Bypassing Genetic Obesity Genes?

obesityFact. Obese mothers tend to have kids who themselves will become obese.

Fact. In 2012, 35.7% of US adults and 16.9% of US children age 2 to 19 were obese, according to the CDC

Fact. Half of all U.S. adults will be obese by 2030 unless they change their ways, according to the Robert Wood Johnson Foundation.

Fact. Obesity raises the risk of numerous diseases, from type 2 diabetes to endometrial cancer, chronic heart disease and stroke.

So we were extremely interested to learn of new research that suggests the unhealthy cycle could be broken by weight-loss surgery.  In a first-of-a-kind study, Canadian researchers tested children born to obese women prior to weight loss surgery and their siblings conceived afterward.

thin_fatThe surprising results?  Kids born after mom lost lots of weight were slimmer than their siblings. They also had fewer risk factors for developing diabetes or heart disease.

Even more intriguing, the researchers discovered that numerous genes linked to obesity-related health problems worked differently in the younger siblings than in their older brothers and sisters.

Although diet and exercise will play a huge role in how fit the younger siblings will continue to be, the findings suggest the children born to mothers who have undergone weight loss surgery might have an advantage.

The impact on the genes, you will see the impact for the rest of your life,” predicts lead researcher Dr. Marie-Claude Vohl of Laval University in Quebec City.

gastric bypassSo why would there be a difference? Clearly weight loss surgery doesn’t change a womans’ genes.  However, it seems as if either the surgery or more likely the subsequent weight loss can change how certain genes operate in her child’s body. The researchers suggest that factors inside the womb seem to affect the chemical  ‘dimmer switches’ that make the fetus’ genes speed up or slow down or switch on and off.

Dr. Susan Murphy of Duke University wasn’t involved in the research says it makes biological sense that the earliest nutritional environment could affect a developing metabolism, although she cautions that healthier family habits after mom’s surgery may play a role, too.

The research has implications far beyond the relatively few women who undergo gastric bypass surgery before having a baby. According to the American College of Obstetricians and Gynecologists, more than half of pregnant women are overweight or obese. Tackling obesity before or during pregnancy can provide a lasting benefit for both mother and baby.

It’s not just a matter of how much moms weigh when they conceive, gaining too much weight during pregnancy increases the child’s risk of eventually developing obesity and diabetes. Overweight mothers have higher levels of sugar and fat in the bloodstream, which in turn makes it to the womb.

How much weight loss is needed to have a healthy baby?

pregnant and obeseIn the study, researchers took blood samples from children born to 20 women before and after the complex gastric bypass surgery, who, on average, lost about 100 pounds. They compared differences in more than 5,600 genes between the younger and older siblings and found significant differences in the activity of certain genes clustered in pathways known to affect blood sugar metabolism and heart disease risk.

Only time will tell if the children born after mom’s surgery really get lasting benefits. Meanwhile, specialists urge women planning a pregnancy to talk with their doctors about their weight ahead of time. Besides having potential long-term consequences, extra pounds can lead to a variety of immediate complications such as an increased risk of premature birth and cesarean sections.

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Born to have Baby Blues?

Mother In Nursery Suffering From Post Natal DepressionIt’ s not clear what causes postpartum depression.  The condition, which is marked by persistent feelings of sadness, hopelessness, exhaustion and anxiety, usually begins within four weeks of giving birth and can persist for weeks, months or even up to a year. An estimated 10 to 18% of all new mothers develop the condition, and the rate rises to 30 to 35% among women with previously diagnosed mood disorders.

Scientists have long believed the symptoms were related to the large drop-off in the mother’s estrogen levels following childbirth, however studies have shown that both depressed and non-depressed women have similar estrogen levels.

Now researchers from Johns Hopkins say they have discovered alterations in two genes that, can reliably predict whether a woman will develop postpartum depression.

genetic link to post-partum depressionThe genetic modifications, which alter the way genes function without changing the underlying DNA sequence, can apparently be detected in the blood of pregnant women during any trimester, potentially providing a simple way to foretell depression in the weeks after giving birth, and an opportunity to intervene before symptoms become debilitating.

By studying mice, the researchers suspected that estrogen induced genetic changes in cells of the hippocampus – the part of the brain that governs mood.  They  then created a complicated statistical model to find the candidate which could be potential predictors for postpartum depression. That process resulted in the identification of two genes, known as TTC9B and HP1BP3.

Little is known about these genes except for their involvement in hippocampal activity. However the team suspects that they may have something to do with the creation of new cells in the hippocampus and the ability of the brain to reorganize and adapt in the face of new environments. Both of these elements are known to be important in mood.

Furthermore, estrogen can behave like an antidepressant, so when it is inhibited, it adversely affects mood.

Postpartum depression can be harmful to both mother and child,” says Zachary Kaminsky, Ph.D., an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “But we don’t have a reliable way to screen for the condition before it causes harm, and a test like this could be that way.”

The findings of the small study involving 52 pregnant women are described online in the journal Molecular Psychiatry.

blood  test + pregnancyThe study involved looking for epigenetic changes tin the thousands of genes present in blood samples from 52 pregnant women with mood disorders. The women were followed both during and after pregnancy to see who developed postpartum depression.

The researchers noticed that women who developed postpartum depression exhibited stronger changes in those genes that are most responsive to estrogen, suggesting that these women are more sensitive to the hormone’s effects. Specifically, changes to the two genes – TTC9B and predicted with 85% certainty which women became ill.

We were pretty surprised by how well the genes were correlated with postpartum depression,” Kaminsky says. “With more research, this could prove to be a powerful tool.”

Evidence suggests that early identification and treatment of postpartum depression can limit or prevent debilitating effects. Alerting women to the condition’s risk factors — as well as determining whether they have a previous history of the disorder, other mental illness and unusual stress — is key to preventing long-term problems.

Research also shows that postpartum depression not only affects the health and safety of the mother, but also her child’s mental, physical and behavioral health.

antidepressants.pregnancy.giIf the results of this preliminary work pan out then a blood test for the biomarkers could be added to the battery of tests women already undergo during pregnancy.  More importantly, the results could help to inform decisions about the use of antidepressants. While there are concerns about the effects of these drugs on the fetus and their use should be weighed against the potentially debilitating consequences to both the mother and child of forgoing them.

As Kaminsky says “If you knew you were likely to develop postpartum depression, your decisions about managing your care could be made more clearly.”

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Beans, Broccoli and Bluefin could help new moms beat the “Baby Blues”

According to an article published last week in the Canadian Journal of Psychiatry, postpartum depression may be caused by low levels of omega-3 fatty acids.

For the 70-80% of all new mothers who experience some negative feelings or mood swings after the birth of their child could the answer lie with legumes?

Women are at the highest risk of depression during their childbearing years, and the birth of a child may trigger a depressive episode in vulnerable women. Postpartum depression is associated with diminished maternal health as well as developmental and health problems for her child.

Symptoms of “baby blues” include:

  • Weepiness or crying for no apparent reason
  • Impatience
  • Irritability
  • Restlessness
  • Anxiety
  • Fatigue
  • Insomnia
  • Sadness
  • Mood changes
  • Poor concentration

Gabriel Shapiro of the University of Montreal and the Research Centre at the Sainte-Justine Mother and Child Hospital says “The literature shows that there could be a link between pregnancy, omega-3 and the chemical reaction that enables serotonin, a mood regulator, to be released into our brains.”

Because omega-3 is transferred from the mother to her fetus and later to her breastfeeding infant, maternal omega-3 levels decrease during pregnancy, and remain lowered for at least six-weeks following the birth.

Furthermore, in addition to the specific circumstances of pregnant women, it has been found that most people in the US do not consume sufficient amounts of omega-3. “These findings suggest that new screening strategies and prevention practices may be useful,” said Shapiro.

And while there are plenty of commercial omega-3 supplements, don’t forget that these clever little fatty acids are also present in seafood, (especially salmon, anchovies, tuna and sardines) as well as in oils, beans, nuts and seeds, winter squash, broccoli and my personal favorite – cauliflower.

Although Shapiro’s study was preliminary and the further research is needed to clarify the link, new moms could do worse than use salmon to stave off sadness or anchovies as the answer to anxiety!

A mobile ear for pregnancy problems

In much of Africa, only the very richest have access to quality healthcare. Nowhere is this more apparent than in family medicine. According to the UN, a woman dies from complications in childbirth every minute and eight million babies die each year before or during delivery or in the first week of life. The maternal mortality ratio in Africa is the highest in the world and has actually increased over the last 20 years. In 2007, experts warned that if nothing was done to arrest this trend there would be 2.5 million maternal deaths, 2.5 million child deaths and 49 million maternal disabilities in the region over the next 10 years. Now, thanks to the ingenuity of a group of computer science students, a primitive 19th century device and some 21st century technology, something is being done. The Pinard Horn, named after the French doctor who invented it back in the 19th Century, is a medical device used to monitor the heart rate of a fetus during pregnancy. It functions similarly to an ear trumpet by amplifying sound. The wide end of the horn is held against the pregnant woman’s belly, while the doctor, nurse, or midwife listens through the other end. Despite its antiquity, the Pinard Horn is still used in many parts of the world and can be very effective in the right hands. It can determine the age, position and heart rate of the fetus, along with an indication of its overall health. But to do this consistently, can take many years of practice. This led the three Ugandan computer science students to think about improving the design. “We saw the technology gap and started thinking about how we might bridge it.” In developed countries, ultrasound is the answer, but these machines are expensive. Even if a hospital could afford one, few expectant mothers could. And so, a new project, known as WinSenga was born.  The new device still consists of a plastic trumpet, but with a highly sensitive microphone inside. It is placed on a women’s abdomen just like the original horn, but now it connects to a Windows-based phone running an app that plays the part of the midwife’s ear. The system picks up the fetal heart rate, transmits it to the phone, and then the phone runs an analysis. The app, developed in conjunction with Unicef medics then recommends a course of action, if necessary, for the mother and her unborn child. “When I first heard the idea, I thought it was brilliant,” says Davis Musinguzi, a medic and Unicef advisor. “But being software developers, they needed guidance on the medical component of the application.” The doctor advised on the medical parameters, procedures and standards that needed to be part of the software. The value of going mobile is pretty clear, allowing carers to visit mothers wherever they are. The students, Joshua Okello, Aaron Tushabe and Josiah Kuvuma won the 2012 Microsoft East and Southern Africa Imagine Cup competition before losing out in the finals held at Sydney. Still, the event partly inspired the name of the new device. The “Win” part comes from the software giant’s own products, while “Senga” refers to the local Ugandan name for the traditional “birth attendants” who used to help village mothers-to-be with their antenatal care and their births. Their loss at the world finals has not held them back. The students have since been approached for potential partnerships and are currently looking for funding to launch a six-month field trial of their system. If that’s successful, then WinSenga could launch as a product. While the team says it’s too early to talk about pricing, they are heartened that the cost of smartphones is rapidly dropping across Africa, making their system much more attractive to potential clients. While they wait for funding, the WinSenga team is far from idle. Despite the fact that all three team members still have busy university schedules, they have already launched an expanded version of the software designed to assist healthcare workers and mothers during labor. The group’s website also promises a version called WinSenga Plus, which would assist with postnatal care as well. And as if that isn’t enough, WinSenga say they are almost ready to launch an Android version of their application, and will then start work on a version for iOS. The use of mobile technology is a relatively new intervention to improving health services,” says Dr. Musinguzi.  “WinSenga and other devices and apps that are coming on to the market, will have to prove themselves to healthcare professionals by reducing the burden of doing what they have always done.” It will take training and investment, he says, but it “will pay off in the long run”. Kudos to you gentlemen. You’re winners in our book!

Finding ADAM to help Eve

Ectopic pregnancies occur when an embryo fails to implant in the womb. Instead, it may occur in the Fallopian tubes leading to rupture of the tube and subsequent loss of the embryo and risk to the life of the pregnant woman.

Currently there is no way to predict whether an ectopic pregnancy will occur. However, that’s all about to change.  Scientists at The Wistar Institute and the University of Pennsylvania School of Medicine have found a protein biomarker – ADAM12 – whose presence showed a nearly 97% correlation with ectopic pregnancy.

This discovery could lead to development of a simple blood test for ectopic pregnancy.

The research teams compared the proteomic signature of blood samples taken from known cases of ectopic pregnancy with blood samples taken from women who experienced a normal pregnancy. What they discovered was about 70 biomarkers that could signal ectopic pregnancy. Through some stringent statistical analysis, they then whittled it down to 12 of the most promising candidates. While some of the proteins had previously been associated with ectopic pregnancies, the researchers found at least two, including ADAM12, that had not.

In case you were wondering, ADAM12 is a biomarker from the disintegrin and metalloprotease protein family. Members of this family are structurally related to snake venom disintegrins, and have been implicated in a variety of biological processes involving cell-cell and cell-matrix interactions, including fertilization, muscle development, and neurogenesis.

SRxA’s Word on Health is hopeful that this discovery could pave the way for a blood test that could be incorporated into routine early prenatal care and save the lives of many women.

The Risks And Rewards Of Inviting Patients To Review Their Medical Records

Technology has placed vast amounts of medical information literally a mouse click away. Indeed, 57% of Americans say they get their primary medical information from the internet.  Maybe that’s because, an individual’s main potential source of information, the doctor’s notes, taken after a visit are not traditionally part of the discussion. Such records have long been out of bounds.

After patient encounters, doctors have long written notes ranging, from cryptic abbreviations on an index card to lyrical essays. Yet despite a patient’s legal right to read their doctor’s note, few do. Although literature suggests that promoting active patient involvement in care may improve doctor-patient communication and clinical outcomes, both patients and doctors express everything from enthusiasm to dismay when it comes to sharing the visit note.

In Open Notes: Doctors and Patients Signing On,  researchers speculate about the risks and rewards of making clinicians’ notes transparent to patients.  “Opening documents that are often both highly personal and highly technical is anything but simple,” say the investigators from Beth Israel Deaconess Medical Center.

Their OpenNotes study will include more than 100 primary care doctors and 25,000 patients who will be invited to read their notes.  Some primary care doctors interviewed as part of a pre-study assessment “…anticipated both clinical benefits and efficiencies from incorporating laboratory findings and recommendations into the note, thereby obviating the need for a follow-up letter.” They hoped for improved patient education and more active involvement by patients in their care.

On the other hand, some doctors “worry first and foremost about the effect on their time, including calls, letters and e-mails as patients seek clarifications, disagree with statements, or correct what the doctors consider trivial errors of fact.”

Others were concerned they would have to leave out important information, omit frightening diagnostic or therapeutic considerations, or that patients would not understand that ‘SOB’ stood for ‘shortness of breath.’   And some were simply embarrassed about how they write!

From the patient perspective, views are also somewhat mixed.  For some of the patients, the dialogue inherent in the process was appealing.  On the other hand, some clearly do not want to read what their doctors write because they are worried about discovering something they would rather not know, finding potential diagnoses that might make them anxious, or reading what their doctors really thought of them.

The study will use secure Internet portals and only include notes written during the trial period. While they are gathering considerable data from the patient and doctors’ experiences during the study period, investigators say their ultimate question is whether the participants will want to leave the OpenNotes switch on after 12 months.

What do you think about sharing notes with your doctor or patients?  Word on Health is waiting to hear from you.

Asthma Warning for Pregnant Women

It may surprise some of our readers to learn that asthma is the most common serious complication of pregnancy.  In fact, up to 55% of women will have at least one acute asthma attack during pregnancy.

Pregnancy may affect asthmatic patients in several ways. Hormonal changes may affect the nose, sinuses and lungs. An increase in estrogen contributes to congestion of the tiny blood vessels in the lining of the nose. A rise in progesterone causes increased respiratory drive, and a consequent feeling of shortness of breath.

Yet, despite this, many pregnant women are just not identified as asthmatic. All too often asthma is not reported by moms-to-be during antenatal visits and is therefore under-treated. Then there are those who know they have asthma but fail to take their controller medications for fear they harm the baby.

Such concerns appear to be unjustified.  According to the American College of Asthma, Allergy and Immunology (ACAAI), well-controlled asthma is not associated with significant risk to mother or fetus.

Uncontrolled asthma, on the other hand, can cause serious complications to the mother, including:

  • high blood pressure
  • toxemia
  • premature delivery
  • death

For the baby, complications of uncontrolled asthma include:

  • increased risk of stillbirth
  • fetal growth retardation
  • premature delivery
  • low birth weight
  • a low APGAR score at birth

The Pregnancy Committee of ACAAI advises that the risks of asthma medications are lower than the risks of uncontrolled asthma. They suggest that women discuss the use of asthma or allergy medication needs with their doctor, ideally before pregnancy.

SRxA’s Word on Health would like to hear your asthma and pregnancy stories.