Pregnant women often deny smoking

Overall, about one in four women who smoke while pregnant deny it, a new study hints. The numbers could be even higher in certain groups of women, like those in their early 20s.

In the United States, smoking by moms-to-be is one of the most common preventable causes of illness and death among infants, Dr. Patricia Dietz from the division of reproductive health at the Centers for Disease Control and Prevention in Atlanta, and colleagues note in their report.

In their study, they estimated how many pregnant and nonpregnant smokers aged 20 to 44 years did not disclose their habit on a health questionnaire.

How did they catch the deception? They took blood samples from the women to measure levels of cotinine -- a byproduct of nicotine that serves as a marker of exposure to tobacco smoke. Their analysis included 994 pregnant women and 3,203 nonpregnant women.

Overall, 13 percent of pregnant women and 30 percent of nonpregnant women were active cigarette smokers. The pregnant smokers smoked an average of 11 cigarettes a day, while the nonpregnant smokers averaged close to 14 cigarettes a day.

According to the investigators, far more pregnant than nonpregnant smokers failed to disclose their habit - 23 percent versus nine percent - and were identified by their cotinine concentrations.

For a variety of reasons, such as the fact that pregnant women's bodies break down cotinine faster, the researchers think the results "likely underestimate" the true number of pregnant women who smoke and don't say so.

Among both pregnant and nonpregnant smokers, those most likely to keep this information to themselves were women aged 20 to 24, as well as those with Medicaid or other source of government-funded health insurance and those with less than a high school education.

Race also factored in. Pregnant smokers who failed to report their habit were most likely to be non-Hispanic black. In women who weren't pregnant, nondisclosure was most common among Mexican-American women and non-Hispanic blacks.

Writing in the American Journal of Epidemiology, Dietz and her colleagues say their findings may have important implications for researchers studying how smoking during pregnancy affects the developing baby, as roughly one in four pregnant smokers, and one in 10 nonpregnant smokers, deny smoking.

Studies and surveillance systems that rely on people to accurately state their smoking status may get inaccurate information, "especially among pregnant women," they warn.

SOURCE: http://link.reuters.com/tux34r American Journal of Epidemiology

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Posted in: Pregnancy,Women's Issues

Mushrooms and Green Tea May Lower Breast-Cancer Risk

By Margaret Furtado

A recent study reported in the International Journal of Cancer suggests that women who eat large amounts of mushrooms and drink a lot of green tea may be at lower risk for developing breast cancer.

The research trial included more than 2,000 Chinese women, with 1,009 breast-cancer patients (aged 20-87) and an equal number of healthy women matched for age. Each woman completed a detailed dietary questionnaire citing specific foods consumed.

Do mushrooms and green tea affect breast-cancer rates?

The researchers found that the greater the mushroom consumption (both fresh and dried), the lower the breast-cancer risk. Those who ate the greatest amounts of fresh mushrooms (10 grams or more per day) were about 2/3 less likely than those who ate none at all to develop breast cancer. Subjects who ate 4 grams per day saw their breast-cancer risk fall by half.

Interestingly, the women decreased their risk even more if they also drank green tea daily. The breast-cancer risk of women who consumed both mushrooms and green tea was 11 percent, compared to 18 percent for women who didn't consume either food. The study used green tea, which is a "younger" tea but which still has caffeine.

No proof yet

While the researchers eliminated possible confounding factors, this study does not prove that mushrooms and green tea actually reduce a woman's chances of getting breast cancer.

Epidemiological studies, however, do show that in places where the Chinese people are still eating the traditional diet, breast-cancer rates are 4-to-5 times lower than those of most developed countries. (All bets are off if a Chinese woman has switched to eating a westernized diet.)

While this study has not nailed down a cause-and-effect relationship, it is the first to link high dietary consumption of mushrooms and green tea to reduced breast-cancer risk. In addition, those participants who ate at least 10 grams of mushrooms per day saw the greatest reductions in their risk.

So eat some!

Half a cup of raw mushrooms weighs roughly 35 grams, so a little more than 1/8 cup of raw mushrooms a day (about 8 or 9 grams' worth) might just help reduce your breast-cancer risk. Even an 8-ounce cup of raw mushrooms would add up to only 10 calories; therefore, a big helping of these tasty fungi might also help you feel fuller and lose weight. Adding green tea may be a good idea, too.

If you're a mushroom-lover or willing to try them, here are some tips:

• Look for mushrooms that are firm, unblemished, and free of mold or surface moisture (but not dry).
• Store pre-packed containers of mushrooms in airtight plastic bags in the fridge, so they'll hold on to their moisture and won't spoil so rapidly.
• Place loose mushrooms in a paper bag and then in your fridge.
• Squeeze some lemon or lime juice onto raw mushrooms to help them retain their color.
  
  
  from: Yahoo Health

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Posted in: breast cancer,Women's Issues

9 Natural Fertility Boosters

Limit caffeine consumption

Several studies have shown reduced fertility for women who consume more than 300 mg of caffeine each day. Fortunately, the threshold is high enough that you can still indulge in that morning cup o' joe, since the average 8-ounce cup of coffee only has 100 to 130 mg of caffeine. Don't forget, though, that black tea, green tea, chocolate, and some sodas also contain caffeine.

For women undergoing in vitro fertilization, however, the threshold is much lower: A mere 50 mg of caffeine—the equivalent of one cup of tea—can negatively impact success rates.

Alice Domar, an assistant professor at the Harvard Medical School who also counsels women dealing with infertility, suggests that you may want to further restrict your caffeine intake if you've been trying unsuccessfully to get pregnant, even if you're not doing IVF. Since only limited research has been done on the topic, Domar worries that further research may show that lower amounts of caffeine still impact fertility.

"Fertility is a very time-limited period in a woman's life, so try everything you can now," Domar recommends. "There's no downside to further limiting your caffeine intake, and if further research shows that lower caffeine intakes negatively impact even non-IVF women, you'll know you’ve done everything you could."

If you're overweight, lose weight

Being extremely overweight can make a woman less likely to get pregnant. Obesity can inhibit ovulation and wreak havoc with hormones. It also puts women at risk for a variety of health problems (such as diabetes, heart disease and high blood pressure) that negatively impact fertility and can create complications during pregnancy. Women who are morbidly obese are also less likely to be successful with fertility treatments.

Part of the problem is the hormonal imbalance that's created by the fat cells themselves. Fat cells produce extra estrogen, says Gerard Letterie, a reproductive endocrinologist at the Northwest Center for Reproductive Sciences. The more fat cells, the more estrogen, so being overweight is very similar to being on birth control pills.

Domar explains that although female fertility peaks with a body mass index in the low- to mid-20s, weight-related fertility problems are most common in women with a BMI greater than 34, which is considered obese. For instance, a woman who is 5 feet, 4 inches tall and weighs 200 pounds isn't just obese; she’s also jeopardizing her fertility.

If you're having trouble losing weight, Letterie recommends a group weight loss program like Jenny Craig or Weight Watchers. "Studies have shown that women participating in group weight loss programs are the most likely to be successful," says Letterie.

You needn't diet down to a size 8 to get pregnant. "Research shows that when obese women lose an average of 10 to 14 pounds, many will get pregnant the natural way, without medical intervention," Domar says.

If you're underweight, gain weight

A normal, healthy Body Mass Index ranges from 18.5 to 24.9. Anything lower than 18.5 is underweight. For instance, woman who is 5 feet 4 inches tall and weighs 105 pounds has a BMI of 18 and is considered to be underweight.

Being even slightly underweight can dramatically reduce your fertility, as fertility starts to plummet for women with BMIs of 18 or lower.

Women who are underweight are less likely to ovulate. Some will stop menstruating completely. Others will menstruate irregularly. But experiencing a monthly period doesn't necessarily mean you're fertile, since it's possible to menstruate without ovulating.

Sometimes low body weight can be caused by excessive exercise and athletic training, which has also been linked to problems with getting and staying pregnant. For such women, dialing back on the exercise can be enough to gain weight and boost fertility.

For low body weight caused by an eating disorder, it's important to seek professional treatment.

Simply gaining some weight is usually enough for women to begin ovulating again, says Letterie. For those women who don't, Letterie stresses that there are simple treatments to help women ovulate again, but only after they've gained the necessary weight.

Check your BMI

Try acupuncture

In May 2006, the journal Fertility and Sterility published two studies showing significantly increased pregnancy rates for women receiving acupuncture treatments in conjunction with the embryo transfer stage of in vitro fertilization. In one study, women receiving acupuncture were more than twice as likely to become pregnant. In another, acupuncture prior to embryo transfer increased rate of pregnancy by 50 percent.

Researchers aren't sure why acupuncture may be helpful. Some speculate that acupuncture may positively impact hormonal levels or increase blood flow to the ovaries and uterus. Another theory: Since acupuncture can induce a relaxation response, it may be counteracting the stress that often accompanies infertility. Reducing infertility-related stress and anxiety has been shown to increase success for IVF treatments.

Despite the positive findings, scientists agree that more research needs to prove that acupuncture is truly effective.

Although Domar herself has called for more rigorous testing of acupuncture, specifically to sort out the issue of the placebo effect, that hasn’t stopped her from recommending acupuncture to her infertility patients. "There is some very promising data out there," Domar says. "Acupuncture is a safe, cheap, non-invasive and easy way to potentially increase your chances of getting pregnant."

Walk 30 minutes per day

Walking just 30 minutes each day is a simple, inexpensive form of exercise that helps ward off problems like heart disease and diabetes, diseases which may impact fertility and can cause complications during pregnancy. In addition, regular exercise helps maintain a normal body weight, which is an important part of maximizing fertility.

Walking may also help boost fertility by increasing circulation to the pelvis and the reproductive organs, since some research has linked decreased blood-flow to the ovaries with ovarian aging and reduced success with in-vitro fertilization.

"Many couples I see have jobs that require them to sit all day in front of the computer. This doesn't do much for circulation to the pelvis and the reproductive organs," says Dr. Susan Carr, a naturopathic physician at Fertile Path in western Washington state. "Exercise is one way to support circulation to these organs."

Daily physical activity is also a great way to improve your mood and help ward off the stress and depression that are common side effects of infertility.

Thirty minutes a day is easy to fit into even the busiest of schedules and can provide a great opportunity to spend quality time with your partner or a good friend.

Deal with depression

While many experts believe that depression doesn't cause infertility, proper treatment for depression can help increase fertility.

Since it's not uncommon for women struggling with infertility to become depressed, try joining a fertility-focused mind-body group. These groups teach techniques to relax and manage the stress and anxiety associated with infertility. Research conducted at the Harvard Medical School found that women undergoing in vitro fertilization who participated in a 10-week mind-body program were more than twice as likely to get pregnant.

If you were seriously depressed before attempting to get pregnant, it's important to seek prompt treatment from a mental health professional. "Women with severe clinical depression are much less likely to eat well, exercise, and otherwise take care of themselves," says Domar. "And women who are less healthy are less likely to get pregnant."

While anti-depressants can be effective in the short term, Letterie encourages women to work with their doctors to get on the lowest dose possible. Ideally, he'd like to see women weaned off of prescriptions before getting pregnant, since taking medication during pregnancy is not without risks.

To learn to manage depression without drugs, Domar recommends that women work with a cognitive behavioral therapist to learn effective ways of dealing with depression. The Association for Behavioral and Cognitive Therapies maintains a database of therapists trained in cognitive behavioral techniques.

Eat a balanced diet

To maximize your chances of conception and a healthy pregnancy, Carr and Domar both recommend eating a healthy, unprocessed diet rich in whole grains, beans, fresh fruit and vegetables, raw nuts and seeds (skip the ones with added oil and salt), healthy oils (like olive oil), lean meat, and cold-water fish like wild salmon that are high in omega-3 fatty acids.

A balanced, whole-foods diet will help you maintain a normal BMI, a critical component in maximizing fertility. In addition, by eating well and minimizing unhealthy fats, white flour, sugar, and salt, you'll reduce your risk of diabetes, heart disease, and high blood pressure—diseases that can decrease your fertility and also cause complications in pregnancy.

To further boost your chances of conception, Carr recommends emphasizing foods that are rich in omega-3 fatty acids, such as wild, cold-water fish, walnuts, and flax seeds. "Omega-3 fatty acids promote fertility, since essential fats are required for hormone balance and healthy cell function," says Carr. "Unfortunately, most diets are deficient."

With just a little extra planning, it's easy to integrate more whole foods into your diet. For breakfast, try a bowl of oatmeal with fresh fruit. For lunch, have a sandwich on whole-grain bread or a colorful salad with olive oil and vinegar. Fresh fruits, as well as raw nuts and seeds, make excellent mid-afternoon snacks. "Just be intelligent about your health," says Domar. "Given a choice between fried dough and an apple, we all know which one to pick."

Strictly limit alcohol consumption

Most reproductive experts agree that one or two drinks each week shouldn’t impact a woman's chances of getting pregnant, while excessive drinking is clearly problematic. However, the jury is still out on exactly how much a woman can drink before her fertility is affected.

While a couple of studies have found no link between moderate alcohol (one to two drinks each day) intake and fertility, one Danish study from 2003 found that just seven drinks a week could negatively impact the chances of conceiving for women more than 30 years old. Another Danish study from 1998 found that even moderate drinking (6 to 10 drinks each week) reduced a woman's chances of getting pregnant, with more excessive drinking further decreasing the chances of conceiving.

For women who are heavier drinkers, Letterie recommends that they get their drinking problem under control before they try to conceive, especially since it's critically important that women cut out alcohol completely once pregnant.

Although it's still unclear whether or not moderate drinking will negatively impact fertility, limiting alcohol consumption to only one or two drinks each week surely won't hurt, especially if you’ve been trying unsuccessfully to get pregnant for more than a few months.

In addition, you should stop drinking after you ovulate during any cycle in which you try to conceive. Alcohol consumption after conception can increase the risk of miscarriage and can cause fetal alcohol syndrome.

Stop smoking and avoid second-hand smoke

More than 100 research studies have consistently linked smoking to decreased fertility and increased problems in carrying a birth to term, says Dr. David Adamson, a reproductive endocrinologist at Advanced Reproductive Care in Palo Alto, Calif.

Smoking damages eggs, reducing the chances of getting pregnant during any given cycle, and smokers may hit menopause several years earlier than their non-smoking peers. Smoking also negatively impacts hormone levels, further reducing fertility.

The problems don't end when a smoker gets pregnant. Smokers are more likely to suffer from miscarriage and complication during their pregnancies, and babies born to smokers are more likely to be underweight.

Although smoking does damage eggs, quitting now can still help boost fertility. Going smoke-free will prevent further reduction in egg quality, help reverse hormonal changes, and increase the chances of carrying a healthy baby to term.

According to the American Society for Reproductive Medicine, it's not enough for just the woman to stop smoking, since second-hand smoke has been shown to be almost as bad for a woman's fertility as actually smoking. Since smoking also reduces fertility in men, it makes sense to make quitting a family affair.

By Lisa Farino for MSN Health & Fitness

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Posted in: Pregnancy,women's Fitness,Women's Issues

Health Tips Every Woman Should Know

Ask a doctor for her one absolute best piece of advice, and what you hear may surprise you. We got that golden nugget from some of the country’s top medical experts—read them and get healthier.

3 ways to get the most out of your doctor visit

"Know what you want out of your next M.D. visit: a diagnosis, a referral to a specialist? Keep your focus and you’ll be more likely to get what you need."—Doctor/patient relations expert Vicki Rackner, M.D.

"Don’t be scared or embarrassed to talk to your doctor—about anything. Of course my patients are reluctant to bring up complaints about things like butt pimples, excessive sweating and body odor, but unless you speak up, you’ll only continue to suffer."—Dermatologist David E. Bank, M.D., author of Beautiful Skin

"Tell your doctor about any supplements you take. Some can have dangerous interactions with prescription drugs."—Gastroenterologist Brian E. Lacy, Ph.D., M.D.

Slash your cancer risk

"Know your family history of cancer. If parents, siblings, grandparents, aunts or uncles were diagnosed before 50, you may be at an especially high risk."—Oncologist Leslie R. DeMars, M.D.

"Aim for 800 to 1,000 IUs of vitamin D a day from a D3 pill. It's often hard to get enough from sunlight in winter—and mounting evidence shows D is not only important for bones, but may also help prevent cancer and heart disease."—Harvard University professor JoAnn E. Manson, M.D.

Easy weight loss tips

"Think percentages, not pounds; they’re less scary. If you're overweight, losing just 5 to 10 percent of your body weight can slash health risks."—Physician nutrition specialist Melina B. Jampolis, M.D.

"If you want to feel full on fewer calories, stick to foods that are high in water, like fruits, vegetables and healthy proteins. Feeling full is based on volume, not calories."—Obesity and nutrition expert William Dietz, M.D., Ph.D.

3 things healthy women do

"If you want to start a healthy habit, make your intention very concrete and specific, like, 'put on sneakers as soon as I get home and walk 10 blocks' instead of just 'exercise more often.'"—Psychologist John A. Bargh, Ph.D.

"Go to good health sites like cdc.gov."—Physician Lori J. Heim, M.D.

"Be future-focused. Most young women are pretty healthy—the problem isn’t their current situation, but where their lifestyle will lead them when they get older. Making changes now, like exercising more and eating better, is like putting money into a bank account."—Internist Robert Lamberts, M.D.

2 heart health tips

"Eat less salt. You may be a healthy young thing now, but half of women over 45 have high blood pressure, and a lot of that is due to sodium."—Cardiologist Nieca Goldberg, M.D.

"Every night before going to sleep, lie on your back and hang your head and shoulders off the bed for up to two minutes. This opens up your chest, increasing blood supply to your lungs and heart, and can help prevent bad posture from hours of hunching over a desk at work."—Ob-gyn Christiane Northrup, M.D., author of Women's Bodies, Women's Wisdom

Reduce your risk of skin cancer

"Do a skin check once a month when you're getting out of the shower. While you put on your moisturizer, look for any striking, dark or changing spots or moles."—Dermatologic surgeon Ellen Marmur, M.D.

"Wear a hat when you're in the sun. I had a patient who always wore sunblock on her face and body but assumed her scalp was fine. One day she found an itchy spot on her head that turned out to be cancer."—Plastic surgeon Michael E. Jones, M.D.

Keep your mouth healthy

"If you don’t floss, at least use an electric toothbrush to get into crannies and fight gum disease."—Dentist Michael Kosdon, D.D.S.

"Rinse your mouth out after drinking a soda. Doing so will help wash its enamel-eroding acids off your teeth."—Dentist Kenneth Magid, D.D.S.

4 healthy eating habits

"Everything you eat should make you stronger, like whole grains for your heart or veggies for immunity. Make 85 percent of your choices this way and you'll be healthier and thinner."—Steven Lamm, M.D., author of Stronger

"Switch from olive oil to canola oil for cooking. Canola has less saturated fat and a lot more omega-3 fatty acids, which have been shown to do everything from lift mood to fight heart disease."—Cardiologist Robert Vogel, M.D., co-author of The Pritikin Edge

"Have a vegetable or fruit at every meal. Boom, healthier."—Eating behaviors researcher Brian Wansink, Ph.D.

"Eat global. Spices like cinnamon and turmeric in Indian and Thai cuisines add flavor and have health benefits, like fighting cancer."—Andrew Weil, M.D., director of the University of Arizona Center for Integrative Medicine

2 ways to boost your immune system

"If you’re truly sick, don’t go to work! You'll just prolong your own illness."—Family doctor Zach Rosen, M.D.

"Wash your hands. Period."—Ear, nose and throat specialist Ralph B. Metson, M.D.

3 keys to happiness

"Get a pet! People with them tend to have better physical health, partly because you have to do active things to maintain them—walk the dog, play with the cat or clean a birdcage. Interacting with pets may also lower blood pressure, decrease anxiety and improve your mood."—Family medicine specialist Jane Sadler, M.D.

"Unplug and talk to someone face-to-face. Facebook, IM and e-mail are all great ways to stay in touch, but actually seeing people and interacting with them is key for mental health."—Family medicine specialist Wilson Pace, M.D.

"Don't be with someone who makes you miserable! When women say a relationship is a huge headache, there could be literal truth to that. Emotions can lead to very real pain."—Psychiatrist Charles Sophy, D.O.

Sleep better: here’s how

"Set your alarm for the time you actually have to get up. Interrupting a sleep cycle to hit snooze will leave you groggy despite the extra' rest."—Sleep specialist Michael Breus, Ph.D.

"Keep things dark if you want a good night’s sleep. Leaving the TV or your reading light on lowers melatonin production, which, in turn, disrupts your sleep cycle."—Mark Liponis, M.D., corporate medical director for Canyon Ranch Health Resorts

"Rid your bedroom of anything that distracts you from sleep or sex. More of both will help keep you healthy and happy."—Michael F. Roizen, M.D., co-author of You: Being Beautiful

3 diet tips

"Toss your diet books—just eat lots of multicolored foods that were recently alive. You know, like vegetables and fruits."—Integrative medicine specialist David P. Rakel, M.D.

"Never crash diet. Research shows it can make you depressed. Nourishing your body also nourishes your mind."—Psychiatrist David Herzog, M.D.

"Remember that every meal is not your last. There will be another turkey dinner, another plate of spaghetti, another brownie. If you keep in mind that this is not your last chance to eat a food you love, it will be easier for you to put down your fork when you've had enough."—Barbara Rolls, Ph.D., author of The Volumetrics Eating Plan

A health treat for your feet

"Go ahead, buy new shoes. Fortunately, platform heels made a huge comeback. You get the height of a stiletto without the arch-busting 45-degree angle that puts so much pressure on the balls of your feet. And the wider heels provide much better support and stability than regular pumps."—Orthopedic surgeon Johnny Benjamin, M.D

3 more keys to happiness

"Get happy. In one study, positive people injected with the cold virus were less likely to get sick than their less happy peers. Happier types live longer too."—Sonja Lyubomirsky, Ph.D., author of The How of Happiness

"Help someone. You can exercise like a maniac and still not feel truly healthy and alive. But stepping beyond yourself makes you realize that you're part of something bigger and more profound. My experience and research show that it leads to better health."—Integrative medicine expert Woodson Merrell, M.D.

"Make sure your needs count. As a woman, you have a breathtaking ability to care for others, but don't relinquish your own health."—Internist Drew Pinsky, M.D.

Easy exercise advice

"Lose unhealthy extra weight now. It'll be much easier to do it in your 20s and 30s than later, when metabolism slows down."—Cardiologist Lori Mosca, M.D., Ph.D., author of Heart to Heart

"I subscribe to the elevator diet: I don't use them! Any activity helps your heart and waistline."—Pamela Peeke, M.D., author of Body for Life for Women

"Consider exercise an everyday thing, like brushing your teeth. It's the best thing you can do for your whole body."—Sports medicine specialist Robert Sallis, M.D.

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Posted in: women's Fitness,Women's Issues

Is Breast Cancer Incidence on the Rise?

By Lillie Shockney, R.N., M.A.S. -

Feel like you can't open a woman's magazine or watch TV without hearing something about breast cancer?

I think we hear more about breast cancer today because in 1992 it "came out of the closet," if you will. That was the year the pink ribbon was introduced to boost breast cancer awareness. People decided to buy them like crazy, and by wearing the pin, start telling others they either had breast cancer or loved someone who has it or survived it.

And with those pink ribbons came a more relaxed and comfortable attitude about breast cancer, talking about it in public and discussing it in open forums—always with the goal that by raising awareness we could save more lives (and breasts). And it's worked.

Another logical explanation of why we're hearing so much about breast cancer these days is that the incidence of breast cancer is increasing. Why?

Well, one reason why reported cases are on the rise is because there's just a lot more women today who are at risk. As of July 1, 2005, the U.S. Census Bureau estimated there were 78.2 million people—baby boomers—born between 1946 and 1964. Since about half of those are women, it follows that the more women there are the more women will develop breast cancer. Statistics suggest that about 1 of every 1,326 women develops breast cancer.

Another reason for a rise in breast cancer cases is that more women are at risk. More women are overweight today and—since we store estogen in our body fat—we are carrying more estrogen around in our bodies. More women are letting their careers take off now too, and starting their families later. While this is is a wonderful trend, the downside is that we know a woman's risk for breast cancer increases when she delays her first pregnancy beyond age 30.

Here's another risk factor: Women are still smoking and drinking alcohol, both of which are risk factors for breast cancer. And we also suspect that certain substances in the environment increase risk, but we really don't have an understanding, yet, of what or how.

There are two positive aspects to all of this:

• The stats on surviving cancer continue to improve by about 1 percent each year and have for several years.
• Perhaps because of the media focus on breast cancer, the numbers of women getting screening mammograms and doing breast self exams is increasing, both of which help catch breast cancer at an early, treatable stage.

I look forward to the day when I'm out of a job because breast cancer has been eradicated. If that day is ever going to come, however, you need to stay informed. Read the articles in the women's magazines, get your annual mammograms, and see your doctor for annual clinical breast exams.

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Posted in: breast cancer,Women's Issues

How Risky Is a Multiple Pregnancy?

By Jean Weiss for MSN Health & Fitness

MSN Health & Fitness Exclusive

The idea of having multiple babies at the same time at first might sound tantalizing. One grueling nine-month period and voilà: You're on your way to synchronized play dates and kids helping each other with homework. The reality is, if you birth multiples, meaning you house more than one baby in your womb, you are less likely to end up appearing on TV and scoring a book deal than you are to end up grappling with complex health issues that last a lifetime. It's worth it, then, to take a look at how multiple births occur, and how having one can affect a family in the short term and over time.

How are multiple pregnancies conceived?

Only 2 percent of multiples are conceived naturally, says William Schoolcraft, M.D., founder and medical director of the Colorado Center for Reproductive Medicine, a Denver fertility clinic widely regarded as one of the best in the world. When we think of a multiple birth, most of us think of in vitro fertilization, but the majority of multiple births, especially those with triplets or higher, are the result of injecting fertility drugs, says Schoolcraft.

In vitro offers a physician more control over how many eggs are implanted in a woman's womb. Clomid, a fertility drug taken orally, increases the likelihood of a twin pregnancy. A pregnancy with triplets, quadruplets, or more is usually the result of injected fertility drugs, along with sexual intercourse or artificial insemination.

"With injected fertility drugs, you can get lots of eggs, perhaps 10 eggs or more, and you really don't have control of how many eggs are produced," says Schoolcraft. "You can look and think you see three or four follicles, but there may be a couple more hiding. [They're] easy to miss." Because of this margin of error, many physicians steer clear of injecting fertility drugs, and instead use Clomid or in vitro. "More and more, doctors are shying away from these injectable drug treatments," says Schoolcraft.

Are multiple births regulated?

While no laws exist in the U.S. to dictate the occupancy limits of a woman's womb, the American Society of Reproductive Medicine has established clear guidelines by which reputable clinics and physicians abide. If a doctor is a member of ASRM, then he or she agrees to follow these standards. The standards are age-based and determined by the likelihood of successful embryo implantation. (The older you are, the more likely it is that you will need to try with more embryos to result in a viable pregnancy.) The ASRM recommends:

Women under 35 should ideally receive one embryo, but no more than two embryos

Women between 35 and 37 are to receive no more than two or three embryos

Women between ages 38 to 40, three or four embryos

Women older than 40 years, no more than five

"So with a 33-year old, you are going to be more careful, because her chance of keeping all embryos [is] greater," says Schoolcraft. "At the age of 41, twins, or more, are uncommon even with the transfer of multiple embryos."

It's a numbers game, and no one can be sure of the outcome. "We have to balance the desire to get pregnant against the risk of multiples, and at the same time we have to make adjustments for age," says Schoolcraft. "Our goal is to avoid triplets at all cost. We try to avoid twins, but the [health] risk [faced by] twins isn't nearly as great."

The ASRM guidelines used to recommend that physicians implant more embryos. That was until 1998, when Schoolcraft's clinic pioneered a method of in vitro fertilization called blastocyst transfer. Using this technique, doctors are able to grow embryos in a petri dish for five days, a longer period of time than had been previously possible. After the five-day time period, it's easier to identify which embryos are most viable, allowing a higher success rate of implantation—thereby lowering the need to implant more embryos than ideally wanted by the mother.

A focus on one healthy embryo

"Most researchers focus on identifying ways to access the best embryo, so we can make one viable pregnancy. We're getting close to the day where we can just put back one embryo and have success."

A woman in the U.S. would receive more than the regulated amount of implanted embryos only if her physician identified a special need. "Rarely, exceptions are made," says Schoolcraft. "You have to make a note in the chart, explaining what are the medical circumstances justifying this altered judgment."

"An octuplet scenario is extreme," says Schoolcraft.

Worldwide, in vitro standards differ from those in the U.S. "In Europe, there are many countries where the government pays for in vitro, and because they pay for it, they can regulate it." In many European countries, the governments allow a physician to implant only one embryo at a time, therefore the pregnancy success rates from in vitro are lower in Europe than in the U.S., says Schoolcraft. In more developing countries, where technology is less sophisticated and there are fewer regulations, physicians are implanting more embryos than what is recommended in the U.S., he says.

What are the health risks for multiple babies?

The ASRM establishes guideline for embryo implantation because the risk factors for multiples are concerning. The biggest risk factor for multiple babies is premature birth, which is defined as one that occurs before 37 weeks' gestation. The average gestation for a single birth baby is 40 weeks; the average gestation for twins is 35 weeks. For triplets, it's 33 weeks, and for quadruplets, the average gestation is 29 weeks. "There is a big risk for premature birth, and the risk goes up the more babies that are inside," says Schoolcraft. "The more premature the babies are, the more complications they suffer."

One issue is nutrition while in utero. Multiple babies and multiple placentas compete for nutrients from the mom, says Schoolcraft. "They can be undernourished, compared to babies who have a uterus all to themselves."

Premature babies are also more likely to have the following health problems, according to the March of Dimes:

Unformed organs

Brain bleeds

Feeding difficulties

Mental retardation

Jaundice

Breathing problems, including asthma later in life

Vision and hearing problems, including blindness and hearing loss

Cerebral palsy (which is three times as common in babies born at 37 weeks compared to full-term infants, and eight times as likely in those born between 30 and 33 weeks)

Developmental delays

Preterm birth is also the leading cause of death in the first month of life.

Sometimes, additional health problems surface later in life, says Schoolcraft. "This is what is behind these guidelines from the American Society of Reproductive Medicine," says Schoolcraft. "Clearly, most physicians in our field would consider triplets a complication to be avoided if at all possible."

What are the health risks for the mother?

And what about the mother? Not that any moms get much attention after the birth of their child, whether one or many. But having multiples does take an exponential toll. Any nutrient depletion the mother may undergo, due to her body's prioritizing the nutrients she eats and stores in her body to be diverted to her babies, can be made up after birth, says Schoolcraft.

However, a mother carrying multiples has an increased risk of the following complications during her pregnancy:

Preeclampsia (high blood pressure, which can lead to eclampsia, which is sometimes fatal)

Gestational diabetes (which has been linked to a greater likelihood of diabetes later in life)

Blood clots

She also, obviously, has an increased chance in having a C-section, especially if pregnant with more than two babies.

She's also at higher risk for postpartum complications, including:

Hemorrhaging

Exhaustion

Postpartum depression

This last one is, once again, a numbers game. Any parent knows it would clearly be easier to secure and ride an elephant through the streets of New York, than to try and coordinate the nighttime sleep habits of two or more newborns.

Can multiples be emotionally healthy?

It can be tough attending to every little need of a baby, yet interaction with a primary-care provider is integral for a child's emotional development. In fact, some theories suggest that close attention to your child's needs during the first year of life, especially between six to 12 months, is a sound start to his or her emotional well-being.

Studies have shown that multiples are at risk for receiving less of this critical caregiver attention, despite a parent's best efforts. One study published in the Journal of Advanced Nursing in December 2001 found that twins and triplets received less individual attention than single infants. Though parents in this study were capable and had proficient childcaring strategies in place, they simply were unable to provide the same level of care. Their multiple children were talked to, held, and looked at less, and left alone more often, than the children of parents who'd birthed one child at a time.

Preemie babies also are at risk for lack of human touch and attention. Though, according to information from the Hospital for Sick Children in Toronto, Canada, any deficiencies that develop during a preemie's stay in the hospital—when incubators and medical equipment can prevent a preemie from being held—can be made up through adequate parental attention within the subsequent two years. If a parent has enough resources in place to offer the right attention and care, it's possible to develop a strong attachment bond.

The book Preemies (Pocket, 2000), co-authored by neonatologist Mia Wechsler Doron, M.D, and Dana Wechsler Linden and Emma Trenti Paroli (both parents of preemies), states that if, for some reason, the child does not receive enough loving care for a long period of time, he or she can develop failure to thrive, a disorder in which a child doesn't grow normally. There's also the risk of developing attachment disorder. Children with attachment disorder are unable to form trusting affectionate relationships and are unable to comfort themselves.

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Posted in: Pregnancy,Women's Issues

Drinking Raises Cancer Risk for Middle-Age Women

By Steven Reinberg, HealthDay Reporter

"Even relatively low levels of drinking -- on the order of one alcoholic drink per day -- increase a woman's risk of developing cancer," said lead researcher Naomi Allen, from the cancer epidemiology unit at the University of Oxford in the United Kingdom. "Because a high proportion of women drink low amounts of alcohol regularly and because most of the increased risk is for breast cancer, the risk among women associated with drinking alcohol is of particular importance."

In fact, the study found that moderate drinking accounts for 13 percent of breast, liver, rectum and upper respiratory/digestive tract cancers among women.

The association between moderate alcohol intake and breast cancer in women is well-known, the researchers point out. What's new here, they say, is the finding that even low levels of drinking can raise a woman's risk of developing cancer of the liver and rectum. For women who smoke, cancers of the mouth and throat were also linked to high alcohol consumption.

The report is published in the Feb. 24 online edition of the Journal of the National Cancer Institute.

For the study, Allen's team collected data on more than 1.2 million middle-age British women participating in the Million Women Study. The researchers used the National Health Service Central Registries to identify cancer cases among these women.

Most women in the study had about a drink a day, and a smaller percentage had three or more drinks a day, the researchers found. Over more than seven years of follow-up, 68,775 women developed cancer.

"These findings are robust, and alcohol consumption was assessed several times before women were diagnosed with cancer, making these estimates reliable," Allen said.

Overall, the risk of cancer increased as alcohol consumption increased. The type of alcohol consumed appeared to make no difference.

Women who drank and also smoked faced increased risk of cancers of the oral cavity and pharynx, esophagus, and larynx (voice box), the researchers found.

The study suggests "that in developed countries, where women typically consume low-moderate amounts of alcohol, we estimate that for every additional drink regularly consumed each day, there would be about 15 extra cases of cancers of the breast, liver, rectum and mouth and throat diagnosed for every 1,000 women up to the age of 75," Allen said. "Most of this excess risk is due to breast cancer."

Susan M. Gapstur, vice president of epidemiology at the American Cancer Society, said the findings confirm and expand on those from previous studies in men and in smaller cohorts of women.

But several questions remain unanswered, she said. "For example, researchers remain concerned about the pattern of consumption," Gapstur said. "It is unclear, for example, whether someone who drinks several glasses of wine on one day during the week has the same risk as someone who drinks one glass of wine per day with a meal. In addition, the effects of quitting or reducing drinking on cancer risk are also unclear."

The American Cancer Society currently recommends limiting intake to one drink a day for women and two drinks a day for men, Gapstur said.

On the other hand, numerous studies have suggested that alcohol, especially red wine, might help deter heart disease -- complicating decisions around drinking and health.

"If you do not drink, there is no reason to start drinking," Gapstur reasoned. "However, in light of the findings from the Million Women Study, women who are concerned about their cancer risk versus their risk of cardiovascular disease might want to discuss the potential risks and benefits of even low alcohol intake with their health-care providers."

In an accompanying journal editorial, Dr. Michael Lauer, director of the Division of Prevention and Population Sciences at the U.S. National Heart, Lung and Blood Institute, said he believes the risk for cancer might outweigh any perceived benefit in terms of heart disease.

"People who are not drinkers should not start drinking to prevent heart disease, and even people who are drinking should discuss this with their physicians," he said. "And as part of that conversation, they should consider other conditions than heart disease. We cannot just focus on heart disease."

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Posted in: cancer,Diet,Women's Issues