Conference Notes

I took lots of notes while at the conference...
Thought I would share bits a pieces with you from time to time. Here is a great quote from an Egyptian doctor.

Women are not dying because of diseases we cannot treat; they are dying because societies have yet to make the decision that their lives are worth saving.
~Dr. Mahmoud Fathall~

New Mom Dies After Giving Birth

Woman Gives Birth, Later Dies From Bacterial Meningitis

How tragic for these families.

Infant Death Due to Hep B Vaccine

Such a sad tragedy for this family. Baby Ian died at 47 days old after having an allergic reaction to the Hep B vaccine.

All 50 states have some sort of vaccine exemption. Here in Utah, it is as simple as going to the health department, paying them $25 and signing a form saying you understand the risks you are taking by not vaccinating. You do have options to selectively vaccinate - or not at all.

Think Twice
Vaccine Links

I also recommend the books The Vaccine Book, by Dr. Sears and What Your Doctor May Not Tell You About Children's Vaccinations, by Stephanie Cave, MD. Both share the history of the disease, history of the vaccination, statistics of the disease, how effective the vaccination is and an alternate schedule for those that choose to vaccinate.

I am not anti-vaccine by any stretch. As with all things, I hope that everyone does their research and are making an informed choice. Know what you are injecting into your children. Once it is given, it cannot be taken back.

Birth By The Numbers

Here is a great 20 minute video that will open your eyes to the current maternity system crisis here in America.
Numbers don't lie.

Birth By The Numbers

Folic acid may boost baby’s heart health

Increased intakes of folic acid by mandatory fortification of grain products to reduce neural tube defects may also reduce a baby’s risk of severe congenital heart defects, says a new study.

The incidence of the heart problems was reduced by 6 per cent following mandatory fortification of grain products, introduced in Canada in 1998, researchers from McGill University and the University of Alberta report in the British Medical Journal.

“Our population based study shows that fortification of grain products with folic acid in Canada was followed by a significant decrease in the birth prevalence of severe congenital heart defects, supporting the hypothesis that folic acid intake in the period around conception reduces the birth prevalence of severe congenital heart defects,” wrote the researchers, led by Louise Pilote.

Folic acid and NTDs

Folate is found in foods such as green leafy vegetables, chick peas and lentils. Folic acid - the synthetic, bioavailable form of folate – is obtained from grain products in the US and Canada following introduction of mandatory fortification in 1998.

Currently, supplementation with folate and folic acid is recommended to all women of child-bearing age since most neural tube defects (NTDs), including spina bifida and anencephaly, occur within the first 22 to 28 days of pregnancy, when the mother-to-be is not aware she is even pregnant.

Folic acid supplements after this time are too late to prevent neural tube defects and therefore fail to benefit women with unplanned pregnancies - more than half of all pregnancies in the US.

Preliminary evidence indicates that the 1998 introduction of public health measures in the US and Canada has reduced the incidence of NTDs by 15 to 50 per cent. In Chile, the measure has been associated with a 40 per cent reduction in NTDs. Parallel measures in European countries, including the UK and Ireland, are still on the table.

In March, a Food Safety Authority of Ireland (FSAI) working group stated there would be no public health benefit from mandatory folic acid fortification, but a final determination would be made at the end of the year when more data would be available.

New data

The new study looked at data from infants born between 1990 and 2005 in Quebec. Out of the 1,324,440 infants born, 2,083 had a congenital heart defects. This is equivalent to an average birth prevalence of 1.57 out of every 1,000 births, said the researchers.

Analysis of the data showed no change in the prevalence of severe birth defects in the nine years before fortification, but a 6 per cent reduction in the prevalence in the seven years after fortification, wrote the researchers.

“An average 6.2 per cent reduction per year in the birth prevalence of severe congenital heart defects observed in this study might seem modest,” wrote the researchers. “However, given that severe congenital heart defects require complex surgical interventions in infancy and are associated with high infant mortality rates, even a small reduction in the overall risk will significantly reduce the costs associated with the medical care of these patients and the psychological burden on patients and their families,” they added.

Commenting on the mechanism, Pilote and her co-workers stated that the B vitamin may have a beneficial role in the early development of an embryo's circulatory system, ensuring correct formation of the heart.

In an accompanying article from Helena Gardiner and Jean-Claude Fouron from Imperial College at Queen Charlotte’s and Chelsea and the Royal Brompton Hospitals, and CHU Sainte-Justine in Montreal, respectively, said that population-wide measures of fortification should be followed, but rather targeting of women of child bearing age.

Reaction

Commenting independently on the research, Dr Sian Astley, a scientist for the Institute of Food Research, told the BBC: "Personally, I do not think mandatory fortification is the way forward. It is like using a sledge hammer to crack a nut.

"It would reduce ill health in children but there are cautionary issues.

"An alternative would be to fortify only certain foods and clearly label them so consumers can make the choice. Co-fortification with other B vitamins would be another sensible option," she added.

Source: British Medical Journal
2009, Volume 338:b1673, doi:10.1136/bmj.b1673
“Prevalence of severe congenital heart disease after folic acid fortification of grain products: time trend analysis in Quebec, Canada”
Authors: Raluca Ionescu-Ittu, A.J. Marelli, A.S. Mackie, L. Pilote

Editorial: British Medical Journal
2009, Volume 338: b1144, doi:10.1136/bmj.b1144
“Folic acid fortification and congenital heart disease”
Authors: H.M Gardiner, J.C. Fouron

Wrinkle Treatment Uses American Babies' Foreskins

By voodoobob

Posted May 24, 2009 at 8:49 p.m.

http://www.scientificamerican.com/article.cfm?id=a-cut-above-the-rest-wrin

"... The fibroblasts in Vavelta are isolated from the foreskins taken from baby boys, given several months to grow and multiply in the lab, and then packaged into treatment vials that are shipped to a select group of U.K. physicians. Each vial costs approximately 750 pounds, or $1,000], according to the company spokesperson."

http://www.acroposthion.com/acroposthion_018.htm

The Foreskin Mafia

"Not only do parents of North American baby boys have to pay between $200 to $300 to obstetricians to circumcise their boys that no sooner are the circumcised foreskins cut off that they are sold on to bio-engineering and cosmetics companies by the hospitals. The numbers of dollars involved are bewilderingly staggering, and this financial force is one which is providing the funds to continue the spread of medical propaganda advocating circumcision. The resale value of neonate foreskins is astronomically dizzying in that from one boy’s foreskin can be grown bio-engineered skin in a lab to the size of a football field. That’s 4 acres of new skin or around 200,000 units of manufactured skin, which is enough skin to cover about 250 people and sells at $3,000 a square foot. Considering that there are 1.25 million neonate foreskins circumcised each year in the U.S alone this translates to one of the most lucrative trades, if not THE most lucrative trade in human body parts."

Wake up people, your children are being exploited for profit.

Great New Resource

Be informed before you make a choice for your child that cannot be taken back.

http://www.circinfosite.com/

Vitamin D Insufficiency Linked To Bacterial Vaginosis In Pregnant Women

Yet another reason why it is so important to get outside and get a little sun. It is so good for you!
___________________________________________________________________

ScienceDaily (May 21, 2009) — Bacterial vaginosis (BV) is the most common vaginal infection in US women of childbearing age, and is common in pregnant women. BV occurs when the normal balance of bacteria in the vagina is disrupted and replaced by an overgrowth of certain bacteria. Because having BV puts a woman at increased risk for a variety of complications, such as preterm delivery, there is great interest in understanding how it can be prevented.

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Vitamin D may play a role in BV because it exerts influence over a number of aspects of the immune system.

This hypothesis is circumstantially supported by the fact that BV is far more common in black than white women, and vitamin D status is substantially lower in black than white women. This relation, however, has not been rigorously studied. To assess whether poor vitamin D status may play a role in predisposing a woman to BV, Bodnar and coworkers at the University of Pittsburgh and the Magee-Womens Research Institute studied 469 pregnant women.

This prospective epidemiologic study investigated the relation between vitamin D status and BV in 209 white and 260 black women at <16>

The data indicate that 41% of all enrolled women had BV, and that 93% had 25(OH)D levels indicative of vitamin D insufficiency. Overall, women with BV had lower serum 25(OH)D concentrations than those without BV (P <>

Volunteerism in Midwifery Conference

Last weekend, I had the privilege of attending Mercy In Action's Volunteerism in Midwifery Conference in Boise, ID. It was a great experience, jam packed with information, wisdom and practice sessions. My big complaint was that I wish we had more time to learn and share!

I picked up three good midwife friends in Vegas (at the airport) on Wednesday, the 13th. Thursday, we did the road trip thing and had a blast. Friday and Saturday was the conference and Sunday we came home. Lots of driving packed into such a short time, but so worth it!

Enjoy some pics!


I spent a lot of time talking and gleaming wisdom from experienced midwives.



Learning about and practicing with the vacuum extractor. Not something to be used here in the States, but a great tool in the mission field.
IVs - it was good practice since it had been a year since I last did one.

Children Who Get Flu Vaccine Have Three Times Risk Of Hospitalization For Flu, Study Suggests

So, the flu vaccine doesn't work for kids and then raises their risk of hospitalization by 3 times! Why are we continuing to encourage it? I am sure a majority of the parents who choose to get this vaccine for their child does not know about this.

ScienceDaily (May 20, 2009) — The inactivated flu vaccine does not appear to be effective in preventing influenza-related hospitalizations in children, especially the ones with asthma. In fact, children who get the flu vaccine are more at risk for hospitalization than their peers who do not get the vaccine, according to new research that will be presented on May 19, at the 105th International Conference of the American Thoracic Society in San Diego.

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Flu vaccine (trivalent inactivated flu vaccine—TIV) has unknown effects on asthmatics.

"The concerns that vaccination maybe associated with asthma exacerbations have been disproved with multiple studies in the past, but the vaccine's effectiveness has not been well-established," said Avni Joshi, M.D., of the Mayo Clinic in Rochester, MN. "This study was aimed at evaluating the effectiveness of the TIV in children overall, as well as the children with asthma, to prevent influenza-related hospitalization."

The CDC's Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) recommend annual influenza vaccination for all children aged six months to 18 years. The National Asthma Education and Prevention Program (3rd revision) also recommends annual flu vaccination of asthmatic children older than six months.

In order to determine whether the vaccine was effective in reducing the number of hospitalizations that all children, and especially the ones with asthma, faced over eight consecutive flu seasons, the researchers conducted a cohort study of 263 children who were evaluated at the Mayo Clinic in Minnesota from six months to 18 years of age, each of whom had had laboratory-confirmed influenza between 1996 to 2006. The investigators determined who had and had not received the flu vaccine, their asthma status and who did and did not require hospitalization. Records were reviewed for each subject with influenza-related illness for flu vaccination preceding the illness and hospitalization during that illness.

They found that children who had received the flu vaccine had three times the risk of hospitalization, as compared to children who had not received the vaccine. In asthmatic children, there was a significantly higher risk of hospitalization in subjects who received the TIV, as compared to those who did not (p= 0.006). But no other measured factors—such as insurance plans or severity of asthma—appeared to affect risk of hospitalization.

"While these findings do raise questions about the efficacy of the vaccine, they do not in fact implicate it as a cause of hospitalizations," said Dr. Joshi. "More studies are needed to assess not only the immunogenicity, but also the efficacy of different influenza vaccines in asthmatic subjects."

The Birth Control Pill and Informed Choice

Choosing the best method of birth control is a very personal matter. As with all things related to pregnancy (and the prevention of), childbirth and parenting, I hope all make an informed choice after educating themselves and thinking over their convictions. I used hormonal birth control for a time before I learned how it worked. For my husband and I, because we believe that life begins at conception, hormonal birth control is not an option for us. We have been successfully using the Fertility Awareness Method (FAM) as our form of birth control for almost 4 years. If you would like more info on FAM, I recommend the book, Taking Charge of Your Fertility. Not only is FAM great for preventing pregnancy, but it is also great for helping to achieve pregnancy.

The Doctors - Ricki Lake and Dr. Lisa Debate Homebirth

I think Ricki Lake and Dr. Stork handled this beautifully. I cannot stand to watch this show because of Dr. Lisa's ignorance. She can't answer the question about our stats in the US and instead turns to throwing out the "dead baby, dead mom card."

This book is on my lending library wishlist.

We Can Be Much Kinder

Breastfeeding Halves SIDS Risk

(NaturalNews) Babies who are breastfed for at least six months are significantly less likely to die from sudden infant death syndrome (SIDS) than those who are formula fed, according to a study conducted by researchers from the German Study of Sudden Infant Death Study Group and the University of Munster, Germany, and published in the journal Pediatrics.

The study adds "to the body of evidence showing that breastfeeding reduces the risk of SIDS, and that this protection continues as long as the infant is breastfed," the researchers wrote.

The researchers compared breastfeeding rates among 333 infants who died of SIDS and 998 children of similar age who did not die. They found that while 83 percent of surviving infants were being breastfed at two weeks of age, only 50 percent of those who died of SIDS were. The rate of breastfeeding at one month was 72 percent among surviving children and only 40 percent among those who died of SIDS. This corresponded to a 50 percent lower risk of SIDS among children who were exclusively breastfed at the age of one month.

"In the last 20 years, the prevention campaigns to reduce the risk of sudden infant death syndrome were very successful," the researchers wrote. "In some countries the advice to breastfeed is included in the campaigns' messages, but in other countries it is not."

Women should be encouraged to breastfeed exclusively until their children are at least six months old, the researchers said.

"In our study, 73 percent of the infants died before six months of age," they wrote. "The implication of our findings is that breastfeeding should be continued until the infant is six months of age and the risk of SIDS is low. Because breastfeeding rates are low in the socially deprived sections of our population, there should be special programs to encourage mothers of low socioeconomic status to breastfeed their infants not only for the established benefits of breastfeeding for the mother and infant but also to reduce the risk of SIDS in their infants."

Sources for this story include: www.reuters.com; www.medscape.com.

Births on cue: C-sections soar in S. Florida

More babies in Miami-Dade are now born by cesarean section than by natural childbirth, state records reveal. Experts won't predict how much higher the rate will go.

BY JOHN DORSCHNER

jdorschner@MiamiHerald.com

Last year, for the first time, more babies in Miami-Dade County were born by cesarean section than were born vaginally, according to state records, and Broward's not far behind, with a rate of 43.7 percent -- both far above the national average.

At Kendall Regional Medical Center in Southwest Miami-Dade, seven out of 10 babies were delivered by C-section, a rate that University of Miami obstetrician Gene Burkett called ``just astounding.''

Locally and nationally, the cesarean rate has been creeping up annually for years. In 2007, the U.S. rate reached 31.8 percent, according to the National Center for Health Statistics -- an increase of more than 50 percent over the past decade.

Many of the reasons have been oft-repeated: doctors afraid of being sued if something goes wrong with natural childbirth and expectant mothers, particularly professional women, wanting to schedule a birth into tight work schedules.

In South Florida, virtually no obstetrician has malpractice insurance, and most believe that they're less likely to be sued if they choose to be active in a crisis, such as operating to remove a baby from the womb, rather than allowing nature to take its course.

But Amitabh Chandra, a Harvard professor of public health policy, said Miami also has a long-standing reputation for high healthcare costs in many programs, including Medicare.

''There is an extraordinary culture of medicine you have there in Miami,'' he said. ''Miami has always been very aggressive in its practice of medicine,'' with specialists dominating treatment patterns and being highly active in care options. ``And cesareans would just be another example.''

Such decisions drive up costs. Data from the Florida Agency for Health Care Administration shows cesareans in South Florida hospitals range from $11,000 and $30,000 -- about twice the $5,000 to $16,000 range for natural births.

THE RISKS

Traditionally, many doctors have warned against cesareans because of the risks anytime a patient is cut open. ''Definitely surgery always has a chance of a serious complication,'' said Douglas Richards, a professor of obstetrics-gynecology at the University of Florida.

Still, in recent years, such warnings have been muted. ''The risks and benefits are much more balanced than they used to be,'' Richards said. ``Cesareans have become so safe and relatively easy for women.''

He means in particular planned C-sections -- ''no rushing around, the baby doesn't have to come out right away.'' Improved anesthetics allow patients to rebound quickly. ``They're happy and pain-free and walking around the first day. Many go home after 48 hours.''

There's also been an opinion shift about the risks of ''V-backs,'' giving birth vaginally after having had a C-section. Some studies have shown that in some situations, such as when the baby is in a breech position, a V-back should be avoided. ''Certain hospitals will not do vaginal deliveries after cesareans,'' said UM's Burkett, who delivers babies at Jackson Memorial, where he says the staff remains committed to V-backs if clinically possible.

Burkett and some other obstetricians also say that some women have abandoned the view that natural childbirth is a badge of honor for womanhood. ''I don't think it's so much a rite of passage anymore.'' But Zulma Berrios, chief of obstetrics at South Miami Hospital, said she has seen no evidence to back that up.

Another key issue is patient choice. The American College of Obstetricians and Gynecologists ''now says the consumer has a right to choose'' a cesarean if they so desire after being informed of the risks and benefits, Burkett said. That's a departure from the past, when many doctors actively discouraged patients from seeking C-sections.

No one in South Florida has statistics on how many women are choosing C-sections, but Berrios at South Miami said, ''Some patients want to be on a planned schedule. They have to juggle work and the baby.'' She says many professional women, including physicians, choose cesareans because they're squeezed for time.

In fact, a recent study from the University of California-Berkeley, found that mothers who took a leave in their last month of pregnancy were less likely to have cesarean deliveries than mothers who worked right up to the end.

HEALTH FACTORS

Obesity also has become an issue. Richards says 25 percent of the expectant mothers seen in Gainesville are clinically obese at the start of their pregnancy, meaning they are more likely to have complications at birth.

More debated is the mother's ''pelvic floor.'' G. Willy Davila, a urogynecologist at the Cleveland Clinic in Weston, said natural childbirth can lead to tendencies later in life for problems like ``leaky bladders.''

Davila said for women planning to have one or two children, C-sections ''could be beneficial . . . an acceptable delivery option'' to avoid urinary problems later.

Three other ob-gyns, however, said that idea is still being debated. ''The jury is still out,'' Berrios said.

Davila and others emphasized that repeat C-sections for women planning to have many babies could pose considerable dangers. ``The risk goes way up for the third, fourth or fifth cesarean for things like the placenta being in the wrong place and other issues.''

AHCA's most recent data measured births from July 2007 through June 2008. Miami-Dade's C-section rate was 51.2 percent.

In addition to Kendall Regional, the hospitals with rates higher than 50 percent were South Miami (59.9), Mercy (58), Hialeah (52), Baptist (50.3) and Jackson Memorial (50.4). In Broward, the lone hospital higher than 50 percent was Holy Cross, at 51.6.

Many of the hospitals didn't want to discuss cesareans. Kendall Regional spokesman Peter Jude acknowledged the AHCA numbers were correct and said the hospital is ``first and foremost committed to the well being and health of our mothers and infants. There are a number of factors patients and physicians consider when determining the delivery method.''

Berrios at South Miami said her hospital has been designated a center for high-risk cases and was close to an infertility clinic, where many of the patients had various risk factors, including multiple fetuses.

Jackson Memorial's rate is high because the hospital gets most of the high-risk births for the entire county, said Burkett, noting that he had just been notified a woman carrying a fetus with heart problems was on her way from the Virgin Islands.

While supporting many reasons for C-sections, Richards in Gainesville emphasized he didn't want to appear to be endorsing rates of 50 percent to 70 percent. ''That's pretty astounding.'' He noted one reason ``not to have a more liberal cesarean policy is that babies born without labor tend to have more respiratory problems.''

Still, when Richards and three other ob-gyns were asked whether there was an upper limit on how high the C-section rate could go, in South Florida or the nation, none wanted to venture a guess. ''We just don't know,'' Berrios said.

Breast Is Best: New WHI Data Extend CV Benefits of Breast-Feeding to Mom

April 24, 2009 — Women who breast-fed for a year or more were less likely to develop hypertension, diabetes, hyperlipidemia, and cardiovascular disease when postmenopausal than women who were pregnant but never breast-fed, a new analysis of the Women's Health Initiative (WHI) has found [1]. Dr Eleanor Bimla Schwarz (University of Pittsburgh Center for Research on Healthcare, PA) and colleagues report their findings in the May 2009 issue of Obstetrics & Gynecology.

"We were able to show that benefits were visible in anyone with six or more months' lifetime duration of breast-feeding," Schwarz told heartwire , with those who reported a lifetime history of more than 12 months' lactation being 10% to 15% less likely to have hypertension, diabetes, hyperlipidemia, and cardiovascular death (CVD) than those who never breast-fed.

She says the findings--from a large data set and one of the first studies to report an effect on vascular events--build on a growing body of literature that demonstrates lactation has beneficial cardiovascular effects, as well as reducing the risk of breast and ovarian cancer. "We've known for years that breast-feeding is important for babies' health; we now know that it is important for mothers' health as well," she notes.

It is imperative that healthcare providers and our society support and educate women concerning the maternal benefits of prolonged breastfeeding.

In an accompanying editorial [2], ob-gyn Dr Edward R Newton (East Carolina University, Greenville, NC) says: "The findings are dramatic and persuasive." Although he notes some possible limitations of this study, he says, "A strong benefit of prolonged breast-feeding is still observed. It is imperative that healthcare providers and our society support and educate women concerning the maternal benefits of prolonged breast-feeding as well as the well-documented benefits of breast-feeding for the child."

Cardiologist Dr C Noel Bairey Merz (Cedars Sinai Healthcare Center, Los Angeles, CA) told heartwire this is "very nice work, controlled for a number of confounders such as education."

The Risks of Not Breast-Feeding

The study examined 139,681 women enrolled in both observational and clinical-trial cohorts of WHI who had had at least one live birth. The dose-response relationship between the cumulative months women lactated and postmenopausal risk factors for CVD were examined; the average age of the women was 63 years. Lifetime duration of breast-feeding was based on patient recollection, and Schwarz admitted this could have been subject to recall bias, a point that Newton also makes in his editorial.

In fully adjusted models, those who reported a lifetime history of more than 12 months of lactation were less likely to have hypertension (odds ratio 0.88; p<0.001), p="0.008)">

And women who breast-fed for seven to 12 months were also significantly less likely to develop CVD (hazard ratio 0.72) than those who never breast-fed.

Schwarz said: "We saw significant trends; the longer someone had breast-fed, the better." In his editorial, Newton says that prior analyses from the Nurses' Health Study show that women who breast-fed for a lifetime total of two years or more significantly reduced a major predictor for CVD--insulin-resistant diabetes--by 14% to 15% and had a 23% lower risk of incident MI [myocardial infarction].

We can talk about the benefits of breast-feeding but perhaps it is better framed as the risks of not breast-feeding.

Schwarz stressed an important point to heartwire . "It's not that you are better off if you have a baby and breast-feed than someone who's never been pregnant, it's that you are better off than someone who becomes pregnant and does not breast-feed. A woman who becomes pregnant and does not breast-feed is actually putting herself at risk. So we can talk about the benefits of breast-feeding but perhaps it is better framed as the risks of not breast-feeding."

Bairey Merz agrees. "We assume the pathway is that breast-feeding protects, but the association could go in the opposite direction--eg, inability to breast-feed may be a marker of early vascular dysfunction," she suggests.

"Women put themselves at risk by becoming pregnant and not fulfilling the cycle that nature has intended," Schwarz says. "In my mind, the cycle really ends with breast-feeding. During pregnancy, the body stores up a bunch of nutrients with the plan that it's going to release much of this in the form of breast milk, a very calorific food. If this doesn't happen, what we see is that the woman's body pays the price. Breast-feeding really helps bring you back to your baseline, and it helps women recover from the stress test that pregnancy entails."

Study of Physiology During Lactation May Help Tackle CVD in Women

In their discussion, Schwarz et al say their finding that women who breast-fed had lower rates of CVD even after adjustment for body mass index (BMI) "indicates that lactation does more than simply reduce a woman's fat stores. Hormonal effects, such as those of oxytocin, may have significant effects on cardiovascular profiles," they note.

Newton says: "The physiologic reasons for these important observations are largely speculative," but "the antistress, probonding effects of oxytocin and intense skin-to-skin contact found with prolonged breast-feeding certainly contribute to the protective effects," he notes.

Although Bairey Merz acknowledges the findings were adjusted for BMI, she says it is well known from many studies "that women who breast-feed lose the pregnancy weight gain better than those that do not--and this likely contributes to their lower CVD risk. What we do not know is whether breast-feeding preferentially impacts the visceral fat deposits, which would be of specific benefit and should be the focus of research."

"A more intense and focused study of maternal physiology during lactation may give us critical information to limit the scourge of CVD in women," Newton concludes.

References

1. Schwarz EB, Ray RM, Stuebe AM, et al. Duration of lactation and risk factors for maternal cardiovascular disease. Obstet Gynecol 2009; 113: 974-982. Abstract
2. Newton ER. Whatsoever a [woman] soweth, that shall [she] also reap. Obstet Gynecol 2009; 113:972-973. Abstract

Clinical Context

CVD is the leading cause of death for women in developed counties. Recent studies have suggested that lactation increases a mother's metabolic expenditure and improves glucose tolerance and lipid metabolism and may be of long-term benefit in reducing CVD risk. However, whether these benefits persist beyond menopause is uncertain.

This is a study within the WHI cohort to examine the association between lactation, duration of lactation, and the risk for postmenopausal CVD and its components.

Study Highlights

• The WHI involved 161,808 healthy postmenopausal women aged 50 to 79 years and data collection included lactation history, parity, any hospitalizations, and CVD.
• Confirmation of outcomes was by medical records review, death certificates, and description of events.
• Lactation history was assessed at baseline when women with at least 1 live birth were asked about lactation including total months (none, 1 - 6, 7 - 12, 13 - 23, and ≥ 24) and age at last lactation.
• 5 CVD factors were considered at baseline: obesity, hypertension, diabetes, hyperlipidemia, and a history of CVD before enrolment in the WHI.
• Dietary information was assessed with use of a 120-item food frequency questionnaire.
• Excluded were nulliparous women and those with incomplete data.
• This study included 139,681 women with at least 1 live birth.
• 58% reported some history of lactation, and only 6% had a cumulative history of lactation greater than 24 months, with few reporting more than 12 months of lactation per live birth.
• On average, 35 years had passed since last lactation.
• 30% of women were obese, and parous women were more likely than nulliparous women to be obese or hypertensive, but parous women who lactated were less likely than those who had not lactated to be obese or to have hypertension.
• Increasing duration of lactation was associated with lower prevalence of obesity and with a reduced risk for CVD risk factors including hypertension, diabetes, and hyperlipidemia even after adjustment for many variables.
• Women with a lifetime history of more than 12 months of lactation were less likely to have hypertension (OR, 0.88; P < .001), diabetes (OR, 0.80; P < .001), hyperlipidemia (OR, 0.81; P < .001), and CVD (OR, 0.91; P = .008).
• Women with a lifetime cumulative duration of lactation of 13 months or more were less likely to go on to have CVD before enrolling in the WHI (OR, 0.91; P = .008).
• Among parous women who did not breast-feed vs those who breast-fed for more than 12 months, 42.1% vs 38.6% would have hypertension, 5.3% vs 4.3% would have diabetes, 14.8% vs 12.3% would have hyperlipidemia, and 9.9% vs 9.1% would have CVD.
• When incident CVD during 7.9 years of follow-up was examined, the duration of lactation was associated with a decrease in incident CVD in univariable, but not adjusted, models.
• Women with at least 1 live birth who breast-fed for 7 to 12 months were significantly less likely to go on to have CVD (hazard ratio, 0.72) vs women who had never breast-fed.
• The number needed to treat to prevent 1 case of hypertension was 29; for hyperlipidemia, 40; for diabetes, 100; and for CVD, 125.
• In parous women with more than 1 live birth, duration of lactation of 24 months or more was associated with a reduced risk for CVD (hazard ratio, 0.58 for ≥ 24 months for 2 live births and hazard ratio, 0.78 for 3 live births).
• The authors concluded that women who breast-fed their children were less likely to have CVD risk factors when postmenopausal.
• They noted that cumulative lifetime lactation of greater than 12 months was associated with a 10% lower likelihood of CVD vs parous women who had never breast-fed.
• They recommended that breast-feeding in the first year of life be endorsed for both infant and maternal benefits.

Clinical Implications

• Lactation is associated with a reduced risk for postmenopausal hypertension, diabetes, hyperlipidemia, and CVD.
• Lifetime lactation duration of 13 or more months vs no lactation in parous women is associated with a 10% reduced risk for CVD.

Low vitamin D linked to female infections

By Stephen Daniells, 29-Apr-2009

Low vitamin D levels may increase the risk of bacterial vaginosis, a common vaginal infection linked to adverse pregnancy outcomes, suggests a new study from the US.

In a study with 469 women participating in a pregnancy cohort study, vitamin D levels below 20 nmol/L were associated with a 34 per cent increase in the prevalence of bacterial vaginosis compared to women with vitamin D levels over 80 nmol/L.

According to researchers led by Lisa Bodnar from the University of Pittsburgh Graduate School of Public Health a potential protective effect of vitamin D may be due to the vitamin’s influence on the immune system.

The findings are published online ahead of print in the Journal of Nutrition.

The study adds to an ever growing body of science supporting the benefits of maintaining healthy vitamin D levels.

In adults, it is said vitamin D deficiency may precipitate or exacerbate osteopenia, osteoporosis, muscle weakness, fractures, common cancers, autoimmune diseases, infectious diseases and cardiovascular diseases. There is also some evidence that the vitamin may reduce the incidence of several types of cancer and type-1 diabetes.

The new study represents the first report linking vitamin D status with the incidence of bacterial vaginosis, according to PubMed.

Bacterial vaginosis (BV) is a highly prevalent vaginal infection that affects about 30 per cent of women between the ages of 14 and 49. It is caused by changes to the normal chemical and biological balance of the vaginal microflora.

While antibiotics are usually prescribed to treat the condition, there is evidence that probiotics may prevent the condition. Extensive research by Gregor Reid from the Canadian R&D Centre for Probiotics at the Lawson Health Research Institute, and The University of Western Ontario, led to the conclusion that the combination of two particular strains - GR-1 (Lactobacilli rhamnosus) and RC-14 (Lactobacilli reuteri) - provide the greatest benefit for the relief and prevention of bacterial vaginosis.

New data

Bodnar and her co-workers examined the pelvises of 469 pregnant women before week 16 of their pregnancy. Blood samples allowed for the quantification of serum levels of 25- hydroxyvitamin D (25(OH)D), the non-active 'storage' form.

According to the Journal of Nutrition, 41 per cent of all the women had BV, and 52 per cent were classed as vitamin D deficient, equivalent to 25(OH)D levels below 37.5 nmol/L.

Women with BV were found to have a lower average 25(OH)D levels (29.5 nmol/L) compared to women free of BV (40.1 nmol/L), said the researchers. Looking at the same issue from another angle, 57 per cent of women with low 25(OH)D levels lower than 20 nmol/L had BV, while BV was diagnosed in only 23 per cent of women with a 25(OH)D levels over 80 nmol/L.

“Compared with a serum 25(OH)D concentration of 75 nmol/L, there were 1.65-fold and 1.26-fold increases in the prevalence of BV associated with a serum 25(OH)D concentration of 20 and 50 nmol/L, respectively,” wrote the researchers.

“Vitamin D deficiency is associated with BV and may contribute to the strong racial disparity in the prevalence of BV,” they concluded.

The study does not prove causality, and further studies are required to add support to the observation that vitamin D levels may be associated with the incidence of bacterial vaginosis.

The details on D

Vitamin D refers to two biologically inactive precursors - D3, also known as cholecalciferol, and D2, also known as ergocalciferol. The former, produced in the skin on exposure to UVB radiation (290 to 320 nm), is said to be more bioactive.

While our bodies do manufacture vitamin D on exposure to sunshine, the levels in some northern countries are so weak during the winter months that our body makes no vitamin D at all, meaning that dietary supplements and fortified foods are seen by many as the best way to boost intakes of vitamin D.

Source: Journal of Nutrition
Published online ahead of print, 8 April 2009, doi:10.3945/jn.108.103168
“Maternal Vitamin D Deficiency Is Associated with Bacterial Vaginosis in the First Trimester of Pregnancy”
Authors: L.M. Bodnar, M.A. Krohn, H.N. Simhan

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