Infertility more common in women with epilepsy

(Reuters Health) - Women with epilepsy may have a higher-than-average risk of fertility problems,
particularly those on multiple anti-seizure drugs, a study published Monday suggests.
Researchers in India found that among 375 women with epilepsy who were trying to become pregnant, 62
percent successfully conceived, usually within two years. The rest, 38 percent, remained infertile over an
average of three years of follow-up.
That compared with an infertility rate of 15 percent among married women in the surrounding Indian state of
Kerala, according to the researchers.
The findings, reported in the journal Neurology, strengthen the evidence that women with epilepsy have a
higher-than-average risk of fertility problems. They also indicate that women taking multiple anti-epilepsy
drugs may be particularly at risk.
Of women on just one medication, 32 percent failed to conceive during the study period. That figure was 41
percent among women on two epilepsy drugs, and 60 percent among those on three or more drugs. Only 7
percent of those not taking any anti-seizure medication failed to conceive during the study.
The results do not prove, however, that the drugs themselves are to blame, or at least fully to blame.
Since women on multiple epilepsy drugs are likely to have more severe epilepsy, it's possible that the
severity of the disorder plays a role, according to Dr. Alison M. Pack, a neurologist at Columbia University
Medical Center in New York and author of an editorial published with the study.
Whatever the reasons for the association, Pack told Reuters Health, "This suggests that women with epilepsy
should be advised that they may have a higher-than-average risk of infertility."
She suggested that women who are planning a pregnancy talk with their doctors; if possible, those on
multiple epilepsy drugs may want to trim their drug regimen down.
Guidelines from the American Academy of Neurology and American Epilepsy Society already suggest that
during pregnancy, women take only one anti-seizure medication whenever possible to lower the chances of
birth defects.
In particular, women are advised to avoid the older epilepsy drug valproate (Depakene, Epival) during
pregnancy; two other older medications -- phenobarbital (Luminal) and phenytoin (Dilantin) -- should also
be limited.
It is not clear which drugs in particular may be related to fertility problems. In the current study,
phenobarbital was the only individual drug associated with an increased infertility risk.
Phenobarbital and some other older epilepsy medications, like carbamazepine (Carbatrol, Tegretol), induce
liver enzymes that affect blood levels of estrogen and other reproductive hormones. So it's possible that they
could affect a woman's ability to become pregnant, said Pack, who is also a consultant to Pfizer, Inc., maker
of the epilepsy drug Neurontin (gabapentin).
She noted that too few women were on any of the newer drugs commonly used in developed countries for
the researchers to assess their association with fertility. Those include medications like topiramate
(Topamax), levetiracetam (Keppra), lamotrigine (Lamictal) and oxcarbazepine (Trileptal).
More research is still needed into how the various epilepsy drugs might affect fertility, Dr. Sanjeev V.
Thomas, the senior researcher on the study, told Reuters Health in an e-mail.
prenatal arsenic exposure quintuples infant death risk
NEW YORK | Thu Oct 7, 2010 3:15pm EDT
NEW YORK (Reuters Health) - Babies born to mothers with high levels of arsenic exposure are five times
more likely to die before their first birthday than infants whose mothers had the least exposure to the toxic
mineral, new research shows.
"We observed clear evidence of an association between arsenic exposure and infant mortality," Dr. Anisur
Rahman of Uppsala University Hospital in Sweden and colleagues state in the November issue of
Epidemiology. And the fact that death risk increased as exposure rose, they add, "is supportive of a causal
relationship."
The study was conducted in Bangladesh, where millions of tube wells dug 30 years ago to improve the
country's water supply are now known to be contaminated with naturally occurring arsenic.
Public health experts estimate that as many as 77 million people in Bangladesh have been poisoned by
arsenic in drinking water; potential approaches to reducing exposure include filtering water through pond
sand, using different types of wells, and harvesting rainwater.
Arsenic causes cancer, and has also been linked to diabetes, high blood pressure, and many other chronic
illnesses. But studies investigating the effects of prenatal arsenic exposure have had mixed results, Rahman
and colleagues say.
Many previous studies were retrospective, meaning researchers asked women about pregnancy outcomes
after the fact and their responses are therefore less reliable, the researchers explain. Most studies have also
measured the amount of arsenic found in local drinking water but have not looked at how much water
women actually consumed during pregnancy, they note.
To address these issues, the researchers followed 2,924 pregnant women who provided urine samples for
arsenic testing, all when they were eight weeks pregnant, and some later in pregnancy. About nine percent of
the women miscarried, three percent had abortions, and two percent had stillborn babies.
Eighty-six percent of the women had live births, while about four percent of these babies died before they
were 12 months old.
Women in the top fifth based on their arsenic exposure had urine concentrations that ranged from 249 to
1,253 micrograms per liter; those in the bottom fifth had concentrations below 33 micrograms per liter.
In the U.S., urine arsenic levels between zero and 35 micrograms per liter are considered normal.
The most heavily exposed women in the study were 40 percent more likely to miscarry than those with the
lowest exposure; however, this relationship was relatively weak and could have been due to chance, the
researchers say.
The investigators also didn't see a dose-response relationship, meaning the risk of miscarriage didn't rise
steadily as exposure increased. Nor was a clear association between arsenic exposure and risk of stillbirth
seen in the group.
But the researchers did find a strong dose-response relationship between arsenic exposure and infant
mortality risk. Among the women who gave birth to a live baby, those in the top fifth for arsenic exposure
were five times as likely to see their infant die before his or her first birthday compared with those in the
bottom fifth.
The infants died of a range of causes, including infections and impaired growth, and the researchers say more
study is needed to understand exactly how a mother's arsenic exposure may contribute to the baby's risk of a
premature death.

SOURCE: link.reuters.com/faq47p Epidemiology, November 2010

 Caffeine may not up preterm birth risk
NEW YORK |
Tue Sep 28, 2010
4:16pm EDT
(Reuters Health) - A new analysis adds to evidence that pregnant women can have a morning cup of coffee
without fearing they will raise their risk of preterm delivery. Combining the results of 22 previous studies,
researchers found no evidence that pregnant women who downed the most caffeine -- roughly equivalent to
three to four cups of coffee per day -- had a higher risk of preterm birth than women who avoided caffeine
throughout pregnancy. Nor did they find any link between the amount of coffee the women drank and their
odds of an early delivery.
Approximately 12 percent of births in the U.S. and 7 percent of births in Europe are pre-term -- occurring
before the 37th week of gestation - according to the authors, whose report appears in the American Journal of
Clinical Nutrition. Earlier this year, the American College of Obstetricians and Gynecologists (ACOG)
issued a statement saying that pregnant women who consume up to 200 milligrams (mg) of caffeine per day
-- about the amount in two 8-ounce cups of coffee -- are unlikely to raise their odds of miscarriage or preterm
delivery. Whether higher caffeine intake might boost those odds remains unclear, according to ACOG.
However, the group also cautions that there are other reasons pregnant women may opt to avoid caffeine.
Some research, for example, has found an association between maternal caffeine intake -- even as little as
100 mg per day -- and low birth weight. Although such studies do not prove that caffeine is the cause,
pregnant women may want to err on the side of caution and limit their intake.
In addition, ACOG notes, excess caffeine could make pregnancy tougher by interfering with a woman's sleep
or contributing to nausea and light-headedness. It can also boost urination and lead to dehydration.
The latest findings do not mean that caffeine is entirely "safe" for pregnant women. But they do support the
conclusion that, at least in moderate amounts, it does not contribute to preterm births, according to the
researchers, led by Ekaterina Maslova of the Harvard School of Public Health.
Their analysis included 22 studies from the U.S., Canada, Europe and Brazil looking at the relationship
between pregnant women's reported intake of coffee, tea and other caffeine sources and their odds of preterm
birth. The two largest studies each included more than 40,000 women. Individually, the studies differed
considerably in their conclusions -- with eight showing either an increased or a decreased risk of preterm
delivery among women who consumed higher levels of caffeine during pregnancy. The rest showed no clear
connection between caffeine and preterm birth, according to Maslova's team. Similarly, when the researchers
combined the data from all the studies, they found that women who reported having 300 mg of caffeine or
more each day, during any trimester, had no higher risk of preterm birth than women who consumed little to
no caffeine.
Still, the results leave open some questions, according to Maslova and her colleagues.
They point out that most of the research they analyzed did not measure caffeine intake beyond 400 mg per
day, so it is not clear whether higher intakes might affect preterm delivery risk.
In addition, most of the studies included mainly white women. Maslova and her colleagues say
there is still a need for studies examining more diverse groups of women to see whether there are
any ethnic differences in the relationship between caffeine and preterm birth.
Genetic differences in how individuals metabolize caffeine could also, in theory, influence any
effects of caffeine on pregnancy, the researchers note.
Further assessing the effects of higher total caffeine intakes, above 400 mg a day, will be "especially
important," they conclude, in light of new caffeine sources beyond coffee and tea -- such as
enhanced bottled waters, energy drinks and herbal supplements, whose caffeine content is often not
recognized.
SOURCE: link.reuters.com/puf85p American Journal of Clinical Nutrition, online September 15,
2010.
 Breastfeeding for a month cuts mom's diabetes risk
By Rachael Myers Lowe
NEW YORK |
Fri Sep 10, 2010
1:29pm EDT
(Reuters Health) - Mothers who don't breastfeed their newborns for at least one month are more
likely to develop type 2 diabetes at some point in their lives than women who do, a Pennsylvania
study finds. Previous research demonstrated health benefits to moms who breastfed as long as six
months or a year. The Pennsylvania results suggest that even a month of breastfeeding can have
positive, lasting effects. "What we found that was somewhat surprising was the pretty dramatic
benefits for moms who breastfed as short as a month after the birth of their child," the lead author,
Dr. Eleanor Schwarz of the University of Pittsburgh, told Reuters Health.
In type 2 diabetes, the most common form of the disease, either the body does not produce enough
insulin or the cells ignore the insulin that the body needs to turn food into energy. An estimated 10
percent of American women have it. To see how long a new mom needs to breastfeed to reap later
benefits to her health, Schwarz and colleagues analyzed a large database of patients treated by
Kaiser Permanente Medical Care Program of Northern California.
They compared the incidence of type 2 diabetes in 2,233 women between the ages of 40 and 78,
divided into three groups: those who had never had children (405 women), those who had children
but never breastfed them (703 women) and those who had breastfed (1,125 women).
The researchers found that 188 (26.7 percent) of the study mothers who didn't breastfeed their
infants later went on to develop diabetes compared to 202 (18 percent) of women who exclusively
breastfed their newborn at least one month and 71 (17.5 percent) of women who never had children.
The findings "highlight the importance to maternal health of consistent lactation after each birth"
and add to the growing body of evidence that not breastfeeding might add to health risks.
"Women who give birth but do not breastfeed face an increased risk of developing type 2 diabetes,"
the authors conclude in the September 9 issue of the American Journal of Medicine.
Why this is so, they point out, is not known. Animal studies have shown that the formation and
secretion of milk by the mammary glands (lactation) may itself start biological processes that
increase sensitivity to insulin and reduce the formation of belly fat.
"Breastfeeding is part of the normal recovery process" from pregnancy and giving birth, Schwarz
said.
Yet only about 14% of new mothers in the US managed to follow the American Academy of
Pediatrics' recommendation to exclusively breastfeed their infants for the first 6 months.
The study results tell new mothers that they can do something for their own health by breastfeeding
for at least a month, Schwarz said. The authors also have a message for moms who, for whatever
reason, never breastfed their children.
"They should talk to their doctor about what steps they can take to modify their own risk of
developing diabetes, because it seems they are probably at higher risk than other women in the
community," Schwarz said.
The authors urge "ongoing support of breastfeeding" from doctors, legislators and employers.
SOURCE: link.reuters.com/fas72p The American Journal of Medicine, September 2010.