One Malaria Episode Early In Pregnancy Triples Miscarriage Risk

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Main Category: Tropical Diseases
Also Included In: Pregnancy / Obstetrics
Article Date: 14 Dec 2011 - 9:00 PST

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According to the largest study on the effects of malaria and different anti-malarial drugs in early pregnancy to date, just one episode of malaria in the first trimester is linked to a three-fold greater risk of miscarriage. Researchers also discovered that women treated with anti-malarial drugs did not suffer any serious side effects or increase their likelihood of miscarriage. The study was published Online First in The Lancet Infectious Diseases.

According to estimates each year, 125 million pregnancies are at risk of malaria. During pregnancy, malaria can cause both severe anemia and parasitic infection in the fetus and increase the risk of low birth-weight, preterm birth, and maternal death.

Until now, scientists know little about the effects of malaria in early pregnancy or the benefits and harms of anti-malarial drugs during the early stages of pregnancy. The treatment of all falciparum malaria is artesunate-based combination therapy (ACT), however, it is not recommend during the first pregnancy trimester as it has been proven toxic in animal studies, potentially causing birth defects or miscarriage.

Leading author Rose McGready from Shoklo Malaria Research Unit in Thailand, explained:

"Both vivax and falciparum malaria contribute significantly to avoidable fetal and infant death. These results suggest that the adverse effects of malaria in the first trimester substantially outweigh any adverse effects of its treatment...[and] emphasizes the importance of early detection of malaria and prompt effective treatment for all pregnant women."

McGready and his team set out to provide more evidence and reviewed records of pregnant women who attended antenatal clinics of the Shoklo Malaria Research Unit on the northwestern border of Thailand between May 1986 and October 2010. They compared outcomes of 16,668 women who no malaria during pregnancy with 945 women who had only a single episode in the first trimester, i.e. at less than 14 weeks into their pregnancy, and discovered that asymptomatic malaria, showing no noticeable symptoms, was linked to almost a three times higher risk of miscarriage compared with those who did not contract malaria, whilst the risk of miscarriage for those with symptomatic malaria tended to be at least four-times more likely. In women with vivax and falciparum malaria the risk of miscarriage was similar.

The researchers discovered that the chances of miscarriage was comparable in women who received chloroquine (26%), quinine (27%), and artesunate (31%) during the first-trimester, with no substantial difference reported between treatments in other birth outcomes, such as still birth or low birth weights. Unlike the findings from animal studies, the researchers detected no additional toxic effects in women treated with artesunate.

The authors comment: "Miscarriage in 24 first-trimester episodes of hyperparasitaemia or severe malaria was high but artesunate did not result in higher rates of miscarriage than did quinine," and conclude saying, that: "These findings have serious implications for malaria treatment and prevention policies, which currently ignore the first trimester...A randomized trial of first-trimester artemisinin-based treatment is now needed to make firm recommendations on the safety of first-trimester malaria treatments with this class of anti-malarial drug."

Meghna Desai and Stephanie Dellicour from the Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya write in an associated comment:

"This study provides a level of reassurance regarding the potential risk associated with artemisinin exposure in early pregnancy, compared with the established risk of malaria. This study, combined with data from ongoing studies done in sub-Saharan Africa, will for the first time allow an informed risk/benefit assessment of disease versus treatment with artemisinin combination treatments in pregnancy."

Written by Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our tropical diseases section for the latest news on this subject. ”Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: a population-based study”
Dr R McGready et al.
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Surprisingly Early Gift Of Gab Revealed By Baby Lab

Main Category: Pediatrics / Children's Health
Article Date: 13 Dec 2011 - 0:00 PST

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From the moment they're born, babies are highly attuned to communicate and motivated to interact. And they're great listeners.

New research from the University of Notre Dame shows that during the first year of life, when babies spend so much time listening to language, they're actually tracking word patterns that will support their process of word- learning that occurs between the ages of about 18 months and two years.

"Babies are constantly looking for language clues in context and sound," says Jill Lany, assistant professor of psychology and director of Notre Dame's baby lab, where she conducts studies on how babies acquire language.

"My research suggests that there are some surprising clues in the sound stream that may help babies learn the meanings of words. They can distinguish different kinds of words like nouns and verbs by information in that sound stream."

Lany's studies shows that babies as young as twelve months can identify "adjacent relationships" in which a phrase or sound like "it's a" occurs immediately before an object.

"If I were to say to you, 'Oh look, it's a dax,' you might not know what a 'dax' is but the cue 'it's a' let's a baby know that what follows is an object," Lany says.

Similarly, if a person were to say "I'm daxing it," the same principal is at work with cues and word patterns that indicate a verb or action word. Babies actually can use these patterns as clues to the meanings of new words they are learning.

By about 15 months, babies are able to track more complicated "non-adjacent relationships" in which the word cue may be even further removed.

"We often think about grammar coming after word-learning, but in fact, my research shows that all this information that babies are picking up in that first year of life about how words are occurring in their language, actually is supporting this process of word-learning prior to mastery of language."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Biopsies Reveal Nature Of Brain Lesions Early In MS Progression, Countering Conventional Wisdom

Main Category: Multiple Sclerosis
Also Included In: Neurology / Neuroscience
Article Date: 09 Dec 2011 - 1:00 PST

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Working together, researchers at Cleveland Clinic and Mayo Clinic have for the first time examined early multiple sclerosis (MS) brain lesions in the cerebral cortex. These lesions are thought to be critical to MS progression and the researchers found that the lesions are distinctly different than previously speculated, giving clues to better disease management.

The long-accepted theory has been that MS begins in the myelin on the inner layers of the brain, also known as white matter. However, the findings of this collaborative study show the opposite -- that the disease likely can move from the outer (cortical) layers of the brain toward the white matter, offering new insight into the progression of MS.

"For patients, the key idea of this research is that we have discovered an entirely new concept of how MS may start," said Richard Ransohoff, M.D., Director of the Neuroinflammation Research Center of the Department of Neurosciences at Cleveland Clinic's Lerner Research Institute, who co-led the study. "This research shows that a non-inflammatory form of MS is much less likely, and the prevailing research path has been going in the right direction."

While the causes of MS remain undetermined, it is thought to be a disease in which the body's immune system attacks and destroys its own myelin, a fatty insulator of the crucial nerve fibers that are responsible for communication between different sections of the brain.

However, in autopsy tissues of MS patients, lesions in the cerebral cortex show demyelination without inflammation, raising a challenging issue: if cortical lesions form entirely without inflammation, then cortical demyelination would not be explainable by current theories of MS nor treatable by current MS therapies.

The present study, published in the New England Journal of Medicine, was a collaborative effort by Dr. Ransohoff, also a staff neurologist at the Mellen Center for Multiple Sclerosis Treatment and Research at Cleveland Clinic's Neurological Institute, and by Claudia Lucchinetti, M.D., of the Mayo Clinic's Department of Neurology.

The study involved examination of 563 brain biopsies resulting in the diagnosis of inflammatory demyelinating disease of the central nervous system, with 138 being determined to have sufficient cortex for study. Of these, 77 cases provided long-term follow-up data, with 58 cases (75 percent) going on to develop verified MS. The vast majority of biopsies were performed at community hospitals with the brain tissue being sent to the Mayo Clinic for neuropathological consultation services. Dr. Lucchinetti leads the National MS Society's MS Lesion project housed at the Mayo Clinic. This study was funded in part by that project as well as the National Institutes of Health.

MRI neuroimaging studies in early multiple sclerosis can't detect cortical lesions but have revealed cortical abnormalities, suggesting that the cortex may be damaged near the time of disease onset. The current research shows that the cortex harbors inflammatory lesions accounting for MRI indicators of damage.

"The next step in this research is to study the lesions to uncover new molecular targets for treatment. We also need to push forward to develop imaging techniques to view these cortical lesions," said Dr. Lucchinetti. "In that way, effects of treatment can more easily be measured."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our multiple sclerosis section for the latest news on this subject. Other authors on this study include: Natalia Moll, M.D., Ph.D., from the Neuroinflammation Research Center and Department of Neurosciences of Lerner Research Institute, Cleveland Clinic; Bogdan Popescu, M.D., Reem Bunyan, M.D., Shanu Roemer, M.D., Joseph Parisi, M.D., Bernd Scheithauer, M.D., Caterina Giannini, M.D., Stephen Weigand, M.S., Jay Mandrekar, Ph.D., all from Mayo Clinic; Hans Lassmann, M.D., from the Center for Brain Research, Medical University of Vienna, Austria; and Wolfgang Bruck, M.D., from the Department of Neuropathology, University Medical Center and Institute for MS Research in Gottingen, Germany.
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Immediate Bisphosphonate Use With Endocrine Therapy Reduced Recurrence And Increased Survival In Postmenopausal Early Breast Cancer

Stress In Early Pregnancy Can Lead To Shorter Pregnancies, More Pre-term Births And Fewer Baby Boys

Main Category: Pregnancy / Obstetrics
Also Included In: Anxiety / Stress;  Aid / Disasters
Article Date: 09 Dec 2011 - 1:00 PST

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Stress in the second and third months of pregnancy can shorten pregnancies, increase the risk of pre-term births and may affect the ratio of boys to girls being born, leading to a decline in male babies. These are the conclusions of a study that investigated the effect on pregnant women of the stress caused by the 2005 Tarapaca earthquake in Chile.

Although it has been known for a while that stress may affect the duration of pregnancy, until now, no study has looked at the impact of both the timing of the stress and the effect that stress might have on the ratio of male-to-female births. The research published online in Europe's leading reproductive medicine journal Human Reproduction [1] today (Thursday), provides answers to these questions and also suggests that it is exposure to stress itself rather than other factors that can often accompany or cause stress, such as poverty, that appears to affect pregnancy.

Professors Florencia Torche (PhD) and Karine Kleinhaus (MD, MPH), of New York University (New York, USA), analysed birth certificates of all babies born between 2004-2006 in Chile; there were over 200,000 births a year. The birth records provided information on gestational age at delivery, sex, weight and height of the baby and whether any medical attention was required. They also included information on the mother's age, marital status, whether or not she had been pregnant before and in which of the 350 counties in Chile she lived. This information gave the researchers very specific information about how exposed the mothers were to the effects of the earthquake, based on how close they lived to the epicentre.

"Looking at information on gestational age at the time of the earthquake in a large, unselected group of women, enabled us to determine the risk for specific birth outcomes by gestational age of exposure to a stressor, which, because it was a natural disaster, was experienced by all at the same time, although in varying degrees of severity, depending on how close they lived to the epicentre," said Prof Torche who is Associate Professor of Sociology. "We were able to capture the developmental periods in which exposure to stress was most detrimental for either sex."

The earthquake measured 7.9 on the moment-magnitude scale (the successor to the Richter scale), which is classified as "disastrous". The areas most affected were the cities of Iquique and Alto Hospicio, and the surrounding towns. The researchers found that women who experienced a severe quake (because they lived closest) during their second and third months of pregnancy had shorter pregnancies and were at higher risk of delivering pre-term (before 37 weeks gestation). The pregnancies of women exposed to the earthquake in the second month of pregnancy were on average 0.17 weeks (1.3 days) shorter than those in the unaffected areas of Chile. The pregnancies of those exposed in the third month were 0.27 weeks (1.9 days) shorter. Normally, about six in 100 women had a pre-term birth, but among women exposed to the earthquake in the third month of pregnancy, this rose by 3.4%, meaning more than nine women in 100 delivered their babies early.

The effect was most pronounced for female births; the probability of pre-term birth increased by 3.8% if exposure to the quake occurred in the third month, and 3.9% if it occurred in the second month. In contrast there was no statistically significant effect seen in male births.

As the stress of the earthquake had greater effect on pre-term births in girls rather than boys, the researchers had to make adjustments for this when calculating the effect of stress on the sex ratio: the ratio of male to female live births. They found that there was a decline in the sex ratio among those exposed to the earthquake in the third month of gestation of 5.8%.

Prof Kleinhaus, who is Assistant Professor of Psychiatry, Obstetrics & Gynecology, and Environmental Medicine, explained: "Generally, there are more male than female live births. The ratio of male to female births is approximately 51:49 - in other words, out of every 100 births, 51 will be boys. Our findings indicate a 5.8% decline in this proportion, which would translate into a ratio of 45 male births per 100 births, so that there are now more female than male births. This is a significant change for this type of measure."

Previous research has suggested that in times of stress women are more likely to miscarry male foetuses because they grow larger than females and therefore require greater investment of resources by the mother; they may also be less robust than females and may not adapt their development to a stressful environment in the womb. "Our findings on a decreased sex ratio support this hypothesis and suggest that stress may affect the viability of male births," said Prof Torche. "In contrast, among female conceptions, stress exposure appears not to affect the viability of the conception but rather, the length of gestation."

The researchers suggest that possible mechanisms to explain their findings could involve the placenta, which sets the duration of the pregnancy, and the effect of the stress hormone cortisol on the placenta's function.

Prof Torche concluded: "In terms of implications, it is clearly unrealistic to recommend avoiding natural disasters. However, this research suggests the need to improve access to healthcare for women from the onset of pregnancy and even before conception. Obviously this will not reduce the exposure to stress, but it may provide care, advice, and tools that would allow women to cope with stressful circumstances.

"A separate implication has to do with our ability to use a 'natural experiment' (the earthquake) to isolate the effect of stress from factors that commonly go with it. In particular, researchers have long suggested that poverty is bad for health outcomes because of the stress it elicits. This is very plausible, but it is difficult to disentangle the effect of stress alone from the effect of other factors associated with poverty, such as nutritional deprivation and poor housing, which could also have an independent impact on women's health and the outcome of their pregnancies. This makes it difficult to ascertain whether stress itself does, indeed, matter. Our research provides strong evidence that it does."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pregnancy / obstetrics section for the latest news on this subject. [1] "Prenatal stress, gestational age and secondary sex ratio: the sex-specific effects of exposure to a natural disaster in early pregnancy", by Florencia Torche and Karine Kleinhaus. Human Reproduction journal. doi:10.1093/humrep/der390
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European Society of Human Reproduction and Embryol. (2011, December 9). "Stress In Early Pregnancy Can Lead To Shorter Pregnancies, More Pre-term Births And Fewer Baby Boys." Medical News Today. Retrieved from
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Obesity Linked To Worse Outcomes In Early Breast Cancer Treatment

Main Category: Breast Cancer
Also Included In: Obesity / Weight Loss / Fitness
Article Date: 08 Dec 2011 - 3:00 PST

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Obesity is associated with worse outcomes overall in early-stage breast cancer, researchers reported at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium, held Dec. 6-10, 2011.

Obesity was linked to shorter time to recurrence (TTR), disease-free survival (DFS) and overall survival (OS). The exception was treatment with endocrine therapy (mainly tamoxifen), in which obesity was associated with a protective effect.

"The findings add to the body of evidence indicating that obesity, in general, increases a patient's chance for having a worse prognosis," said lead researcher Sao Jiralerspong, M.D., Ph.D., an assistant professor of medicine at Baylor College of Medicine.

"Obesity is a probable risk factor for worse breast cancer outcomes, and ours is the latest study to suggest it has an effect on treatment outcome as well," Jiralerspong said.

Using data from the Lester and Sue Smith Breast Center at Baylor, Jiralerspong and colleagues examined the link between weight and treatment modality in 4,368 patients treated between 1970 and 1995.

For the group as a whole, data revealed that overweight patients had similar outcomes to normal-weight patients, but obese patients had an increased risk for worse TTR, DFS and OS.

Among patients who received no adjuvant chemotherapy or endocrine therapy, there was a trend for worse survival outcomes in obese patients compared with normal-weight patients.

Obese patients who received chemotherapy fared significantly worse compared with normal-weight patients, "with the magnitude of this effect approaching that of the degree of benefit expected from chemotherapy," Jiralerspong said.

In contrast, overweight patients who received endocrine therapy, predominantly tamoxifen, fared significantly better compared with normal-weight patients.

"Finding that overweight patients have a better outcome than normal-weight patients after tamoxifen treatment is surprising. We are examining the possible reasons for this," Jiralerspong said.

He said that obesity could contribute to worse outcomes because of biological factors associated with excess weight, such as higher blood insulin and estrogen levels, inflammation and growth factors secreted by fat cells. But Jiralerspong also added that more research is needed to understand the effect of body mass on adjuvant treatment because of the unexpected findings and because additional agents are in use today compared with the time period studied.

The study was funded by the Lester and Sue Smith Breast Center at Baylor College of Medicine.

Article adapted by Medical News Today from original press release. Source: American Association for Cancer Research
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In Early Vs. Late Hormone Receptor-Positive Breast Cancer, Molecular Differences May Be Used To Predict Breast Cancer Recurrence

Main Category: Breast Cancer
Also Included In: Genetics
Article Date: 08 Dec 2011 - 0:00 PST

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Researchers may have discovered a series of genes that will help predict whether or not a woman with hormone receptor-positive invasive breast cancer will experience early, late or no recurrence of her disease.

Minetta C. Liu, M.D., associate professor of medicine and oncology and director of translational breast cancer research at Georgetown Lombardi Comprehensive Cancer Center, presented the findings at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium, held Dec. 6-10, 2011.

"There are clear biological differences within the supposedly unified group of hormone receptor (HR)-positive breast cancers, and these differences distinguish subtypes relative to the time at which they recur," Liu said. "Understanding what drives these distinctions will allow us to tailor treatment and improve patient outcomes."

Women with HR-positive breast cancer are frequently treated with tamoxifen, which is credited with saving the lives of hundreds of thousands of women. Although tamoxifen prevents or delays cancer recurrence in many women, some will recur 10 years or more from their original diagnosis. Until now, the molecular basis for this recurrence pattern was unknown.

Liu and colleagues, in collaboration with investigators from the University of Edinburgh, evaluated high-quality frozen tumor samples obtained at the time of breast cancer diagnosis. These tissue samples were linked to data on treatment and clinical outcomes, allowing researchers to analyze gene expression patterns present before the initiation of any systemic therapy.

Together with engineers at Virginia Polytechnic Institute, Liu and colleagues identified significant gene expression patterns among the tumor samples. These patterns correlated strongly with the development of distant metastatic disease.

"We confirmed what many have already suspected," said Liu. "There are biological drivers that define - at the time of tumor development - whether or not breast cancer will recur early, late or not at all. Now we need to validate these findings and take our knowledge to the next step."

Liu hopes that this research can be used to help personalize treatment in day-to-day clinical practice. "Endocrine therapy and chemotherapy are not without toxicity," she said. "The ability to predict which patients will recur early in their treatment course can lead to more appropriate recommendations for adjuvant chemotherapy. It might also identify those women who would benefit most from studies using investigational agents to enhance the effects of tamoxifen or aromatase inhibitors."

She added: "At the other extreme are those patients with HR-positive tumors who recur long after completing five years of endocrine therapy. These are the patients for whom extended endocrine therapy and its related side effects are really worth it."

The team's next step is to validate their predictive model for the timing of recurrences on tamoxifen so that physicians and patients can make more informed decisions about the potential added benefits of adjuvant chemotherapy, extended endocrine therapy and involvement in clinical trials. They will also investigate combinations of molecular targets with the ultimate goal of delaying or preventing the development of metastatic breast cancer, Liu said.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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American Association for Cancer Research. (2011, December 8). "In Early Vs. Late Hormone Receptor-Positive Breast Cancer, Molecular Differences May Be Used To Predict Breast Cancer Recurrence." Medical News Today. Retrieved from
http://www.medicalnewstoday.com/releases/238755.php.

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