Women's health policy highlights

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

• "Increased Breast Calcifications in Women With ESRD on Dialysis: Implications for Breast Cancer Screening," American Journal of Kidney Disease: Mario Castellanos of the Staten Island University Hospital and colleagues compared the mammograms of 45 women who were on hemodialysis with a control group of 86 age-matched women with normal kidney function (Reuters Health, 8/21). Researchers reported a "statistically significan[t] increase" in the total number of breast calcifications in the group with decreased kidney function, compared with the control group (American Journal of Kidney Diseases, 8/21). Among women in the dialysis group, 84.4% developed breast calcifications, compared with 59.0% of women in the control group, the study finds. The researchers concluded, "Every woman on dialysis therapy should be referred for screening mammography, and the physician taking care of these patients should be aware of the slightly increased risk for workup and possibly resultant psychological stress after screening dialysis patients" (Reuters Health, 8/21).
  
  
• "Tobacco Control Policies: Do They Make a Difference for Low SES Women and Girls?" Journal of Epidemiology and Community Health: Policies that aim to reduce secondhand smoke exposure have been less effective for girls and women of lower economic status than for people of higher economic statues, the report finds. The American Legacy Foundation in the report finds that tobacco control polices have led to a reduction in secondhand smoke exposure for many U.S. residents, and policies such as higher prices have helped to reduce smoking among lower-income women. The report also says women who do not complete high school or who have "blue-collar" jobs are less likely than other women to live in homes without smoke, CQ HealthBeat reports (Abruzzese, CQ HealthBeat, 8/11).
  
  
• "Optimism, Distress, Health-Related Quality of Life, and Change in Cancer Antigen 125 Among Patients With Ovarian Cancer Undergoing Chemotherapy," Psychosomatic Medicine: Janet de Moor of the Ohio State University School of Public Health and colleagues examined the outlook of 90 women with epithelial ovarian cancer at the beginning and end of chemotherapy. De Moor, who conducted the study while at the Dana-Farber Cancer Institute, analyzed the participants' self-reported feelings of optimism and distress, as well as aspects of health-related quality of life among the women, and compared their findings with the women's cancer antigen 125 levels (de Moor et al., Psychosomatic Medicine, 8/1). Decreases in CA 125 levels are used to determine the probability of remission and survival in women with ovarian cancer, Reuters Health reports (Rauscher, Reuters Health, 8/15). According to the study, women who reported higher levels of optimism at the start of chemotherapy experienced greater decreases in anxiety, distress and CA 125 levels than those who reported lower levels of optimism (Psychosomatic Medicine, 8/1). "It is important for health care providers to identify patients who feel less optimistic about life and their cancer and treatment because this population may be vulnerable to distress, diminished quality of life and suboptimum clinical outcomes," de Moor said, adding, "Patients who are less optimistic may benefit from interventions to help them cope with their cancer diagnosis" (Reuters Health, 8/15).