A fascinating case study and exploration of the WHY behind the delay in evidence to implementation in health care. Although the article does not address maternal health care, the philosophy is clear – does this sound familiar?
David Epstein/ProPublica writes:
“Most of my colleagues,” Christoforetti says, “will say: ‘Look, save yourself the headache, just do the surgery. None of us are going to be upset with you for doing the surgery. Your bank account’s not going to be upset with you for doing the surgery. Just do the surgery.’”
The first case study in the article looked at two patients with very different outcomes. Neither one needed a stent. The patient who got one did not survive. The article explains:
Stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all.What the patients in both stories had in common was that neither needed a stent. By dint of an inquiring mind and a smartphone, one escaped with his life intact. The greater concern is: How can a procedure so contraindicated by research be so common?
When you visit a doctor, you probably assume the treatment you receive is backed by evidence from medical research. Surely, the drug you’re prescribed or the surgery you’ll undergo wouldn’t be so common if it didn’t work, right?
For all the truly wondrous developments of modern medicine—imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few—it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable—or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.
The entire article contains several case studies and a thorough look at the research. It is a great read! What are your thoughts relating to maternal health care?
From time to time, we have lab companies come in and present information about new testing and technology available to offer our clients. As we sat in the presentation, the complex ethical questions were apparent – especially as we started to consider the future application of the developing technology. With the availability of more information comes the ultimate question – what do you DO with that information? A recent article explores the potential available in the very testing we were discussing:
Secrets of Life in a Spoonful of Blood: The intricate development of the fetus is yielding its long-held secrets to state-of-the-art molecular technologies that can make use of the mother’s blood. By Claire Ainsworth, Nature.com
Now, a crop of molecular technologies is giving scientists tantalizing hints about how to fill in those gaps. Improved ways of reading and interpreting the information in fetal genetic material are uncovering a raft of genes involved in human development, and letting researchers eavesdrop on the hum of gene activity before birth. They can see which genes turn on or off at pivotal moments, and sense how the environment nurtures or intrudes on this.
Even the vital life-support system that we jettison at birth — the placenta — is laying bare its secrets. “It really is this great mystery in reproduction,” says Zev Williams, a reproductive endocrinologist and infertility specialist at the Albert Einstein College of Medicine in New York City. “It’s obviously such a critical part of human development, but it’s been so understudied.”
Until now, much of the work has relied on amniotic or placental samples obtained during routine invasive tests such as amniocentesis. But scientists are eyeing the next step: studies that are non-invasive for the fetus and are done on a teaspoonful of blood drawn from a pregnant woman’s arm. In this way, researchers could monitor fetuses as they develop and, down the line, develop non-invasive tests for a broad range of conditions, in both fetus and mother.
It is always hard to balance the right to know against the potential harm of revealing the presence of a DNA variant — especially if scientists can’t be sure what the effect of that variant will be, says Shendure. “It’s just going to get really tricky.”
Guess what? Eating, drinking and moving in labor promotes a more effective labor! And there is a new study to support what we have known in the birth center setting for a while…
We predict the next study will evaluation the benefits of proper hydration while exercising. Ha. Ha.
Authors Ciardulli A1, Saccone G, Anastasio H, Berghella V. Author information 1Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Rome, and the Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania. Citation Obstet Gynecol. 2017 Feb 6. doi: 10.1097/AOG.0000000000001898. [Epub ahead of print] CONCLUSION: Women with low-risk singleton pregnancies who were allowed to eat more freely during labor had a shorter duration of labor. A policy of less-restrictive food intake during labor did not influence other obstetric or neonatal outcomes nor did it increase the incidence of vomiting. Operative delivery rates were similar.
Have you ever wondered why many medications aren’t studied in pregnant women? Have you noticed that even most over-the-counter medications or supplements carry the warning to “consult with your provider” before using in pregnancy? Did you know that up to 95% of late-stage clinical trials still exclude pregnant women AND is estimated that over 50% of pregnant women take some kind of medication? A recent study calls for change!
But for most medications, we have no idea how they work in pregnant women because we’ve never studied it. And with such little information, some pregnant women choose to err on the side of caution, which could mean suffering through pain, discontinuing antidepressants, and putting themselves at risk of disease. There are a few reasons for this. First, there’s the fear of harming the fetus. In the 1950s the drug thalidomide was prescribed to pregnant women as a way to treat morning sickness. But after thousands of babies were born with limb deformities, it became clear that medications taken by a pregnant woman posed a risk to the fetus she carried.
This was further emphasized by diethylstilbestrol, a drug once thought to prevent miscarriages and later found to cause vaginal tumors in females exposed to it in the womb. Pregnant women and even women of childbearing age were then explicitly excluded from clinical trials for some time. Once the underrepresentation of women in clinical trials was recognized as a problem and including them in trials became a priority in the 1990s, it was strongly suggested that they either use contraception or abstain from sex while taking part in trials. Currently, up to 95 percent of late-stage clinical trials still explicitly exclude pregnant women. Other reasons are more financially-based. “The market for pregnant women is much smaller than the general market,” says Costantine. This means drug companies don’t want to take a risk on a smaller slice of the market, especially when there are no regulations in place to protect them from legal action if something went wrong. If a woman needs a medication while pregnant or was already using one prior to pregnancy, her doctor has to anticipate and measure any potential changes in its therapeutic effect. “For some drugs you follow the concentration in the blood and adjust the doses accordingly,” says Costantine.
A new study shows that preterm birth is “independently predictive” of heart disease in women. The study adjusted for other factors such as pre-pregnancy lifestyle and other risk factors for heart disease. The information is very useful to counsel women on preventative care and early detection.
A recent study finds that women with a low vitamin B12 are more likely to have a preterm birth. The study, published in the American Journal of Epidemiology, also found that low maternal vitamin B12 led to low birth weight in newborns as well. Low birth weight and preterm births are a leading cause of death in infants in the first 28 days of life.
Megan McNamee, Babymoon’s Registered Dietician, recommends natural sources of vitamin B12 such as:
Animal proteins, including meat, fish, pork and poultry, as well as eggs and dairy are great sources. Vegetarian sources include fortified products (like cereals and non-dairy milks) and nutritional yeast.
Most prenatal vitamins, like Thorne Basic Prenatal, will contain above-adequate amounts of B12, so additional supplementation is not necessary if women are regularly taking their prenatal vitamin. Since vitamin B12 is water soluble and is not stored in the body, it is okay for prenatal vitamins to have higher doses than the Recommended Daily Allowance of 2.6mcg for pregnant women.
Babymoon Inn is a full-scope midwifery practice and wellness center with locations in Phoenix and Tucson. Our team is committed to improving maternal outcomes and providing personalized, evidence-based care to all people.
Babymoon Inn is a full-scope midwifery practice and wellness center with locations in Phoenix and Tucson. Our team is committed to improving maternal outcomes and providing personalized, evidence-based care to all people.