UK researchers report that inducing labour at more than 37 weeks of gestation reduces the rate of stillbirth or dying in the first month of a baby’s life, without increasing the rate of caesareans. However, inducing labour increased the number of babies admitted to neonatal intensive care compared with standard labour management. The researchers analysed pregnancies in more than one million women from 1981 until 2007.

One of the authors, Dr Sarah Stock from the University of Edinburgh, is currently on a Maternal-Fetal Medicine Fellowship at Perth’s King Edward Memorial Hospital and with the University of Western Australia’s School of Women’s and Infants’ Health.

Feel free to use these quotes in your stories. Any further comments will be posted here. The research material is available in the registered area. If you would like to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Professor Mary-Ann Davey is a Senior Research Fellow at Mother & Child Health Research at La Trobe University, Melbourne. Prof Davey is independent of the study

“This study looks at routinely-collected records for over one million births of full-term, singleton babies in Scotland between 1981 and 2007. They compared a number of outcomes between the women whose labour was induced at each week of gestation between 37 and 41 weeks with those women whose labour was not induced.

They found that babies born after induced labours were less likely to be stillborn or to die in the first month of life, and that unassisted vaginal birth was no less likely with induced labours. However babies were more likely to be admitted to neonatal intensive care and special care nurseries following induced labour, and their mothers were more likely to experience two adverse outcomes: ruptured uterus and difficulty delivering the baby’s shoulders.

Some apparent problems with this study include:

• Women were excluded from the induced group if they had specified complications of pregnancy recorded, but women were not excluded from the comparison group if they had these conditions recorded. This means that the induced group is likely to be a healthier group of mothers than those not induced, so would be expected to have fewer adverse outcomes and fewer operative births.
• Babies whose labour was not induced were more likely to be poorly grown than those who were induced, placing them at greater risk of death, and also of caesarean birth.
• It is not clear when babies in the comparison group died (assumptions were made), so it is not certain that induction of labour at any particular time could have prevented their death.

Studying elective induction of labour is very difficult to do well. Even large randomised controlled trials in the area have been seriously flawed. There remains considerable work to do on the impact of elective induction of labour.”

 Prof Davey is unavailable this evening but will be able to do interviews tomorrow.

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Professor Jenny Gamble is Professor of Midwifery and Maternity and Family Unit Leader at the Research Centre for Clinical and Community Practice Innovation at Griffith University. Prof Gamble is independent of the study

“This study compares medically managed birth (elective induction) with expectant management. Usual care for women in the expectant management (comparator) group was likely to involve labour care by people the woman had not met before and with no assurance of one-on-one care in active labour. On the other hand, women undergoing elective induction may have had increased observation and attendance by midwives and/or doctors and this may have affected the outcome. There is significant evidence that continuity of care by a known midwife improves a range of outcomes for women and their babies, and it may well be that healthy pregnant women trying to birth in medicalised environments are at greater risk than women under closer medical management such as during induction of labour. Research into the use of medical interventions on childbearing women should ensure that the comparator group is receiving evidence-based care.

Women with medical indications for induction were excluded from the elective induction of labour group but not excluded from the comparator group (expectant management). There may well have been significant numbers of women in the comparator group with medical indications for induction but not induced (e.g. hypertension or previous still birth) and this may have inflated perinatal mortality in the comparator group. Similarly, women with prelabour rupture of membranes were excluded from the elective induction group but not the comparator (expectant management) group, yet prelabour rupture of membranes, particular when this is prolonged, is associated with an increased rate of complications for the fetus and newborn.

Admission to neonatal nursery was increased in association with elective induction of labour at all gestations and is of serious concern. Despite this, the extent of newborn health concerns was not documented. We do not know about the babies’ condition at birth (Apgar score), reason for admission to neonatal nursery, length of neonatal nursery stay, impact on breastfeeding, or associated costs. No data is provided on short, medium or long-term neonatal morbidity of elective induction at term in healthy women.”

 ———–

 *Outcomes of elective induction of labour compared with expectant management: population based study, Stock et al., BMJ, 11 May 2012

Research from the US shows exposure of pregnant rhesus monkeys to Bisphenol A (BPA) altered the developing mammary glands of their offspring. BPA is used in the manufacturing of various plastics and resins for food packaging and consumer products. BPA can act as an endocrine disruptor (a chemical that can interfere with the balance of hormones in the body); specifically, BPA has been found to mimic oestrogen (in animal models), with implications for development and reproduction. 

Feel free to use these quotes in your stories.  If you would like a copy of the research or to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Dr Ian Musgrave is a senior lecturer in the Discipline of Pharmacology at the University of Adelaide

Is this research and its findings of concern to the human population?

“No, doses used and plasma concentrations reached do not represent most human exposure (see next section). The only significant finding was that the number of terminal buds in breast tissue were increased. This is of doubtful relevance to cancer. No other aspect of breast tissue structure at the gross or microscopic level was changed. “

Is the dosage used in the report similar to that of the regular person’s exposure to Bisphenol A?

“No, the dosage used was 8 times higher than the upper limit of permitted human exposures. It was also administered as a single, large dose which would have produced a much larger concentration in the blood than was seen when the plasma levels were measured 4 hours later. The serum level of total BPA measured at this time were around 50 times higher than is seen in several human studies, but as this plasma level was measured several hours after dosing, the actual exposures would be much higher.” 

Should this be a warning of the dangers of Bisphenol A exposure during pregnancy or infant developmental stages?

“In long term studies with rats at these high levels of exposure, no adverse effects have been seen.” 

Is there a way to lower ones exposure to the Bisphenol A, considering its ubiquity in the modern world?

“The best way is to consume less processed food. This reduces BPA intake, and also limits salt, sugar and fat intake which also has important health benefits.”

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 Comments from the UK SMC:

Professor Warren Foster, Department of Obstetrics & Gynecology, McMaster University, said:

 “The paper by Tharp et al., 2012 examined the effect of developmental exposure to Bisphenol A (400 ug/kg BW) given from gestational day 100 to term in rhesus monkeys. At birth the mammary glands were removed and examined either by whole mount or histomorphometry and immunohistochemistry for estrogen receptors. The paper has a number of strengths which include the use of a non-human primate model that more closely reflects human development and physiology. In addition, the animals were exposed via an oral route to the test compound and the methods of analysis are appropriate for the stated objectives.

 “There are several weaknesses with this paper which include but are not limited to the small sample size. It is appreciated that non-human primate studies are expensive and difficult to run, yet four and five animals/group is not robust and it is difficult to extrapolate the findings to the larger population. Furthermore, the authors state that their dosing paradigm resulted in blood concentrations of free BPA that are representative of the human population as summarized in the Vandenberg and colleagues review paper.  However, the exposure to BPA is not representative of how humans are exposed. Specifically, the monkeys received a single high dose exposure which, at the time samples were collected, produced a circulating concentration that was representative of human serum concentrations. Note that the serum concentrations in human studies are in the range quoted in this study in small biomonitoring studies, whereas more recent larger studies show lower median concentrations. Moreover, humans are primarily exposed to BPA through the diet to low concentrations of BPA. Of note a recent pharmcokinetic study conducted by Teegaurden and colleagues shows that people consuming meals with relatively high concentrations of BPA did not result in detectable concentrations of BPA in their circulation, while conjugated BPA was measured in the urine. Hence, a large bolus of BPA administered once during the day can result in very high circulating concentrations of free BPA in the serum that fall through the concentration reported in biomonitoring studies but may not necessarily be reflective of how people and tissues are exposed. Other minor criticisms may arise from the use of a single dose and the absence of a positive control group for comparison. Finally, the results demonstrate premature development of the mammary gland but do not demonstrate any pre-cancerous lesions.

“Overall, this is a scientifically sound paper that extends the findings in rodents to the non-human primate. The results do not however suggest that BPA is a carcinogen or that it is implicated in breast cancer. Furthermore, the dosing paradigm is not representative of human exposure which make generalization of the study results to humans difficult.”

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Professor Richard Sharpe, MRC Centre for Reproductive Health, Edinburgh University, said:

“This preliminary study shows that fetal exposure of rhesus monkeys to high levels of bisphenol A (a weakly oestrogenic chemical) may result in an increase in terminal end buds in mammary glands at birth (the only significant finding). It is unlikely the effects described have any health implications for humans, for two reasons.

 “First, the exposure levels of BPA used in this study are 400- to 4000- times higher than exposure of the normal human population. Levels of unconjugated (biologically active) bisphenol A in blood in humans are so low they cannot be measured; this is probably because ingested bisphenol A is rapidly inactivated during absorption from the gut.

 “Second, at birth in humans breast tissue is enlarged (boys as well as girls) because of exposure to the extremely high pregnancy levels of oestradiol. Additional exposure to minimal amounts of bisphenol A (more than 1000 times less potent than oestradiol) is unlikely to add significantly to this.

 “Similar effects on mammary terminal end buds have been shown in laboratory rats exposed to bisphenol A, but again at exposure levels many times higher than in humans (as in the monkeys). However, even then no adverse long-term effects (eg mammary cancer) from exposure to bisphenol A alone have been shown to result.

 “Statistical note:

This is an extremely small study (N=4, 5) and terminal end bud number varied hugely in controls and overlapped with values for bisphenol A-exposed animals. This could mean the present findings are due entirely to chance.”

 * ‘Bisphenol A alters the development of the rhesus monkey mammary gland’ by Tharp et al. www.pnas.org/cgi/doi/10.1073/pnas.1120488109

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Researchers from the University of Adelaide have compared the risk of major birth defects for each of the reproductive therapies commonly available internationally, including IVF. Below experts respond.

Feel free to use these quotes in your stories.  Any further comments will be sent out and posted here. To speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email. The research paper is available on the registered area of this site.

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Professor Peter Illingworth is Medical Director at IVF Australia and an Associate Professor with the University of Sydney

“This paper confirms the previously widely reported association between babies being conceived through assisted reproduction technologies (ART) and having a slightly higher risk of congenital anomalies.

These findings are consistent with previously widely reported data in this area. What is new about this paper is that Professor Davies has, for the first time, looked at other women in similar situations.

The big question underlying the association between assisted reproduction and congenital anomalies is whether this is due to the laboratory process itself, or whether it’s a reflection of the fact that people who have to use ART to have their family already have pre-existing damage to their eggs and sperm that puts them at higher risk of having children with congenital anomalies. 

Professor Davies’ findings suggest the later explanation. He has, for the first time, looked at the siblings who have been conceived normally of children who have been conceived from ART. He has also looked at women who have presented to antenatal clinics with a past history of infertility but who have not had ART. Both of these groups show a very similar effect, with a higher risk of congenital anomalies, as do the children who have been conceived using ART. This is a new finding.

The other interesting feature about his results is the fact that, when he separates the two types of ART into IVF and intra-cytoplasm sperm injection (ICSI), his findings are that IVF children do not have a higher risk of congenital anomalies and that the risk is limited to children who have been conceived using ICSI. This is contrary to other findings in large studies in Europe. The explanation for this is not at all clear. It may well be that the sort of families who have to use ICSI have extreme sperm damage, and this may be the explanation as to why there is a higher rate of congenital anomalies in this group.

I think this is a very important paper; it’s one that we’ve needed for a long time. I think Professor Davies should be congratulated on his work.”

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The following comment was obtained by our colleagues at the UK Science Media Centre:

Dr Allan Pacey, fertility expert at the University of Sheffield and Chairman of the British Fertility Society, said:

“This is an interesting paper which analyses the register of birth defects in South Australia with the data from clinics providing infertility treatments such as IVF and ICSI. This is with the aim of trying to find any links between the two, a common approach in this kind of work requiring large numbers of patients to make sure any statistical associations are robust.

 “Several links are found by the authors, but these largely confirm what is already known and suggest that whilst babies born from IVF are as healthy as their naturally conceived counterparts, there is still some residual risk to babies born through ICSI that currently cannot be explained. An important point to make is that we know that babies conceived naturally to couples previously diagnosed with infertility are also at slightly higher risk which suggests that it may be something to do with the ‘infertility’ rather than the ‘technology’ used to conceive them.

 “Couples undergoing assisted conception are understandably concerned about the potential health of any babies born and studies like this are enormously helpful in giving them accurate information and helping to put the risk into context. It should be stressed that the vast majority of babies born are healthy and the actual risks of any problems being detected are small.”

 ———–

 *Reproductive Technologies and the Risk of Birth Defects, Davies et al., New England Journal of Medicine, 10.1056/nejmoa1008095, 2012

German and US researchers report that cognitive ageing could be delayed by up to 2.5 years in elderly people who eat greater amounts of blueberries and strawberries, flavonoid-rich berries. Flavonoids are compounds found in fruits, nuts and vegetables that have been linked to disease prevention through their antioxidant and anti-inflammatory properties. Berries are particularly high in a subclass of flavonoids called anthocyanidins, which can cross the blood–brain barrier and localise in areas of learning and memory. The research used data from the Nurses’ Health Study – a cohort of 121,700 female, registered nurses who since 1980 have been surveyed every four years regarding their frequency of food consumption. Between 1995 and 2001, cognitive function was measured in 16,010 subjects over the age of 70 years, at two-year intervals.

The study shows that women who had higher berry intake delayed cognitive aging by up to 2.5 years. The authors caution that while they did control for other health factors in the modelling, they cannot rule out the possibility that the preserved cognition in those who eat more berries may be also influenced by other lifestyle choices, such as exercising more.

 Feel free to use these quotes in your stories.  Any further comments will be posted on our website at here. If you would like a copy of the research or to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Dr Bryce Vissel is Head of the Neurodegeneration Research Laboratory at the Garvan Institute of Medical Research

“Cognitive decline is often a sign of the onset of dementia and Alzheimer’s in the elderly. There are currently no known therapies that slow the dementia disease process. The results of this study by Dr Devore et al in the USA suggest that significant berry intake may delay cognitive aging by up to 2.5 years. Their research suggests that this may be due to the flavonoid content of the berries. The public policy implications of this research are sufficiently important to merit further study. However, the implications are further reaching, as they show that research offers the possibility to identify ways to slow dementia. Most importantly, if research can show that lifestyle affects cognitive decline, then it seems logical to suggest that research will also deliver effective treatments that slow cognitive decline, given the chance.  

The potential implications of this type of research are that simple berries could potentially reduce the time before elderly people may need care. However, the broader point is that more research is needed and it is needed urgently.”

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Professor Peter Howe is a Research Professor in Nutritional Physiology at the University of South Australia

“Flavonoids are not simply antioxidants – they can have very specific effects on mechanisms involved in circulatory function and inflammation as well as potentially acting on the nervous system. This large scale prospective study has been able to drill down and show that a specific class of flavonoids, the anthocyanidins (that are coming predominantly from strawberries and blueberries) are able to improve cognitive function. There are other sources of flavonoids like tea and cocoa that have also been shown to have cognitive benefits. (Some of the best work in this area has been done by Andrew Scholey at Swinburne’s Centre for Human Psychopharmacology.)

 The flavonoids appear not only to influence cognitive function but also visual function. Research in Canada is showing how the consumption of blueberries can enhance visual acuity, and there is also evidence for similar effects with the cocoa flavanols.

 What I think is happening here, which is not considered in this paper, is that the flavonoids are acting on the blood vessels in the brain and the eyes to improve the circulation. We’re conducting research at the Nutritional Physiology Research Centre looking at how foods rich in flavonoids, like the ones present in these berries, are able to improve blood flow in the brain, because that may be the key to their cognitive benefits. We’re leading that particular line of research at the moment. And we’re doing that in collaboration with our colleagues at Swinburne University.”

Prof Howe will give a presentation on this topic at the Canadian Nutrition Society’s annual meeting next month in Vancouver.

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Associate Professor Shawn Somerset is Associate Professor of Public Health at the Australian Catholic University in Brisbane

 “My previous work has shown that in elderly Australians the most likely source of flavonoids is wine. Berries are expensive, and there are other good sources of anthocyanadins, eg. aubergine (eggplant). Australian intake of vegetables is inferior to fruit, therefore vegetable consumption needs to be promoted above fruit consumption. The most sensible advice is to consume a wide range of flavonoids (rather than large amounts of specific ones, since excessive amounts of some are problematic). This translates to consuming a range of vegetables and fruits, not just one type.”

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 Comments from the UK SMC:

Dr Eric Karran, Director of Research at Alzheimer’s Research UK, said:

“Population studies like this can provide useful clues about the effects of lifestyle and diet on cognition, but we must be sensible when interpreting the results. The study suggests a link between eating berries and slower cognitive decline, but there could be many factors at play.

“It is not possible to say whether the increased consumption of berries resulted in an increased, beneficial level of flavonoid antioxidants in the brain. Further research will be needed to conclude whether antioxidants in berries are beneficial in the brain and we can’t assume that simply eating berries could protect against cognitive aging or dementia.

“Understanding the factors that affect our memory and thinking as we age can help us to understand possible risk factors for dementia. Previous evidence has shown that eating fruit as part of a healthy diet in midlife could help to reduce our risk of dementia and so eating a healthy balanced diet is something we should all be thinking about. With 820,000 people in the UK living with dementia, there is an urgent need to understand more about how to reduce the risk.”

———–

 Carol Brayne, Professor of Public Health Medicine, University of Cambridge, said:

“Broccoli, blueberries, Mediterranean diet, Sudoku…..it is very difficult indeed to be sure that this is not residual confounding as these kinds of dietary patterns are associated with many other positive attributes, which themselves are associated with healthier ageing.

“Blueberries have been of interest for many years and it’s certainly worth further investigation, but for definitive evidence we have to await well designed trials as this is another observational study.”

 ———–

 Derek Hill, CEO of IXICO and Professor of Medical Imaging Sciences, University College London, said:

“Later this year, two major drug trials targeting the proteins in the brain associated with Alzheimer’s Disease will announce their results. Many experts fear these drugs will be added to the long list of potential dementia treatments that fail to demonstrate conclusively that they slow cognitive decline.  

 “This latest research suggesting that a diet high on berries can slow cognitive decline in the elderly population is therefore especially welcome. It is a large and well-designed study that significantly strengthens the evidence that changes to diet may be able to delay onset of dementia symptoms. This suggests that we can take further steps to tackling the scourge of dementia in society while we await the arrival of effective new medicines.”

 ———–

* ‘Dietary Intakes of Berries and Flavonoids in Relation to Cognitive Decline’ by Devore, E. et al. will be published in Annals of Neurology at 2pm AEST on Thursday 26th April, which is also when the embargo will lift.

Embargo lifted at 9.01am AEST Wed 25 April 2012

NEWS BRIEFING:  The dangers of youth – a Lancet series on adolescent health

ONLINE BRIEFING – Tue 24 April at 9.30am AEST

There are around 4.8 million adolescents (those aged 10-24 years) in Australia today, comprising around a fifth of our total population. However, new research is beginning to suggest that despite how invincible teenagers feel, when it comes to health, these are not the ‘best days of our lives’.

While half a century ago it was common for young people to settle down and have a family in their early 20s, today these milestones are delayed and the window of risk for adolescent behaviour has substantially increased.

Facebook and Twitter, along with globalisation, and urbanisation have changed traditional family and community influences. For many adolescents, modern-day youth culture now also includes fast-food, binge drinking, cyber bullying and ‘sexting’. Yet despite this being a period of high risk, there is little focus on the specific health challenges faced by adolescents while they are actually adolescents.

The 45^th Session of the United Nations Commission on Population Development takes place in New York from April 23-27. To coincide with this, The Lancet journal is launching a special series on adolescent health. Two of the Australian scientists who contributed to this series will stay up late in New York to brief Australian journalists on the key findings and how Australia fares.

SPEAKERS:

• Professor Susan Sawyer, Director of the Centre of Adolescent Health at Murdoch Children’s Research Institute, and University of Melbourne | Susan’s Powerpoint
• Professor George Patton, Director of Research at the Centre of Adolescent Health at Murdoch Children’s Research Institute, and University of Melbourne | George’s powerpoint

BRIEFING DETAILS:

DATE: Tuesday 24 April
START TIME: 9.30am AEST
DURATION: 35 min
VENUE: Online  |   A recording of the full briefing is now available here

For further information, please contact the AusSMC on 08 7120 8666 or email us.

NB:  The AusSMC generally runs two different types of media briefings:
NEWS BRIEFINGS – Where new research or data will be released as part of the briefing
BACKGROUND BRIEFINGS – Where experts discuss an issue which is in the news or an issue we consider newsworthy, but no new research or data is being released