̽��ֱ�� of Cambridge - reproductive health

Mind Over Chatter: ̽��ֱ��future of reproduction

ns480 — Thu, 27 May 2021 12:41:58 +0000

Season 2, episode 6

Our reproductive capabilities are changing in exciting ways, altering our fundamental understanding of fertility, reproduction, and even parenthood.

In this episode of Mind Over Chatter, we ask our guests what the consequences of novel reproductive technologies are likely to be, and how they will impact the future of human reproduction.

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We cover topics ranging from egg-freezing, so-called ‘three-parent-babies, and the importance of studying the embryonic development of primates.

Historical demographer, Dr Alice Reid, who researches fertility, mortality and health in the late nineteenth and early twentieth centuries, tells us how reproduction has changed over the last 200 years and how it has been influenced by improvements in gender equality, as well as discussing the likely demographic impact of assisted reproduction.

Dr Lucy Van de Wiel, whose research focuses on the social and cultural analysis of assisted reproductive technologies such as egg freezing, introduces the important ways in which reproductive technologies must be considered in the context of wide social and political issues.

Finally, Dr Thorsten Boroviak shares his cutting-edge research on developing new reproductive technologies – the ability to generate your own egg or sperm from any cell of your body – and the importance of studying the embryonic development of primates.

Key points:

[2:10]- change of human reproduction over the last 200 years

[5:45]- egg freezing and changing meaning of what it means to be ‘fertile’

[12:05]- higher levels of gender equity can produce higher levels of fertility

[23:19]- generating eggs and sperms from any human cell

[24:02]- can a man produce an egg?

[40:37]- when should one freeze their eggs?

[64:54]- reproductive justice and reproductive equity. Ensuring reproductive autonomy while ensuring non-exploitation

[65:59]- Final question: what is the most exciting thing that will happen to humankind in the future?

Mind Over Chatter: ̽��ֱ��Cambridge ̽��ֱ�� Podcast

Online atlas explores north-south divide in childbirth and child mortality during Victorian era

sc604 — Tue, 15 May 2018 07:36:56 +0000

̽��ֱ��Populations Past website is part of the Atlas of Victorian Fertility Decline research project based at the ̽��ֱ�� of Cambridge, in collaboration with the ̽��ֱ�� of Essex. It displays various demographic and socio-economic measures calculated from census data gathered between 1851 and 1911, a period which saw immense social and economic change as the population of the UK more than doubled, from just under 18 million to over 36 million, and industrialisation and urbanisation both increased rapidly.

̽��ֱ��atlas allows users to select and view maps of a variety of measures including age structure, migration status, marriage, fertility, child mortality and household composition. Users can zoom in to an area on the map and compare side-by-side maps showing different years or measures.

̽��ֱ��maps reveal often stark regional divides. “Geography plays a major role in pretty much every indicator we looked at,” said Dr Alice Reid from Cambridge’s Department of Geography, who led the project. “In 1851, more than one in five children born in parts of Greater Manchester did not survive to their first birthday. In parts of Surrey and Sussex however, the infant mortality rate at the same time was less than a third that number.”

While there are broad north-south divides in most of the maps, patterns at a local level were more complicated: in the northern urban-industrial centres such as Manchester, infant and child mortality were high, while many rural areas of the north had mortality rates as low as rural areas of the south. And in London, there is a sharp east/west divide in fertility, infant mortality, the number of live-in servants, and many other variables.

̽��ֱ��researchers also found that different types of industry were often associated with different types of families: in coal mining areas where there was little available work for women, women married young and often ended up with large families. In contrast, women in the textile-producing areas of Lancashire and Yorkshire had more opportunities to earn a wage, and perhaps consequently, had fewer children on average.

There are also big differences over time. ̽��ֱ��period saw a sharp drop in the number of women who continued to work after marriage, for instance. In 1851, more than a third of married women were in work across large sections of the country, but by 1911, only a tiny fraction of married women worked outside the home, apart from the textile-producing areas of the Northwest.

“This might be associated with the rise of the culture of female domesticity: the idea that a woman’s place is in the home,” said Reid.

Across the Western world, fertility rates have declined over the past 150 years. Gaining a historical perspective of how and why these trends have developed can help improve understanding of the way in which modern societies are shaped.

Between 1851 and 1911, England and Wales changed from countries where there were variable fertility and mortality rates to countries where rates for both were low. Child mortality and fertility fell from the 1870s, together with a fall in illegitimacy, but infant mortality did not start to fall until the dawn of the twentieth century.

As part of the project on fertility decline, the researchers have investigated fertility in more detail. For the first time, they have been able to calculate age-specific fertility rates for more than 2000 sub-districts across England and Wales during this era, and their results challenge views on the way that fertility fell.

“It’s long been thought that the fall in fertility was achieved when couples decided how many children they wanted at the outset of their marriage, and stopped reproducing once they had reached that number,” said Reid. “While this may have happened in more recent fertility transitions, such as in South-East Asia and Latin America, when reliable contraception was widely available, it was not a realistic scenario in the Victorian era.”

“We don’t find age patterns of fertility which would be produced by this type of ‘stopping’ behaviour during the Victorian fertility decline,” said Reid’s collaborator Dr Eilidh Garrett from the ̽��ֱ�� of Essex. “Such behaviour would show up as a larger reduction of fertility among older women, but instead, women of all ages appear to have been reducing their fertility.”

As well as the interactive maps, the Populations Past site provides a variety of resources for researchers, teachers and students at all levels. ̽��ֱ��research was funded by the Economic & Social Research Council and the Isaac Newton Trust.

A new interactive online atlas, which illustrates when, where and possibly how fertility rates began to fall in England and Wales during the Victorian era has been made freely available from today.

In 1851, more than one in five children born in parts of Greater Manchester did not survive to their first birthday. In parts of Surrey and Sussex however, the infant mortality rate at the same time was less than a third that number.

Alice Reid

Populations Past

Early childhood mortality rates in 1851 (left) and 1911 (right). ̽��ֱ��highest rates are in red and the lowest in blue.

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Placenta plays pivotal “umpire” role to influence pregnancy outcomes

tdk25 — Mon, 12 Sep 2016 19:00:56 +0000

Researchers have shown for the first time how the placenta “umpires” a fight for nutrients between a pregnant mother and her unborn baby. ̽��ֱ��study suggests that the placenta will adjust the amount of nutrients transported to the foetus for growth in line with the mother’s physical ability to supply.

̽��ֱ��findings, published in the journal PNAS, suggest that if the bodily environment that a mother provides for her baby is unfavourable, for example through small body size or metabolic dysfunction, the placenta will change the flow of nutrients to the foetus relative to her own state. This can affect foetal development, resulting in complications at birth.

It is the first time that scientists have been able to provide clear evidence that the placenta plays the decisive role in this delicate balancing act, rather than merely acting as a passive interface which enables the transfer of nutrients from mother to foetus.

̽��ֱ��study, by researchers at the ̽��ֱ�� of Cambridge, involved making a precise genetic change in mice, which caused poor growth and changed the mother’s bodily environment. They then observed how the placenta developed and acted in response, finding that in mothers in which this alteration had been made, the structure of the placenta was different, and fewer nutrients reached the foetus.

A better understanding of how the placenta manages the trade-off will eventually enable researchers to reduce pregnancy complications in both humans and other mammals.

̽��ֱ��study was led by Dr Amanda Sferruzzi-Perri, a Research Associate at St John’s College, ̽��ֱ�� of Cambridge, and is part of a five-year project in the Department of Physiology, Development and Neuroscience examining the relationship between the placenta and pregnancy complications.

“During pregnancy there is a kind of ‘tug-of-war’ going on between the mother and the foetus over who gets the nutrients that the mother ingests,” Sferruzzi-Perri said. “This work shows for the first time that the placenta is the umpire which controls that fight. Understanding more about the placenta’s role is extremely important. If nutrients cannot be divided correctly during pregnancy, it can lead to life-threatening complications for expectant mothers, and long-term health consequences for both mother and child.”

At least one in every eight pregnancies in the UK is affected by complications stemming from impairment of the placenta. In the developing world the rate is even higher, with at least one in every five pregnant women affected. ̽��ֱ��potential consequences include abnormal birth weight, premature delivery, pre-eclampsia, and maternal diabetes.

A major cause appears to be the placenta’s response to unfavourable biological changes in the mother herself. These may, for example, be the result of poor nutrition, high stress levels, metabolic dysfunction, or obesity.

How the placenta allocates nutrients in these situations, however, and the hormonal signals that the placenta may be releasing while doing so, is not fully understood. By understanding these processes better, researchers hope to identify both the biological early warning signals that a problem has arisen, and their relationship to specific causes, enabling them to develop therapeutic interventions that reduce the number of complications overall.

̽��ֱ��new study represents a step towards those aims because researchers were able to directly influence the balancing act that the placenta performs and observe it in relation to both the physiology of the mother, and the actual growth and nutrient supply of the foetus.

To achieve this they used a model system where an enzyme called p110 alpha was genetically modified in mice. In a healthy mother, this enzyme is activated by hormones like insulin and insulin-growth factors (IGFs), kick-starting a relay race within cells which stimulates nutrient uptake and, as a result, normal growth and metabolic function. By altering this enzyme, the team reduced the mother’s overall responsiveness to such hormones, creating an unfavourable environment.

̽��ֱ��results showed that in mothers which carried the altered form of p110 alpha, the placenta’s growth and structure was impaired. As well as being physically different, it was also found to be transporting fewer nutrients to the unborn offspring.

Because of the way in which the experiments were set up, the team were also able to see what would happen to the placenta if the foetus carried the altered form of p110 alpha, but the mother was normal. They found that in these cases, the placenta also showed defects, but was able to compensate for this by transporting more nutrients to the foetus, and thus optimising nutrition.

This shows that the placenta will fine-tune the distribution of nutrients between the mother and foetus, in response to the circumstances in which it finds itself. It also indicates that, because the mother needs to be able to support her baby both during pregnancy and after birth, the placenta will do its best to judge how much nutrition the foetus receives, so that the mother’s health is not compromised.

“ ̽��ֱ��placenta is taking in signals all the time from the mother and the foetus,” Sferruzzi-Perri explained. “If the mother has some sort of defect in her ability to grow, the placenta will limit the amount of nutrients it allocates to the foetus to try and preserve her health.”

“What this tells us is that the mother’s environment is a very strong, modifiable characteristic to which we should be paying more attention, in particular to see if there are specific factors that we can change to improve the outcome of pregnancies. Being able to influence the mother’s environment through changes in p110 alpha gives us a means to study this in a controlled way, and to work out what those critical factors are.”

̽��ֱ��next stage of the research will involve examining the signals that the placenta sends to the mother to affect the way she uses the nutrients she ingests, potentially providing important clues about biomarkers which provide an early warning of pregnancy complications.

Dr Sferruzzi-Perri’s research is supported by a Dorothy Hodgkin Fellowship from the Royal Society. Her paper, Maternal and fetal genomes interplay through phosphoinositol 3-kinase(PI3K)-p110α signalling to modify placental resource allocation, is published in PNAS. ̽��ֱ��work was supported by a Next Generation Fellowship from the Centre for Trophoblast Research.

New research provides the first clear evidence that the amount of nutrients transported to the foetus by the placenta adjusts according to both the foetal drive for growth, and the mother’s physical ability to provide.

During pregnancy there is a kind of ‘tug-of-war’ going on between the mother and the foetus over who gets the nutrients that the mother ingests. This work shows for the first time that the placenta is the umpire which controls that fight

Amanda Sferruzzi-Perri

Free stock image via Pexels.

"Pregnant".

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Zika warnings lead to ‘significant’ increase in demand for abortions in Latin America

cjb250 — Wed, 22 Jun 2016 21:00:51 +0000

However, in many of these countries, abortion is either illegal or highly restricted, leaving pregnant women with few options and potentially driving women to use unsafe methods, access abortion drugs without medical supervision or visit underground providers.

On 17 November 2015, the Pan American Health Organization (PAHO) issued an alert about the Zika virus in Latin America. Although the virus, spread by mosquitos, causes only mild symptoms, it can have serious complications for unborn children, ranging from eye and hearing defects through to microcephaly (abnormally small heads) and other severe fetal brain defects. Following the PAHO alert, several countries issued health advisory warnings, including urging women to avoid pregnancy.

For several years, one option for women seeking an abortion in Latin America has been Women on Web, a non-profit organisation that provides medical abortion outside the formal healthcare setting through online telemedicine, in countries where safe abortion is not universally available. A team of researchers from the US and UK analysed data on requests for abortion through the website between 1 January 2010 and 2 March 2016 in 19 Latin-American countries, assessing whether requests for abortion increased beyond expected trends following the PAHO alert.

̽��ֱ��researchers found that in almost all of the countries that had issued health warnings about Zika and had legal restrictions on abortions, the number of requests for abortion through Women on Web rose significantly – effectively doubling in Brazil, Ecuador and Venezuela, and increasing by over a third in most of the other countries. In countries that had issued no health warnings, there was no statistically-significant increase.

Assistant Professor Abigail Aiken from the ̽��ֱ�� of Texas at Austin, said: “Accurate data on the choices pregnant women make in Latin America is hard to obtain. If anything, our approach may underestimate the impact of health warning on requests for abortion, as many women may have used an unsafe method or visited local underground providers.”

Dr Catherine Aiken from the Department of Obstetrics & Gynaecology at the ̽��ֱ�� of Cambridge added: “ ̽��ֱ��World Health Organization predicts as many as four million Zika cases across the Americas over the next year, and the virus will inevitably spread to other countries. It isn’t enough for health officials just to warn women about the risks associated Zika – they must also make efforts to ensure that women are offered safe, legal, and accessible reproductive choices.”

̽��ֱ��research was supported by the National Institutes of Health and the National Science Foundation.

Reference
Aiken, ARA et al. Requests for Abortion in Latin America in the Wake of Zika Virus. NEJM; 22 June 2016. DOI: 10.1056/NEJMc1605389

Declaration of interests
Rebecca Gomperts is Founder and Director of Women on Web. James Trussell serves on the Advisory Board of Women on Web. Marc Worrell is an IT Consultant for Women on Web.

Health warnings about complications related to Zika virus significantly increased demand for abortions in Latin American countries, according to a new study published today in the New England Journal of Medicine.

It isn’t enough for health officials just to warn women about the risks associated Zika – they must also make efforts to ensure that women are offered safe, legal, and accessible reproductive choices

Catherine Aiken

Pan American Health Organization

Sin Zancudos no hay Zika - Cúcuta

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Maternal obesity and diabetes in pregnancy result in early overgrowth of the baby in the womb

cjb250 — Thu, 07 Apr 2016 23:02:40 +0000

Gestational diabetes is a condition that can affect women during pregnancy, with those who are obese at greater risk. As well as affecting the mother’s health, the condition also causes the unborn child to grow larger, putting the mother at risk during childbirth and increasing the likelihood that her offspring will develop obesity and diabetes during later life. ̽��ֱ��condition can usually be controlled through a combination of diet and exercise, and medication if these measures fail.

Women are screened for the condition through a blood glucose test at around 8-12 weeks into pregnancy. Current guidelines in the UK and the USA recommend that mothers found to be at greatest risk should then be offered a full test at between 24 and 28 weeks into pregnancy; however, in practice the majority of women are screened at the 28 week mark.

Researchers at the Department of Obstetrics & Gynaecology at the ̽��ֱ�� of Cambridge analysed data from the Pregnancy Outcome Prediction study, which followed more than 4,000 first time mothers using ultrasound scans to assess the growth of their babies in the womb. They measured the abdominal and head circumference of the foetuses and compared the growth in women who developed gestational diabetes with those who did not. ̽��ֱ��results are published today in the journal Diabetes Care.

Of the 4,069 women studied, 171 (4.2%) were diagnosed with gestational diabetes at or beyond 28 weeks. ̽��ֱ��researchers found no association between the size of the child at 20 weeks and the mother subsequently developing gestational diabetes. However, they found that the foetuses of women subsequently diagnosed with gestational diabetes grew excessively prior to diagnosis, between 20 and 28 weeks. Hence, the babies were already large at the time of diagnosis, and their findings suggest that the onset of fetal growth disorder in gestational diabetes predates the usual time of screening.

̽��ֱ��researchers also studied women who were obese, as it is well recognised that maternal obesity is a risk factor for childhood obesity. Even in the absence of diabetes, the babies of obese women were also twice as likely to be big at 28 weeks. ̽��ֱ��combination of obesity and gestational diabetes was associated with an almost 5-fold risk of excessive fetal growth by the 28 week scan.

“Our study suggests that the babies of women subsequently diagnosed with gestational diabetes are already abnormally large by the time their mothers are tested for the disease,” says Dr Ulla Sovio from the Department of Obstetrics and Gynaecology at the ̽��ֱ�� of Cambridge, the study’s first author. “Given the risk of complications for both mother and child from gestational diabetes, our findings suggest that screening women earlier on in pregnancy may help improve the short and long term outcomes for these women.

“Early screening may be particularly beneficial for obese women, as fetal growth is already abnormal by 20 weeks among these women. Any intervention aimed at reducing the risk of abnormal birthweight in the infants of obese women may need to be implemented even earlier.”

Senior author Professor Gordon Smith, also from the ̽��ֱ�� of Cambridge, adds: “We know that the offspring of women with gestational diabetes are at increased risk of childhood obesity, but so far no clinical trials have successfully demonstrated that screening and intervention in pregnancy reduces this risk. Our study suggests a possible explanation: screening and intervention is taking place when the effects of gestational diabetes are already manifested in the foetus.

“ ̽��ֱ��evidence from our study indicates that there is an urgent need for trials to assess the effect of earlier screening, both on the outcome of the pregnancy and the long term health for the offspring.”

Janet Scott, Research and Prevention Lead for the stillbirth charity Sands said: “We know from recent enquiries that failure to screen for gestational diabetes currently plays a part in a significant number of potentially avoidable stillbirths at term. Good risk assessment is crucial to avoiding harm to mothers and babies and we welcome these important findings which have real potential to inform better antenatal care for these high risk pregnancies. We are delighted to have supported this research, funded with donations from bereaved families.”

̽��ֱ��work was supported by the National Institute for Health Research (NIHR) Cambridge Comprehensive Biomedical Research Centre and SANDS (the stillbirth and neonatal death charity).

Reference
Sovio, U et al. Accelerated fetal growth prior to diagnosis of gestational diabetes mellitus: a prospective cohort study of nulliparous women. Diabetes Care; 8 April 2016; DOI 10.2337/dc16-0160

̽��ֱ��babies of obese women who develop gestational diabetes are five times as likely to be excessively large by six months of pregnancy, according to new research led by the ̽��ֱ�� of Cambridge. ̽��ֱ��study, which shows that excessive fetal growth begins weeks before at-risk women are screened for gestational diabetes, suggests that current screening programmes may take place too late during pregnancy to prevent lasting health impacts on the offspring.

Given the risk of complications for both mother and child from gestational diabetes, our findings suggest that screening women earlier on in pregnancy may help improve the short and long term outcomes for these women

Gordon Smith

Tatiana Vdb

Pregnancy

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New research leaves tumours with nowhere to hide

Anonymous — Thu, 24 Sep 2015 09:25:29 +0000

̽��ֱ��small tumours concealed in the adrenal gland are “unmasked” in early pregnancy, when a sudden surge of hormones fires them into life, leading to raised blood pressure and causing risk to patients.

New research published today in the New England Journal of Medicine conducted by a team led by Professor Morris Brown, professor of clinical pharmacology at Cambridge ̽��ֱ�� and a Fellow of Gonville & Caius College, identifies this small group of lurking tumours for the first time, and explains why they behave as they do.

̽��ֱ��study means that, when patients are found to have high blood pressure early in pregnancy, doctors will now be encouraged to consider that the cause could be the tumours, which can be easily treated. Currently, adrenal tumours are not usually suspected as the cause of high blood pressure in pregnancy, and so go undiagnosed.

Brown and an international group of PhD students including first-author Ada Teo of Newnham College used a combination of state-of-the-art gene “fingerprinting” technology and old-fashioned deduction from patient case histories to work out that the otherwise benign tumours harbour genetic mutations that affect cells in the adrenal gland.

̽��ֱ��mutation means the adrenal cells are given false information and their clock is effectively turned back to “childhood”, returning them to their original state as ovary cells. They then respond to hormones released in pregnancy, producing increased levels of the salt-regulating hormone aldosterone.

Aldosterone in turn regulates the kidneys to retain more salt and hence water, pushing up blood pressure. High blood pressure – also known as hypertension – can be fatal, since it greatly increases the risk of stroke and heart attack.

̽��ֱ��new findings build on a growing body of research focusing on the adrenal gland and blood pressure. Sixty years ago, the American endocrinologist Dr Jerome Conn first observed that large benign tumours in the adrenal gland can release aldosterone and increase blood pressure (now known as Conn’s Syndrome).

Brown and his team have previously found a group of much smaller tumours, arising from the outer part of the gland, that have the same effect. ̽��ֱ��latest discovery drills down still further, revealing that roughly one in ten of this group has a mutation that makes the cells receptive to pregnancy hormones.

Brown said: “This is an example of what modern scientific techniques, and collaborations among doctors and scientists, allow you to do [through a form of genetic fingerprinting]. Conditions are often around for 60 years which we have had no explanation for, and now we can get to the heart of what has gone wrong.”

But the discovery also relied on what doctors call “clinical pattern recognition” – using experience to spot similarities. Brown was able to link together the cases of two pregnant women almost ten years apart and a woman in early menopause. All suffered high blood pressure, leading him to screen their adrenal tumours and identify a matching genetic mutation.

Pregnant women found to have the newly identified subset of tumours can now be identified more readily, and the tumours either treated with drugs or potentially even removed.

̽��ֱ��research was funded by the Wellcome Trust, National Institute for Health Research, British Heart Foundation and A* Singapore.

Hidden tumours that cause potentially fatal high blood pressure but lurk undetected in the body until pregnancy have been discovered by a Cambridge medical team.

Conditions are often around for 60 years which we have had no explanation for, now we can get to the heart of what has gone wrong

Morris Brown

11C metomidate PET CT of small Conn's tumour

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New NICE thresholds could miss up to 4,000 women per year at risk from diabetes in pregnancy

cjb250 — Thu, 11 Jun 2015 23:00:47 +0000

A team of researchers from the ̽��ֱ�� of Cambridge and Cambridge ̽��ֱ�� Hospitals Foundation Trust has discovered that the proposed new NICE thresholds are less effective than international thresholds set by World Health Organization (WHO) at identifying women who are adversely affected by high blood sugar levels during pregnancy.

Diabetes that arises during pregnancy, often disappearing after delivery, is known as gestational diabetes and is becoming increasingly common in the UK. However, there is a lack of consensus about the best way to identify women with the condition. Untreated gestational diabetes can create a risk to the health of both mother and baby and may be associated with pre-eclampsia, excessive amniotic fluid, birth defects, high birthweight, emergency Caesarean section, and low blood sugar levels in the babies after birth. Identifying gestational diabetes during pregnancy allows treatment and dietary advice to be given that reduces the risk of adverse outcomes.

There is a lot of controversy about the best criteria to use to diagnose gestational diabetes. ̽��ֱ��international criteria recommended by WHO require three blood tests to be taken altogether. One test is taken in the fasting state and the other tests are taken one and two hours after a drink containing sugar. These criteria consider that women with high fasting blood sugars have gestational diabetes, with a 75% increased risk of pregnancy complications. However, these diagnostic thresholds would diagnose substantially more women with gestational diabetes than are currently identified, which may create strain on resources for antenatal care.

In February 2015, NICE introduced new guidelines requiring two blood tests only (fasting and two hours after a sugary drink) and recommending a less strict fasting blood sugar threshold for the diagnosis of gestational diabetes. However, these criteria were identified based on cost effectiveness estimates alone, using old NHS hospital payment data, and have never been tested in clinical practice.

Dr Claire Meek and a team of doctors and scientists assessed the risks related to high blood sugar in over 25,000 women who gave birth at the Rosie Hospital in Cambridge between 2004 and 2008 using anonymised hospital records as part of a service evaluation. They found that women who had borderline levels of fasting blood sugar were at much higher risk of having a high birthweight baby compared to the healthy population. In fact, these babies were on average 350g heavier. Their mothers were twice as likely to have had an emergency Caesarean section and seven times more likely to develop excessive amniotic fluid. These women would be missed using the new NICE criteria.

Using the WHO guidelines instead of the NICE guidelines at the Rosie Hospital would have resulted in 126 more diagnoses of gestational diabetes over five years. Although this accounts for less than one in 200 pregnancies, these pregnancies accounted for a disproportionately high number of poor outcomes – four in 100 cases of high birthweight babies; just under three in 100 cases of pre-eclampsia; and over five in 100 cases of excessive amniotic fluid), many of which might have been preventable with treatment. Overall, the researchers estimate that this issue is likely to affect 3,000 to 4,000 women each year in the UK.

“There is a fundamental difference between the international criteria and the new NICE 2015 criteria: the international criteria are based on minimising the risk of harm to the mother and baby, whereas the NICE criteria have been based upon reducing costs to the NHS,” explains Dr Meek from the Wellcome Trust-MRC Institute of Metabolic Science, ̽��ֱ�� of Cambridge. “While cost effectiveness is important in any health care system, we must not forget the psychological and emotional distress that complications can cause. This cannot be measured in economic terms alone.”

̽��ֱ��study authors also express concern that the UK will miss out on international efforts to improve care for women with diabetes in pregnancy by using lower standards than most other countries.

“ ̽��ֱ��new NICE guidelines contain many different recommendations for the management of diabetes in pregnancy and almost all of these recommendations are beneficial and based upon up-to-date evidence,” adds Dr David Simmons from Cambridge ̽��ֱ�� Hospitals. “This is not the case with the diagnostic criteria for gestational diabetes. These should aim to improve health for all pregnant women and their babies by identifying those at greatest risk of complications, and who may benefit the most from dietary changes or other forms of treatment.

“Doctors need to be aware that the new NICE criteria will miss high-risk women, especially those with borderline fasting blood sugar.”

̽��ֱ��research was funded by the European Union, the Wellcome Trust and GlaxoSmithKline.

Adapted from a press release from Diabetologia

Reference
Meek, CL et al. Diagnosis of gestational diabetes mellitus: falling through the net. Diabetologia; 12 June 2015

̽��ֱ��new threshold for diabetes in pregnancy recently introduced by the UK’s National Institute for Health and Care Excellence (NICE) misses a significant number of women at risk of serious complications, a report published today in the journal Diabetologia shows.

While cost effectiveness is important in any health care system, we must not forget the psychological and emotional distress that complications can cause. This cannot be measured in economic terms alone

Claire Meek

Torsten Mangner

Yin & Yang

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Shopping vouchers could help one in five pregnant women quit smoking

cjb250 — Thu, 26 Feb 2015 00:00:34 +0000

While the prevalence of smoking in pregnancy has declined, it remains high amongst more socially deprived groups. In England, one in eight (12%) of women smoke throughout pregnancy, ranging from one in 200 (0.5%) in areas of low deprivation to one in four (27%) in areas of high deprivation. A recent review found that financial incentive schemes to be the single most effective intervention for encouraging women to stop smoking during pregnancy. However, this work was based on a few small trials in the USA and only measured smoking cessation after one week.

In order to assess the potential effectiveness of financial incentives and inform their use in clinical practice – and also to see to what extent it leads to mothers ‘gaming’ the system – researchers carried out a study of women attending antenatal clinics at a hospital in Chesterfield, Derbyshire, an area of high deprivation. 239 pregnant women – two out of five women who attended the clinic – enrolled into the financial incentives scheme.

At each visit to the antenatal clinic, the women were asked if they had smoked since the last visit and were given a carbon monoxide breath test (which showed positive if the individual had smoked in the preceding few hours). If they had not smoked, they were given a shopping voucher – the first voucher was worth £8 and the value increased by £1 for each visit up, providing a potential maximum of £752 in vouchers. Testing positive for smoking resulted in the incentive being withheld at that visit and the value being reset to £8 for the next visit; following two consecutive test results indicating no smoking, the incentive was re-set to the highest point attained prior to the lapse.

̽��ֱ��researchers also used saliva samples from the women to assess at time of delivery and then six months later whether the women had stopped smoking, complemented with urinary and saliva tests at enrolment, 28 and 36 weeks into pregnancy and then two days and six months after the birth of their child.

Of the women who enrolled into the scheme, 143 received at least one voucher, suggesting that they had attempted to quit. One in five of the women (48 women) had managed to quit by the time of delivery. 25 women (10%) were still not smoking six months after the birth of their child. This compared to the previous year, when only a very small number of women (less than 1%) were recorded as having stopped smoking. In all cases, women from areas of highest deprivation were the least likely to succeed in quitting. Urinary or salivary tests suggested that ten women (4%) had smoked cigarettes whilst claiming vouchers.

Professor Theresa Marteau from the Behaviour and Health Research Unit at the ̽��ֱ�� of Cambridge, who led the study, said: “We all know of the dangers of smoking, particularly during pregnancy, but quitting can be extremely difficult. Offering financial incentives clearly works for some women – with very few ‘gaming’ the system and a significant number stopping smoking at least for the duration of their pregnancy.”

Julie Hirst, Public Health Principal at Derbyshire County Council, said: “Giving every child the best start in life is crucial to promoting health and reducing health inequalities across the life course. Helping pregnant women to quit smoking is one of the most effective ways to achieve both of these outcomes. ̽��ֱ��health benefits for these babies and their mothers will be felt for the rest of their lives.

“Smoking is very addictive and these women have done incredibly well to quit. ̽��ֱ��incentive scheme gave them that bit of extra help that made all the difference. As a Council we are committed to extending this scheme the other areas of Derbyshire where there is a higher than average prevalence of smoking in pregnancy.”

In total, £37,490 was spent on the financial incentive, which the researchers believe is likely to prove an acceptable ratio of cost to benefit. Based on modelling of other interventions for smoking cessation in pregnancy, they argue it is most likely that these schemes would fall within the acceptable range of cost effectiveness set by the National Institute for Health and Care Excellence (NICE).

Diana Ierfino from the Centre for the Study of Incentives in Health, King’s College London, added: “ ̽��ֱ��big question will be whether offering financial incentives is economically viable. Our estimates suggest that the ratio of cost to benefit is likely to be acceptable, given the financial implications of treating the health consequences of smoking.

“However, before a scheme like this is rolled out nationwide, there is still work to be done to understand the amount, frequency of type of incentives that would be most effective.”

̽��ֱ��scheme was funded by NHS Derbyshire County Primary Care Trust and Derbyshire County Council, with funding for the evaluation coming from the Wellcome Trust.

Reference
Ierfino, D et al. Financial incentives for smoking cessation in pregnancy: a single arm intervention study assessing cessation and gaming. Addiction; 26 Feb.

Financial incentives could help one in five women quit smoking during pregnancy, according to new research published today in the journal Addiction. ̽��ֱ��study, led by researchers at the ̽��ֱ�� of Cambridge and King’s College London, found that only a small number of women ‘gamed’ the system to receive the incentives whilst continuing to smoke.

We all know of the dangers of smoking, particularly during pregnancy, but quitting can be extremely difficult. Offering financial incentives clearly works for some women

Theresa Marteau

jim simonson

Smoking girl

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