Tag Archives: pregnancy

Early Menopause and lack of child birth increase risks for Heart Failure

Heart Health in Women has many risk factors associated with it. A new study, another retrospective one, examined 28,516 women, who were enrolled as part of the Women’s Health Initiative (link below), a great effort that is now providing invaluable statistics that can be used to identify root causes and create awareness.

Eliminating all other known factors, such as BMI, smoking etc., two new factors popped up:

  1. Early Menopause
  2. Lack of pregnancy

They also identified that for every year’s worth of delay in menopause initiation, a woman’s heart failure rate drops by 1%. The other risk is caused by nulliparity, or lack of pregnancy. I am quoting directly here:

The latest study also found that women who had never given birth were 2.75 times more likely to have diastolic heart failure than women who had children.

The study authors did not establish a direct causal link, but they were able to identify a statistical link. The lead author did mention that polycystic ovary syndrome (a blog post for another day) has been known to increase cardiovascular risk. Diastolic Heart Failure happens when the heart is not able to pump enough blood to the body.

Study Limitations

Retrospective studies, especially ones based on efforts such as the Women’s Health Initiative, where large amount of data can be a treasure trove of information, just as this study has been. However, there are limitations. The current study only shows an association, not a causation, and no clues on the actual causation.

Such limitations however can be overcome by future studies, that focus on trying to identify causes.

Mitigating Circumstances

The more causes that are identified for the risk of heart failure, the better. Instead of considering these things in a negative light, women and doctors can better prepare ahead, taking precautionary measures ensuring a long and fruitful lifespan. It is also true that women in this century, prefer to make their life choices and therefore, knowing that avoiding pregnancy means a need to plan and prepare ahead for optimal health is always very good!

References:

  1. The study (sits behind a paywall): http://www.sciencedirect.com/science/article/pii/S0735109717367694
  2. The Guardian Article summarizing the study: https://www.theguardian.com/science/2017/may/15/earlier-menopause-puts-women-at-greater-risk-of-heart-failure-study-shows
  3. The Women’s Health Initiative: https://www.nhlbi.nih.gov/whi/
  4. Nulliparity: http://medical-dictionary.thefreedictionary.com/nulliparity
  5. A simple review of early menopausehttp://www.webmd.com/menopause/guide/premature-menopause-symptoms#1
  6. Diastolic Heart Failure: http://www.webmd.com/heart-disease/heart-failure/tc/diastolic-heart-failure-topic-overview#1
  7. Image Courtesy, Pexelshttps://www.pexels.com/photo/sunset-hands-love-woman-5390/

Some shocking revelations on violence and trauma during pregnancy!

The American College of Obstetrics and Gynecologists (ACOG) has its annual meeting this week, and how I wish I could be there! Maybe next year. Meanwhile, some shocking new findings are being presented at the meeting!

The results are from researchers at the Perelman School of Medicine at the University of Pennsylvania, who analyze a statewide analysis, for pregnancy related hospital trauma cases over a decade, for the State of Pennsylvania.

Please read the key findings in the link below. You may also refer to the proceedings poster.

A Couple of Shockers

The data itself is shocking, about 1 in 12 women have trauma during pregnancy, that may be due to accidents or assaults. This is also the leading non-obstetric  reason for death among pregnant women. There are the usual caveats about how pregnancy complicates everything. But, I found a couple of things really shocking! Here is one from Neha Deshpande MD, the clinical resident, who is also the lead author of the study:

“Despite the severity of the issue, little is known about how trauma actually impacts pregnant women since accidental and incidental causes of death are excluded in many statewide and national maternal mortality reviews. The striking results of our study suggest that widespread screening for violence and trauma during pregnancy may provide an opportunity to identify women at risk for death during pregnancy.”

  1. The “little is known” gave me pause and I had to re-read it twice! And, apparently not much screening of trauma and pregnancy occurs!
  2. The second thing that shocks me is that “accidental and incidental causes of death” are excluded from many state and national maternity mortality reviews! Well, there is something in need of fixing! If we don’t even do a good job of counting the causes and cases carefully, how would we proactively fight pregnancy related trauma?

Other Findings

  1. Some of the other findings were disturbing as well. The study found that injuries in pregnant women were fewer than in women who weren’t, but even with the reduced severity, pregnant women were nearly twice as likely to die! Clearly, resource availability and planning have to be increased to give immediate special care and attention to pregnant women.
  2. The next one, mental health, ignored for long, seems to be particularly troublesome when it comes to pregnant women. Nearly 1 in 5 pregnant women reported some form of psychiatric illness. What little attention has been provided to pregnancy related mental health issues, usually focuses (not that it should be reduced) on postpartum depression. Well, it appears, this attention should be increased and should span the entire pregnancy timeline!
  3. In more disturbing news, minority and uninsured women were reported be significantly more likely to experience assault. It is already reported through many channels that minority women and uninsured women have the most problems, and this makes things worse. Given the recent proposed changes to healthcare laws in the US, and the debate surrounding affordable care, and access to care, these findings are the most disturbing and alarming!

The Future?

Results from a single state, spanning a decade are commendable, as much as their findings give much cause for concern. But, what of the future? I think alongside making more resources available, and creating more awareness, a few changes are in order:

  1. Change how pregnancy related morbidity and mortality data are collected, specifically to highlight accidents and violence.
  2. As I mentioned before, make maternal mental health a central issue through the pregnancy cycle. Is there any reason to believe (and this is in no way in defense of) that both parents face mental health issues during pregnancy, and perhaps, sometimes, violence is a result? This might be important to know.
  3. Do pregnant women know how to approach for help when abused? Where to go? What treatment options are available?
  4. How would this data about pregnancy look like, if collected and analyzed globally?

This study, from U.Penn is truly an eye opener, but if anything, it tells us not enough is being done.

Reference:

  1. The MedicalXpress Article: https://medicalxpress.com/news/2017-05-pregnancy-linked-higher-death-traumatic.html
  2. Image courtesy, Pexels: https://www.pexels.com/photo/motherhood-parenthood-pregnancny-mother-59894/