The use of emergency contraception doubled in just six years, but the latest data shows it has failed to slash rates of conception or sexually transmitted infections, reports dailymail.co.uk.

The findings by the Cochrane Library Review cast serious doubt over the British government’s decision to promote emergency contraception as part of its Teenage Pregnancy Strategy.

Ministers hoped easier access to morning-after pills through pharmacies and even schools would bring down rates of unplanned pregnancies and abortions.

In 1996, six percent of women who requested an abortion had tried emergency contraception first. By 2002, this figure had doubled to 12 percent.

The review concludes that women who receive an advance supply of the morning-after pill have an equal chance of becoming pregnant as those who do not have early access to the contraceptive.

The research, based on 11 trials of almost 8,000 women in the US, India, China and Sweden, also found that the presence of emergency contraception does not lead to an increase in promiscuity.

Two articles published Online First in The Lancet report that community support groups can reduce neonatal mortality. In addition, they can lower rates of maternal depression, provided that the population coverage is wide enough and the programs are suitably designed.

In trials in Nepal, participatory women’s groups have shown promise. Neonatal mortality was reduced by about one-third. Two research teams undertook to test this approach further. They carried out cluster-randomized controlled trials that were led by Anthony Costello, University College London Centre for International Health and Development, Institute of Child Health, London, UK.

Prasanta Tripathy, Ekjut, Chakradharpur, Jharkand, India and colleagues explain their work in the first article. They assigned clusters in a population of 228,186 people in Jharkand and Orissa in eastern India to either participating in women’s groups focusing on the reduction of maternal and newborn health problems, or not. A total of 19,030 births were monitored over 3 years. They found that neonatal mortality was 32 percent lower overall. It was 45 percent lower in years 2 and 3 for women who had been living in areas where women’s groups existed than for those who had not. Moderate maternal depression had fallen by 57 percent by the third year.

The authors explain: “Women’s groups led by peer facilitators reduced neonatal mortality rates and moderate maternal depression at low cost in largely tribal, rural populations of eastern India. The most likely mechanism of mortality reduction was through improved hygiene and care practices.”

They write in conclusion: “Participatory groups have the advantage of helping the poorest, being scalable at low cost, and producing potentially wide-ranging and long-lasting effects. By addressing critical consciousness, groups have the potential to create improved capability in communities to deal with the health and development difficulties arising from poverty and social inequalities.”

Professor Kishwar Azad, Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh and colleagues describe their work in a second article. They monitored neonatal mortality for 36,113 births over 3 years in a population of 503,163. As with Tripathy et al’s study, the study population was divided into clusters. Some of which were assigned to support from women’s groups. Findings indicate that the community support made no difference to neonatal mortality rates.

They comment: “For participatory women’s groups to have a significant effect on neonatal mortality in rural Bangladesh, detailed attention to programme design and contextual factors, enhanced population coverage, and increased enrolment of newly pregnant women might be needed.”

They note: “Women’s groups, if scaled to an adequate coverage, have the potential to reach the poorest people and bring about substantial health and non-health benefits. Nonetheless, a women’s group approach requires adequate human resources support for community mobilisation and appropriate coverage.”

“Effect of scaling up women’s groups on birth outcomes in three rural districts in Bangladesh: a cluster-randomised controlled trial”

Current evidence suggests that using Doppler ultrasound in high-risk pregnancies to monitor a fetus’ health may reduce caesarean sections and the number of babies who die, according to a new Cochrane Systematic Review.

Doppler ultrasound is a well established technique used to diagnose problems during pregnancy. In the same way that a speed radar measures how fast cars are travelling, Doppler ultrasound can monitor how fast blood is moving in the umbilical blood flow. Professionals can then look to see whether the blood flow is normal, indicating that the fetus is healthy, or abnormal, indicating that the fetus is under stress. The health professionals can then decide which high-risk pregnancies need assistance in delivering the baby, and which women can be left to deliver without assistance.

The aim of using Doppler is to reduce risk to the baby. However, some experts argue that it may prompt some unnecessary early interventions.

The review included 18 studies which together included 10,000 women in “high risk” groups. High risk women included those who had previously lost babies during pregnancy, those carrying growth restricted babies and women with hypertension or diabetes. Women who were examined with Doppler ultrasound were compared with those who had no Doppler or with those who had cardiotocography (CTG), which monitors the baby’s heartbeat. According to the results, Doppler reduced infant deaths, possibly through better timing of caesarean sections, as well as reducing the number of caesarean sections themselves, and inductions of labour. However, the researchers say the studies included were of questionable quality.

“A case could certainly be made for a higher quality, multi-centre trial of Doppler ultrasound than we have so far seen,” said lead researcher Zarko Alfirevic, who is based at the Division of Perinatal and Reproductive Medicine at the University of Liverpool. “It is quite possible that for some so-called high risk groups fetal Doppler offers little or no benefit. Women with diabetes are one such group where fetal Doppler may, in fact, give false reassurance.

“It is important to point out, of course, that it is the clinical decision that follows a Doppler ultrasound examination that changes the outcome for the baby, and currently there is little agreement on what intervention should follow an abnormal Doppler finding.”

One of the most exciting times for pregnancy is the routine ultrasound that is usually performed around the 18th week of pregnancy when physicians check fetal growth, perhaps check the sex of the baby, and count all the fingers and toes. For a very few women, the scan may detect something a little more serious – a condition called amniotic band syndrome, or ABS.

Amniotic constriction bands are strands of fluid-filled sacs that surround a baby in the womb. They are caused by a tearing of the inner part of the placenta called the amnion, which produces the fiber-like bands that may trap the baby’s extremities such as the arms, legs, fingers or toes. As the baby grows, the bands constrict or tighten, they cause a reduction in blood supply and they may develop abnormally or become amputated. In more serious cases, the band may cause an abnormal gap in the face, called a cleft, or cause a defect in the abdomen or chest wall. The most severe cases occur if the band becomes wrapped around the head or umbilical cord, which can result in fetal death.

Other names for the condition include Streeter dysplasia, congenital constriction bands or rings, or amniotic deformity adhesions mutilations (ADAM).

Amniotic banding affects approximately 1 in 1,200 to 1 in 15,000 live births. It is also believed to be the cause of about 178 in 10,000 miscarriages. About 80% of cases involve the hands and fingers and a significant number of clubfoot cases are correlated with ABS.

The timing of the rupture is believed to occur between 28 days after conception to 18 weeks of gestation. Late bands can occur and present at birth, even after a normal ultrasound was performed earlier in the pregnancy. The cause is generally unknown. It most often happens spontaneously, but can also occur if the woman experiences trauma to the lower abdomen.

If diagnosed in utero, rare because the individual strands are small and difficult to see, a higher level 3D ultrasound or MRI may be used for a more detailed and accurate diagnosis. Most often, the baby will be monitored throughout the remainder of the pregnancy, particularly if the bands are not in danger of amputating a limb or causing significant deformity. In these cases, fetal surgery, called amniotic band release surgery, may be considered.

After birth, plastic or reconstructive surgery for the infant will be considered, depending upon the extent of the deformity. Other therapies, such as physical or occupational therapy, would also be considered.

Amniotic band syndrome is considered a chance event and does not appear to be hereditary, except in the case of Ehlers-Danlos syndrome (EDS), a connective tissue disorder. The cause of the amnion tearing is often unknown and there are no preventative measures a mother-to-be can take to prevent its occurrence.

Women with a diabetic sibling are at an increased risk of developing gestational diabetes much more than having one or even two diabetic parents, according to a new study in the American Journal of Obstetrics and Gynecology, Reuters reports. The study’s authors said the results seem to suggest that gestational diabetes follows a different inheritance path than Type 2 diabetes, which is typically associated with being overweight.

The study found that having two parents with diabetes increased a woman’s likelihood of having diabetes eightfold but only doubled the likelihood of gestational diabetes. When a woman has a diabetic sibling, there was a sevenfold increase in the risk of gestational diabetes but only a slightly elevated risk of Type 2 diabetes. The results were based on a study of 4,566 mothers who participated in the National Health and Nutritional Examination Survey.

“Sibling-only history may be a greater risk factor than previously documented,” study author Catherine Kim of the University of Michigan Medical School and colleagues wrote. The researchers called for further study of the patterns to identify which women with gestational diabetes have the greatest risk of later developing Type 2 diabetes

Bones, muscles and tendons work together to provide the perfect balance between stability and movement in the skeleton. Now, Weizmann Institute scientists show that this partnership begins in the embryo, when the bones are still taking shape. The study, published in a recent issue of Developmental Cell, describes a previously unrecognized interaction between tendons and bones that drives the development of a strong skeletal system.

‘Our skeleton, with its bones, joints and muscle connections serves us so well in our daily lives that we hardly pay attention to this extraordinary system,’ says Dr. Elazar Zelzer of the Weizmann Institute’s Molecular Genetics Department. ‘Although previous research has uncovered mechanisms that contribute to the development and growth of each component of this complex and wonderfully adaptable organ system, specific interactions between bones, muscles and tendons that drive the assembly of the musculoskeletal system are not fully understood.’

Zelzer, research student Einat Blitz, Sergey Viukov and colleagues, were interested in uncovering the molecular mechanisms that regulate the formation of bone ridges – bony protuberances that provide a stable anchoring point for the tendons that connect muscles with bones. Bone ridges are critical for the skeleton’s ability to cope with the considerable mechanical stresses exerted by the muscles. The researchers used embryonic mouse skeletons to study a bone ridge called the deltoid tuberosity, located on the humerus bone in the arm.

They discovered, to their surprise, that rather than being shaped by processes within the skeleton, bone-ridge formation was directly regulated by tendons and muscles in a two-phase procedure. First, the embryonic tendons initiated bone-ridge formation by attaching to the skeleton. This interaction induced the tendon cells to express a specific protein called scleraxis, which in turn, led to the production of another protein, BMP4 – a molecule involved in the onset of bone formation. Blocking BMP4 production in tendon cells prevented deltoid tuberosity bone ridge formation. In the second phase, the subsequent growth and ultimate size of the deltoid tuberosity was directly regulated by muscle activity.

The results demonstrate that tendons play an active role in initiating bone ridge patterning. Zelzer: ‘These findings provide a new perspective on the regulation of skeletogenesis in the context of the musculoskeletal system, and they shed light on an important mechanism that underlies the assembly of this system.’

The widespread use of so-called fertility drugs, not just high-tech laboratory procedures, likely plays a larger role than previously realized in the growing problem of premature births in the United States, because these drugs cause a high percentage of multiple births, the March of Dimes said today.

The organization’s comments came in response to a study published in the American Journal of Epidemiology by authors from the Centers for Disease Control and Prevention (CDC) and the March of Dimes that found controlled ovarian hyperstimulation (COH) drugs — used to stimulate a woman’s ovaries to speed the maturity and multiply the production of eggs — accounts for four times more live births than assisted reproductive technologies (ARTs) such as in vitro fertilization.

“Many people have focused on the role of ARTs in multiples and have not fully appreciated that fertility drugs alone are responsible for one out of every five multiple births,” said Alan R. Fleischman, M.D., medical director of the March of Dimes. “COH drugs are widely prescribed, and some health care professionals — and their patients — are not aware of the serious risks of fertility drugs to women and their babies. There is a very high possibility of multi-fetal pregnancy resulting from use of these drugs, and that brings a high risk of prematurity and lifelong health problems for the babies as a consequence.”

“The March of Dimes urges more research and leadership from professional societies to develop specific guidelines and encourage acceptance of best practices for the proper use and dosage of fertility drugs, as well as the careful counseling and monitoring of women treated with these drugs. Women who are taking fertility drugs should always ask their doctor what they can do to prevent having a multi-fetal pregnancy,” Dr. Fleischman said.

Dr. Fleischman noted that approximately 88,000 babies are born preterm annually as a result of the recent increase of twins, triplets, and other multiple births. About 60 percent of twins, more than 90 percent of triplets, and virtually all quadruplets and higher-order multiples are born prematurely, he noted. In addition to the increased risks associated with multiple birth, studies have also suggested that even infants born singly, but conceived with ovulation stimulation are at increased risk for preterm delivery than naturally conceived single births, the study authors pointed out.

Dr. Fleischman said it is critical for the American Society for Reproductive Medicine, the American College of Obstetricians and Gynecologists, and other clinical societies to develop clear guidelines on the use of fertility drugs to help prevent many premature births.

The study found that 4.6 percent of live births in 2005 resulted from fertility drug use, a figure 4 times higher than the 1.2 percent of births resulting from ARTs. A total of 22.8 percent of babies born as multiples were conceived using fertility drugs alone.

The study authors conclude that more than 190,000 infants per year are conceived with fertility drug use, but also say this figure is an underestimate because there is no system for population-based surveillance of births resulting from fertility drug treatment.

“The estimates from this analysis, together with separate published estimates from the National ART surveillance system, indicate that in all, approximately 6 percent of US infants are now exposed to ovulation stimulation treatments,” stated Laura Schieve, epidemiologist at the CDC’s National Center on Birth Defects and Developmental Disabilities. “Thus, we must continue to study both the short- and long-term health outcomes among the many women treated and the many children annually conceived with these infertility treatments.”

New research shows that premature babies who listened to the music of Wolfgang Amadeus Mozart get stronger faster, compared to those who do not. Scientists of Tel Aviv University compared infants born prematurely, finding that those who listened to Mozart gained weight faster and became stronger compared to babies who did not listen to music.

Exposing the premature babies to one thirty minute session of Mozart decreased the need for calories. The preterm babies expended less energy after hearing the music.

“It’s not exactly clear how the music is affecting them, but it makes them calmer and less likely to be agitated,” says Dr. Mendel, a lecturer at Tel Aviv University. After listening to Mozart the researchers measured how much energy the premature infants expended at rest finding that the infants were more restful, expending fewer calories.

Dr. Mandel says it is possible that “The repetitive melodies in Mozart’s music may be affecting the organizational centers of the brain’s cortex. Unlike Beethoven, Bach or Bartok, Mozart’s music is composed with a melody that is highly repetitive. This might be the musical explanation. For the scientific one, more investigation is needed.

It is important for babies born prematurely to gain weight before leaving the hospital. The researchers hope to learn more about how exposing premature infants to music can facilitate treatment. “The point of our research is to quantify these effects so that standards and care-guides can be developed. We still don’t know the long-term effects of the music, or if other kinds of music will work just as well.”

Other suggestions to help premature infants gain weight, develop and go home include listening to ethnic music, rap music, pop music, and, and other classical music like Bach, Beethoven and Mozart, says Dr. Mandel. Exposing premature infants to music may lead to an entirely new approach for treating babies born too early.

Feeling guilty that you didn’t breastfeed your children enough or at all? Relax. New research shows that breast milk is not as important for either the mother or the child’s health.

Researchers at the Norwegian University of Science and Technology have found that the association between breastfeeding and healthy children is not as strong as has previously been believed. It is true that breastfed infants are slightly healthier than bottle-fed babies. But apparently it is not the milk that makes the difference. Instead, the baby’s overall health is all determined before he or she is born. So why do so many studies associate breastfeeding with better health for young babies. The answer is simple: If a mother is able to breastfeed, and does so, this ability is essentially proof that the baby has already had an optimal life inside the womb.

Hormones are a determinant

Researchers at NTNU’s Department of Cancer Research and Molecular Medicine have recently found a correlation between the level of male hormones (androgens) in pregnant women and how much the women breastfed after birth.

“Pregnant women who have higher levels of androgens breastfeed less,” says Professor Sven M. Carlsen. “Probably, this is a direct effect of hormones that simply limit nursing ability, by reducing milk production in the breast.”

For example, there is a clear link between testosterone and breastfeeding ability. In fact, until 1980, when more suitable drugs were introduced, testosterone was used to stop milk production in circumstances where it was desirable.

“This was one of the reasons that we wanted to investigate whether the effects attributed to mother’s milk really should be attributed to hormonal factors in pregnant women”, says Carlsen.

Not a matter of will

Carlsen and colleagues have for years researched the connections between the conditions for the foetus in utero, and the effects these conditions have on the newborn. Among other things, they have looked at the relationship between testosterone levels and various risk factors that are believed to affect breastfeeding.

Women who are smokers, or are overweight, or who have the hormonal disorder polycystic ovary syndrome (PCOS) tend to breastfeed less than their peers. All the women in these groups have higher levels of testosterone in their bodies when they are pregnant.

In contrast, the older a woman is, the more likely she is to breastfeed. All these relationships can be explained by the level of testosterone, Carlsen says. “It’s thus not the woman’s will to breastfeed. Women who had more testosterone in their bodies during pregnancy feel the effects of a hormone that limits breastfeeding. That is clearly why it is not as easy to breastfeed.”

Placenta is key

Carlsen believes that it is the placenta, not breast milk, that has more of an effect on children’s health.

“What happens is that there are hormones that come from the foetus that are converted to testosterone and oestrogen in the placenta — if the process goes as it should. This is an energy intensive process. If the placenta does not have enough energy, a portion of the testosterone that would have been converted to oestrogen is in fact not converted. Then what happens is that the testosterone goes to both the mother and child, and probably affects both of them”, he said.

For the mother, this means reduced development of glandular tissue in the breasts, so that the ability to make milk does not develop optimally during pregnancy. This translates into less or no milk breast milk.

For the child, it looks as if increased exposure to testosterone as a foetus can lead to an increased incidence of obesity, type 2 diabetes and polycystic ovary syndrome in girls.

Much fuss

Breastfeeding is less common in younger women, smokers, women who have had preeclampsia or are overweight, or with lower birth weight or premature babies, or in women with PCOS, and when the child is a boy.

There are a number of models that are used to explain this erroneously, Carlsen and his colleagues say. For example, it is claimed that the bond between a mother and her child will not be as strong if the baby is a boy than if the baby is a girl.

“This is the purest nonsense”, Carlsen says. “Boys are not less loved by their mothers than girls. We can blame biology here, not mothers. All these relationships can be explained by one and the same cause, namely the level of male hormones during pregnancy.”

“We find it very interesting that almost all of the factors previously shown to be associated with breastfeeding can be explained by changes in testosterone levels in the mother during pregnancy,” he adds.

Message to new mothers: Relax!

The researcher stresses that it is inappropriate to blame mothers who are unable to breastfeed as much as they are advised. Mothers should not worry that their children will be sicker than children who are breastfed. And even though a child’s health risks have already been established at birth, the differences are so small that they can only be detected when looking at large groups.

Carlsen says mothers should not worry about this. “If you are pregnant, you should live as healthy a lifestyle as possible: quit smoking, cut back on your consumption of coffee and tea, and avoid alcohol”, he says. “And when you give birth, you will do the best that you can, if you want to breastfeed.”

The research adds that if a mother has a hard time breastfeeding, she should just relax and enjoy her newborn. “Don’t let overzealous health professionals give you a guilty conscience” he says.

No breast milk benefit

The researchers reviewed more than fifty international studies about the relationship between breastfeeding and health. Most studies concluded that the more children are nursed, the healthier the children which on the surface is correct, Carlsen says.

“But even if this is statistically true, it is not because of breastfeeding itself. There are very few studies that have examined the underlying controls on breastfeeding ability” he adds.

The largest study that has been done on breastfeeding and health was undertaken in Belarus. More than 17 000 women and children were studied, and the children were followed until they were six years old. This study cuts the legs out from underneath most of the assertions that breastfeeding has health benefits, the researchers say. For example, the Belarus study found no signs that asthma and allergies were less prevalent in children who were nursed for longer than children who were nursed less.

The only area where the study concluded that breastfeeding confers a benefit was in mental abilities.

“It appears that children who are breastfed have a small IQ advantage”, Carlsen says. “But this needs to be confirmed in new, carefully planned and conducted studies.”

Breastfeeding should be out of politics

The researcher believes it is time for nursing enthusiasts to calm down.

“There are many good reasons to breastfeed. But concern for the child’s health is not one of them. There is no reason why women who are struggling to breastfeed should have to go around feeling guilty, or think that they are giving their child a poor start in life if they can’t nurse. Baby formula is as good as breast milk”, Carlsen says.

Carlsen adds that it is far worse for babies to have a tired, stressed-out mother with a guilty conscience, than to forgo breast milk. The health aspects of breastfeeding should be left out of political arguments, he says.

Breastfeeding environmentally sound

Carlsen believes that the strongest reason to encourage mothers to breastfeed is because of the environment. Breastfeeding avoids the environmental costs of producing bottles and formula, and the energy consumption that goes with sterilizing bottles.

Breastfeeding is also the right approach for developing countries, where economics, hygienic conditions and the lack of natural resources makes breastfeeding superior to bottle feeding.

Exercise and diet

A study is underway to see if exercise has an impact on testosterone levels, and thus perhaps also on breastfeeding.

“We would also like to have funding to implement a larger study on the effect of diet and nutrition counselling for pregnant women. There is still much we do not know”, Carlsen said.

The US Food and Drug Administration (FDA) is funding a new programme to study the effects of prescription drugs taken by women while they are pregnant.

The federal agency announced on 30 December that it was setting up a new research programme called the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP) in collaboration with the HMO Research Network Center for Education and Research in Therapeutics (CERT), Kaiser Permanente and Vanderbilt University.

Because of concerns for the health of pregnant women and their unborn children, few clinical trials have tested the safety of drugs in pregnancy, yet according to an article published in the American Journal of Obstetrics and Gynecology, about two-thirds of American women who give birth have taken at least one prescription drug during their pregnancy, reported the FDA.

One way to overcome this predicament is to gather as much information as possible on the health of mothers and babies from cases where the mother took prescribed drugs during pregnancy.

Between them, 11 sites participating in MEPREP will have healthcare information on about 1 million births covering seven years from 2001, said the FDA. In many of these cases the mothers will have used prescribed medication while pregnant, and the program should be able to mine useful research data from the records.

Director of the Office of Surveillance and Epidemiology at the FDA’s Center for Drug Evaluation and Research (CDER), Dr Gerald Dal Pan told the media that:

“Results of these studies will provide valuable information for patients and physicians when making decisions about medication during pregnancy.”

The 11 health-plan affiliated sites involved in the program are the FDA and:

* Kaiser Permanente (Northern California, Southern California, Georgia, Pacific Northwest, and Colorado regions).
* Harvard Pilgrim Health Care Institute.
* Group Health Research Institute.
* HealthPartners, Lovelace Clinic Foundation.
* Meyers Primary Care Institute.
* Tennessee State Medicaid.

The program will be coordinated by the HMO Research Network CERT Data Center at the Department of Population Medicine of Harvard Medical School and Harvard Pilgrim Health Care Institute.

All the lead investigators at the 11 centers have been involved on several studies linked to use of medication in pregnancy and birth outcomes, said the FDA. They have also worked on research looking at the effect of anti-depressants, antibiotics, and cardiovascular drugs on birth defects and birth outcomes.

The FDA did not say when the studies would be completed or when any interim or final reports might be available.