Women’s News – Heartburn during pregnancy

Heartburn symptoms are one of the most commonly reported complaints among pregnant women.

Heartburn usually starts during the first trimester and tends to worsen during the second and third trimesters.

Studies have shown elevated levels of the hormone progesterone accompanied by increased intra-abdominal pressures from the enlarging uterus, may lower esophageal sphincter (LES) pressure in pregnant women contributing to heartburn symptoms, according to research highlighted in the newly updated “Pregnancy in Gastrointestinal Disorders” monograph by the American College of Gastroenterology (ACG).

From the monograph, physician experts from ACG have compiled important health tips on managing heartburn symptoms, and importantly, identifying which heartburn medications are safe for use in pregnant women and those, which should be avoided.

Strategies to Ease Heartburn Symptoms during Pregnancy
According to the ACG, pregnant women can treat and relieve their heartburn symptoms through lifestyle and dietary changes. The following tips can help reduce heartburn discomfort:

1. Avoid eating late at night or before retiring to bed. Common heartburn triggers include greasy or spicy food, chocolate, peppermint, tomato sauces, caffeine, carbonated drinks, and citrus fruits.
2. Wear loose-fitting clothes. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.
3. Eat smaller meals. Overfilling the stomach can result in acid reflux and heartburn.
4. Don’t lie down after eating. Wait at least 3 hours after eating before going to bed. When you lie down, it’s easier for stomach contents (including acid) to back up into the esophagus, particularly when you go to bed with a full stomach.
5. Raise the head of the bed 4 to 6 inches. This can help reduce acid reflux by decreasing the amount of gastric contents that reach the lower esophagus.
6. Avoid tobacco and alcohol. Abstinence from alcohol and smoking can help reduce reflux symptoms and avoid fetal exposure to potentially harmful substances.

The Do’s and Don’ts of Using Heartburn Drugs during Pregnancy
Pregnant women with mild reflux usually do well with simple lifestyle changes. If lifestyle and dietary changes are not enough, you should consult your doctor before taking any medication to relieve heartburn symptoms.

According to ACG President Amy E. Foxx-Orenstein, DO, FACG, “Heartburn medications to treat acid reflux during pregnancy should be balanced to alleviate the mother’s symptoms of heartburn, while protecting the developing fetus.”

Based on a review of published scientific clinical studies (in animals and humans) on the safety of heartburn medications during pregnancy, researchers conclude there are certain drugs that are considered safe for use in pregnancy and those which should be avoided.

Antacids are one of the most common over-the-counter medications to treat heartburn. As with any drug, antacids should be used cautiously during pregnancy.

Antacids

1. Antacids containing aluminum, calcium, or magnesium are considered safe and effective in treating the heartburn of pregnancy.
2. Magnesium-containing antacids should be avoided during the last trimester of pregnancy because it could interfere with uterine contractions during labor.
3. Avoid antacids containing sodium bicarbonate. Sodium bicarbonate could cause metabolic alkalosis and increase the potential of fluid overload in both the fetus and mother.

Histamine-type II (H-2) Receptor Antagonists
While limited data exists in humans on the safety of histamine-type II (H-2) receptor antagonists, ranitidine (Zantac?) is the only H-2 antagonist, which has been studied specifically during pregnancy.

In a double-blind, placebo controlled, triple crossover study, ranitidine (Zantac?) taken once or twice daily in pregnant heartburn patients not responding to antacids and lifestyle modification, was found to be more effective than placebo in reducing the symptoms of heartburn and acid regurgitation. No adverse effects on the fetus were reported. (Larson JD, et al., “Double-blind placebo-controlled study of ranitidine for gastroesophageal reflux symptoms during pregnancy.” Obstet Gynecol 1997; 90:83-7.)

A study on the safety of cimetidine (Tagamet?) and ranitidine (Zantac?) suggests that pregnant women taking these drugs from the first trimester through their entire pregnancy have delivered normal babies. (Richter JE., “Gastroesophageal reflux disease during pregnancy. Gastroenterol Clin N Am 2003; 32:235-61.)

Proton Pump Inhibitors
Proton pump inhibitors should be reserved for pregnant patients with more severe heartburn symptoms and those not responding to antacids and lifestyle and dietary changes. Lansoprazole (Prevacid?) is the preferred PPI because of case reports of safety in pregnant women. Limited data exists about human safety during pregnancy with the newer PPIs.

Women’s Health – Clinical guidance for managing pregnant patients

Physician experts from the American College of Gastroenterology have released an updated educational monograph highlighting the unique clinical challenges of caring for women with chronic digestive disorders during pregnancy and managing GI complications relating to pregnancy.

“Given the large number of pregnancies each year complicated by GI disorders, gastroenterologists need to be aware of the underlying physiologic changes in GI motility during pregnancy and provide appropriate therapy for pregnant patients with special consideration being given to the safety of the mother and fetus,” according to ACG President Amy E. Foxx-Orenstein, DO, FACG.

This seven-chapter monograph entitled, “Pregnancy in Gastrointestinal Disorders,” provides up-to-date clinical recommendations on managing common gastrointestinal disorders and challenges during pregnancy:

• Constipation
• Diarrhea
• Hemorrhoids
• Heartburn
• Nausea
• Vomiting
• Hyperemesis gravidarum
• Liver diseases in pregnancy
• General guidelines for sedation and surgery
• Endoscopy in pregnancy
• Managing inflammatory bowel disease during pregnancy

The monograph explores the physiologic changes during pregnancy that may contribute to GI disorders in pregnant patients. Various studies attribute increased levels of female sex hormones, particularly progesterone, with changes in GI motility in pregnancy. Another highlighted study found elevated levels of progesterone accompanied by increased intra-abdominal pressures from the enlarging uterus, may lower esophageal sphincter (LES) pressure contributing to heartburn symptoms, one of the most commonly reported complaints of pregnant women.

Another important focus of the monograph addresses the challenges encountered in the treatment and management of chronic digestive disorders in pregnancy. It includes a discussion of pharmacologic and alternative therapies available to treat GI symptoms in pregnancy and, importantly, identifies which medications are safe for use in pregnant women and those which should be avoided.

“The major risk to the fetus is encountered during the first trimester of pregnancy,” says Dr. Foxx-Orenstein. “It is important for physicians and expectant mothers to maintain a high level of concern for the use of prescription and over-the-counter drugs to treat GI symptoms during pregnancy.”

The authors of the monograph also evaluated the safety of endoscopy during pregnancy. Based on a review of published scientific studies, they conclude endoscopy appears to be a safe modality for evaluating GI symptoms in pregnancy.

Women’s Health – Topical treatment for age spots

Sun-induced skin damage can cause brown age spots, especially on oft-exposed areas like the hands and face.

At one time, the only remedy was to cover them up with cosmetics. Now, there are therapies that help reverse the signs of photoaging at the physiological level. One approach is physical removal by surgery, microdermabrasion, or chemical peel. But many women prefer something gentler, and topical medications can help, reports the December 2007 issue of Harvard Women’s Health Watch.

The topical drugs used for treating age spots work mainly by interrupting the formation of melanin, the pigment responsible for tanning. To get the best results, you should also use a sunscreen with an SPF of 30 or higher. Harvard Women’s Health Watch describes the following commonly used agents.

Hydroquinone. Many dermatologists consider this cream the best choice for treating age spots. You can expect to see results in four to six weeks, with the greatest improvement after four to six months. The most common side effect is irritation or reddening. The FDA recently proposed a ban on over-the-counter preparations containing hydroquinone because studies found that the drug may cause cancer when fed to rats and mice. So far, there are no studies showing any increased risk to humans using the drug topically. The FDA is still responding to challenges from critics who oppose the ban.

Tretinoin. Topical tretinoin was first approved for treating acne, but trials have demonstrated that it also improves photoaged skin. It can take several months to lighten age spots, and side effects include redness, scaling, and itchiness, although these generally subside after a few weeks. Brand names include Retin-A, Renova, and Avita.

Women’s News – U.S. teen birth rate rose in 2006 for the first time since 1991

The teen birth rate in the United States rose in 2006 for the first time since 1991, and unmarried childbearing also rose significantly, according to preliminary birth statistics released today by the Centers for Disease Control and Prevention (CDC).

The statistics are featured in a new report, “Births: Preliminary Data for 2006,” prepared by CDC’s National Center for Health Statistics, and are based on data from over 99 percent of all births for the United States in 2006. Although the findings in this early version will not change, the final report will have more detailed data.

The report shows that between 2005 and 2006, the birth rate for teenagers aged 15-19 rose 3 percent, from 40.5 live births per 1,000 females aged 15-19 in 2005 to 41.9 births per 1,000 in 2006. This follows a 14-year downward trend in which the teen birth rate fell by 34 percent from its all-time peak of 61.8 births per 1,000 in 1991.

“It’s way too early to know if this is the start of a new trend,” said Stephanie Ventura, head of the Reproductive Statistics Branch at CDC. “But given the long-term progress we’ve witnessed, this change is notable.”

The largest increases were reported for non-Hispanic black teens, whose overall rate rose 5 percent in 2006. The rate rose 2 percent for Hispanic teens, 3 percent for non-Hispanic white teens, and 4 percent for American Indian teens.

The birth rate for the youngest teens aged 10-14 declined from 0.7 to 0.6 per 1,000 and the number of births to this age group fell 5 percent to 6,405. The birth rate for older teens ages 18-19 is 73 births per 1,000 population – more than three times higher than the rate for teens ages 15-17 (22 per 1,000). Between 2005 and 2006 the birth rate rose 3 percent for teens aged 15-17 and 4 percent for teens aged 18 and 19.

The study also shows unmarried childbearing reached a new record high in 2006. The total number of births to unmarried mothers rose nearly 8 percent to 1,641,700 in 2006. This represents a 20 percent increase from 2002, when the recent upswing in non-marital births began. The biggest jump was among unmarried women aged 25-29, among whom there was a 10 percent increase between 2005 and 2006.

In addition, the non-marital birth rate also rose sharply, from 47.5 births per 1,000 unmarried females in 2005 to 50.6 per 1,000 in 2006 – a 7 percent one-year increase and a 16 percent increase since 2002.

The study also revealed that the percentage of all U.S. births to unmarried mothers increased to 38.5 percent, up from 36.9 percent in 2005.

The report contains other significant findings:

• The preliminary estimate of total births in the U.S. for 2006 was 4,265,996, a 3 percent increase — or 127,647 more births — than in 2005.
• Birth rates increased for women in their twenties, thirties and early forties between 2005 and 2006, as well as to teenagers.
• The Caesarean delivery rate rose again in 2006, to 31.1 percent of all births, a 3 percent increase from 2005 and a new record high. The percentage of all births delivered by cesarean has climbed 50 percent over the last decade.
• The preterm birth rate rose slightly between 2005 and 2006, from 12.7 percent to 12.8 percent of all births. The percentage of births delivered before 37 weeks of gestation has risen 21 percent since 1990.
• The low birthweight rate also rose slightly in 2006, from 8.2 percent in 2005 to 8.3 percent in 2006, a 19 percent jump since 1990.
• As a result of the increases in the birth rates for women aged 15-44, the total fertility rate – an estimate of the average number of births that a group of women would have over their lifetimes – increased 2 percent in 2006 to 2,101 births per 1,000 women. This is the highest rate since 1971 and the first time since then that the rate was above replacement – the level at which a given generation can replace itself.

The full report is available at www.cdc.gov/nchs.

Women’s News – Early abortions may be made easier for women

The British government is considering making early abortions available to women at doctors surgeries.

At present women who want to terminate a pregnancy before nine weeks can be prescribed drugs to induce a miscarriage.

The drugs are given in two doses, 48 hours apart, at private clinics and National Health hospitals and needs the approval of two doctors.

The Department of Health in Britain has conducted two pilot studies in order to evaluate whether such “medical” abortions can be carried out in “non-traditional” settings including doctors’ surgeries.

The British Medical Association has cautiously welcomed the move but the debate over access to abortion has been reignited.

A House of Commons committee, which examined the case for lowering the 24-week legal limit, found women were experiencing unnecessary delays and called for easier access to terminations and the scrapping of the two doctors’ signatures rule.

The committee also said nurses and midwives with suitable training and professional guidance should not be prevented from carrying out all stages of early medical abortions involving the use of drugs and early surgical abortions.

The committee evaluation is expected to be completed in early 2008.

But there is apparently growing opposition to abortions by many doctors; a survey earlier this year in a doctors magazine revealed that one in five believe it should be banned and more than half say that the 24 week limit should be reduced.

The British Pregnancy Advisory Service (BPAS) which provides 10,000 early medical abortions each year, says offering more localised care for women needing an abortion makes absolute sense.

The Family Planning Association too is in agreement and says other countries provide abortion services in the community and British women should also have that service.

In 2006 there were almost 200,000 abortions in England and Wales and 13,000 in Scotland.

The vast majority were early abortions and were carried out before 13 weeks.