Written by Thu Tran, MD,FACOG
October 23, 2016
Bariatric Surgery and Safer Interval for Pregnancy
A study, published in JAMA, concurs with the recommendation from the American College of Obstetrics and Gynecology for women with bariatric surgery to wait for two years or more after the procedure before getting pregnant. The authors indeed suggest extending this wait to three years.
The researchers, from University of Washington Medical Center in Seattle, analyzed records from 10,296 patients spanning from 1980-2013, and compared pregnancy outcomes of 2,000 women of similar weights who had received bariatric surgery to those who had not undergone the procedure. Those with history of bariatric surgery had higher rates of cesarean section, premature deliveries, neonatal intensive care admissions for their newborns, and lower birth weight. Women whose bariatric surgery was less than two years before conception time had the highest risks.
Morbid obesity has been shown to be correlated with multiple and higher negative outcomes from pregnancy, both for the mother and her baby. Bariatric surgery for qualified women would help prevent some of these risks. However, this study from Washington State University suggest how important it is for patients to pay attention to the optimal time between bariatric surgery and pregnancy, as nutritional deficiencies and other side effects of bariatric procedures could lead to poorer pregnancy outcomes.
HPV Vaccinated Women May Need Less Cervical Screenings
A study from Harvard T.H. Chan School of Public Health in Boston concludes that women who received HPV vaccine may require less frequent cervical screenings for cancer. The researchers believe HPV vaccine greatly reduces the risk of cervical cancer in these women and frequent screenings only increase the healthcare costs or problems with false positive testing.
Dr. Jane Kim, the lead researcher, suggests that those who received the updated HVP vaccine, which protects against seven strains of HPV, should receive screening only every 10 years, from ages 30 to 35, and then stop this screening at age 65. Those who received the earlier version of the vaccine, which protects against two of the most dangerous strains of HPV, should receive cervical screening every 5 years starting from age 25 or 30 years old.
HPV is responsible for nearly all cases of cervical cancer. The earlier version of HPV vaccine reduces the risk of cervical cancer by 70% while the updated vaccine reduces the risk for the receivers by 90%. Unfortunately, the rate of HPV vaccination in the US remains quite low, and more physicians, especially pediatricians, need to inform their patients of this important vaccine.
Intense Anger or Heavy Exertion May Lead to Heart Attack
The Population Health Research Center at McMaster University in Canada reported in the Journal of Circulation that intense anger or heavy physical exertion may double the risk of suffering a heart attack in the next hour in some people. This risk seemed to triple if people were angry while engaging in heavily exerting themselves. This study of 12,000 people from 52 countries, who had their first heart attack, was a much larger study than other studies with similar conclusion.
Dr. Andrew Smyth, the lead researcher, stated that since not all those who were angry or who were engaging in heavy exertion suffered a heart attack, it is likely that only people with pre-existing artery-clogging plaques would be more vulnerable to plaque rupture. Dr. Smyth advised those at risk for a heart attack to avoid heavy exertion when possible, and to learn strategies to avoid extreme anger.
Dr. Barry Jacobs, a spokesman for the American Heart Association, suggested meditation, breathing and relaxation exercises, and anger and stress management programs as possible strategies to avoid extreme emotional stress.
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