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A drug that is low cost and easy to administer may help prevent maternal deaths, according to results of a randomized clinical trial. Plus: Does air pollution affect menstrual regularity? Also: According to a statement published by the American Heart Association (AHA), breast cancer patients may be at increased risk of cardiovascular disease (CVD).
A drug that is low cost and easy to administer may help prevent maternal deaths, according to results of a randomized clinical trial presented at The Pregnancy Meeting. Conducted by French investigators, the research showed that when given to women who had delivered vaginally and received prophylactic antibiotics, tranexamic acid is associated with lower risk of postpartum hemorrhage (PPH) than placebo without higher risk of severe adverse events (AEs).
Nearly 4,000 women participated in the trial held at multiple centers in France, exceeding the number required to demonstrate a 30% decrease in the primary outcome (incidence of postpartum blood loss ≥ 500 mL). All of the women had planned vaginal delivery at term ≥ 35 weeks with a singleton live fetus. They were randomized to receive, in labor, either 1g of intravenous tranexamic acid or placebo plus prophylactic oxytocin within 2 minutes after delivery. Besides measuring PPH using a graduated collector bag, the authors also looked at measures of PPH and potential AEs of the drug up to 3 months after delivery.
PPH hemorrhage occurred in 8.1% of the women (151) in the tranexamic acid group versus 9.8% of the women (188) who received placebo (95% CI, 0.68-1.01; P = 0.07). The women who received the drug also had lower incidences of PPH > 500 mL and clinically significant PPH compared with the participants who received placebo (6.6% versus 8.8%; P = 0.01 and 7.8% versus 10.4%; P = 0.04, respectively). Additional uterotonics were required in 9.7% of the women who received placebo versus 7.3% of the tranexamic acid group (P = 0.003).
Regarding AEs, the investigators found that nausea and vomiting in labor were more common in the women who received tranexamic acid (7.0% versus 3.2%; P < 0.001) but there were no significant differences in thrombotic events or other AEs between the two groups.
In a subgroup analysis, tranexamic acid was found to reduce PPH in women who had instrumental delivery (9.6% versus 14.5%; RR 0.66; 95% CI 0.44-1.0; P = 0.0498) but not women who delivered spontaneously or those with versus without episiotomies (12.3% versus 17.3%; RR 0.73; 95% CI 0.53-1.00; P = 0.049).
“Tranexamic acid should be considered for women who deliver via operative vaginal delivery and episiotomy in conjunction with prophylactic oxytocin,” said lead author Loïc Sentilhes, MD, PhD, in a statement released by the Society for Maternal-Fetal Medicine. “At the dosage studied, the only side effect observed was an increase in nausea and vomiting.
Does air pollution affect menstrual regularity?
A study recently published in Human Reproduction found that air pollution is linked to irregular menstrual cycles. The research focused on exposure to air pollution among teenage girls (ages 14-18) and found an association between the exposure and a slightly increased chance of menstrual irregularity along with longer time to attain regularity.
The researchers used a cross-sectional study of 34,832 of the original 116,430 women enrolled (29.91%) in 1989 from Nurses’ Health Study II (NHSII). Looking at the perimenarchal exposure to total suspended particulate (TSP) in air during the participants’ years of high school attendance, the researchers compared exposure levels with time to menstrual cycle regularity, as self-reported by the participants. They created three case definitions including high school menstrual irregularity and androgen excess.
In multivariable adjusted models, the authors observed that for every 45 mg/m3 increase in average high school TSP, the odds of moderate, persistent, and persistent with androgen excess irregularity phenotypes increased by 1.08 (1.03 – 1.14), 1.08 (1.02 – 1.15) and 1.10 (0.98 – 1.25), respectively. TSP was also associated with longer time to cycle regularity, with stronger results seen in women who were older at menarche and also among participants living in the Northeast or the West.
The researchers noted a few limitations in the study. The participant responses may have been susceptible to recall bias since the outcomes of menstrual regularity and time to cycle regularity were retrospectively assessed. They also noted potential for selection bias since women participating in the study had to live until 2011 to provide addresses to the researchers. The researchers noted that while this research aligns with existing literature on air pollution and reproductive tract diseases, more study is needed to determine the wider implications of the findings.
AHA: Breast cancer treatments may increase risk of CVD
According to a statement published by the American Heart Association (AHA) in its journal, Circulation, breast cancer patients may be at increased risk of cardiovascular disease (CVD). The statement also gives examples of breast cancer treatments that could negatively impact a patient’s cardiovascular system and suggests that both oncologists and cardiologists focus on educating their patients about the risks and encouraging them to make lifestyle choices that reduce their risk of both diseases.
The statement is an overview of what the AHA currently knows about risk factors common to both breast cancer and heart disease, the potential harm to the heart from some breast cancer treatments, and suggested strategies to prevent or minimize heart damage from the treatments. Noting that most breast cancer survivors, especially women over age 65, are more likely to succumb to CVD than breast cancer, breast cancer patients need to be made aware of the importance of managing heart disease risk factors both during and after cancer treatment. Some cancer treatments can also exacerbate cardiovascular risks. For example, HER-2 targeted therapies can cause weakening of the heart muscle. In some cases, this weakening is temporary, while in other cases, heart failure can be permanent. The AHA recommends monitoring cardiovascular health during breast cancer treatment and noted that early development of heart failure can signal a need to change the patient’s treatment.
The AHA statement also highlights other drugs that could negatively affect the cardiovascular systems in patients with breast cancers. Doxorubicin can damage heart cells but studies have shown that risk of heart failure may be lowered when the drug is administered slowly, rather than all at once. The cell damage may be reduced with dexrazoxane, which has been approved for patients with metastatic breast cancer who receive high doses of doxorubicin. Radiation treatments can affect arteries and exacerbate coronary artery disease or blockages. Anthracyclines can result in abnormal heart rhythms, which may be benign in some patients but in others can be life-threatening. Other treatments, such as antimetabolites, can cause the arteries to spasm, which in milder cases causes chest pain symptoms but can also lead to heart attacks in more serious cases.
Advanced age, poor diet, tobacco use, physical inactivity, and family history can all increase a patient’s risk for both breast cancer and heart disease. However, the AHA notes that there are lifestyle choices that could help reduce the risk for both diseases, primarily through diet and exercise. The organization suggests that breast cancer patients adhere to The AHA’s Life’s Simple 7 health campaign. This campaign focuses on encouraging patients to be physically active, achieve and maintain a healthy body weight, eat a healthy diet, refrain from tobacco, and maintain healthy levels of blood pressure, blood sugar, and cholesterol. Adhering to the AHA guidelines is associated with a trend towards a lower incidence of breast cancer