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Do women suffer from more migraines as they transition into menopause? Plus: A report indicates that hospitals may not be adequately supporting breastfeeding in teenaged mothers. And, a look at prenatal exposure to bronchodilators and autism.
Women who are approaching menopause may experience an increased number of migraine headaches, according to a new observational study published in Headache: The Journal of Head and Face Pain, a publication from the American Headache Society.
The study used data from the 2006 American Migraine, Prevalence and Prevention study survey, which included women who met the modified ICHD-3 beta criteria for migraine and were aged 35 to 65 years. The survey was used because it had included detailed questions about the participants’ menstrual cycles. The stage of menopausal transition was defined based on self-report of cycle length and/or duration of amenorrhea. The primary outcome, headache frequency, was defined with a cut score of ≥10 headache days per month.
Two logistic regression models were used to assess data. The first model included adjustments for menopausal transition and sociodemographics and the second model included sociodemographics, depression, medication overuse, preventative medications, and body mass index.
The mean age of the 3664 women in the sample was 46 years. A lower frequency of headaches was reported in 8.0% (99/1242) of the premenopausal women compared with 12.2% (154/1266) of the perimenopausal women and 12.0% (131/1095) of the postmenopausal women. The adjusted odds of being in the high-frequency group was 1.62 (95% confidence interval [CI] = 1.23, 2.12) for perimenopausal women and 1.76 (95% CI = 1.23, 2.52) for postmenopausal women compared with the premenopausal group in Model 1. In Model 2, only the perimenopausal women had a high frequency of headaches, with an odds ratio of 1.42 (95% CI = 1.03, 1.94).
The investigators concluded that women in perimenopause were at increased risk of high-frequency headache in comparison to women in premenopause. They believe that this increased risk during the menopausal transition indicates a need for better treatments for migraine during that period in a patient’s life.
Are hospitals doing enough to help teen mothers breastfeed?
According to a new report from the Centers for Disease Control and Prevention (CDC), adolescent mothers aged 12 to 19 may be getting little to no advice on breastfeeding while at the hospital.
The CDC analyzed 2009-2011 Pregnancy Risk Assessment Monitoring System (PRAMS) data from New York City and 10 states which included maternal practices module during at least 1 study year and had met the 65% response rate threshold. Only women who had given birth in a hospital, initiated breastfeeding, and lived with their child at the time of the survey completed the maternal practice module.
Nine questions were examined to assess breastfeeding-supportive maternity practices; 8 revolved around the Ten Steps* and 1 assessed the distribution of gift packs containing formula in hospitals. Only adolescent mothers of babies who weighed ≥2500 g at birth, had never been admitted to the neonatal intensive care unit, and were full-term (≥37 weeks) were included, a total of 1325 women.
Overall, 64.4% (95% confidence interval [CI]: 59.5 – 69.1) of the adolescent mothers reported any breastfeeding for ≥4 weeks and just 40.9% (95% CI: 36.2 – 45.7) reported exclusively breastfeeding for ≥4 weeks. At ≥8 weeks, the prevalence of any breastfeeding had fallen to 44.6% (95% CI: 39.7 – 49.5) and exclusive breastfeeding dropped to 30.9% (95% CI: 26.6 – 35.6).
Breastfeeding-supportive maternity practices varied with 95.4% of the mothers saying that they had received information about breastfeeding, but only 29.2% reporting that they had not received a gift pack with infant formula. Only 4 of the breastfeeding-supportive practices were experienced by more than 80% of the sample: receiving information about breastfeeding, receiving assistance with breastfeeding, newborn staying in the same room as the mothers, and receiving information about how to get assistance with breastfeeding issues, but none of the practices were linked to study outcomes.
Two maternity practices were strongly associated with all breastfeeding outcomes: feeding only breast milk at the hospital and breastfeeding within the first hour following delivery. Additionally, hospital staff encouragement to feed on demand, no pacifier use in the hospital, and not receiving a gift pack with formula also showed an association with breastfeeding practices. Only 7% of the sample said that they had experience with all 5 of the practices shown to have an impact and 9.6% of the sample said that they had no experience with the 5 practices.
Because breast milk provides optimal nutrition for infants and breastfeeding also has health advantages for mothers, the report’s authors concluded that more needs to be done to increase the prevalence of breastfeeding among adolescents, especially because teenaged mothers typically express a desire to breastfeed their children.
*The WHO/UNICEF Ten Steps are having a written breastfeeding policy that is routinely communicated to all health care staff; training of all health care staff in skills necessary to implement the policy; informing all pregnant women about the benefits and management of breastfeeding; helping mothers initiate breastfeeding within 1 hour of birth; showing mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants; giving newborn infants no food or drink other than breast milk, unless medically indicated; practicing “rooming in”-allowing mothers and infants to remain together 24 hours a day; encouraging breastfeeding on demand; giving no pacifiers or artificial nipples to breastfeeding infants; and fostering establishment of breastfeeding support groups and referring mothers to them on discharge from the hospital or clinic.
Prenatal use of bronchodilators and autism
Results of a new case-control study suggest that there may be a link between prenatal use of bronchodilators and risk of autism spectrum disorders (ASD) in offspring. The report, by Danish investigators, was published Pediatrics.
For the study, the investigators analyzed data from Denmark’s health and population registers on children born from 1997 to 2006. A total of 5200 cases with ASD admission diagnoses and 5200 controls without ASD were matched on month and year of birth. Odds ratios (ORs) and confidence intervals (Cis) for exposure to β-2-adrenegic receptor agonist drugs (β2ARs) during pregnancy were estimated using conditional logistic regression models.
Of the children, 3.7% with ASD and 2.9% without ASD were exposed to β2ARs during pregnancy. Prenatal use of the drugs was associated with an increased risk of ASD even after adjustment for maternal asthma and other covariates (OR 1.3, 95% CI 1.1-1.5). The elevated risk was seen during preconception as well as during the first, second, and third trimesters (OR 1.3, 95% CI 1.0-1.6; OR 1.3, 95% CI 1.-1.5; OR 1.5, 95% CI 1.1-1.7; and OR 1.4, 95% CI 1.1-1.7, respectively).
Longer use of β2AR drugs during pregnancy, the authors said, was associated with the increased risk of ASD. They cautioned, however, that if the linkage they observed is real, the benefits of use of the medication by pregnant women must be balanced against the risks.