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Long-term Pill use may double glaucoma risk

Reproductive Health

Long-term Pill use may double glaucoma risk

2013-11-19

Women who used birth control pills for three years or more have twice the risk of developing glaucoma later in life, according to new research.

Glaucoma is a disease that damages the eye’s optic nerve and is a leading cause of blindness in the United States.

It’s been well documented that low-estrogen levels following menopause contribute to glaucoma in women. Scientists don’t know exactly why this happens.  But years of using birth control pills, which can also lower estrogen levels, may add to the problem.

The study, conducted by researchers at University of California, San Francisco, Duke University School of Medicine and Third Affiliated Hospital of Nanchang University, Nanchang, China, did not differentiate between women who took low-estrogen or regular birth control pills. Investigators theorize that when women are not on the pill, their natural estrogen levels go up and down, which seems to prevent the eye from developing glaucoma.  When women go on the pill, their estrogen levels are consistent, and in some cases consistently low, which could cause them to develop the condition.

This research project is the first to suggest an increased risk of glaucoma in women who have used oral contraceptives for three or more years. The researchers looked at data on more than 3,400 women aged 40 and older from across the United States, who answered questionnaires about their reproductive health and eye exams.

“We believe at this point, by analyzing the data, there is an association between long-term birth control use and glaucoma,”  said Elaine Wang, of Duke University and an author of the study.

“Why?  We’re not sure. The next step is to examine the eyes carefully and look at exactly what is happening to a woman’s vision when she’s on birth control pills.  We need to verify these findings.”

Although study authors say more research needs to be done, they do stress that gynecologists and ophthalmologists need to be aware of the fact that oral contraceptives may play a role in glaucomatous diseases.  They believe doctors should make sure their female patients have their eyes screened for glaucoma, especially if they also have other risk factors, such as race, (African-Americans are at highest risk) family history of glaucoma or a history of increased eye pressure problems.

“This study should be an impetus for future research to prove the cause and effect of oral contraceptives and glaucoma,” said Dr. Shan Lin, lead researcher and professor of clinical ophthalmology at the University of California, San Francisco. “At this point, women who have taken oral contraceptives for three or more years should be screened for glaucoma and followed closely by an ophthalmologist, especially if they have any other existing risk factors.”

Because glaucoma affects 60 million people worldwide and is the leading cause of bilateral blindness, second only to cataracts, screening for the condition is encouraged for all people, especially over the age of 50. Although it can be treated, doctors say any new information on glaucoma is important.

“This supports the importance of getting screened, especially if you fall into the high risk category,” noted Dr. Thomas Yau, an ophthalmologist from Silver Spring, Maryland, and a member of the American Academy of Ophthalmology .  “It brings to the equation a possible new risk factor for glaucoma. Should we be raising the red flag?  Not yet, but birth control use should be looked at as a possible risk when talking to patients.”

The research was presented Monday at the annual meeting of the American Academy of Ophthalmology.

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Want to Stay Healthy? Don’t Rely on Vitamins Read more: Government Experts Say Supplements Don’t Prevent Heart Disease, Cancer

Behaviour

Want to Stay Healthy? Don’t Rely on Vitamins Read more: Government Experts Say Supplements Don’t Prevent Heart Disease, Cancer

2013-11-12

By

vitamin-150x150

Americans spend nearly $12 billion each year on vitamin supplements, hoping they will steer us away from diseases like cancer and heart attacks. But it turns out they’re just a drain on our wallets.

Should healthy people take supplements to keep them healthy? A panel of experts convened by the government, the U.S. Preventive Services Task Force, says that for most vitamins and minerals, there is not enough evidence to determine whether the pills can lower risk of heart disease or cancer. And when it comes to beta-carotene (found in carrots and tomatoes) and vitamin E, there is no evidence that they can protect against either heart disease or cancer; in fact, beta-carotene use contributed to an increased risk of lung cancer in smokers.

That will come as a surprise to most Americans, who pop pills of omega-3 fatty acids hoping to fend off a heart attack or down vitamins C and E, which are high in antioxidants, to counteract the free-radical damage that contributes to cancer. “In the absence of clear evidence about the impact of most vitamins and multivitamins on cardiovascular disease and cancer, health care professionals should counsel their patients to eat a healthy, well-balanced diet that is rich in nutrients. They should also continue to consider the latest scientific research, their own experiences, and their patient’s health history and preferences when having conversations about nutritional supplements,” task-force member Dr. Wanda Nicholson said in a statement.

The panel based its conclusion on a review of 26 studies, conducted from 2005 to ’13, some of which involved single supplements and others that investigated multivitamins and their relationship to heart disease, cancer and death outcomes. The review built on the panel’s previous report on supplements, in 2003, in which the task-force members said that there was not enough evidence to recommend vitamin A, C or E supplements, multivitamins or antioxidant combinations to prevent heart disease or cancer. At that time, the members also recommended against beta-carotene supplements because of their connection to a higher risk of lung cancer among smokers. In the current review, the members considered additional data on other vitamins and nutrients, including vitamins B and D, as well as zinc, iron, magnesium, niacin and calcium.

The conclusions apply to otherwise healthy people who take the supplements to prevent disease, so it’s not clear how effective, if at all, the pills can be in those at higher risk of heart problems or cancer. There have been hints, however, that the pills might not be the panacea that many people hoped they would be. In 2012, for example, a study published in the Journal of the American Medical Association showed that omega-3 supplements, touted as a powerful weapon against heart disease, did not lower risks of heart attack, stroke, or death from heart disease or any cause. Another study published in 2011 even linked vitamin-and-supplement consumption to a higher risk of death, reporting that women who took multivitamins were 6% more likely to die over a 19-year period, compared with women not taking them.

Why the takedown of vitamins, especially if they are so prevalent in good-for-you foods such as fruits and vegetables? Experts believe that the benefits of nutrients like vitamins may depend on how they are presented to the body; some may need the help of other compounds found in their natural form that are inadvertently stripped from individual pills that try to concentrate the health benefits of specific vitamins or minerals. “[T]he physiologic systems affected by vitamins and other antioxidant supplements are so complex that the effects of supplementing with only 1 or 2 components is generally ineffective or actually does harm,” write the authors in their report, published in the Annals of Internal Medicine.

They recognize, however, that their conclusions are based on relatively few studies, since few trials have addressed the question of whether supplements can prevent disease in healthy people. So the results hold only until more data become available to understand the association more completely. In the meantime, the best way to take advantage of any health-promoting effects of nutrients like vitamins and minerals is to get them in their natural state, by eating a well-balanced diet high in low-fat dairy, fruits, vegetables and lean proteins.

No Satisfaction: Woman Are Less Likely to Orgasm During Casual Sex Read more: Study Shows Women Don’t Always Orgasm During Hook-Ups

Sexual Health

No Satisfaction: Woman Are Less Likely to Orgasm During Casual Sex Read more: Study Shows Women Don’t Always Orgasm During Hook-Ups

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The hookups may be exciting, but they’re ultimately anti-climactic for many women

By Maya Rhodan

Though women are nearly as likely as men to engage in casual sex, they are less likely to receive the same, ahem, benefits as their partners during those casual hookups. According to research presented at the International Academy of Sex Research’s annual meeting, women are more likely to orgasm from intercourse while in a serious relationship than during a hookup.

“The notion of sexual liberation, where men and women both had equal access to casual sex, assumed a comparable likelihood of that sex being pleasurable,” Kim Wallen, a professor of neuroendocrinology at Emory University told the New York Times.  “But that part of the playing field isn’t level.”

The study of 600 college students found that women were half as likely to orgasm from oral sex or intercourse during a casual hookup than when they were in a serious relationship. This backs earlier research by New York University sociologist Paula England, which showed that just 40% of the 24,000 college aged women she studied over five years at 21 colleges reached orgasm during a hookup while 80% of men did. Nearly 75% of women who were in a relationship, on the other hand, had an orgasm during sex.

Women, researchers say, likely do not feel comfortable telling their hook-ups what they want and need during sex while their male partners are admittedly less focused on pleasing a casual sex partner.

“I’m not going to try as hard as when I’m with someone I really care about,” Duvan Giraldo, 26, told the Times. Though, he said pleasing his partner is “always my mission.”

Casey Romaine, 22, told the Times, hook-ups are often just about sharing an intimate moment, rather than having a particularly good sexual experience.

“I think a lot of the time it almost is weirdly irrelevant whether or not the sex is actually good,” she said.

If Moms Argue With Their Friends, Their Kids Will Too Read more: If Moms Argue With Their Friends, Their Kids Will Too

Behaviour

If Moms Argue With Their Friends, Their Kids Will Too Read more: If Moms Argue With Their Friends, Their Kids Will Too

2013-11-08

By

 

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Do as I say, not as I do. Sounds good in theory, but as every mom and dad knows, it doesn’t work as a parenting tactic. Now there’s more evidence that kids may mimic their parents behaviors, even when it comes to the quality of their friendships.

The latest research delves into a relatively unexplored area of the parent-child dynamic: how mothers’ friendships affect their adolescent kids’ same-sex friendships and overall well-being.

The study, to be published in the Journal of Research on Adolescence, examined whether the positive or negative qualities of mothers’ friendships (not enough fathers agreed to participate) had an effect on their adolescent kids’ friendships. The investigators accomplished this by giving school kids in fifth, eighth and eleventh grades and their mothers questionnaires that explored the quality of their most important friendships.  They also gave the parents and kids tests of emotional health. When mothers reported high levels of negative quality with a good friend (such as getting on each others’ nerves, getting upset or mad at each other often), kids were likely to report similar verbal antagonism and heated arguments with a close friend.

So could moms be good role models for their children by having more positive connections with their friends? Unfortunately, no. The study’s lead author Gary Glick, a doctoral candidate in psychological sciences at the University of Missouri, says the team did not find a strong link between mothers’ positive friendship qualities and those of their teens. “Maybe,” Glick says, “kids are more likely to notice adults screaming at each other.”
The fact that adolescents’ friendships mimic those of a parent, is not surprising, given that development is about learning and imitating behaviors. “Adolescents,” says clinical psychologist Joshua Klapow, are in the midst of forming their internal templates for social norms and therefore parental role models are critical. In fact, watching adolescents interact with their peers often is a mirror of how parents interact with their own peers.”

But the fact that the mothers’ positive friendships did not seem to filter down to their children’s own relationships could simply be the result of the artificial way the relationships were defined in the study. Dr. Gayani DeSilva, a child and adolescent psychiatrist at St. Joseph’s Hospital in Orange, CA, notes that friendships are often a complicated mix of positive and negative interactions. The study authors, he says, “divide parental friendships into either positive or negative categories, when healthy friendships are much more complex than that. The more helpful and developmentally appropriate perspective would be to examine how teens are influenced by parental conflict resolution patterns within their friendships.”

In fact, Carleton Kendrick, a family therapist and author of “Take Out Your Nose Ring, Honey. We’re Going to Grandma’s,” says he has observed the opposite effect over 40 years of working with families.“If they witness their parents continuing loyalty, commitment and unwavering commitment to friends,” he says, “through both good times and bad times, they see what it takes for them to possess such cherished friendships. They take mental notes and try to imitate and adopt the attitudes, behavior and commitment they see present in their parents’ successful friendships.”

Kendrick says that the study, which is “a snapshot in time,” does not consider enough variables in the teens’ and parents’ lives and that it does not adequately examine other possible reactions that adolescents might have to their mothers’ problems with friends. “Over and over I have heard kids of all ages tell me privately, in confidence,” Kendrick says, “that they are seriously worried about their parents on many levels.” And conflicts with family and friends were among these worries.

Such internalizing of their parents’ conflicts could have more profound implications for adolescents beyond just the types of interactions they have with their own friends. In the study, mothers with high levels of negativity in their friendships were also likelier to have kids who were more anxious and depressed than those with more positive interactions with their friends. And this, says Glick, was independent of whether the mothers were anxious and depressed themselves.

However children are interpreting and responding to their parents’ choices when it comes to friendships, the study suggests that these decisions could have a greater effect on understanding teen friendships and fostering them in a healthy way than previously thought. “Developing more adult-like relationships with their peers,” says Stephen Gray Wallace, Director of the Center for Adolescent Research and Education at Susquehanna University, “is one of the primary developmental tasks of adolescence.” And parents, it seems, can play an important role in pushing that development in a positive direction, even if they aren’t doing so in a direct and conscious way.
Read more: If Moms Argue With Their Friends, Their Kids Will Too | TIME.com http://healthland.time.com/2013/11/07/if-moms-argue-with-their-friends-their-kids-will-too/#ixzz2k3J1qX00

Primary-Care Doctors Don’t Have the Best Tools for Treating Depression Read more: Primary-Care Doctors Don’t Have Best Tools for Treating Depression

Psycological Health

Primary-Care Doctors Don’t Have the Best Tools for Treating Depression Read more: Primary-Care Doctors Don’t Have Best Tools for Treating Depression

2013-11-07

By

 

Doctor discussing reports with unhappy patient
Doctor discussing reports with unhappy patient

Not all doctors are able to treat depression effectively, including those who are most likely to see patients’ first symptoms.

Even though patients may turn first to their primary-care physicians with any concerns about depression, the tools that those doctors use to evaluate their patients for mental-health disorders aren’t necessarily helping to improve their patients’ symptoms, according to the latest study published in the Journal of the American Medical Association of some of the most common practices used by these physicians.

Researchers from the University of California, Davis, looked at techniques, designed for patients, that help primary-care physicians to assess mental-health symptoms more easily in a doctor’s office or even the waiting room. The depression engagement video (DEV) helps patients to identify depression and guides them on how to talk to their doctors about symptoms. The interactive multimedia computer program (IMCP) similarly helps patients to recognize and discuss depression with their doctors, via an interactive program that gives them feedback about their symptoms and their level of depression.

Among 925 adult patients treated by 135 primary-care doctors in the study, 603 patients were already diagnosed with depression and 322 patients did not show signs of the condition. All the patients were randomly assigned to either of the two digital assessments, or to a control group, and then followed up 12 weeks later to see if the interventions improved the patients’ mental-health symptoms.

Doctors were more likely to offer referrals to mental-health programs or antidepressant medications after evaluating patients using the DEV or IMCP, at rates of 17.5 % and 26%, respectively, compared with those who didn’t rely on the programs. And patients were more likely to ask for information from their doctors about depression if they used the tools.

That did not mean, however, that the patients who were referred to additional services such as seeing a therapist or prescribed medications fared better than those in the control group. When the researchers assessed the participants’ depression symptoms 12 weeks later using a questionnaire, they found that those who received the additional services and those who did not scored similarly on the mental-health evaluation. So while the strategies may appear to help primary-care doctors to better assess depression, the researchers say the tools may not be as effective as hoped for matching the right treatments to the right patients in order to improve their symptoms. And that, potentially, could lead to worsening symptoms and deeper depression. “Further research is needed to determine effects on clinical outcomes and whether the benefits outweigh possible harms,” the authors write.

Study: Smoking Makes You Look Older Using twins to determine effect Read more: Study: Smoking Makes You Look Older

Behaviour

Study: Smoking Makes You Look Older Using twins to determine effect Read more: Study: Smoking Makes You Look Older

2013-11-05

By

 

Discarded cigarette butts littering gully at back of building
Discarded cigarette butts littering gully at back of building

A study of 79 pairs of twins — each with one smoker and one non-smoker — indicates that cigarette users are likely to get wrinkles and bags under their eyes at a more accelerated pace than their genetically identical counterparts.

Unbiased judges, who had no prior knowledge of the twins’ smoking status, said that the smoker looked older more than 50 percent of the time.

The twins were primarily female and in their late 40s.

“Smoking makes you look old,” Dr. Elizabeth Tanzi told Reuters. “That’s all there is to it.”

Less Is More: One, Instead of Three Doses of HPV Vaccine May Protect Against Cervical Cancer Read more: One Dose of HPV Vaccine May Protect Against Cervical Cancer

Reproductive Health

Less Is More: One, Instead of Three Doses of HPV Vaccine May Protect Against Cervical Cancer Read more: One Dose of HPV Vaccine May Protect Against Cervical Cancer

By

Public-health officials may not have to worry so much about the low percentage of girls who don’t get all three doses of the human papillomavirus (HPV) vaccine.

The HPV vaccine is one of the best ways to prevent genital warts and infection with the virus that can cause cervical cancer, so since 2007, the Centers for Disease Control and Prevention recommended girls get three doses of the shot when they are 11 or 12 years old, and since 2011, advised that boys of the same age get routinely immunized as well. But about a third of eligible young people in the U.S. start the three-shot regimen, which takes six months to complete, and never complete the schedule; around half of eligible children are fully immunized against HPV.

Cost — all three doses of the immunization cost about $400 — and the lack of follow-up over six months contribute to the low compliance rate, so scientists have been investigating whether fewer doses could protect against infection just as well. A 2011 study reported that people had similar levels of protection at two doses, and now researchers believe even one shot may be enough.

The researchers studied Cervarix, which, like the other HPV vaccine approved by the Food and Drug Administration, Gardasil, protects against HPV subtypes 16 and 18. The researchers measured the immune response to the vaccine in groups of 78, 192 and 120 women who received one, two and three doses of the vaccine, respectively. They then compared the amount of antibodies these women produced against those of a group of 113 women who did not get immunized but had been infected with HPV at some point in their lives.

The vaccinated women in all three groups continued to show HPV antibodies in their blood for up to four years. These levels were similar among women who received two doses and those who were vaccinated with all three doses. But the women who just got one dose also had stable antibody levels, even though they were lower than those found in the other groups. These levels, however, were still 24 times higher than those among women who never received the vaccine but had been infected with the virus. So a single dose of the vaccine, the researchers believe, may be sufficient to provide some protection against infection with HPV.

They still aren’t sure, however, whether the antibodies generated by the vaccine are sufficient for long-term protection, such as that provided by immunizations against hepatitis A and polio, or whether people will need to boost waning levels of antibodies with additional shots over time.

There are hints that three doses may not be necessary, however. In Chile and British Columbia, public-health officials recommend just two doses of the HPV vaccine. But before the current recommendation in the U.S. is changed, more research is needed to clarify what type of protection the vaccines provide, and whether there are differences between the two currently approved shots. So for now, it’s not likely that the needle-phobic will get a break when it comes to getting up to date on their HPV shots.

Could you be almost depressed?

Psycological Health

Could you be almost depressed?

2013-10-28

By Shelley Carson, Special to CNN

Man behind a window
Man behind a window

Editor’s note: Shelley Carson is an associate of the Department of Psychology at Harvard University. She’s the co-author of “Almost Depressed: Is My (or My Loved One’s) Unhappiness a Problem?“

Consider whether the following questions describe you or someone you love:

Are having trouble enjoying things in life that used to be fun?

Do you find that you are constantly irritable and overreacting to petty incidents? Are you are regularly finding excuses to avoid spending time with friends or family?

Does it seem like you’re “just going through the motions” and barely getting through the day? Do you feel overstressed and believe there is no way you can ever catch up with what you have to do?

If any of these questions rings true, you may be almost depressed. And you are not alone. Research suggests that as many as 12 million people in the United States may be suffering from low-grade depression symptoms that are not severe enough to warrant clinical treatment.

Almost depression is not a mental disorder. It is a state of low mood that can leave you exhausted and de-energized, keeping you from savoring life and working at your peak performance level. It is a gray area of mood problems that lies on a continuum between the ups and downs of normal mood, and full-blown major depression.

(You may wonder how you can tell if your mood symptoms put you in the almost depressed range, or if they are serious enough to be considered major depression. If you are thinking about death or suicide, have lost a significant amount of weight because of appetite changes, or have feelings of hopelessness or extreme guilt, or if you believe your symptoms may be severe enough possibly to warrant a diagnosis of major depression, please contact a mental health professional.)

At Harvard Medical School, we have been investigating the effects that almost depression and other subclinical conditions can have on an individual’s quality of life. People who are almost depressed report a number of issues, including lower job satisfaction, lower satisfaction with their marriage and other personal relationships, more anxiety issues, less control over their lives and lower overall well-being than people who do not fall into the almost depressed range.

In fact, on some of these measures, people who are almost depressed report feeling worse off than people who actually fall into the clinically depressed range. Clearly, even though almost depression does not rise to the level of a diagnosable mental disorder, it is nevertheless associated with a substantial amount of distress and suffering.

There is also another more serious problem: Research indicates about 75% of cases of low-grade depression will devolve into full-blown major depression if they are not recognized and arrested.

Major depression is a deadly disorder. People who are depressed have four times the risk of heart disease and almost six times the risk of dying after a cardiac event than people who are not depressed.

People who are depressed also have between nine and 16 times the risk for suicide than people who are not depressed.

It is therefore vitally important to recognize the symptoms of almost depression in yourself and your loved ones, and to take steps to reduce the suffering it causes.

There are a number of things you can do to combat almost depression that have been shown to be effective in randomized clinical trials (the gold standard of treatment testing). Here is a list of some these “evidence-based” steps:

Make sure you are getting enough exercise. The minimum amount for treating depression is 30 minutes of continuous aerobic exercise (70% to 85% of maximum heart rate) plus a 10-minute warm-up and cool-down period three times a week.

Integrate activities you have found pleasurable in the past into your weekly calendar. Even if you feel that you no longer enjoy them, such activities will increase the activation of the pleasure centers in your brain. As your symptoms resolve, you will regain pleasurable feelings.

Use creative outlets to express your negative feelings. You don’t need experience or talent to express yourself creatively, so paint, write or play music. Expressive creative work reduces depressive symptoms.

Manage your stress level. Stress has negative effects on both the brain and the body and can be a major source of depressive symptoms.

Challenge the way you think. Our moods are dependent not upon what happens to us in our lives, but in how we interpret what happens. Changing your interpretation has been shown to reduce depressive symptoms.

Increase your level of mindfulness. Mindfulness training and practice is an effective way to keep depression at bay.

Reduce the power you give to your “inner critic.” Often the negative and critical things we say to ourselves lead to feelings of depression and powerlessness.

Increase your social support circle. Having a strong social support system is a known protective factor against depression.

Improve your self-care. Poor nutrition and poor sleep habits can augment feelings of depression. In some cases, specific nutritional supplements can work wonders.

The steps that work for you will be dependent upon your specific signs and symptoms, the severity of your symptoms and your personality. If one step doesn’t work, do not give up.

There are many pathways to wellness, and with patience you will find the way that works for you.

You don’t have to be almost depressed. You can take charge of your symptoms and make your way out of the gray shadows and into the full light of good mental health.

How Sweden’s New Text Message Plan Is Saving Cardiac Arrest Victims

Behaviour

How Sweden’s New Text Message Plan Is Saving Cardiac Arrest Victims

Trained volunteers receive notifications in order to shave crucial minutes off emergency response times.

By using text messages, the city of Stockholm, Sweden is getting emergency responders to cardiac arrest victims faster.

Here’s how it works. Volunteers who are trained in CPR are added to a network called SMSlivräddare, (or SMSLifesaver). When a resident dials 112 (the equivalent of 911 in the states), a text message is sent to all CPR volunteers who are within 500 meters of the person needing emergency care. This way, a volunteer may get to the patient faster than an ambulance.

The likelihood of survival from cardiac arrest drops 10% for every minute it takes first responders to arrive. CPR administered by bystanders has been found to significantly increase the likelihood of survival, but not everyone feels comfortable doing it, or even knows how.

SMSlifesavers is run by Stockholm South General Hospital and the Karolinska Institute and currently has 9,600 registered volunteers. According to Quartz, there are about 200,000 Swedes who have undergone CPR training and could participate.

SMSlifesavers’ spokesperson, Dr. Mårten Rosenqvist, told Quartz that traditional ambulance services have trouble reaching cardiac arrest victims in teh Stockholm area due to lack of vehicles, traffic and other patient duties.

New Definition of “Full-Term” Pregnancy Presents Other Problems

Reproductive Health

New Definition of “Full-Term” Pregnancy Presents Other Problems

2013-10-23

By @ProfEmilyOsterOct. 22, 2013

Big news for women who are 38 weeks pregnant: you are no longer considered “full term.” The American College of Obstetricians and Gynecologists (ACOG) announced today that they would introduce a new classification system for the end of pregnancy.  Previously women who were 37 to 41 weeks pregnant were all considered “Full Term” and women 42+ weeks “Post-term”.  The new classification system calls for four groups:  “Early Term” (37-38 weeks), “Full Term” (39-40 weeks), “Late Term” (41 weeks) and “Post-term” (42+weeks).

I know, that’s a lot of terms. But the big change here is to separate out the 37 to 38 week period and acknowledge that, for most babies, this isn’t the ideal time to be born. Evidence has been piling up that babies born in this period do worse than babies born at 39 or 40 weeks. One very recent paper shows babies at 37 to 38 weeks are more likely than those born later to need time in the NICU, mechanical ventilation and IV fluids. But as induction and scheduled C-sections have become more common, the share of babies born at 37 or 38 weeks has risen from 17% in 1983 to 27% in 2009. Many of these deliveries are elective and driven, at least in part, by the perception by women (or their doctors) that things are ready to go at 37 weeks. The push to reduce these early-term deliveries has been going on for years.

This change in wording could make a big difference in practice. Early term births are expensive because of their added complications and by explicitly distinguishing them it makes it easier for insurers to refuse to cover elective births in this period. The problem, however, with having a strict guideline like this is that sometimes people start to treat it the cutoff itself as meaningful.

It is worth reflecting back on why this change is even necessary.  The idea that 37 weeks is “full term” is intended to be descriptive.  As pregnancy moves forward, the baby becomes more developed.  Among the last organs to develop are the lungs, and usually this happens by 37 weeks, so calling 37 weeks “full term” is simply an acknowledgement of this. But women, and their doctors, can start to think that when you move from 36 weeks 7 days pregnant to 37 weeks 0 days pregnant there is a magic switch which means your baby is ready.  This is obviously not the case.

This is illustrative of a broader issue, in medicine and elsewhere, with any kind of sharp rule-like cutoff.  In one example, researchers have shown that as a result of drawing the cutoff for very low birth weight at 1500 grams, babies born right below 1500 grams of weight actually have better outcomes than those right above, because they are given extra treatment.  Again, there is nothing biologically special about 1500 versus 1499.  The cutoff is descriptive, and when it’s treated as a rule, odd things happen. The same issues come up in finance, closer to my own field, when looking at lenders who used sharp cutoffs in credit scores in deciding who to lend to.  There is nothing special about a credit score of 620 compared to 619, and when you treat it like there is, you can get into trouble.

The worry, of course, to return to the babies, is that what is happening here is we are replacing one rule with another. The new guidelines fix one issue, but could lead doctors (in theory) to be too cautious about delivery in 37 or 38 weeks when medically warranted. It could also lead them to be too gung-ho about delivery as soon as you hit 39 weeks. The best case would be if women and their doctors took these terms as they are intended— as descriptive guidelines, not rules—and got better about letting nature take its course unless there is a medical reason not to.  If that happens, this truly will be a major change, and not just for the women at 38 weeks.

 

Pregnant woman holding belly
Pregnant woman holding belly