Tag Archives: obstetrics and gynecology

Health

Complications during pregnancy linked to a higher risk of heart disease, study finds

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CNN
 — 

Five major pregnancy complications are strong lifelong risk factors for ischemic heart disease, a new study finds, with the greatest risk coming in the decade after delivery.

Ischemic heart disease refers to heart problems, including heart attack, caused by narrowed or dysfunctional blood vessels that reduce blood and oxygen flow to the heart.

Gestational diabetes and preeclampsia increased the risk of ischemic heart disease in the study by 54% and 30%, respectively, while other high blood pressure disorders during pregnancy doubled the risk. Delivering a baby early – before 37 weeks – or delivering a baby with a low birth weight were associated with a 72% and 10% increased risk, respectively.

The study, published in Wednesday in the BMJ, followed a cohort of more than 2 million women in Sweden with no history of heart disease who gave birth to single live infants between 1973 and 2015.

Roughly 30% of the women had at least one adverse pregnancy outcome. Those who had multiple adverse outcomes – whether in the same or different pregnancies – showed further increased risk of ischemic heart disease.

“These pregnancy outcomes are early signals for future risk of heart disease and can help identify high-risk women earlier and enable earlier interventions to improve their long-term outcomes and help prevent the development of heart disease in these women,” said Dr. Casey Crump, an author of the study and professor of family medicine at the Icahn School of Medicine at Mount Sinai.

Heart disease is the leading cause of death among women in the United States and accounts for 1 in 5 female deaths, according to the US Centers for Disease Control and Prevention. This research adds to mounting evidence that pregnancy provides important information about a woman’s cardiovascular health.

“What happens to a woman during pregnancy is almost like a stress test or a marker for her future cardiovascular risk after pregnancy. And unfortunately, a lot of women don’t get told this by anybody,” said CNN Medical Correspondent Dr. Tara Narula, an associate professor of cardiology and the associate director of the Women’s Heart Program at Lenox Hill Hospital. She was not involved in the new study.

Although it’s not completely clear why, experts say the normal changes that occur during pregnancy may unmask underlying health issues in some women with certain risk factors.

Experiencing an adverse pregnancy outcome – even temporarily – could result in changes to blood vessels and the heart that may persist or progress after delivery, increasing a woman’s risk for cardiovascular disease.

This heightened risk is a particular concern for women in the US, experts say, where the maternal mortality rate is several times higher than in other high-income countries.

“There’s been a change in the birthing population. US women are getting pregnant at a later age, and they have already accrued maybe one or two cardiovascular risk factors. Perhaps there are other stressors in life – depression, stress, isolation, obesity – lots of different things that are impacting women in the US,” said Dr. Garima Sharma, associate professor of cardiology and director of the Cardio-Obstetrics Program at Johns Hopkins University School of Medicine, who also was not involved in the new study.

Pregnancy complications are carefully monitored during pregnancy, but there is little evaluation of and education about the effects on cardiovascular health after delivery for women, experts say.

“And so they have their delivery, they’ve had maybe preeclampsia or gestational diabetes, and nobody really follows up with them. They are not told that, in fact, they are at increased risk,” Narula said.

Gestational diabetes is a marker not only for increased risk of diabetes but also for general cardiovascular disease. Preeclampsia and eclampsia are markers for hypertension risk as well as general cardiovascular risks.

Narula, a cardiologist who specializes in caring for women, regularly considers adverse pregnancy outcomes when evaluating patients and emphasizes the continued need for this.

“The classic risk calculator that we use doesn’t have anything in there for pregnancy complications, but you know, it should for women, and hopefully someday, they will start to take that into account,” she said.

The American Heart Association recommends that all health care professionals take a detailed history of pregnancy complications when assessing a woman’s heart disease risk, but this is not consistently done in clinical practice, especially in primary care, where most women are seen, Crump says.

“Raising awareness of these findings among physicians as well as women hopefully will enable more of these women to be screened early and hopefully improve their long-term outcomes,” he said.

Roughly 1 in 3 women will have an adverse pregnancy outcome. Experts say that improving your health before getting pregnant can help avoid these issues.

“Reducing your risk should start preconception, and so getting your body and yourself into the healthiest state possible before you ever even get pregnant is really the first step,” Narula said.

This includes achieving and maintaining a healthy body weight with a good diet and regular exercise, controlling high blood pressure and diabetes, quitting smoking and managing stress.

Taking action after pregnancy is equally important, as research has estimated that only 30% to 80% of women have a postpartum checkup 6 to 8 weeks after delivery.

“Making sure that these women actually are appropriately followed after their delivery and that there is a warm handoff between [obstetrics] and [maternal-fetal medicine] to their primary care doctors or preventive cardiologists who can then talk about optimizing cardiovascular risks and reduction of these risk factors post-pregnancy in the postpartum time frame is crucial,” Sharma said.

Experts hope that increased patient and provider awareness of the connection between pregnancy and heart health will keep birth from being a cause of death.

“Cardiovascular disease is preventable. It’s a leading cause of maternal mortality, but it doesn’t have to be. If we do a better job at screening patients before they get pregnant, if we do a better job of treating them during pregnancy and postpartum, we can improve women’s outcomes,” Narula said. “It’s a tragedy to bring a new life into the world, and then the mother suffers some horrible complication and/or death that could have been prevented.”

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Health

Large new review underscores the risks of Covid-19 during pregnancy

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CNN
 — 

Pregnant women and their developing babies are at higher risk for severe outcomes if they get Covid-19, and now a large, international review is helping to underscore how devastating those risks can be.

The study draws on data from 12 studies from as many countries—including the United States. Altogether, the studies included more than 13,000 pregnant women—about 2,000 who had a confirmed or probable case of Covid-19. The health outcomes for these women and their babies were compared to about 11,000 pregnancies where the mother tested negative for Covid-19 or antibodies to it at the time of their deliveries.

Across the studies about 3% of pregnant women with Covid-19 needed intensive care, and about 4% needed any kind of critical care, but this was far higher than the numbers of pregnant women who needed that kind of care outside of a Covid-19 infection.

Compared to pregnant individuals who weren’t infected, those who got Covid-19 were nearly 4 times more likely to be admitted to an intensive care unit. They were 15 times more likely to be ventilated and were 7 times more likely to die. They also had higher risks for pre-eclampisa, blood clots, and problems caused by high blood pressure. Babies born to moms who had Covid-19 were at higher risk for preterm birth and low birth weights.

Previous studies have suggested that Covid-19 may increase the risk of stillbirth, but this study didn’t find that same link.

Still, the findings paint a clear picture that shows the risks of pregnancy are amplified by Covid-19 infections.

“It’s very clear and even it’s consistent, you know, whether we’re talking about Sweden where we have really generally great pregnancy outcomes to other countries that you know, have bigger problems with maternal morbidity and mortality, that having COVID and pregnancy increases risk for both mom and baby,” said lead study author Emily Smith, who is an assistant professor of global health at George Washington University.

The study has some caveats that may limit how applicable the findings are to pregnant individuals in the Omicron era.

First, the studies were conducted relatively early in the pandemic, at a time when most people were still unvaccinated and uninfected. That means people in the study were likely at higher risk not just because they were pregnant, but also because they were immunologically naïve to the virus—they didn’t have any pre-existing immunity to help them fight off their infections.

Since then, many pregnant individuals have gotten vaccinated, or had Covid-19 or both. As of the first week of January, about 72% of pregnant people in the U.S. have had their primary series of Covid-19 vaccines, and about 95% of Americans are estimated to have had Covid-19 at least once, or been vaccinated against it, according to data from the Centers for Disease Control and Prevention. That means it’s likely they have some immune memory against the virus that may help protect against severe outcomes.

That immune memory appears to fade over time, however. CDC data show just 19% of pregnant women have had an updated booster, meaning many people may not have as much protection against the virus as they think they do.

Lead study author Emily Smith, who is an assistant professor of global health at George Washington University, says the study results reflect the risk of Covid-19 and pregnancy in unvaccinated people.

Unfortunately, Smith says, many countries still don’t have clear guidelines advising vaccination during pregnancy. And there are some parts of the world, such as China, that still have substantial proportions of their population who’ve never been been infected.

For people who are trying to weigh the risks and benefits of Covid-19 vaccination during pregnancy, Smith says this study helps tip the scales firmly on the side of vaccination.

“It’s worth it to protect yourself in pregnancy,” Smith said.

She says this study didn’t look at the benefits of vaccination in pregnancy, but other studies have, showing big decreases in the risk of stillbirth, preterm birth and severe disease or death for mom.

“And so that’s kind of the complementary story,” said Smith.

Dr. Justin Lappen, division director of Maternal Fetal Medicine at the Cleveland Clinic, praised the study and said its findings reinforce and advance previous research, which has found that Covid-19 markedly increases the risk of severe outcomes for mom and baby. He wasn’t involved in the study.

He says the findings highlight the importance of preventing and treating Covid-19 in pregnant women.

Therapies that are indicated or otherwise recommended should not be withheld specifically due to pregnancy or breastfeeding, Lappen wrote in an email to CNN.

The study is published in the journal BMJ Global Health.

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Entertainment

Sharon Osbourne reveals daughter Kelly has welcomed her first child

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CNN
 — 

Sharon Osbourne revealed that her daughter Kelly Osbourne has quietly welcomed a baby, her first, with her boyfriend, Sid Wilson.

Osbourne and the Slipknot DJ are new parents to a baby boy named Sidney, her mom announced during an appearance on Britain’s “The Talk” on Tuesday.

“So great, so great. She won’t let a picture go out of him, and I’m so proud of her,” Osbourne said of her daughter.

Kelly Osbourne first shared publicly she was pregnant last May with a sonogram pic on Instagram.

“I know that I have been very quiet these past few months so I thought I would share with you all as to why,” she wrote at the time. “I am over the moon to announce that I am going to be a Mumma.”

In November, she said on her Instagram Stories, “Okay, here we go,” with no other information.

The new baby makes five grandchildren for Ozzy Osbourne and Sharon.



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Science

Fossil site was birthing ground for giant marine reptiles, study reveals

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CNN
 — 

The final resting place for dozens of massive prehistoric marine reptiles lies in what’s now Nevada’s Humboldt-Toiyabe National Forest.

But why the ichthyosaurs died in such large numbers at this one particular fossil site some 230 million years ago has long been a source of debate among paleontologists. Scientifically known as Shonisaurus popularis, the species resembled a chunky dolphin and grew at least 50 feet (15.2 meters) long.

Theories suggested a mass stranding event or that the ichthyosaurs were poisoned by toxins from an algal bloom.

Now, though, scientists say that they have ruled out these hypotheses and have a much better understanding of why 37 of the ancient creatures died at the same location. The researchers believe their findings illuminate a fascinating aspect of the reptile species reproductive behavior, which is shared by some of today’s marine mammals.

“We present evidence that these ichthyosaurs died here in large numbers because they were migrating to this area to give birth for many generations across hundreds of thousands of years,” said study coauthor Nicholas Pyenson, a research geologist and curator at the Smithsonian National Museum of Natural History in Washington, DC, in a news release.

“That means this type of behavior we observe today in whales has been around for more than 200 million years.”

Present-day whale species, including blue and humpback whales, routinely migrate across oceans to breed and give birth in waters where predators are scarce. Many whales congregate year after year along the same stretches of coastline.

“There are other examples of ichthyosaur embryos and newborns, but this is the first time we have strong evidence for reproductive grouping behavior,” said study coauthor Randy Irmis, chief curator and curator of paleontology at the Natural History Museum of Utah in Salt Lake City.

“We know this is something many large marine vertebrates exhibit in the present, so it makes sense that simialr behavior occurred in the past. But we really didn’t know how far back, especially with extinct animal groups like ichthyosaurs, that have no close living relatives,” Irmis said in an email to CNN.

The researchers from the United States, United Kingdom and Belgium used new techniques, such as 3D modeling, to investigate the fossil site, which is part of Berlin-Ichthyosaur State Park.

The team examined the chemical makeup of rocks surrounding the fossils and found no evidence of any sudden increases in organic matter, such as algae, that might have starved the creatures of oxygen.

Geological evidence also suggested the ichthyosaurs’ bones had sunk to the bottom of the sea, which then covered much of present-day Nevada, rather than along a shoreline shallow enough to suggest the marine reptiles had beached themselves.

What’s more, the team noticed the fossils were predominantly of adult ichthyosaurs, with very few other marine vertebrates present. Nor were there any juvenile ichthyosaurs.

A breakthrough came when tiny ichthyosaur remains were identified among both new fossils collected at the site and within older museum collections. Micro-CT X-ray scans revealed the small bones belonged to embryonic and newborn ichthyosaurs.

“Once it became clear that there was nothing for them to eat here, and there were large adult Shonisaurus along with embryos and newborns but no juveniles, we started to seriously consider whether this might have been a birthing ground,” said lead author Neil Kelley, a research assistant professor in Earth and environmental sciences at Vanderbilt University in Nashville, Tennessee, in the news release.

The authors concluded that the area must have been a preferred birthing habitat for the prehistoric creatures — and that the high number of fossilized remains was a result of the high numbers of ichthyosaurs that congregated there, perhaps over millions of years, to give birth.

“This is a clear ecological signal, we argue, that this was a place that Shonisaurus used to give birth, very similar to today’s whales. Now we have evidence that this sort of behavior is 230 million years old,” Pyenson said.

The journal Current Biology published the research on Monday.

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World

Ukrainian women on the front line struggle to find uniforms that fit. One couple aims to fix that

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Kyiv, Ukraine
CNN
 — 

Andrii Kolesnyk and Kseniia Drahanyuk both beam with excitement as they crouch over a box.

They are about to unpack Ukraine’s first ever military uniform for pregnant women, which they recently commissioned after a pregnant sniper got in touch.

The young couple, both TV journalists before the war started, are now fully dedicated to their independent NGO, “Zemlyachki,” or “Compatriots,” which procures vital items for women in the armed forces.

The initiative started when Andrii’s sister was sent to the front on February 24, the day Russia invaded Ukraine.

“She received men’s uniform, men’s underwear,” he says. “Everything that [was] designed for men.”

It soon became clear that servicewomen needed a lot more than uniforms. Everything from smaller boots to lighter plates for bulletproof vests to hygiene products is in demand.

So, the couple turned to private company donations, charity funds and crowdfunding to purchase goods independently of the military. Some customized gear such as women’s fatigues is produced under their own brand by a factory in Kharkiv in the country’s east – including the new pregnancy uniform.

Other items, including body armor plates, helmets and boots, come from companies as far afield as Sweden, Macedonia and Turkey. But Kolesnyk and Drahanyuk say they are struggling with the procurement of winter items like sleeping bags and thermal clothing that will be important for comfort as winter sets in.

Kolesnyk says they have distributed equipment worth $1 million so far and helped at least 3,000 women. If they’re on the front-line shooting rockets they might as well do it “in minimum comfort,” he tells CNN.

There are currently about 38,000 women in the armed forces, according to the country’s Ministry of Defense.

“We are doing this to help our government,” Kolesnyk says, not to compete with it. Their hub is overflowing with cardboard boxes full of kit, all paid for from crowdfunding and grants.

A physical disability prevents Kolesnyk from joining his sister, father and brother-in-law on the front lines, a fact that saddens him.

“For a man, it’s hard to understand that you can’t go there, and your sister is there. So, I’m trying to do my best here to help not only my family, but the whole army,” he says.

Twenty-one-year-old Roksolana, who gave only her first name for security reasons, walks in to pick up a uniform and other gear before heading out on her next assignment. An art school graduate, she joined the army in March and is now part of an intelligence unit.

“It’s so valuable to have these people who understand that we are tired of wearing clothes that are three sizes too big,” she says. “We had no helmets, we had old flak jackets, wore tracksuits and sneakers. Now we feel that we are humans.”

She giggles as she laces up her new boots with impeccable long fingernails. Before they hug goodbye, Drahanyuk hands Roksolana a copy of “The Choice,” the best-selling memoir by Holocaust survivor and psychologist Edith Eger. The aim is that this can be a tool to help process trauma. Zemlyachki has also formed partnerships with military psychologists to whom women in combat can reach out.

Other women, such as 25-year-old Alina Panina, are receiving psychological support through the Ukrainian military. A border guard with a canine unit, Panina spent five months in captivity at the infamous Olenivka prison in the Russian-controlled Donetsk region after leaving the besieged Azovstal steel plant in Mariupol.

She was finally released on October 17 as part of an all-female prisoner exchange with Russia and went into mandatory rehabilitation at a military hospital, under whose care she remains.

Ukraine recently demanded that the International Committee of the Red Cross send a delegation to the Russian prisoner of war camp.

“I was not prepared [for captivity], and we discussed this a lot with other women prisoners that life hasn’t prepared us for such [an] ordeal,” Panina says at a pizza bar run by veterans in downtown Kyiv.

She says prison guards “were unpredictable people” who sometimes abused prisoners verbally, but that she was spared any physical harm.

Now her partner’s fate is up in the air. He is also a border guard who is still in captivity. “I know he is alive but don’t know in which prison he is,” Panina says sadly as she scrolls through pictures of him.

When asked what gives her hope, she simply says, “our men, our people.”

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Health

Who should get the flu vaccine and why? Our medical analyst explains

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CNN
 — 

Welcome to this year’s flu season.

This year’s flu strain has already begun spreading across the United States, according to new data from the US Centers for Disease Control and Prevention. There have been at least 880,000 cases of influenza, nearly 7,000 hospitalizations and, tragically, 360 deaths from the flu this fall, including one pediatric death. Not since 2009, during the height of the H1N1 swine flu pandemic, have there been this many cases of influenza so early in the season.

Despite these numbers, many people wonder if the flu is really that serious of an illness. What’s the benefit of the vaccine, especially if some people may still get the flu despite being vaccinated? Could you get the flu from the vaccine? If you get the Covid vaccine, do you still need the flu vaccine?

To guide us through these questions and more, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician, public health expert and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

CNN: Is the flu a serious illness? What symptoms do people experience?

Dr. Leana Wen: It certainly can be serious. The CDC estimates that flu resulted between 9 million and 41 million illnesses, 140,000 to 710,000 hospitalizations, and 12,000 to 52,000 deaths annually across the US between 2010 and 2020.

Symptoms of the flu include fever, muscle aches, headaches, fatigue, coughing and a runny nose. A lot of people recover within several days, but some may still be feeling unwell as long as 10 days to two weeks after the onset of their symptoms. Some will develop complications, including sinus and ear infections, pneumonia, and inflammation of the brain. The flu can also exacerbate underlying medical conditions — for example, people with chronic lung and heart diseases can see their conditions worsen due to the flu.

Even generally healthy people can become very ill due to the flu. However, those particularly susceptible to severe outcomes include those 65 and older, young children under 2, pregnant people and people with underlying medical conditions.

CNN: What’s the benefit of the vaccine, especially if some people may get the flu despite being vaccinated?

Wen: The flu vaccine does two things. First and most importantly, it reduces your chance of severe illness — that is, of being hospitalized or dying. Second, it can also reduce your likelihood of getting sick from the flu at all.

In a sense, this is not too different from the Covid-19 vaccine. The most important reason to get vaccinated against both the flu and the coronavirus is to prevent severe illness. New data released in the CDC’s latest morbidity and mortality report shows this year’s flu vaccine reduces the risk of hospitalization by about 50%. A 2018 study found that people vaccinated against the flu were 59% less likely to be admitted to the ICU due to influenza when compared with those who were unvaccinated.

The vaccine’s effectiveness can vary depending on how well matched the vaccine is to circulating influenza strains. The CDC cites vaccine effectiveness against “medically attended illness” anywhere from 23% to 61% depending on the year and vaccine-to-strain match. It’s true, then, that you could get the flu vaccine and still contract the flu. But the vaccine does reduce your chance thereof — and, crucially, it reduces the likelihood that you could end up very ill.

Another thing to consider is that there are a lot of other viruses that can cause flu-like symptoms. The flu vaccine helps protect against viral infections caused by influenza, but there are a lot of other causes of viral syndromes, including adenovirus, rhinovirus, parainfluenza and others. These other viruses spread easily, too, and there aren’t vaccines against them. I often hear patients say they once got the flu the same year they had a flu vaccine, and that’s why they don’t want to get vaccinated again. But when I ask them whether they were actually diagnosed with the flu or just had flu-like symptoms, they would say the latter.

CNN: Should children and pregnant people also get the flu vaccine?

Wen: Absolutely. These are groups particularly vulnerable to severe outcomes, so it’s very important they receive the flu vaccine.

One study found the flu vaccine reduces children’s risk of severe life-threatening influenza by 75%. Another found it reduced flu-related emergency department visits in children by half.

Similar results are found in people who are pregnant. Not only does the flu vaccine protect the pregnant person, if the vaccine is given during pregnancy it also helps protect their baby from the flu for the first few months of its life. That’s important, because the flu vaccine is not available to babies until they are 6 months or older.

CNN: Could you get the flu from the vaccine?

Wen: No. The flu vaccine is an inactivated vaccine, which means it does not contain the live virus and therefore cannot cause the flu. It is also a very well-tolerated vaccine, with the most common side effect being discomfort at the injection site that is gone after a day.

CNN: If you got the Covid-19 vaccine, do you still need the flu vaccine?

Wen: Yes. Different vaccines target different viruses. The Covid vaccine helps to protect against Covid, but does not protect against the flu, and vice versa. You can receive the Covid vaccine (or bivalent booster) at the same time as you receive the flu vaccine, just in a different injection site.

CNN: Some people have been waiting until later in the flu season to get the flu vaccine. Is this a good idea?

Wen: At this point, no, because it’s now clear this flu season is starting earlier than usual. Cases are already high, and it takes about two weeks to reach optimal immune protection after vaccination. I’d encourage people who have not yet received the flu vaccine to get it now.

CNN: What should people know about treatments for the flu?

Wen: Most cases of the flu can be treated symptomatically, meaning patients get rest, hydration and treatment for symptoms that come up — such as fever-reducing medicines like acetaminophen or ibuprofen. There are also antiviral treatments available. These are really important for people at high risk for severe influenza complications and/or who are very ill. The earlier such treatments are started, the better. An oral medication, oseltamivir (Tamiflu), can also be given to non-high-risk patients, too, within 48 hours of the start of their illness.

I’d encourage everyone to have an influenza plan, the same way they should have a Covid plan. Ask your doctor in advance if you should receive Tamiflu or another antiviral treatment. Know how you can get testing and where you can access treatment, including after hours and on weekends.

CNN: How can people prevent catching the flu?

Wen: The flu is primarily spread through droplets — if an infected person coughs or sneezes, these droplets can land on someone else nearby. It’s also possible that the droplets land on a surface, from which someone gets infected after touching it and then touching their nose, mouth or eyes.

We can help to reduce flu transmission by staying away from others while symptomatic. We should all cough or sneeze into our elbow or a tissue, and wash our hands frequently, including after touching high-contact surfaces. Individuals particularly vulnerable to severe outcomes should consider wearing a mask to reduce their chance of contracting viral illnesses like the flu. And, of course, get vaccinated!

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Health

Drinking caffeine while pregnant impacts child’s height: Study

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Editor’s Note: Sign up for CNN’s Eat, But Better: Mediterranean Style. Our eight-part guide shows you a delicious expert-backed eating lifestyle that will boost your health for life.



CNN
 — 

Starting the day with a hot cup of caffeinated coffee or tea may sound divine to some, but it could have negative impacts for the children of people who are pregnant, according to a new study.

Children who were exposed to small amounts of caffeine before birth were found on average to be shorter than the children of people who did not consume caffeine while pregnant, according to the study published Monday in JAMA Network Open.

Children of parents who consumed caffeine while they were in the womb were shown to be shorter in stature at age 4 than those whose parents did not — and the gap widened each year through age 8, according to lead author Dr. Jessica Gleason, a perinatal epidemiologist.

“To be clear, these are not huge differences in height, but there are these small differences in height among the children of people who consumed caffeine during pregnancy,” said Gleason, who is a research fellow at Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The American College of Obstetricians and Gynecologists currently recommends limiting caffeine consumption to less than 200 milligrams per day while pregnant.

For context, a mug of caffeinated tea typically has about 75 milligrams of caffeine, a mug of instant coffee has about 100 milligrams and a mug of filtered coffee has about 140 milligrams, according to the Cleveland Clinic. And even chocolate has about 31 milligrams of caffeine.

But the differences found in the most recent study were found even in the children of parents who drank less than half a cup of coffee per day while pregnant — well below the current guidelines, Gleason said.

It’s not clear whether this study effectively shows causation between maternal caffeine consumption and child height, according to Dr. Gavin Pereira, a professor of epidemiology and biostatistics at Curtin University in Australia. Pereira was not involved in the study.

“The correlation observed in this study can be explained by the existence of a common cause of both caffeine consumption and growth restriction e.g., poverty, stress, and dietary factors,” said Pereira in a statement to the Science Media Centre.

If shorter height in early childhood were to persist into adulthood, there would be a chance those children could face the risk of poor cardiometabolic outcomes, such as heart disease and diabetes, which are associated with smaller stature.

But there is still no way to know if the difference would persist into adulthood, and studies like this that focus on population outcomes are no reason for individual families to panic, Gleason said.

These population-level trends should instead be taken together with other research for organizations to reassess their recommendations, Gleason said.

In the past, there were inconsistent studies regarding whether consuming caffeine during pregnancy impacted the fetus, but the evidence has come together in recent years, Gleason said.

A 2015 meta-analysis that reviewed all of the existing research found there is a dose response association between consumption of caffeine and smaller birth size. And a 2020 study revealed there is no safe level of caffeine for a developing fetus.

Even without the panic that Gleason cautioned against, some people might want to cut back on caffeine — and then find that it’s easier said than done.

Remember, caffeine is found in coffee, tea, soft drinks, energy drinks and shots, as well as cocoa and chocolate. It’s also present in fortified snack foods, some energy bars and even some pain medications. (For a more extensive list of caffeine content from various sources, check the chart from the Center for Science in the Public Interest.)

A 2016 Johns Hopkins University study found that it was helpful when individuals identified situations or moods in which they are most likely to crave caffeine so they could avoid situations that trigger cravings, especially during the first few weeks of modifying caffeine use. Caffeine drinkers could also have a plan for when cravings occur, like taking a five-minute relaxation break involving deep-breathing exercises.

Remember to always discuss any major lifestyle or dietary changes with your health care provider first, as changes may affect your mood or medical conditions.

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Health

Drinking caffeine while pregnant impacts child’s height: Study

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CNN
 — 

Starting the day with a hot cup of caffeinated coffee or tea may sound divine to some, but it could have negative impacts for the children of people who are pregnant, according to a new study.

Children who were exposed to small amounts of caffeine before birth were found on average to be shorter than the children of people who did not consume caffeine while pregnant, according to the study published Monday in JAMA Network Open.

Children of parents who consumed caffeine while they were in the womb were shown to be shorter in stature at age 4 than those whose parents did not — and the gap widened each year through age 8, according to lead author Dr. Jessica Gleason, a perinatal epidemiologist.

“To be clear, these are not huge differences in height, but there are these small differences in height among the children of people who consumed caffeine during pregnancy,” said Gleason, who is a research fellow at Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The American College of Obstetricians and Gynecologists currently recommends limiting caffeine consumption to less than 200 milligrams per day while pregnant.

For context, a mug of caffeinated tea typically has about 75 milligrams of caffeine, a mug of instant coffee has about 100 milligrams and a mug of filtered coffee has about 140 milligrams, according to the Cleveland Clinic. And even chocolate has about 31 milligrams of caffeine.

But the differences found in the most recent study were found even in the children of parents who drank less than half a cup of coffee per day while pregnant — well below the current guidelines, Gleason said.

It’s not clear whether this study effectively shows causation between maternal caffeine consumption and child height, according to Dr. Gavin Pereira, a professor of epidemiology and biostatistics at Curtin University in Australia. Pereira was not involved in the study.

“The correlation observed in this study can be explained by the existence of a common cause of both caffeine consumption and growth restriction e.g., poverty, stress, and dietary factors,” said Pereira in a statement to the Science Media Centre.

If shorter height in early childhood were to persist into adulthood, there would be a chance those children could face the risk of poor cardiometabolic outcomes, such as heart disease and diabetes, which are associated with smaller stature.

But there is still no way to know if the difference would persist into adulthood, and studies like this that focus on population outcomes are no reason for individual families to panic, Gleason said.

These population-level trends should instead be taken together with other research for organizations to reassess their recommendations, Gleason said.

In the past, there were inconsistent studies regarding whether consuming caffeine during pregnancy impacted the fetus, but the evidence has come together in recent years, Gleason said.

A 2015 meta-analysis that reviewed all of the existing research found there is a dose response association between consumption of caffeine and smaller birth size. And a 2020 study revealed there is no safe level of caffeine for a developing fetus.

Even without the panic that Gleason cautioned against, some people might want to cut back on caffeine — and then find that it’s easier said than done.

Remember, caffeine is found in coffee, tea, soft drinks, energy drinks and shots, as well as cocoa and chocolate. It’s also present in fortified snack foods, some energy bars and even some pain medications. (For a more extensive list of caffeine content from various sources, check the chart from the Center for Science in the Public Interest.)

A 2016 Johns Hopkins University study found that it was helpful when individuals identified situations or moods in which they are most likely to crave caffeine so they could avoid situations that trigger cravings, especially during the first few weeks of modifying caffeine use. Caffeine drinkers could also have a plan for when cravings occur, like taking a five-minute relaxation break involving deep-breathing exercises.

Remember to always discuss any major lifestyle or dietary changes with your health care provider first, as changes may affect your mood or medical conditions.

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Health

New RSV vaccines may soon put an end to rough seasons

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CNN
 — 

It’s shaping up to be a severe season for respiratory syncytial virus infections – one of the worst some doctors say they can remember. But even as babies struggling to breathe fill hospital beds across the United States, there may be a light ahead: After decades of disappointment, four new RSV vaccines may be nearing review by the US Food and Drug Administration, and more than a dozen others are in testing.

There’s also hope around a promising long-acting injection designed to be given right after birth to protect infants from the virus for as long as six months. In a recent clinical trial, the antibody shot was 75% effective at heading off RSV infections that required medical attention.

Experts say the therapies look so promising, they could end bad RSV seasons as we know them.

And the relief could come soon: Dr. Ashish Jha, who leads the White House Covid-19 Response Task Force, told CNN that he’s “hopeful” there will be an RSV vaccine by next fall.

Charlotte Brown jumped at the chance to enroll her own son, a squawky, active 10-month-old named James, in one of the vaccine trials this summer.

“As soon as he qualified, we were like ‘absolutely, we are in,’ ” Brown said.

Babies have to be at least 6 months old to enter the trial, which is testing a vaccine developed at the National Institutes of Health – the result of decades of scientific research.

Brown is a pediatrician who cares for hospitalized children at Vanderbilt University Medical Center in Nashville, and she sees the ravages of RSV firsthand. A recent patient was in the back of her mind when she was signing up James for the study.

“I took care of a baby who was only a few months older than him and had had nine days of fever and was just absolutely pitiful and puny,” she said. Brown said his family felt helpless. “And I was like, ‘this is why we’re doing it. This single patient is why we’re doing this.’ “

Even before this year’s surge, RSV was the leading cause of infant hospitalizations in the US. The virus infects the lower lungs, where it causes a hacking cough and may lead to severe complications like pneumonia and inflammation of the tiny airways in the lungs called bronchiolitis.

Worldwide, RSV causes about 33 million infections in children under the age of 5 and hospitalizes 3.6 million annually. Nearly a quarter-million young children die each year from complications of their infections.

RSV also preys on seniors, leading to an estimated 159,000 hospitalizations and about 10,000 deaths a year in adults 65 and over, a burden roughly on par with influenza.

Despite this heavy toll, doctors haven’t had any new tools to head off RSV for more than two decades. The last therapy approved was in 1998. The monoclonal antibody, Synagis, is given monthly during RSV season to protect preemies and other high-risk babies.

The hunt for an effective way to protect against RSV stalled for decades after two children died in a disastrous vaccine trial in the 1960s.

That study tested a vaccine made with an RSV virus that had been chemically treated to render it inert and mixed with an ingredient called alum, to wake up the immune system and help it respond.

It was tested at clinical trial sites in the US between 1966 and 1968.

At first, everything looked good. The vaccine was tested in animals, who tolerated it well, and then given to children, who also appeared to respond well.

“Unfortunately, that fall, when RSV season started, many of the children that were vaccinated required hospitalization and got more severe RSV disease than what would have normally occurred,” said Steven Varga, a professor of microbiology and immunology at the University of Iowa, who has been studying RSV for more than 20 years and is developing a nanoparticle vaccine against the virus.

A study published on the trial found that 80% of the vaccinated children who caught RSV later required hospitalization, compared with only 5% of the children who got a placebo. Two of the babies who had participated in the trial died.

The outcomes of the trial were a seismic shock to vaccine science. Efforts to develop new vaccines and treatments against RSV halted as researchers tried to untangle what went so wrong.

“The original vaccine studies were so devastatingly bad. They didn’t understand immunology well in those days, so everybody said ‘oh no, this ain’t gonna work.’ And it really was like it stopped things cold for 30, 40 years,” said Dr. Aaron Glatt, an infectious disease specialist at Mount Sinai South Nassau in New York.

Regulators re-evaluated the guardrails around clinical trials, putting new safety measures into place.

“It is in fact, in many ways, why we have some of the things that we have in place today to monitor vaccine safety,” Varga said.

Researchers at the clinical trial sites didn’t communicate with each other, Varga said, and so the US Food and Drug Administration put the publicly accessible Vaccine Adverse Events Reporting System into place. Now, when an adverse event is reported at one clinical trial site, other sites are notified.

Another problem turned out to be how the vaccine was made.

Proteins are three-dimensional structures. They are made of chains of building blocks called amino acids that fold into complex shapes, and their shapes determine how they work.

In the failed RSV vaccine trial, the chemical the researchers used to deactivate the virus denatured its proteins – essentially flattening them.

“Now you have a long sheet of acids but no more beautiful shapes,” said Ulla Buchholz, chief of the RNA Viruses Section at the National Institutes of Allergy and Infectious Diseases.

“Everything that the immune system needs to form neutralizing antibodies that can block and block attachment and entry of this virus to the cell had been destroyed in that vaccine,” said Buchholz, who designed the RSV vaccine for toddlers that’s being tested at Vanderbilt and other US sites.

In the 1960s trial, the kids still made antibodies to the flattened viral proteins, but they were distorted. When the actual virus came along, these antibodies didn’t work as intended. Not only did they fail to recognize or block the virus, they triggered a powerful misdirected immune response that made the children much sicker, a phenomenon called antibody-dependent enhancement of disease.

The investigators hadn’t spotted the enhancement in animal studies, Varga says, because the vaccinated animals weren’t later challenged with the live virus.

“So of course, we require now extensive animal testing of new vaccines before they’re ever put into humans, again, for that very reason of making sure that there aren’t early signs that a vaccine will be problematic,” Varga said.

About 10 years ago, a team of researchers at the NIH – some of the same investigators who developed the first Covid-19 vaccines – reported what would turn out to be a pivotal advance.

They had isolated the structure of the virus’s F-protein, the site that lets it dock onto human cells. Normally, the F-protein flips back and forth, changing shapes after it attaches to a cell. The NIH researchers figured out to how freeze the F-protein into the shape it takes before it fuses with a cell.

This protein, when locked into place, allows the immune system to recognize the virus in the form it’s in when it first enters the body – and develop strong antibodies against it.

“The companies coming forward now, for the most part, are taking advantage of that discovery,” said Dr. Phil Dormitzer, a senior vice president of vaccine development at GlaxoSmithKline. “And now we have this new generation of vaccine candidates that perform far better than the old generation.”

The first vaccines up for FDA review will be given to adults: seniors and pregnant woman. Vaccination in pregnancy is meant to ultimately protect newborns – a group particularly vulnerable to the virus – via antibodies that cross the placenta.

Vaccines for children are a bit farther behind in development but moving through the pipeline, too.

Four companies have RSV vaccines for adults in the final phases of human trials: Pfizer and GSK are testing vaccines for pregnant women as well as seniors. Janssen and Bavarian Nordic are developing shots for seniors.

Pfizer and GSK use protein subunit vaccines, a more traditional kind of vaccine technology. Two other companies build on innovations made during the pandemic: Janssen – the vaccine division of Johnson & Johnson – relies on an adenoviral vector, the same kind of system that’s used in its Covid-19 vaccine, and Moderna has a vaccine for RSV in Phase 2 trials that uses mRNA technology.

So far, early results shared by some companies are promising. Janssen, Pfizer and GSK each appear effective at preventing infections in adults for the first RSV season after the vaccine.

In an August news release, Annaliesa Anderson, Pfizer’s chief scientific officer of Vaccine Research and Development, said she was “delighted” with the results. The company plans to submit its data to the FDA for approval this fall.

GSK has also wrapped up its Phase 3 trial for seniors. It recently presented the results at a medical conference, but full data hasn’t been peer reviewed or published in a medical journal. Early results show that this vaccine is 83% effective at preventing disease in the lower lungs of adults 60 and older. It appears to be even more protective – 94% – for severe RSV disease in those over 70 and those with underlying medical conditions.

“We are very pleased with these results,” Dormitzer told CNN. He said the company was moving “with all due haste” to get its results to the FDA for review.

“We’re confident enough that we’ve started manufacturing the actual commercial launch materials. So we have the bulk vaccine actually in the refrigerator, ready to supply when we are licensed,” he said.

Even as the company applies for licensure, GSK’s trial will continue for two more RSV seasons. Half the group getting the vaccine will be followed with no additional shots, while the other group will get annual boosters. The aim is to see which approach is most protective to guide future vaccination strategies.

Janssen’s vaccine for older adults appears to be about 70% to 80% effective in clinical trials so far, the company announced in December.

In a study on Pfizer’s vaccine for pregnant women published in the New England Journal of Medicine this year, the company reported that the mothers enrolled in the study made antibodies to the vaccine and that these antibodies crossed the placenta and were detected in umbilical cord blood just after birth.

The vaccines for pregnant women are meant to get newborns through their first RSV season. But not all newborns will benefit from those. Most maternal antibodies are passed to baby in the third trimester, so preemies may not be protected, even if mom gets the vaccine.

For vulnerable infants and those whose mothers decline to be vaccinated, Dr. Helen Chu, an infectious disease specialist at the University of Washington, says the long-acting antibody shot for newborns, called nirsevimab, should cover them for the first six months of life. She expects it to be a “game-changer.”

That shot, which has been developed by AstraZeneca, was recently recommended for approval in the European Union. It has not yet been approved in the United States.

The field is so close to a new approval that public health officials say they’ve been asked to study up on the data.

Chu, who is also a member of an RSV study group of the Advisory Committee on Immunization Practices, a panel that advises the US Centers for Disease Control and Prevention on its vaccine recommendations, says her group has started to evaluate the new vaccines – a sign that an FDA review is just around the corner.

No companies have yet announced that process is underway. FDA reviews can take several months, and then there are typically discussions and votes by FDA and CDC advisory groups before vaccines are made available.

“We’ve been working on this for several months now to start reviewing the data,” Chu said. “So I think this is imminent.”

Watching this year’s RSV season unfold, Brown, the pediatrician who enrolled her son in the vaccine trial for toddlers, says progress can’t come fast enough.

“The hospital is surging. We’re not drowning the way some states are. I mean, Connecticut, South Carolina, North Carolina, they’re really drowning. But our numbers are huge, and our services are so busy,” she says.

Brown says her son is mostly healthy. He doesn’t have any of the risks for severe RSV she sees with some of her patients, so she was happy to have a way to help others.

And while it’s far too early to say whether the vaccine James is helping to test will prove to be effective, the trial was unblinded last week, and Brown learned that her son was in the group that got the active vaccine, not the placebo

He has done well through this heavy season of illness, she says. The NIH-sponsored study they participated in is scheduled to be completed next year.

The vaccine, which is made with a live but very weak version of virus, is given through a couple of squirts up the nose, so there are no needles. The hardest part for squirmy James, she said, was being held still.

“If we can do anything to move science forward and help another child, like, sorry, James. You had to have your blood drawn, but it absolutely was worth it.”

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US

Parkland shooting: School shooter avoids the death penalty after jury recommends life in prison

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Fort Lauderdale, Florida
CNN
 — 

The Parkland school shooter has avoided the death penalty after a jury recommended he be sentenced to life in prison without the possibility of parole for the February 2018 massacre at Florida’s Marjory Stoneman Douglas High School – a move that left some of the victims’ loved ones disappointed and angry.

The jury’s recommendation Thursday, coming after a monthslong trial to decide Nikolas Cruz’s punishment, is not an official sentence; Broward Circuit Judge Elizabeth Scherer still is expected to issue the gunman’s formal sentence on November 1. Under Florida law, however, she cannot depart from the jury’s recommendation of life.

Families of the gunman’s victims bowed or shook their heads as the verdict forms for each of the 17 people he killed were read in court Thursday morning. The jury found the aggravating factors presented by state prosecutors did not outweigh the mitigating circumstances – aspects of Cruz’s life and upbringing his defense attorneys said warranted only a life sentence.

None of the jurors looked in the direction of the victims’ families as their verdicts were read, but instead looked down or straight ahead. Cruz – flanked by his attorneys, wearing a blue and gray sweater over a collared shirt and eyeglasses – sat expressionless, looking down at the table in front of him.

Live updates: Jury reaches decision in Nikolas Cruz sentencing trial

Tony Montalto, the father of 14-year-old victim Gina Montalto, called the jury’s recommendation a “gut punch” for the victims’ families, lamenting that “the monster that killed them gets to live to see another day.”

“This shooter did not deserve compassion,” he said outside the courtroom, after the jury’s findings were read. “Did he show the compassion to Gina when he put the weapon against her chest and chose to pull that trigger, or any of the other three times that he shot her? Was that compassionate?”

Cruz, now 24, pleaded guilty last October to 17 counts of murder and 17 counts of attempted murder for the shooting in Parkland, Florida, in which 14 students and three school staff members were killed, and 17 others were injured. Because Cruz pleaded guilty to all counts, the trial phase was skipped and the court went directly to the sentencing phase.

Prosecutors had asked the jury to sentence the gunman to death, arguing Cruz’s decision to carry out the shooting was not only especially heinous or cruel, but premeditated and calculated and not, as the defense contended, related to any neurological or intellectual deficits.

To illustrate their point, prosecutors detailed Cruz’s thorough planning for the shooting, as well as comments he made online expressing his desire to commit a mass killing.

In their case, the shooter’s defense attorneys said Cruz had neurodevelopmental disorders stemming from prenatal alcohol exposure, and presented evidence and witnesses claiming his birth mother had used drugs and drank alcohol while pregnant with him. Cruz’s adoptive mother was not open about this with health professionals or educators, preventing him from receiving the appropriate interventions, the defense claimed.

Of the 12 jurors, three voted against the death penalty, jury foreman Benjamin Thomas told CNN affiliate WFOR, saying, “I don’t like how it turned out but it’s that’s how the jury system works.”

“There was one with a hard ‘no,’ she couldn’t do it, and there was another two that ended up voting the same way,” said Thomas.

The woman who was a hard no “didn’t believe because he was mentally ill he should get the death penalty,” Thomas said.

The parents of Alyssa Alhadeff, another 14-year-old victim, said they were disgusted by the verdict.

“I’m disgusted with those jurors,” Alyssa’s father, Ilan Alhadeff, said. “I’m disgusted with the system, that you can allow 17 dead and 17 others shot and wounded, and not get the death penalty. What do we have the death penalty for?”

Linda Beigel Schulman, the mother of geography teacher Scott Beigel, echoed that question, telling reporters, “If this was not the most perfect death penalty case, then why do we have the death penalty at all?”

She, like many of the families who addressed reporters, commended prosecutors for their work, saying they perfectly executed the state’s arguments against the gunman.

“Justice was not served today,” her husband, Michael Schulman, said.

The jury’s recommendation robbed the victims’ families of justice, the father of 14-year-old Jaime Guttenberg told reporters, saying it could make another mass shooting “more likely.”

“We are all in this position now of doing the work that we do around this country to keep this from happening to another family,” Fred Guttenberg said after court. “This decision today only makes it more likely that the next mass shooting will be attempted.”

“This jury failed our families today,” Guttenberg said.

The widow of 49-year-old Christopher Hixon, who was the school’s athletic director, said the jury’s decision indicated the gunman’s “life meant more than the 17 that were murdered” and the rest of the community who remain “terrorized and traumatized.”

Debra Hixon also rejected the defense’s arguments about the gunman’s mental or intellectual struggles, pointing to another one of her sons, who has special needs.

“I have a son that checked … a lot of those boxes that the shooter did as well,” she said. “And you know what? My son’s not a murderer. My son’s the sweetest person that you could ever meet.

Florida Gov. Ron DeSantis also was disappointed by the jury’s decision, he said Thursday, as well as how long it took for the judicial process to play out.

“I was very disappointed to see that,” he said of the jury’s verdict. “I’m also disappointed that we’re four and a half years after these killings, and we’re just now getting this.”

Broward County Public Defender Gordon Weekes commended the attorneys in his office who represented the gunman, telling reporters, “With the greatest bit of sympathy, we attempted to prepare this case and present this case in the most professional and legal manner as we could.”

Weekes urged the community to respect the verdict, saying Thursday “is not a day of celebration, but a day of solemn acknowledgment, and a solemn opportunity to reflect on the healing that is necessary for this community.”

Weekes declined to comment when asked whether Cruz had a reaction to the jury’s recommendation.

To decide on a recommended sentence, jurors were asked to weigh the aggravating factors and mitigating circumstances presented by the prosecution and defense during trial.

Prosecutors pointed to seven aggravating factors, including that the killings were especially heinous, atrocious or cruel, as well as cold, calculated and premeditated. Other aggravating factors, prosecutors said, were that the defendant knowingly created a great risk of death to many people, and that he disrupted a lawful government function – in this case, the running of a school.

The defense, meantime, offered 41 possible mitigating circumstances, including that Cruz was exposed to alcohol, drugs and nicotine in utero; that he has a “neurodevelopmental disorder associated with prenatal alcohol exposure;” and that his adoptive mother did not follow the recommendations of medical, mental health and educational providers, among many others.

For each victim, jurors unanimously agreed the state had proven the aggravating factors beyond a reasonable doubt and that they were sufficient to warrant a possible death sentence.

However, to recommend death, all jurors still would have needed to find that the aggravating factors outweighed the mitigating circumstances. They did not unanimously agree on this, the jurors indicated Thursday on their verdict forms – meaning Cruz must be sentenced to life in prison and not death.

In closing arguments Tuesday, prosecutors argued Cruz’s decision to commit the shooting was deliberate and carefully planned, while Cruz’s defense attorneys offered evidence of a lifetime of struggles at home and in school.

“What he wanted to do, what his plan was and what he did, was to murder children at school and their caretakers,” lead prosecutor Michael Satz said Tuesday. “The appropriate sentence for Nikolas Cruz is the death penalty,” he concluded.

However, defense attorney Melisa McNeill said Cruz “is a brain damaged, broken, mentally ill person, through no fault of his own.” She pointed to the defense’s claim that Cruz’s mother used drugs and drank alcohol while his mother was pregnant with him, saying he was “poisoned” in her womb.

“And in a civilized humane society, do we kill brain damaged, mentally ill, broken people?” McNeill asked Tuesday. “Do we? I hope not.”

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