Mistruths and misconceptions surrounding the COVID-19 pandemic continue to spread, including who’s at risk of contracting the virus, certain drugs to counteract its effects, and so on. To dispel the many mistruths and “un-facts” surrounding the virus, MJH Life Sciences COVID-19 Coalition will host a free, 1-hour webinar at 6 p.m. EST on Tuesday, Sept. 29.

Fact or Fiction? COVID-19 Myths and Controversies’

 will feature a panel of top-tier experts, including infection prevention epidemiologists, virologists, and research specialists.

Articles

Hosted by MJH Life Sciences COVID-19 Coalition, this free webinar will feature expert insight into the myths and controversies of the global pandemic. 

COVID-19 Fact or Fiction?

Researchers ultimately found that congenital cytomegalovirus infection significantly increased the prevalence of microcephaly at delivery 7-fold. These findings suggest that preventing cytomegalovirus in pregnancy may substantially reduce the number of babies with microcephaly at birth.

A new study in JAMA Pediatrics analyzed the number of microcephaly cases that resulted from congenital microcephaly and how it may be a larger cause than the 2016 Zika epidemic. 

Congenital cytomegalovirus may be leading cause of microcephaly

Dr. Einarsson, Deputy Editor, is Associate Professor of Obstetrics ad Gynecology, Harvard Medical School, and Director, Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.

’s Deputy Editor Jon I. Einarsson, MD, MPH, was honored as Distinguished Surgeon by the society for his contributions to the field of gynecologic surgery — clinically and/or through research and innovation.

In his current role, Einarsson serves as the chief of the Division of Minimally Invasive Gynecology at Brigham and Women’s Hospital in Boston. His clinical interests include cervical insufficiency/incompetence, endometriosis, fibroids, laparoscopic surgery, LGBTQ health, and prolapse.

Senior Editor Angie DeRosa and Associate Editor Lindsey Carr sat down with Einarsson to discuss highlights from the scientific meeting. Einarsson gives his take in this video interview, including that surgeries are getting back to a normal schedule as the medical world works through COVID-19.

“All of our patients are getting tested and so on, but we’re back to a fairly normal schedule now,” he reports.

One of the presentations he highlighted was based on a multicenter randomized clinical trial of permanent versus delayed-absorbable monofilament suture for vaginal graft attachment during minimally invasive total hysterectomy and sacrocolpopexy.

According to PubMed, the objective of the study was to compare mesh and permanent suture exposure rates in the first year after minimally invasive total hysterectomy and sacrocolpopexy with a light-weight polypropylene mesh using permanent or delayed absorbable sutures. 

Across five centers in the United States, women were randomized to permanent or delayed absorbable suture for vaginal attachment of a Y-mesh during hysterectomy and sacrocolpopexy for stage II prolapse and worse. The primary outcome was mesh or permanent suture exposure in the first year after surgery. 

The secondary outcome was to compare a composite measure for success defined as leading edge of prolapse not beyond the hymen and apex not descended more than one third vaginal length, and no subjective bulge and no prolapse retreatment. 

Patients completed a pelvic examination including the pelvic organ prolapse quantification system and questionnaires at baseline, 6 weeks, and 1-year post-surgery. A sample size of 80 per group was planned to compare the rate of mesh or permanent suture exposure in the permanent compared with delayed absorbable groups. From April 2015 to May 2019, 204 patients (n=102 permanent; n=102 delayed absorbable) were randomized. 

One hundred ninety-eight women had follow-up data, with 182 (93%) completing 1-year follow-up: 95 of 99 (96%) permanent, 87 of 101 (86%) delayed absorbable. The total rate of mesh or permanent suture exposure was 12 of 198 (6.1%): 5.1% for permanent compared with 7.0% for delayed absorbable (risk ratio 0.73, 95% CI 0.24-2.22). 

The majority (9/12) were asymptomatic. Composite success was 93% for permanent compared with 95% for delayed absorbable suture, P=.43). Six (3.0%) women had a serious adverse event.1

The trial essentially showed that there was no difference in outcomes between the two groups, which Einarsson found interesting because traditionally permanent sutures have been used for this procedure.

“It appears probably that the mesh just gets so incorporated into the tissues that using the permanent suture is not necessary, and that has some advantages because if those sutures get eroded through the vagina you can tell the patient, then, if it’s delayed absorbable, it’s just going to go away on its own, as opposed to a permanent suture you may have to go and remove it,” he explains. 

“In our practice, we converted to delayed absorbable sutures maybe 3 or 4 years ago and we haven’t noticed any difference in our clinical outcomes, so it was reassuring I guess for us to see that there wasn’t a difference in this randomized trial. There had been other studies, but they were cohort studies or retrospective studies, so I thought that was pretty interesting.”

Watch the full video interview to hear all that Einarsson has to say about this topic and other findings presented during this scientific meeting.

Matthews CA, Geller EJ, Henley BR, et al. Permanent Compared With Absorbable Suture for Vaginal Mesh Fixation During Total Hysterectomy and Sacrocolpopexy: A Randomized Controlled Trial. 

. 2020;136(2):355-364. doi:10.1097/AOG.000000000000388

Videos

The Society of Gynecologic Surgeons (SGS) held its 46th Annual Scientific Meeting virtually in July, in much the same way that all other associations are holding meetings or conferences these days.

SGS 46th Annual Scientific Meeting highlights

Researchers found that maternal perinatal depression and anxiety were significantly associated with poorer outcomes in cognitive, language, adaptive behavior, social-emotional, and motor skill functions: 

cognitive (antenatal period, r = −0.12 [95% CI, –0.19 to –0.05]; postnatal period, r = −0.25 [95% CI, –0.39 to –0.09])

language (antenatal period, r = −0.11 [95% CI, −0.20 to 0.02]; postnatal period, r = −0.22 [95% CI, −0.40 to 0.03])

adaptive behavior (antenatal period, r = −0.26 [95% CI, −0.39 to −0.12])

offspring social-emotional (antenatal period, r = 0.21 [95% CI, 0.16-0.27]; postnatal period, r = 0.24 [95% CI, 0.19-0.28])

motor (antenatal period, r = −0.07 [95% CI, −0.18 to 0.03]; postnatal period, r = −0.07 [95% CI, −0.16 to 0.03])

Findings also showed that these results went beyond the infant years into childhood and adolescents.

A new study published in JAMA Network Open investigated whether perinatal depression and/or anxiety impacted childhood development.

Perinatal mental health can significantly impact child development

This legislation seeks to address the country’s maternal morbidity crisis through the implementation of rural obstetric networks, maternal telehealth programs, staff-focused implicit bias training, and integrated health care services for pregnant and postpartum women.

 applauding its passage, the president of the American College of Obstetrics and Gynecologists (ACOG) urged the U.S. Senate to pass and sign the Maternal Health Quality Improvement Act into law by the end of 2020.

“The pandemic has underscored the importance of the Medicaid program, which already plays a critical role in maternity care—covering 43 percent of births nationwide. By also passing H.R. 4996, the House and Senate would support state efforts to extend Medicaid coverage beyond the standard 60 days to one year postpartum and close critical coverage gaps for women after pregnancy,” the statement read.

If signed into law, H.R. 4995 will provide $65 million annually for perinatal quality collaboratives, which unite health care providers to develop and implement programs to address underlying causes of maternal mortality and morbidity. It would also provide medical and nursing schools $5 million annually for courses on reducing and preventing discrimination with implicit bias training.

On Monday, September 21, 2020, the House of Representatives unanimously passed the Maternal Health Quality Improvement Act (H.R. 4995). 

The Maternal Health Quality Improvement Act passes in the U.S. House of Representatives

Researchers from the University of Toronto conducted a study, published in 

 that investigated the actual risk of death associated with DCIS in women with a DCIS diagnosis between 1995 and 2014.

“In the population studied, the risk of dying of breast cancer…suggests that our current treatment focus on preventing invasive recurrence is insufficient to eliminate all deaths from breast cancer after DCIS,” said the team led by Vasily Giannakeas, MPH, a doctoral candidate at the University of Toronto and Women’s College Research Institute.

Read more about the findings and their implications on 

According to new research, women with ductal carcinoma in situ (DCIS) are more than three times as likely to suffer from breast cancer mortality than women in the general population. 

Women with DCIS at higher risk of death from breast cancer

According to data from 2012 and 2013, the estimated incidence of metabolic syndrome in Canadian women is 20%, and as high as 38% among women aged 60 to 79.

“Most recently, metabolic syndrome has been associated with an increased risk of breast cancer development, poor prognostic characteristics including triple-negative hormone receptor status, increased likelihood of recurrence, and higher mortality,” wrote the Canadian investigators, who presented their findings in the journal 

The authors evaluated whether menopause is an independent risk factor for the development of metabolic syndrome or its components, including hypertension, central obesity, dyslipidemia, and elevated glycated hemoglobin.

The study cohort consisted of 12,611 women whose baseline data were included in the Canadian Longitudinal Study on Aging Comprehensive Cohort. The data were collected from 2012 to 2015.

Among the cohort, 79.6% had undergone menopause and 20.4% were premenopausal.

Overall, 32.6% of postmenopausal women met the criteria for metabolic syndrome versus 20.5% of premenopausal women (

In both postmenopausal and premenopausal women with a small waist circumference threshold (≥ 80 cm), based on the criteria for metabolic syndrome, the prevalence of metabolic syndrome was higher: 38.2% and 23.2%, respectively (

However, after adjusting for age, body mass index (BMI), and other covariates, the occurrence of menopause was not linked to a significantly higher relative risk of metabolic syndrome when using the unified criteria. For metabolic syndrome: adjusted relative risk (aRR) 1.09; 95% confidence interval (CI): 0.99 to 1.19. (A unified set of criteria were developed in 2009 by organizations including the International Diabetes Federation, the American Heart Association, and the National Heart, Lung, and Blood Institute.)

But women in menopause had a significantly higher relative risk of metabolic syndrome when using criteria for the lower waist circumference: aRR 1.10; 95% CI: 1.01 to 1.19.

The study also found that menopause, rather than the metabolic syndrome, was associated with a higher risk of impaired glucose tolerance (aRR 1.42; 95% CI: 1.26 to 1.59), elevated blood pressure (aRR 1.12; 95% CI: 1.03 to 1.21), and elevated triglycerides (aRR 1.17; 95% CI: 1.08 to 1.26).

Conversely, there was no significant difference in the risk of metabolic syndrome or the occurrence of menopause by age group.

Among postmenopausal women, 38.7% reported using menopausal hormone therapy (MHT), but there was no significant difference in the risk of metabolic syndrome among postmenopausal women on MHT compared to those who were not on therapy.

Premenopausal women reported more weight gain than postmenopausal women. This finding is of particular importance to the Canadian population, “as perhaps women in Canada gain weight earlier, presenting an opportunity to increase awareness among younger women around expected weight change during their upcoming menopause transition,” wrote the authors.

Lifestyle interventions targeted at women with metabolic syndrome can prevent type 2 diabetes mellitus and cardiovascular risk, according to the authors. “Perimenopause may be an important preventative care opportunity to assess metabolic risk factors and improve health and longevity of Canadian women,” they wrote.

Christakis MK, Hasan H, De Souza LR, Shirreff L. The effect of menopause on metabolic syndrome: cross-sectional results from the Canadian Longitudinal Study on Aging. 

. 2020 Sep;27(9):999-1009. doi:10.1097/GME.0000000000001575

Postmenopausal women are significantly more likely to meet criteria for metabolic syndrome than are premenopausal women, according to a cross-sectional analysis of women aged 45 to 85.

Postmenopausal women more likely to experience metabolic syndrome

Female Pelvic Medicine & Reconstructive Surgery

 has concluded that patients undergoing isolated midurethral sling placement filled a median of 150 cumulative morphine milligram equivalents (MMEs) from 28 days before surgery to 28 days after surgery.

Patients were identified in the Truven Health Analytics MarketScan Commercial Claims and Encounters Database, from which the investigators determined whether sling placement was an isolated procedure or performed in conjunction with other benign gynecologic procedures.

All outpatient prescription drug claims for opioids were recorded from 28 days before surgery to 28 days after surgery. The investigators then flagged the number of prescriptions filled and calculated MMEs in the allotted perioperative window.

The study cohort comprised 153,631 patients, of whom 51.5% underwent an isolated procedure, and the remaining 48.5% multiple benign procedures.

Overall, 72% of the patients who had isolated midurethral sling placement received at least 1 opioid prescription in the allocated perioperative window compared with 79% of those undergoing combined procedures (

The median cumulative MMEs for isolated midurethral sling and midurethral sling + multiple procedures were 150 MMEs and 225 MMEs, respectively (

For the entire study period, the number of prescription opioid claims was 161,471, with hydrocodone (54.4%) and oxycodone (31.8%) representing most (86.2%) of the prescription drug claims.

In addition, 81.9% of all prescriptions included combination narcotics, with 53.0% acetaminophen/hydrocodone and 28.9% acetaminophen/oxycodone.

Among patients undergoing isolated midurethral sling placement, 15.1% filled an opioid prescription during the 28-day presurgical period vs. 19.7% of patients who underwent multiple procedures (

Also, presurgically, patients undergoing an isolated sling procedure received a median of 200 MMEs, whereas patients undergoing multiple procedures received a median of 225 MMEs (

Postsurgically, though, the percentage of patients who filled an opioid prescription rose dramatically: 64.6% of patients undergoing isolated sling placement vs. 69.2% of patients who underwent multiple procedures (

Patients undergoing isolated sling placement received a median of 150 MMEs in the postsurgical period, whereas patients undergoing multiple procedures received 225 MMEs (

“Interestingly, this study revealed that among both isolated and multiple surgery patients who had filled a prescription for an opioid in the 28 days before surgery, approximately half-filled at least one additional prescription in the postsurgical period,” wrote the authors. “Although we acknowledge that this pattern could be secondary to chronic opioid use among some of the study population, it raises the question of possible duplicative or excess prescribing.”

For the total study period, every 1-year increase in the year of surgery was associated with 11% higher odds of filling an opioid prescription: odds ratio (OR) 1.11; 95% confidence interval (CI): 1.10 to 1.12 (

Compared to isolated procedures, multiple procedures had 36% higher odds of filling an opioid prescription during the entire study period: OR 1.36; 95% CI: 1.33 to 1.39; 

 < 0.001). But for the whole study period, there was no significant change in median cumulative MME over time.

There is a continuing need for information on evidence-based use of opioids, given the highly variable prescribing patterns for the drugs, according to the authors. It is hoped that future studies can be done to identify parameters for optimal use of opioids after midurethral sling placement.

Feroz RT, Boyd SS, Schaefer EW, Swailes AL, Long JB. Postoperative opioid filling patterns in women undergoing midurethral sling placement. Female 

. Published online September 4, 2020. doi:10.1097/SPV.0000000000000919

The proportion of patients filling perioperative opioid prescriptions also substantially increased over the study period, which spanned 2005 to 2016.

Perioperative opioid filling for midurethral sling

The meeting will include the latest information on menopause and midlife women’s health with a focus on reaching new heights in menopause care.

Registration will open on September 28 and fees vary. Participants will be provided with 12-month access to the Plenary Symposia, special lectures, Menopause 101 course, Pre-Meeting Symposium, Live Q&A sessions, a Virtual Exhibit Hall, abstract presentations, a Poster Session, and Product Theater.

Fees for the 2020 NAMS Virtual Annual For those already registered for the in-person meeting, NAMS will automatically refund the registration fees paid. See 

for additional details and updates on this year’s NAMS Annual Meeting.

The North American Menopause Society (NAMS) has announced its decision to host the 2020 Annual Meeting virtually from September 30 to October 3.

NAMS 2020 Virtual Annual Meeting

, suggests house dust mite allergens present in breast milk may lead to food allergy developments later in life. 

 through breast milk altered tolerance to the common food allergen ovalbumin—the main protein found in egg whites.

For early prevention of food allergies, the researchers say that targeting certain allergens may be the key. “The next steps will be to validate our observation in a large human study,” the authors wrote. “If validated, we propose that manipulating the levels of 

 allergen in breast milk and/or its protease activity will be necessary to endow breast milk with the capacity to protect from food allergy by oral tolerance induction.”

Dust mite allergens in breast milk may prevent food allergies, according to new research. 

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