Study underscores need to spot signs of heart failure in pregnancy

April 17, 2018

Analysis of data from more than 50 million pregnancy-related hospitalizations shows that more needs to be done to identify new mothers at high risk for heart failure (HF) before they leave the hospital. Plus: Incidence of occult cancer during benign gynecology surgery is low but not insignificant. Also: According to a recent study, nearly 5% of non-pregnant women of childbearing age experience major depression, but less than half of those patients use antidepressants.

Analysis of data from more than 50 million pregnancy-related hospitalizations shows that more needs to be done to identify new mothers at high risk for heart failure (HF) before they leave the hospital. Published in Circulation, the study showed that 60% of HF diagnoses associated with pregnancy occur during the postpartum period.

For the analysis, the researchers looked at data from the 2001 to 2011 Nationwide Inpatient Sample, the largest all-payer inpatient care database in the United States. Rates of HF were calculated by patient and hospital characteristics, and survey logistic regression was used to estimate odds ratios (Ors) representing the association between HF and each outcome, stratified by antepartum, delivery, and postpartum periods.

Overall, the rate of HF was 112 cases per 100,000 pregnancy-related hospitalizations. While nearly two-thirds of HF cases occurred postpartum, 27.3% were at delivery and 13.2% occurred antepartum. From 2001 to 2006, postpartum hospitalizations for HF increased annually by 7.1% (95% confidence interval [CI], 4.4 to 9.8) and the incidence was steady through 2011. From 2001 to 2011, HF rates during antepartum hospitalizations rose an average of 4.9% annually (95% CI, 3.0 to 6.8).

Adverse maternal outcomes were more likely in women diagnosed with HF, as reflected by outcome-specific ORs during the antepartum (2.7 to 25), delivery (6 to 195) and postpartum 

 

NEXT: Incidence occult cancer during benign gyn surgery low but not insignificant

 

Incidence occult cancer during benign gyn surgery low but not insignificant

A study recently published in Obstetrics and Gynecology has found that while incidence of occult gynecological cancer in women who undergo hysterectomy or myomectomy for benign indications is low, it is still prevalent, especially in women older than age 55. The study looked at occurrence of uterine, cervical and ovarian cancers.

The research was a secondary analysis of data from the 2014-2015 American College of Surgeons National Surgical Quality Improvement Program. The authors identified adult women undergoing hysterectomies (24,076) and myomectomies (2,368) without evidence of existing cancer at the beginning of surgery. The primary outcome was pathology-confirmed malignancy in the corpus uteri, cervix uteri, and ovary.

Malignancy of the corpus uteri was found in 1.44% (95% CI 1.29-1.59%) of the women undergoing hysterectomy. However, the rate varied greatly depending on surgical route. In patients who underwent laparoscopic supracervical hysterectomy, the rate was 0.23% (95% CI 0.06-0.58%) and for total laparoscopic or laparoscopic-assisted vaginal hysterectomy, the rate was 1.89% (95% CI, 1.65-2.14%).

The study also found that older women were significantly more likely to have preoperatively undetected malignancy of the corpus uteri (adjusted odds ratio 6.46, 95% CI, 4.96-8.41 for women age ≥ 55 vs age 40-54). Of the women who underwent abdominal hysterectomy, 9.72% aged ≥ 55 were diagnosed with corpus uteri cancer; women aged 40 to 54 had a diagnosis rate of only 1.06%. A majority of the occult corpus uteri and ovarian cancers tended to be found in the early stages; 80% of corpus uteri cancer and 60.9% of the ovarian malignancies were stage I-IC neoplasms. Among women with occult cervix uteri cancer, 44.1% and 40.7% had cancers of stage I-IB2 and cancers of stage NOS, respectively.

Of the women who underwent hysterectomy for benign conditions, 0.60% (95% CI, 0.50-0.70%) were found to have malignancy of the cervix uteri, and 0.19% (95% CI 0.14-0.25%) were found to have ovarian cancer. In patients undergoing myomectomy, 0.21% (95% CI, 0.03-0.40%) were found to have malignancy of the corpus uteri with no occult cervical or ovarian cancer identified.

The authors believe that the findings from their study indicate that power morcellation may have potential use in select patient groups. Since occult cancer of the corpus uteri was not found in patients undergoing laparoscopic myomectomy, the benefits of minimally invasive procedures enabled by power morcellation, along with careful screening, may outweigh the risk of occult malignancy in these patients. One of the noted strengths of this study was exclusion of surgeries performed by gynecologic oncologists, which helped eliminate the likelihood that a patient had a complex or high-risk surgery that may have indicated a greater chance of having a malignancy. A noted limitation was the lack of data on surgical indications. In addition, because cervical and ovarian tissue was not always included in the pathology assessment at time of hysterectomy or myomectomy, prevalence of occult cervical and ovarian cancers may have been underestimated in the analysis. The authors believe that given the results of their study, it is critical to continue developing gynecologic cancer screening techniques.

 

NEXT - Study: Depression in young women common and undertreated

 

Study: Depression in young women common and undertreated

According to a recent study published in Obstetrics and Gynecology, nearly 5% of non-pregnant women of childbearing age experience major depression. In addition, antidepressants are used by one-third of those with major depression and one-fifth of those with minor depression.

Using data from the National Health and Nutrition Examination Surveys 2007-2014, the researchers performed a cross-sectional study of 3,705 non-pregnant women aged 20 to 44. Women who were pregnant or had given birth in the past 12 months were excluded from the study. The primary outcome was prevalence of major depression, while the secondary outcomes were prevalence of minor depression, antidepressant usage rates, and identification of predictors of major and minor depression. The researchers distinguished between major and minor depression using responses to the Patient Health Questionnaire (PHQ-9). Major depression in participants was classified as having five or more depressive symptoms more than half the days in the past 2 weeks, while minor depression involved fewer than five symptoms over the same period of time.

The researchers found that the overall prevalence of major and minor depression was 4.8% (95% CI 4.0-5.7%) and 4.3% (95% CI 3.5-5.2%), respectively. Among women with major and minor depression, prevalence of use of antidepressants was 32.4% (95% CI 25.3-40.4%) and 20.0% (95% CI 12.9-29.7%), respectively. Factors that were most strongly associated with major depression were government insurance (adjusted relative risk [RR] ratio 2.49, 95% CI 1.45-3.96) and hypertension (adjusted RR 2.09, 95% CI 1.25-3.50). For minor depression, having a highest education level less than high school (adjusted RR 4.34, 95% CI 2.09-9.01) or high school (adjusted RR 2.92, 95% CI 1.35-6.31) were the factors with the greatest association.

The researchers believe their findings are noteworthy since they illustrate the lack of adequate treatment for depression in women of childbearing age. They believe that raising awareness of the issue could help physicians develop a treatment plan for those at risk, especially before pregnancy, a time when the impact and rates of depression increase. The authors noted that the associations between education levels and government insurance and depression are just that- associations, not risk factors, and more research is needed.