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Women's health policy highlights

Published on August 24, 2006 at 5:48 PM · No Comments

The following highlights recently released journal articles on women's health issues.

Pregnancy & Childbirth

"Neonatal Mortality and Morbidity Rates in Term Twins With Advancing Gestational Age," American Journal of Obstetrics and Gynecology: Jennifer Soucie and colleagues at the University of Ottawa's OMNI Research Group examined the records of 60,443 twins born between 1995 and 1997 in the U.S. after at least 37 weeks' gestation (BBC News, 8/11). The study finds that infants born after 40 weeks' gestation are more than 2.5 times as likely to die as twins born at 37 weeks' gestation. In addition, twins born after 40 weeks' gestation have a 74% higher chance of having low Apgar scores -- which measures heart rate, breathing, muscle tone, color and response to stimulus -- as twins born at 37 weeks' gestation. There is no significant change in the mortality rates of infants born at 38 or 39 weeks' gestation, compared with those born at 37 weeks' gestation. In addition, infants born during week 39 of gestation are 17% less likely than infants born at 37 weeks to require breathing assistance. The researchers concluded that twin infants should be delivered at less than 40 weeks' gestation but that there is not "compelling evidence" that they should be delivered at less than 38 weeks' gestation (Reuters Health, 8/10).
"Cost-Effectiveness Analysis of Levonorgestrel Intrauterine System and Thermal Balloon Ablation for Heavy Menstrual Bleeding," BJOG: P.M. Brown of the University of Auckland and colleagues compared the cost-effectiveness of levonorgestrel intrauterine system and thermal balloon ablation in 79 women seen at a menstrual disorders clinic at National Women's Hospital in Auckland, New Zealand, for the treatment of heavy menstrual bleeding. Forty women received the levonorgestrel-releasing IUD, and 39 women underwent thermal ablation -- a procedure that involves inserting into the uterus a balloon, which is then inflated and heated to destroy endometrial tissue lining the uterus. The study finds that women who receive the IUD system have better "quality of life" and report less bleeding than those who undergo thermal ablation, Reuters Health reports. In addition, the study finds that cost for the IUD therapy is $869, compared with $1,693 for the thermal ablation treatment. According to the researchers, the IUD system showed "better outcomes ... although the differences are slight." The IUD system "should be considered an effective alternative for the treatment of heavy menstrual bleeding," the researchers concluded (Reuters Health, 8/11).
"Risk of Stress Urinary Incontinence Twelve Years After the First Pregnancy and Delivery," Obstetrics & Gynecology: Lars Viktrup of Eli Lilly and the University of Copenhagen and colleagues asked 241 women during their first pregnancy and 12 years after to complete questionnaires about stress urinary incontinence, or urine loss as a result of stresses, such as laughing or coughing. The researchers found that 102 of the women, or 42%, reported incontinence 12 years after their first pregnancy. About 56% of the women who had incontinence during their first pregnancy had incontinence 12 years later, compared with 78% who experienced incontinence shortly after delivery and 30% who had no initial symptoms. The study finds that although it is unclear what causes incontinence during or after a pregnancy, women who experience it during or shortly after their first pregnancy have a greater risk of developing the condition in the long term (Reuters Health, 8/14).
Preterm birth, Proceedings of the National Academy of Sciences: Jerome Strauss, dean of Virginia Commonwealth University's School of Medicine, and colleagues discovered a variant in a gene that directs the production of collagen and is a found in the amniotic sac that lines the uterus of a pregnant woman. Women who are carriers of the variant gene are more apt to rupture the amniotic sac, the Chicago Tribune reports. According to Roberto Romero, chief of perinatology research at NIH's National Institute for Child Health and Human Development, the "premature rupture of membranes" causes about 40% of premature births in the U.S. The study finds that the variant gene and sac ruptures are more common in black women. "We're not saying this gene causes prematurity," Strauss said, adding, "But it could be a contributor, along with other genetic and environmental factors" (Graham, Chicago Tribune, 8/22).

Public Health

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