Institute of Medicine browsing by tag


Free Birth Control For All? Yes!

Friday, July 22nd, 2011

When you’re on a strict budget, out-of-pocket costs can convince a woman to forego birth control. But getting pregnant is a much more expensive proposition and comes with a lifelong commitment — one that many women are neither emotionally or financially ready to make.

The new health care law requires the Department of Health and Human Services to create a list of health services that new health insurance plans must provide without deductibles or co-pays. And the National Academy of Sciences’ Institute of Medicine (IOM) has prepared a report recommending that birth control be on that list.

…the Guttmacher Institute estimates that 98 percent of sexually active women will use contraception at some point during their reproductive years, and that cost concerns are frequently cited as a reason for inconsistent use or use of a less then optimal method.


In fact, Guttmacher said in testimony submitted to the IoM earlier this year, “Women citing cost concerns were twice as likely as other women to rely on condoms or less effective methods like withdrawal or periodic abstinence.”

Along with the recommendations concerning birth control, the IOM recommended a number of other preventive care services for women be made available without deductibles or co-pays:

…annual “well-woman” visits; screening of pregnant women for gestational diabetes; screening for sexually transmitted diseases, including HIV; more support for breast-feeding mothers; and counseling and screening for possible domestic violence.

I urge HHS Secretary Sibelius to accept the IOM recommendations. Women’s health issues have taken a backseat for too long.

– Yvonne S. Thornton, MD, MPH

Leading Ob-Gyn Group Backs Findings of My Weight Gain in Pregnancy Study

Tuesday, January 12th, 2010

Last June, in the Journal of the National Medical Association, I published the results of clinical trials that showed that it was safe for obese pregnant women who followed a well-balanced diet to gain little or no weight. Prior to my study, the conventional wisdom was that all women, even obese ones, should gain 26 to 35 pounds. That guidance had come from the most august body of ob-gyns in the U.S., The American College of Obstetricians and Gynecologists (ACOG), whose recommendations were based upon what we knew in the 1980s. That was before we fully understood the dangers of obesity in pregnancy. Yet, the guidelines had never been updated.

Being obese during pregnancy greatly increases the risks of preeclampsia, diabetes, stillbirth, and blood clots, among other problems. Gaining more weight if you’re already obese makes complications more likely while limiting weight gain makes them less so.

But until my study was published, obstetricians lacked the evidence that limiting weight gain among pregnant women was safe. The ACOG’s guidance from the 1980s stated that, unless a woman, obese or not, gained at least 26 pounds, the baby in her womb would be at risk of dying.

Right before my study results were published, a government body recommended that obese women gain somewhat less weight: between 11 and 20 pounds. It was a start but still not enough. And most board certified obstetricians would wait for the ACOG to – you’ll excuse the pun – weigh in before they changed their practices.

I’m delighted to say that, in a commentary in the peer-reviewed journal Obstetrics & Gynecology, the ACOG has just come out in favor of limiting weight gain among obese pregnant women. My study, which was quoted in the commentary, appears to have been instrumental in effecting this turnaround.

Now that the ACOG is changing its recommendations, obstetricians are more likely to change how they manage their patients. Fewer women will be told that it’s fine to gain weight during pregnancy if you’re already obese. And that will mean healthier moms and healthier babies.

I’m proud to have played a role in helping to make this happen.

– Yvonne S. Thornton, MD, MPH

Health care reform will save the U.S. $250 billion per year says Institute of Medicine

Thursday, September 17th, 2009

No one should die in America for lack of health insurance. Yet so many people do – one every thirty minutes.

We know we have to change this. It’s one of the great moral issues our country faces. Yet, there are those who say, we can’t afford to cover everyone. I can’t fathom that argument. I believe that all deserve the right to life-saving treatment.

So I was happy to learn that we will soon have an economic argument as well as a moral argument to support making health care available to all.

The Institute of Medicine is about to release a study that reportedly found that, some years after reform is instituted, we  may save up to $250 billion per year over what we’d pay if we did nothing.

That gives us every reason to reform health care and no excuses not to. The moral imperative is obvious, at least to me, as a doctor who has treated both the very poor and the very wealthy. The economic argument should counter those who want to do less or nothing at all.

To save lives (and even, we now learn, to save money), it’s time to provide no loopholes, no fine print, real, affordable health care coverage for all.

– Yvonne  S. Thornton, MD, MPH

UPDATE: The above figures, showing that one person dies every 30 minutes due to lack of health insurance, are from The Institute of Medicine statistics of 2002. A new study, just released today by Harvard Medical School researchers, shows that it’s even worse than that: today, one person dies every 12 minutes due to lack of health insurance.

More media attention for the study

Friday, June 5th, 2009

Forbes reports on my study, showing that obese pregnant women should limit weight gain as does Medline.

Other media outlets giving the study prominent coverage are United Press International, Yahoo News, The Baltimore Sun, US News and World Report, and even the Times of India.

– Yvonne S. Thornton

My study on obesity and pregnancy in the news

Wednesday, June 3rd, 2009

I’m pleased to see that the media is getting the word out: obese pregnant women should be eating healthier diets and limiting their weight gain.

In the past few days, I’ve been interviewed by a number of news organizations about the study. You can see some of the reports at the following links:


The Atlanta Journal-Constitution

Science Daily

The Los Angeles Times

and Health Day

– Yvonne S. Thornton, MD, MPH

Study’s author concerned that new guidelines for pregnant obese women don’t go far enough

Tuesday, June 2nd, 2009

You may have read the headlines last week that The Institute of Medicine (IOM) is changing its guidelines for obese pregnant women. Instead of recommending that women who are obese gain at least 15 pounds during pregnancy, the IOM now recommends a weight gain of 11 to 20 pounds.

It’s a start. But, as the lead researcher of a new study of obese women, pregnancy and weight gain, I’m concerned that obese women are being told to gain any weight.

My study, which is being published today in the Journal of the National Medical Association, found that obese pregnant women who followed a well-balanced diet and gained little or no weight had maternal-fetal outcomes that were equal to or better than those who gained substantial weight.

As a specialist in high-risk pregnancies who has delivered more than 5,500 babies over a 35-year career and supervised the delivery of 12,000 more, I wasn’t surprised by the findings of our study. I know that those extra pounds mean extra risks for both mother and baby. Obesity greatly increases the chance of developing complications in pregnancy such as preeclampsia, stillbirth, and blood clots, among others.

Twenty-three of the more than 200 obese women in our study lost weight. The average weight gained was just 11 pounds. And yet, these women and their babies were at least as healthy as those who put on substantial pounds. There were fewer babies weighing 10 pounds or more, fewer cesareans, and the mothers were less likely to develop gestational diabetes.

You can read more about the study, here.

So, if you’re carrying significant extra weight, forget the old adage about eating for two. Believe it or not, for a pregnant woman of normal weight, only an additional 300 calories per day is needed during her pregnancy – the equivalent to a quart of skimmed milk per day.

– Yvonne S. Thornton, MD, MPH