a 6 Pack

Polites added that, as she enters her third trimester, both she and baby are in good health, noting that the little one is actually 20% larger than the average unborn baby at this stage of pregnancy.

In a previous interview with Health, Margaret Dow, MD, an assistant professor of obstetrics-gynecology at the Mayo Clinic, explained that baby bumps do indeed come in all shapes and sizes, and only a woman and her doctor know if her weight is in a safe range.

Polites is choosing to focus on the encouragement she’s been receiving from her fans. “Thank you for the overwhelmingly positive support,” she wrote in a recent post. “[A]ll women’s bodies should be celebrated and we are all entitled to share our own journeys.”

That’s certainly a message we can get behind.

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Why Heavy Drinking Seems to Boost Desire to Smoke More

WEDNESDAY, May 18, 2016 (HealthDay News) — The reason alcoholics struggle to stop smoking may be because their heavy drinking speeds up how quickly their body breaks down nicotine, a new study suggests.

“Our study showed that chronic heavy alcohol consumption may lead to an increase in the rate of nicotine metabolism, which could be one contributing factor to the poor smoking cessation rates in smokers addicted to alcohol,” said senior study author Maciej Goniewicz.

Nicotine metabolism is the term used to describe how quickly a body breaks down this addictive substance. People who break down nicotine more slowly may have an easier time quitting because the nicotine stays in their body longer. But, the investigators found, alcohol appears to speed up the breakdown of nicotine.

For the study, the researchers measured markers (such as cotinine) that indicated nicotine levels among male smokers in Poland who were being treated for alcoholism. The measurements were taken immediately after they’d stopped drinking, and four and seven weeks later.

The results indicated that nicotine metabolism returned to normal by the fourth week after the men stopped drinking, according to Goniewicz, an assistant professor of oncology at Roswell Park Cancer Institute in New York, and colleagues.

The study didn’t prove that heavy drinking makes it harder to quit smoking. But, Goniewicz said, “it is an important finding since a faster rate of nicotine metabolism was previously found to be associated with smoking more cigarettes per day, greater nicotine withdrawal symptoms and decreased efficacy of nicotine replacement therapy for smoking cessation.

“Importantly, we also found that when smokers stopped drinking, their nicotine metabolism slowed down,” he added in an institute news release. Once that happened, nicotine stayed longer in their bodies so their withdrawal symptoms were not as intense.

Study co-author Dr. Neal Benowitz, a professor of medicine at the University of California, San Francisco, said the findings “could have important implications for understanding smoking behavior and improving smoking cessation interventions for current and former heavy alcohol drinkers.”

In addition, Benowitz said, “This could have implications for the timing or choice of smoking cessation treatments in recovering alcoholics.”

The study was published recently in the journal Drug and Alcohol Dependence.

Goniewicz received a research grant from Pfizer Inc., and Benowitz serves as a paid consultant to pharmaceutical companies that market or are developing smoking cessation medications and has been a paid expert witness in litigation against tobacco companies.

More information

The American Cancer Society offers a guide to quitting smoking.

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Early Palliative Care Seems to Help Caregivers, Too

WEDNESDAY, May 18, 2016 (HealthDay News) — Palliative care that’s offered soon after a terminal cancer diagnosis can also help caregivers, a new study indicates.

“This study suggests that early palliative care creates a powerful positive feedback loop in families facing cancer,” study author Dr. Areej El-Jawahri said in news release from the American Society of Clinical Oncology.

She noted that patients get a direct benefit from such care, and it seems that “their caregivers experience a positive downstream effect, which may make it easier for them to care for their loved ones.” El-Jawahri is an oncologist with the Massachusetts General Hospital Cancer Center in Boston.

The study included 275 family caregivers. Their loved ones had recently been diagnosed with lung and gastrointestinal cancers. The cancers were incurable.

The patients let the researchers know who their primary caregiver was. It could have been a friend or family member. The researchers met with the caregivers at the start of the study. They saw the caregivers again at 12 and 24 weeks.

Introducing palliative care shortly after cancer diagnosis led to better quality of life for caregivers. It also led to fewer symptoms of depression among the caregivers, the study found.

This study is the first to show that offering palliative care early may offer significant benefits for people caring for dying cancer patients, the researchers said.

The findings are to be presented Wednesday during a briefing that will preview the American Society of Clinical Oncology’s annual meeting in Chicago. Studies are generally considered preliminary until they’ve been published in a peer-reviewed journal.

More information

The American Cancer Society has more about palliative care.

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Tumor Location Affects Colon Cancer Survival: Study

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, May 18, 2016 (HealthDay News) — Your survival odds against colon cancer may depend on which side of your colon the tumor develops, new research contends.

In a study of more than 1,000 men and women with colon cancer that had spread, those whose tumor was on the left side survived just over 33 months, while those whose tumor was on the right side survived only slightly more than 19 months.

“It’s a stunning and surprising finding, and the difference is dramatic,” said lead researcher Dr. Alan Venook, a professor of medicine at the University of California, San Francisco.

It appears that colon cancer that begins on the right side is different from colon cancer that begins on the left side, he said.

“We thought of the colon as a tube that propelled stool out of the body, but it’s not that simple,” Venook said. “Each side of the colon starts in a different place, which is why the cancers are biologically different.

“We don’t have just colon cancer, but varieties of colon cancer, and some have better prognosis than others,” Venook added. “The bad ones tend to be on the right side of the colon and the better ones are on the left side.”

The researchers also found that patients with tumors on the left side of the colon lived an average of 36 months after the chemotherapy drug cetuximab (Erbitux) was added to their treatment. However, patients treated with cetuximab whose tumor was on the right side of the colon survived a little less than 17 months.

The researchers found a similar pattern among patients who were on another drug called bevacizumab (Avastin): Overall survival was slightly more than 31 months for those with left-sided tumors and just over 24 months for those with right-sided tumors.

In the future, this finding will lead to different treatment, depending on which side of the colon the cancer is on, Venook predicted.

“Right now, we don’t know the biology, we just know there is something we need to figure out,” he added.

“Now that we are aware of this, there’s a whole lot more to learn and a lot of digging to do,” Venook said. “People don’t just have colon cancer, they have a particular brand of colon cancer, much as we see with breast cancer.”

The findings were released Wednesday during a media briefing that previewed some of the research to be presented in June at the American Society of Clinical Oncology annual meeting in Chicago. Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

One expert was surprised by the finding.

“I would have never thought that the location of the cancer should have any bearing on how people deal with treatment,” said Dr. Arun Swaminath, director of the inflammatory bowel disease program at Lenox Hill Hospital in New York City.

Only a colonoscopy can find cancer and pre-cancer on either side of the colon, he said. The goal of colon cancer screening is to find cancer before it spreads and remove it.

“Having metastatic [spreading] colon cancer is terrible, regardless of whether it’s right- or left-sided, Swaminath said. “So, everyone over 50 should have a colonoscopy to decrease the risk of developing cancer.”

More information

Visit the American Cancer Society for more on colon cancer.

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Antibacterial Agent May Not Be a Dirty Word After All: Study

WEDNESDAY, May 18, 2016 (HealthDay News) — Triclosan, an ingredient used in some antibacterial products and toothpaste, is a dirty word in certain circles. But triclosan might not cause the harms that some fear, new research suggests.

“There are a lot of people who are fearful of triclosan, but we didn’t find anything to support that concern in our study,” said principal study investigator, Dr. Julie Parsonnet.

The small study, funded by the U.S. National Institutes of Health, found triclosan doesn’t dramatically alter the microbiome of the gut or the mouth, or significantly affect the endocrine system.

In the early 1960s, triclosan was introduced in a wide range of cleaners and personal hygiene products. The chemical was so prevalent that by 2008 it was detected in 75 percent of human urine samples, the researchers said.

More recently, chronic metabolic diseases, such as diabetes and obesity, have been linked to changes in the human microbiome — the trillions of bacteria and other microbes that naturally dwell in the gut, the study authors noted.

Scientists have become concerned that widespread use of triclosan could have negative effects on the human microbiome and also contribute to antimicrobial resistance.

Parsonnet, a professor of medicine and health research and policy at Stanford University’s School of Medicine, and colleagues set out to investigate triclosan’s effects on the human microbiome. The investigators randomly assigned 13 healthy people to use household and personal care products with or without the ingredient.

After analyzing participants’ blood, urine, stool and oral samples, the researchers found that use of products that contained triclosan were linked to greatly increased levels of the agent in people’s urine.

Triclosan, however, had little effect on the endocrine system, which influences almost every cell and organ in the body, or the microbiome of the mouth or gut, the study authors said.

“We found that some organisms were changed a little bit, but there was no major blow to oral flora or gut flora,” Parsonnet said in a news release from the American Society for Microbiology. She said the study “should be reassuring” for people who are very fearful of triclosan.

“When you throw most antibiotics into humans, they are an atom bomb on the microbiota, but we found that when people are exposed to triclosan through normal household products, it does not cause a major blow to our microbial ecosystems,” Parsonnet said.

In 2013, the U.S. Food and Drug Administration proposed requiring manufacturers of antibacterial soaps and body washes to prove that products containing triclosan are safe and more effective in preventing illness than regular soap.

Since then, triclosan has largely been removed from soaps sold in the United States. But it’s still found in certain cleaning products used by hospitals and some toothpaste, the researchers noted.

The study results were published online May 18 in mSphere.

More information

The University of Utah has more about the human microbiome.

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Pain, Epilepsy Drug Lyrica May Increase Birth Defects Risk, Study Suggests

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, May 18, 2016 (HealthDay News) — The widely prescribed drug pregabalin (Lyrica) may slightly increase the risk for birth defects, a new study suggests.

In a small study, researchers found that among women taking Lyrica during the first trimester of pregnancy, 6 percent had infants with major birth defects. In women who weren’t taking the drug, 2 percent had a baby with a major birth defect, the study found.

“These results should be taken with caution,” said study senior author Dr. Thierry Buclin, from the Swiss Teratogen Information Service and the division of clinical pharmacology at the Lausanne University Hospital, in Switzerland. “It’s a warning, but it cannot be taken as a certainty.”

Lyrica is prescribed for a range of health problems, including epilepsy, fibromyalgia and anxiety.

The new study findings should be investigated further, Buclin said. “We should not unduly alarm mothers-to-be about a definite risk. This is just a signal, a warning that there might be a problem with Lyrica,” he said.

Experiments in animals have also linked Lyrica to birth defects, Buclin said. “But there are many examples of drugs showing an adverse effect, which turn out to be rather safe in humans,” he explained.

Buclin doesn’t currently recommend Lyrica for women who are thinking about becoming pregnant.

Steven Danehy, a spokesman for Pfizer Inc., the maker of Lyrica, said, “The study has significant limitations and cannot be used to draw definitive conclusions.”

The study was small, did not account for other medical conditions or medications, “and the women taking Lyrica had higher rates of smoking and diabetes, all of which can negatively affect pregnancy outcomes,” Danehy said.

The report was published online May 18 in the journal Neurology.

Lyrica is approved by the U.S. Food and Drug Administration to treat epilepsy, fibromyalgia and neuropathic pain, such as pain from diabetic neuropathy or pain after shingles or spinal cord injury, according to the prescribing label information. In addition, doctors prescribe it “off label” for anxiety and other mental health problems, the study authors said.

The study included 164 women who took Lyrica during their first trimester of pregnancy. Researchers compared these women to a group of 656 pregnant women who didn’t take Lyrica.

Among the women taking Lyrica, 115 used it to treat neuropathic pain; 39 took it for depression, anxiety, bipolar disorder or psychosis; five were taking it for epilepsy; and one for restless legs syndrome.

Most of the women taking Lyrica started taking it before they became pregnant but stopped taking the drug an average of six weeks into their pregnancy, the researchers said. Twenty-two of these women were also taking another anti-seizure drug.

Birth defects linked to Lyrica included heart defects and problems with the central nervous system or other organs. Women taking Lyrica were six times more likely to have a baby with a major defect in the central nervous system than women not taking the drug, the researchers said they found.

At least one physician said it’s probably best to avoid Lyrica if you’re planning to get pregnant until more is known about the drug’s effects.

“The risk of birth defects is probably higher with Lyrica,” said Dr. Page Pennell. She is an associate professor of neurology at Harvard Medical School in Boston, and coauthor of an accompanying journal editorial.

“It’s that we just can’t prove that with this study,” she said. “This is probably the best information we are going to get, and there is a signal of concern here.”

Because many anti-seizure drugs can cause birth defects, it’s important to plan pregnancies, Pennell said. “If you have a planned pregnancy, it gives the woman a chance to discuss with her doctor the pros and cons of staying on a medication,” she said.

But, some women may need to stay on Lyrica while pregnant, Pennell said. Any potential risks associated with the drug need to be “weighed against the need to maintain maternal disease control,” she wrote.

Buclin and Pennell both recommended careful monitoring of the pregnancy if a woman takes Lyrica while pregnant.

Pennell said birth defects can start very early in pregnancy. “So you cannot wait until you have a positive pregnancy test and think about whether a drug is safe during pregnancy,” she said.

More information

Learn more about birth defects from the U.S. Centers for Disease Control and Prevention.

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Is Monthly Rotation of Medical Residents a Risky Time for Patients?

WEDNESDAY, May 18, 2016 (HealthDay News) — Hospital patients may face an increased risk of death when medical residents leave their monthly rotations, new research suggests.

“Most hospitals have guidelines for the handoffs that occur on a daily basis, and usually those handoffs include a face-to-face discussion between doctors about what will happen to the patient during the next shift,” lead researcher Dr. Joshua Denson said in a news release from the American Thoracic Society. Denson is a fellow in pulmonary and critical care medicine at the University of Colorado.

“But few have guidelines for this monthly handoff, in which a resident turns over for good the care of 10 to 20 patients, often in an email or telephone conversation,” said Denson, who was chief resident at the New York University health system while the research was conducted.

For the study, the researchers examined more than 230,000 patient discharges from 10 Veterans Administration hospitals that occurred between 2008 and 2014.

The researchers identified almost 64,000 patients who died or were discharged within seven days of being transferred from the care of an intern (a first-year medical resident), a resident or a combination of the two.

Other discharges included in the study served as a control group.

The study authors also analyzed deaths that occurred 30 days and 90 days after patients left the hospital. Among patients in the three handoff groups, researchers found:

• a 64 percent to 95 percent increase in in-hospital deaths;
• a 76 percent to 82 percent increase in 30-day deaths;
• a 72 percent to 84 percent increase in 90-day deaths.

After taking other contributing risk factors into account, such as the patients’ age, health issues and length of hospital stay, the researchers found the link between resident handoffs and deaths 30 days and 90 days after discharge remained significant at all 10 of the hospitals examined.

The link between handoffs and in-hospital deaths remained significant only with first-year residents, study authors said.

It remains unclear, however, why the transition in care is seemingly risky, the researchers pointed out, although the study did not prove that such transitions caused an increased death risk.

“We don’t know the root cause of this,” Denson said. “Transitions in care are common, they are not preventable and they can be dangerous, particularly those that occur at the end of a resident’s clinical rotation. We need high-quality research to make them safer.”

The findings were to be presented Wednesday at the American Thoracic Society’s annual meeting, in San Francisco. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.

More information

The Association of American Medical Colleges provides more information on teaching hospitals.

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The FDA Begins Process of Defining “Natural” Label

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How do you define “natural”?

That’s what the Food and Drug Administration (FDA) asked the public to answer. Over 7,600 people commented to let the government organization know just how they felt about the controversial food label. The commenting period closed May 10, and now the FDA will be sorting through these comments for the next several months to try and reach an actual definition.

RELATED: A Natural Label Means Next to Nothing. Here’s Why.

Currently, the FDA has no real definition (or requirements for labeling) a product as natural. In recent years, some consumers have filed lawsuits against companies using this loophole to label highly-processed foods as “all natural.” Each time a judge in these cases requests for the FDA to define the label, they choose to decline and instead point to an informal advisory that is over two decades old (and not legally enforceable) that defines natural as “nothing artificial or synthetic.”

Consumer Reports found that two-thirds of shoppers thought that the natural food label means more than it really does and almost half incorrectly thought that any claims of “natural” had to be independently verified. This leaves room open for companies to abuse the label and for consumers to be buying products that they believe are healthy based on questionable marketing.

Now that the public had their own soap boxes to stand on and tell the FDA their minds, we sorted through some of the comments to see what the general consensus on “natural” was. The most common recurring theme was that foods labeled natural should not contain GMOs, have unnatural additives (preservatives, artificial colors and flavors, etc.), or be grown with intense pesticides. There were also many commenters who would prefer that the word “natural” be banned from food labels due to its current corrupt state.

RELATED: A “Natural” Label on Food Means Next to Nothing. Here’s Why.

Here are just a few of the comments sent in to the FDA:

• “‘Natural’ means nothing added and not tampered with. No additives such as dyes, preservatives, artificial thickeners, chemically processed oils, hydrogenated oils, artificial sugars, chemically altered sugars, sulfites, food enhancers, soy, GMO’s, chemical fertilizers, petrochemicals, insecticides, herbicides, and all the other chemically manufactured substances our food is poisoned with.” –Marie Field-Carpenter

• “I think the label ‘natural’ should not be used in labeling food products because it is hard to regulate the definition since everything essentially comes from earth and can be considered ‘natural.’ This term has been abused by advertisers, is misleading, and the FDA should put an end to

• “When the word ‘natural’ comes up people don’t think about dyes, additives, GMO, and trans fats. People think of food caused by nature, not humankind creation. Food manufacturers using the word ‘natural’ are deceiving and misleading their customers. This behavior is unacceptable and everybody should deserve to have information of the food they’re consuming.” –Anonymous

• “The way that food is marketed has grand effects on people’s eating patterns and therefore their health. To define natural with ingredients that contribute to massive diet-related illness across the US is irresponsible.” –Haley Baron

• “The FDA should define the term ‘natural’ so that food companies can stop hiding their products behind it.” –Hillary McMullin

This article originally appeared on CookingLight.com.

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GMO Crops Don’t Harm Human Health, Report Says

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Genetically engineered crops pose no additional risks to humans and the environment when compared to conventional crops, according to a new report.

The research, published by the National Academies of Sciences, Engineering and Medicine, is the result of a sweeping review of nearly 900 publications on the effects of genetically modified crops on human health and the environment. Genetic engineering has helped agricultural producers in the U.S., including small farmers thrive, according to the report.

But genetic modification is not all good news, the report suggests.Widespread use of genetically modified crops, which are often engineered to resist the effects of pesticides, has contributed to concerning levels of pesticide resistance in weeds and insects. Pests improve in their ability to resist pesticides every time the chemicals are sprayed, creating a vicious cycle of increased spraying and more resistance.

RELATED: Activists Are Restricting a Major Pesticide By Forcing Users to Actually Follow the Label

“There have been claims that [genetically engineered] crops have had adverse effects on human health,” the report says. “Sweeping statements about crops are problematic because issues related to them are multidimensional.”

Researchers behind the report called for a process that evaluates potential health and environmental concerns about new type of crops regardless of whether they are genetically engineered.

The report comes as public health and environmental advocates continue to push for mandatory labeling of genetically modified food. The results of the National Academy report suggest that such measures may not be necessary. Report committee member Michael Rodemeyer said at a press conference that without evidence of health effects from GMO crops, the Food and Drug Administration does not even have the authority to mandate such labels.

RELATED: The GMO Controversy Misses the Point

But the report is unlikely to stop calls for labeling that have already succeeded in some states, such as Vermont, and led some food manufacturers like Whole Foods to promise to curtail their use of genetically modified ingredients. Report authors acknowledged that their report would not—and should not—settle the debate over GMOs.

“We’re hoping that our report is not this big tome but something that starts a conversation,” North Carolina State University professor Fred Gould, who chaired the committee behind the report. He also hoped the findings would help fuel an evidence-based discussion rather than a heated back and forth between. “It would nice not to have a debate, but maybe an eight-hour discussion,” Gould added.

This article originally appeared on Time.com.

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