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A look at the impact of prehypertension on the risk of stillbirth. And, the CDC issues guidance on alcohol consumption in women of childbearing years. Plus: Does the type of hysterectomy alter endometrial cancer survival?
Prehypertension in pregnancy may lead to smaller babies and a greater risk of stillbirth, according to results of a new Swedish study. Published in Hypertension, the findings shed light on the relationship between maternal blood pressure and fetal well-being and suggest that impaired maternal perfusion of the placenta contributes to small-for-gestational age (SGA) birth and stillbirth.
For the population-based study, the researchers looked at a cohort of 155,446 women without hypertension who had singleton deliveries at ≥37 weeks (n = 155,446). Using normotensive women (diastolic blood pressure [DBP] <80 mm Hg) as a reference, they calculated adjusted odds ratios (aOR) between prehypertension (DBP 80–89 mm Hg) at 36 weeks and the risks for SGA infants or stillbirth. They also estimated whether an increase in DBP from early to late pregnancy affected these risks.
Of the women in the study, 11% had prehypertension in late pregnancy. The condition was associated with an increased risk of an SGA infant (95% confidence interval [CI] 1.69; 1.51–1.90) and stillbirth (95% CI 1.70; 1.16–2.49). For each mm Hg rise in DBP from early to late pregnancy, risk of an SGA infant in a term pregnancy increased by 2.0% (95% CIs 1.5–2.8). No similar relationship was found between DBP increases in pregnancy and risk of stillbirth.
Prehypertension in late pregnancy, the researchers concluded, was positively associated with an increased risk of SGA infants and stillbirth and that increases in DBP during gestation also were correlated with rising risk of delivering an SGA newborn.
CDC urges women planning pregnancy not to drink
Based on a new analysis of alcohol-exposed pregnancies in the United States, the Centers for Disease Control and Prevention (CDC) is urging women who want to become pregnant not to drink. Published in Morbidity and Mortality Weekly Report, the CDC’s findings also point to a need for physicians to counsel women about the adverse effects of alcohol on a fetus.
For the report, data from the 2011 to 2013 National Survey of Family Growth on 4303 alcohol-exposed pregnancies in women aged 15 to 44 were analyzed. Estimates for risk of an alcohol-exposed pregnancy were calculated and stratified by age, race/ethnicity, marital status, education, number of live births, and smoking status. The researchers also looked at the impact of a desire to get pregnant, sexual activity, and contraception status on alcohol consumption.
A woman was considered at-risk of a pregnancy exposed to alcohol if she had vaginal sex with a male during the past 4 weeks, drank alcohol in any amount in the past 30 days, she and her partner did not use contraception during the month before the interview, and neither she nor her partner were sterile. A desire for pregnancy was defined as having sex without using contraception in the month of the interview and a woman doing so because she or her partner wanted to become pregnant as soon as possible.
Prevalence of alcohol consumption in the past 30 days and 95% confidence intervals (CIs) were calculated for 4 groups of women: 1) those who wanted to get pregnant as soon as possible and had sex with a man without using contraception; 2) those who did not want to get pregnant as soon as possible but had sex with a man without using contraception; 3) those who had sex using contraception or whose partner was sterile; and 4) those who did not have sex with a man.
The researchers found that 3.3 million women were at risk of an alcohol-exposed pregnancy during the study period. At 10.4% (95% CI 7.2-14.6), risk was highest among women aged 25 to 29 and lowest among women aged 15 to 20 (2.2%; 95% CI 1.2-3.9; P<0.001). Being married or cohabiting also was associated with higher risks (11.7% [95% CI 9.1-14.8; P<0.001] and 13.6% [95% CI 9.2-19.8], respectively) as was having a bachelor’s degree or more education versus less than a high school degree (8.7% [95% CI 6.0-12.3] and 3.4% [95% CI 2.0-5.6; P=0.002], respectively). Prevalence of alcohol-exposed pregnancy risk did not differ by race/ethnicity.
Commenting on the public health implications of the data, the researchers noted that use of alcohol during pregnancy can cause fetal alcohol spectrum disorders, which are characterized by lifelong physical, behavioral and intellectual disabilities. Their study, they said “reinforces the importance of routinely screening women of reproductive age for alcohol use, and providing intervention before pregnancy. Health care professionals need to advise women who want to become pregnant and have discontinued contraception to stop drinking alcohol.”
Impact of hysterectomy type on endometrial cancer survival
Results of a new population-based study published in the Journal of Clinical Oncology suggest that compared with open hysterectomy, a minimally invasive procedure does not compromise survival in women with endometrial cancer.
Performed by researchers from Columbia University, the analysis looked at women with stage I to III endometrial cancer who underwent hysterectomy from 2006 to 2011 and were represented in the Surveillance, Epidemiology, and End Results (SEER) database. Women who had undergone an abdominal procedure were compared to those who had a minimally invasive procedure, either laparoscopic or robot-assisted. Following propensity score balancing, perioperative morbidity, use of adjuvant therapy, and long-term survival were tallied.
The study included data on 4139 (65.7%) patients who had undergoing abdominal hysterectomy and 2165 (34.3%) who had undergone a minimally invasive procedure. The authors noted that between 2006 and 2011, the rate of minimally invasive hysterectomy increased from 9.3% to 61.7% in 2011 and that robotic procedures accounted for 62.3% of the minimally invasive procedures.
When compared to women who underwent abdominal hysterectomy, those who underwent minimally invasive procedures had lower overall rates of complication (22.7% vs 39.7%; P < .001) and lower rates of perioperative mortality (0.6% vs 1.1%). However, women who underwent minimally invasive procedures were more likely to receive brachytherapy (33.6% vs 31.0%; P < .05) and adjuvant pelvic radiotherapy (34.3% vs 31.3%). Rates of complication were higher for robot-assisted than for laparoscopic hysterectomy (23.7% vs 19.5%; P = .03).
No association was found between the use of minimally invasive hysterectomy and overall mortality (hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.75 to 1.04) or cancer-specific mortality (HR, 0.83; 95% CI, 0.59 to 1.16).