The effect of marijuana use in pregnancy on fetal growth: journal club
Dear colleagues,
The use of marijuana has become somewhat of a hot topic in medicine. It seems to have a lot of indications and has recently caught my attention. Today, I would like to share this study with you - one on the effect of marijuana use in pregnancy.
The research studied a total of 109 marijuana-using pregnant women and a randomly selected control group of 171 non-using pregnant women. They controlled for significant confounders and found a significant (p< 0.05) decrease in newborn weight after first trimester use only (-154g) and continued exposure throughout pregnancy (-185g). Head circumference was also affected following marijuana exposure during the first and second trimester only (-0.83cm) and exposure throughout pregnancy (-0.79cm). Newborn length was not affected.
Thoughts:
- One of my first thoughts were: did they adjust for tobacco use as it is often consumed recreationally used with marijuana? The answer is yes.
- Because of high rates of denial of marijuana use, the researchers also required self-reported and biochemical confirmation of non-use in the control group. This is great and shows that the researchers showed social and cultural knowledge in regard to patient behaviors as well.
- It appears the majority of the effect occurs in the first trimester. This is potentially more difficult to prevent, as the women may not know they are pregnant. Nonetheless, anyone trying to conceive should be advised against regular marijuana use.
- As the researchers used historical data for the study, they had no method of quantifying the amount of marijuana used or even frequency of use. Nor did they document or account for the method of use (inhalation, ingestion etc.) or preparation.
- Though the sample size was not as big as one would like for observational studies, it is relatively good for an obstetric study. I can imagine that this type of data is difficult to come across. However, as marijuana use becomes more prevalent, I will imagine that there will be an increase in data volume.
What are your thoughts on the study? I would love to hear from you. Thanks once again.
Fertility/pregnancy on tamoxifen
My patient has just booked an appointment with me and I already know what she is going to ask. She is 37 years old, previous breast cancer (ductal carcinoma in situ) treated with lumpectomy and tamoxifen for 2.5 years. She wants to have a baby. Is it advisable to pause tamoxifen? If yes, what is the average time to conception?
Copyright
Chrisnata, V., Sugiarto, A., Erniody, E. et al.
Chrisnata, V., Sugiarto, A., Erniody, E. et al. Sudden life-threatening laryngeal edema in pregnancy: a case report. J Med Case Reports 17, 180 (2023). https://doi.org/10.1186/s13256-023-03880-7
Copyright © 2023 Chrisnata, V. et al.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
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Pediatrics
Lebanon
I believe this man deserves further investigation of his “back pain” causes, before referral for spinal specialist. It is mandatory to check for internal causes of his presumably referred pain.The fact that his pain is not constant and comes in recurrences, especially at such a severity, points to a cause separate from back issues; ex Aortic abdominal aneurysm, or even pancreatitis( though u’d expect the pain to be at a higher level, yet still, n I wonder whether he had associated abdominal pain, n or vomiting n fever at any time. Also kidney issues of huge impacted kidney stones could refer to the back, n also disseminated cancer-seems eliminated by studies?!?, also can cause such pains
. “Sources of referred pain to the low back (and might be confused with a spinal problem) may include abdominal aneurysm (enlarged artery in the belly), tubal pregnancy, kidney stones, pancreatitis, and colon cancer.”
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Pediatrics, Occupational Medicine
Brazil
Some years ago, here in the University Hospital, the obstetricians carried out a blank cesarean in a very obese woman with imaginary pregnancy. She was so obese and such a good simulator that she was submitted to a 'blank' cesarean transection. In the discussion of the case, we reminded that indeed x-rays are not indicated in pregnancy overall, above 25 weeks of gestacional age, if the baby is born he will be submitted to several x-rays. So, if in a future case one finds a very obese woman simulating a delivery, a simple x-ray should be indicated as to reveal if there is really a baby inside there.
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General Medicine
United Kingdom
I would check her haemoglobin - above 80 is fine
Duty of candour means you need to tell her the flight is equivalent to an operation so 2 operations 2 times the risk of VTE - LMWH plus no alcohol plus keep hydrated
If she had severe pre eclampsia or heart failure in pregnancy, be aware decompression effectively creates right sided failure so I would do an echo
and finally presume the child is also travelling so check no congenital issues or persistent foetal circulation
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FDA Approves First Over-the-Counter Birth Control Pill
THURSDAY, July 13, 2023 (HealthDay News) -- The U.S. Food and Drug Administration on Thursday approved the nation's first over-the-counter birth control pill, a move that will likely pave the way for far greater access to contraception for Americans.
Women will be able to buy the progestin-only oral contraceptive at drug stores, convenience stores, and grocery stores, the FDA said. There is no age limit.
Opill (norgestrel) should be available in stores starting in January or February, The Washington Post reported. The suggested retail price is expected to be announced this fall. Opill was first approved by the FDA in 1973. Other types of birth control pills will remain prescription only.
"Today's approval marks the first time a nonprescription daily oral contraceptive will be an available option for millions of people in the United States," Patrizia Cavazzoni, M.D., director of the FDA Center for Drug Evaluation and Research, said in an agency news release announcing the approval. "When used as directed, daily oral contraception is safe and is expected to be more effective than currently available nonprescription contraceptive methods in preventing unintended pregnancy."
In its decision, the FDA followed the recommendation of an advisory panel, which voted unanimously in May in favor of the over-the-counter pill. In briefing documents filed before the advisory panel meeting, the agency raised concerns about whether people will use these pills appropriately. Studies showed that a high proportion of consumers understand the Opill label instructions, supporting their ability to properly use the drug over the counter, the FDA has said.
The American Medical Association, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and other medical organizations already support over-the-counter access to hormonal contraception without age restrictions.
The approval of Opill was granted to Laboratoire HRA Pharma, recently acquired by Perrigo.
Copyright © 2020 HealthDay. All rights reserved.
COVID-19-Related Stress During Pregnancy Tied to Poor Postpartum Outcomes
THURSDAY, March 16, 2023 (HealthDay News) -- Antenatal COVID-19-related stress is significantly associated with poor postpartum maternal mental health outcomes, according to a study published online March 14 in JAMA Network Open.
Susanne Schweizer, Ph.D., from University of Cambridge in the United Kingdom, and colleagues examined the association of antenatal COVID-19-related stress with postpartum maternal mental health and infant outcomes in women from the United States, United Kingdom, and Australia. The analysis included 318 participants who reported being pregnant between May 5 and Sept. 30, 2020, and completed follow-up to Oct. 28, 2021, to April 24, 2022.
The researchers found that antenatal COVID-19-related stress was significantly associated with maternal postpartum distress (β = 0.40), depression (β = 0.32), and generalized anxiety (β = 0.35). Additionally, antenatal COVID-19-related stress was associated with infant negative affectivity (β = 0.45). The findings persisted during sensitivity analyses.
"A research agenda needs to be outlined to track the longer-term associations of COVID-19-related stress with maternal and infant outcomes. There is a particular need to identify biological and psychological markers of vulnerability in this population to tailor antenatal care approaches," the authors write. "Pregnant individuals should be classified as a vulnerable group during pandemics as these results show, especially in terms of mental health."
Copyright © 2020 HealthDay. All rights reserved.
Black Women at Higher Risk: The Disturbing Reality of Maternal Mortality Rates
The federal government has launched a civil rights investigation into how Cedars-Sinai Medical Center in Los Angeles treats Black women who give birth at the hospital. The federal investigation stems from the tragic case of Kira Dixon Johnson. In April 2016, Kira Dixon Johnson lost her life after experiencing internal bleeding following a cesarean section. Although her baby, Langston Johnson, survived, Kira's untimely death sparked a national conversation about the racial disparities in Black maternal care.
Racial disparities in maternal healthcare in the United States are a significant concern. According to the Centers for Disease Control and Prevention, around 700 women die each year in the U.S. due to pregnancy-related complications. The data reveals that a disproportionate number of these deaths occur among Black women, who are two to three times more likely to die from pregnancy-related causes than White women. The National Vital Statistics System's report further highlights the widening gap in maternal mortality rates, with non-Hispanic Black women experiencing a rate 2.6 times higher than non-Hispanic white women...Read More
Why is this still happening?
