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Women replete in vitamin D more likely to have live birth, positive pregnancy test, clinical pregnancy THURSDAY, Nov. 16, 2017 (HealthDay News) -- For women undergoing assisted reproductive treatment (ART), those who are replete in vitamin D have better outcomes, including live birth, a positive pregnancy test, and clinical pregnancy, according to a review published online Nov. 14 in Human Reproduction. Justin Chu, M.B.Ch.B., from the University of Birmingham in the United Kingdom, and colleagues conducted a systematic review and meta-analysis of 11 published cohort studies that included 2,700 women and examined the correlation between vitamin D and ART outcomes. Based on data from seven studies that reported live birth (including 2,026 patients), the researchers found that live birth was more likely in women replete with vitamin D versus those with vitamin D deficiency or insufficiency (odds ratio, 1.33). In five studies with 1,700 women, the likelihood of achieving a positive pregnancy test was higher for women replete in vitamin D versus those who were deficient or insufficient in vitamin D (odds ratio, 1.34). Based on data from all 11 studies, the likelihood of clinical pregnancy was higher in women replete with vitamin D (odds ratio, 1.46). There was no correlation for miscarriage with vitamin D concentration based on data from six studies that included 1,635 patients. "The findings of this systematic review show that there is an association between vitamin D status and reproductive treatment outcomes achieved in women undergoing ART," the authors write. "Our results show that vitamin D deficiency and insufficiency could be important conditions to treat in women considering ARTs." Abstract/Full Text Copyright © 2017 HealthDay. All rights reserved.

Physical Therapy in Women's Health Webinar Recording Now Available!

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Share your original research with the PA community — submit a proposal today for the ePoster Sessions at AAPA 2018, May 19-23, in New Orleans. Open to both PAs and PA student researchers, research must be about the PA profession or PA education, or conducted by PAs and/or PA students. Deadline is Dec. 31.

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Prevention - Original Article

Yeast infections happen. They’re itchy, icky, and uncomfortable. At least they're usually easy to treat, either with a course of over-the-counter cream or prescription medication (or these highly effective yeast infection solutions). But what if they keep coming back?

“Yeast infections, or candidiasis, are incredibly common: More than half of women will have at least one in their lifetime,” says Katharine O'Connell White, MD, director of fellowship in family planning at Boston Medical Center. But there's a big difference between getting that gross cottage cheese-like discharge occasionally and having to run to the drugstore (or your doctor's office) several times a year.

If you're in the chronic camp, there's a chance that your yeast infections could be a sign of something more serious. One possibility: diabetes. Candida albicans, the fungus responsible for a yeast infection, normally lives in the vagina in small amounts. It typically won't hurt you, but it flourishes when there's excess sugar available, says Anita Somani, MD, an ob-gyn at Comprehensive Women’s Care in Columbus, Ohio.

If you have undiagnosed (and untreated) diabetes—or if you know you have diabetes but it's poorly-controlled—your vaginal secretions are likely to contain excess sugar. And when yeast in your vagina has access to that sugar, the yeast begins to take over and cause an infection, Somani explains.

Chances are frequent yeast infections won't be your only sign of diabetes; you might also feel extra thirsty, more tired than usual, or have blurry vision. But when in doubt, ask your doctor for a blood test to check your glucose levels—especially if other vaginal infections like bacterial vaginosis (bv) and STDs have already been ruled out.

If a patient comes to White with a recurrent yeast infection, her first step is to consider what she calls “yeast look-alikes," which include bv, trichomonas, chlamydia, and gonorrhea. (Here are 5 common reasons for vaginal itching other than a yeast infection—and 5 products that help.) Yeast infections can also sometimes be a sign of HIV: The body is weakened by the virus, which in turn allows yeast to increase and infect the vaginal membranes, Somani says.

Bottom line: If the itchy infection doesn't go away or keeps coming back, call your doctor and get it sorted out.

11/09/2017

November 9, 2017 – The U.S. Preventive Services Task Force posted today a final research plan on screening for hepatitis B virus infection in pregnant women. The draft research plan for this topic was posted for public comment from July 13, 2017 to August 9, 2017. The Task Force reviewed all of the comments that were submitted and took them into consideration as it finalized the research plan. To view the final research plan, please go to https://www.uspreventiveservicestaskforce.org/Page/Document/final-research-plan/hepatitis-b-virus-infection-in-pregnant-women-screening.

by Molly Walker, Staff Writer, MedPage, November 06, 2017


BALTIMORE -- More than 21 million pregnant women, or an average of 18% of women worldwide, are colonized with group B Streptococcus bacteria, or GBS, which contributes to stillbirth, preterm birth, and in some cases, death in their infants, researchers here estimated.

While India had the largest number of pregnant women with group B Streptococcus (over 2 million), the United States was fourth after China and Nigeria, with almost 1 million women colonized with the bacteria, reported Anna Seale, BMBCh, and Joy Lawn, BMedSci, both of the London School of Hygiene & Tropical Medicine, and colleagues.

In an 11-paper supplement published in Clinical Infectious Diseases, researchers detailed global estimates of the burden of group B Streptococcusbacteria among pregnant women, as well as the impact on infants and stillbirths, with the goal of moving closer to developing a vaccine.

The data were presented simultaneously at the American Society of Tropical Medicine & Hygieneannual meeting here.

While incidence of GBS previously focused mostly on infant cases in high-income countries, researchers described worldwide burden of the bacteria as "one of the great 'black holes' for public health worldwide." They added that this is the first comprehensive study of the burden of group B Streptococcus including outcomes for both pregnant women and their babies.

Researchers also performed a series of systematic reviews and meta-analyses. To estimate colonization data for pregnant women, they analyzed 390 articles from 84 countries, for a total of almost 300,000 pregnant women. In the 188 studies that met CDC-recommended criteria, researchers found the average adjusted estimate for maternal group B Streptococcus global colonization was 18% (95% CI 17%-19%), with substantial regional variation, ranging from 11% in Eastern Asia to 35% in the Caribbean.

Seale & Lawn and colleagues also found that out of 15 examined studies, a single study estimated the incidence of "invasive maternal GBS disease" at 0.38% per 1,000 pregnancies. Pooled estimates found that two-thirds of cases were detected during labor and delivery or post-partum. The overall case fatality risk of pregnant or postpartum women experiencing invasive GBS was 0.20% (11 studies, 2 deaths, 890 cases), researchers said.

They then estimated the cases of group B Streptococcus colonization worldwide using a compartmental model, and found that of 140 million live births in 2015, 21.3 million infants were exposed to maternal GBS colonization at delivery. Moreover, they estimated there were 319,000 cases of infant invasive GBS disease worldwide, with 205,000 early-onset GBS disease and 114,000 late-onset GBS cases.

Researchers estimated 90,000 infant deaths due to group B Strep disease worldwide. Notably, they estimated 51,000 infant deaths due to early-onset GBS without access to healthcare. Stillbirth attributable to GBS disease was estimated at 57,000 cases, and the range of cases of preterm birth caused by GBS disease was 0 to 3.5 million.

Researchers noted that the treatment for pregnant women with group B Streptococcus is antibiotics prior to delivery, with 60 countries having an antibiotic policy for use in pregnancy that aims to prevent newborn GBS disease.

While intrapartum antibiotic prophylaxis prevented an estimated 29,000 infant deaths attributable to early-onset GBS and 3,000 deaths attributable to late-onset GBS, gaps in research remain.

"Existing recommendations should be implemented, but these are insufficient, and the number of affected families remain unacceptable," co-author Johan Vekemans, MD, of the World Health Organization, said in a statement. "It is now essential to accelerate the GBS vaccine development activities."

Indeed, researchers estimate that with worldwide maternal vaccination, a vaccine with 80% efficacy and 50% coverage would prevent an estimated 127,000 infant and maternal cases of GBS, 23,000 stillbirths, and 37,000 infant deaths.

Vekemans added that a "comprehensive evaluation" is needed on the cost-effectiveness of a vaccine against group B Streptococcus, and work is needed to strengthen existing maternal immunization programs worldwide.

This supplement was supported by the Bill & Melinda Gates Foundation.

Authors disclosed support from the Bill & Melinda Gates Foundation, Wellcome Trust, Medical Research Council UK, the Thrasher Foundation, the Meningitis Research Foundation, the NIH, Sequirus Inc, CureVac Inc, Pfizer Inc., Novartis, Belpharma Eumedica, GlaxoSmithKline and Minervax.

Members of the Expert Advisory Group received reimbursement for travel expenses to attend working meetings related to this series.

LAST UPDATED 11.07.2017

• Reviewed by F. Perry Wilson, MD, MSCEAssistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Primary Source
American Society of Tropical Medicine & Hygiene

• Source Reference: Seale AC "Estimating the global burden of group B Streptococcus in pregnant women, stillbirths and children to inform vaccine development" ASTMH 2017; Session 6.

Secondary Source
Clinical Infectious Diseases

• Source Reference: Seale AC, Lawn JE "The burden of group B Streptococcus worldwide for pregnant women, stillbirths and children" Clin Infect Dis 2017; 65(2).

The November 2017 ACOG Practice bulletin, entitled Long-Acting Reversible Contraception: Implants and Intrauterine Devices, summarized data regarding the extended use of levonogestrel IUDs. The bulletin stated the following: “Current data support the efficacy of the LNG-20 beyond its approved duration of use. Extended-use studies are ongoing…”. The current FDA approval for duration of use of levonogetrel IUDs is 5 years for levonogestrel-20 (Mirena®), 4 years for levonogestrel-18.6 (Liletta®), 5 years for levonogestrel-19.5 (Kyleena®), and 3 years for levonogestrel-13.5 (Skyla®) and these recommendations should be followed until studies are complete and evidence clearly outlines efficacy for longer duration of use. 

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INDIANAPOLIS—The Indiana State Department of Health (ISDH) today kicked off a strategic planning effort designed to identify and reduce the state’s number of cervical cancer cases and deaths. September is National Gynecologic Cancer Awareness Month, and the ISDH marked the occasion by bringing together public health experts, medical professionals, researchers and others across the state to discuss ways to protect Hoosiers from this disease.

“Cervical cancer is nearly 100 percent preventable, yet every year, Indiana women die from this terrible disease,” said Deputy State Health Commissioner Pamela Pontones. “By convening key leaders from all corners of our state, we can work together to reduce the burden of cervical cancer and save lives.”

Cervical cancer is an abnormal growth of cells on, or that began in, the cervix. It is nearly 100 percent preventable through regular routine screening, avoiding tobacco products and other controllable risk factors, and vaccination against the human papillomavirus (HPV).

In Indiana, 1,283 new cases of cervical cancer were diagnosed and 446 cervical cancer-related deaths occurred from 2011–2015, according to the Indiana State Cancer Registry. The American Cancer Society estimates that nationally in 2017, 12,820 new cases of cervical cancer will be diagnosed and 4,210 deaths will occur.

HPV is the single greatest risk factor for cervical cancer. According to the Centers for Disease Control and Prevention, American Academy of Pediatrics, American Academy of Family Physicians and the American College of Physicians, all boys and girls ages 11 or 12 should get vaccinated against HPV. Although older teens and young adults can receive the vaccine through age 26, studies have shown that the vaccine produces a better immune response at earlier ages.

House Bill 1278, enacted earlier this year, charged ISDH with identifying methods to increase the number of Hoosiers vaccinated for HPV, increasing regular cervical cancer screenings and creating partnerships throughout the state to reduce the number of cases.

Visit the Indiana Cancer Consortium (ICC) at http://indianacancer.org/cervical_cancer_toolkit/ for more information on cervical cancer, risk factors and prevention.

Follow ISDH on Twitter at @StateHealthIN and on Facebook at www.facebook.com/isdh1 for important health and safety updates.

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