Women’s health issues

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How late can you wait to have a baby?

Tuesday, April 13th, 2010

Today, many women are delaying starting families, most likely due to career and  economic concerns. Pregnancy rates are down in all age groups except for those 40 to 44 years of age, says the CDC, where pregnancy rates are up by 4 percent.

With all those over-40 women having babies, does this mean you can wait indefinitely if you hope to get pregnant? Not really.  A woman’s peak of fertility is about 25 years of age.  After that, “it’s all downhill.”  The likelihood of becoming pregnant drops dramatically well before you reach menopause, which is what many women think of as the end of their fertile years. A great number of those after-40 pregnancies are the results of medical interventions such as in vitro fertilization and donor eggs from 25 year olds.  Unlike our male counterparts who keep producing new sperm every 74 days, women are given their complement of eggs way before they are even born and there are no more new eggs to be produced.   Therefore, at 36 years of age, a woman’s eggs are 36+ years old with all the attendant risks that accompany any aging process.  According to the March of Dimes:

“At age 25, a woman has about a 1-in-1,250 chance of having a baby with Down syndrome; at age 40, the risk increases to 1-in-100 chance; and at 45, the risk  of carrying a child with a chromosomal anomaly such as Down syndrome, continues to rise to 1-in-30 chance.”

The advent of artificial reproductive technologies virtually transforms a woman’s “biological clock” into a perpetual calendar, but not without risks.  In studies, babies born via in vitro fertilization have been shown to have a higher risk of birth defects.

If an older woman doesn’t mind having a baby who carries none of her DNA, she may opt for a donor egg from a younger woman, which is then fertilized by her husband and the embryo transferred into her uterus.  Many of the older celebrities have chosen this route for their family planning.

Medical interventions, while they seem miraculous when they work, aren’t guaranteed to be successful. Just as in getting pregnant the old-fashioned way, your chances of success drop the older you are.  In vitro fertilization will result in a live birth among women past 40 only 6 to 10 percent of the time versus a 30 to 35 percent success rate among women younger than 35.

Nature’s message is clear, and unfortunately, it doesn’t offer any leeway in difficult economic times or while you are working your way up the corporate ladder: if you want to start a family, you’re more likely to be successful if you begin well before you turn 40.

– Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, Fertility & Infertility, Pregnancy, Women's health issues, Your newborn baby | 1 Response »
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A court says that genes can’t be patented – and why that’s good news for women

Wednesday, March 31st, 2010

For many years, corporations have been filing patents to claim ownership of the genes that researchers have discovered. Nevermind that these genes exist in our bodies and were designed, not by scientists, but by nature. Once a corporation or other institution gets a gene patent, that gene becomes its property.

Those who control the genes get to decide whether to allow other researchers to use the gene in further research. The gene’s “owners” also get to corner the market in potentially life-saving tests involving the gene.

That’s led to some pretty significant price-gouging of women whose genetics put them at risk for certain breast and ovarian cancers. Myriad Genetics controls the patents for the genes that are associated with about 10 percent of breast and ovarian cancers. So if your doctor told you that you needed a test to see whether you carry a gene that makes you more susceptible to these cancers, you could get hit with a bill from Myriad for a whopping $3,000.

But that’s about to change.

This week, a federal court ruled, in a lawsuit against Myriad Genetics, that its gene patents were invalid because genes occur naturally. From an article about the court’s ruling that appeared in The New York Times:

Judge Sweet… said that many critics of gene patents considered the idea that isolating a gene made it patentable “a ‘lawyer’s trick’ that circumvents the prohibition on the direct patenting of the DNA in our bodies but which, in practice, reaches the same result.”

The case could have far-reaching implications. About 20 percent of human genes have been patented, and multibillion-dollar industries have been built atop the intellectual property rights that the patents grant.

“If a decision like this were upheld, it would have a pretty significant impact on the future of medicine,” said Kenneth Chahine, a visiting law professor at the University of Utah who filed an amicus brief on the side of Myriad. He said that medicine was becoming more personalized, with genetic tests used not only to diagnose diseases but to determine which medicine was best for which patient.

Mr. Chahine, who once ran a biotechnology company, said the decision could also make it harder for young companies to raise money from investors. “The industry is going to have to get more creative about how to retain exclusivity and attract capital in the face of potentially weaker patent protection,” he said.

I take issue with anyone who claims that denying patents on what nature creates will thwart research. And I am in total agreement with the court’s decision to invalidate these patents on genes. Patenting genes invites a type of commercial perversion of what is a natural occurrence. As a researcher myself, I disagree that invalidating gene patents removes incentives for future research. There will always be research. However, the results of that research will have checks and balances rather than the current focus on the “bottom line” of profit, that takes advantage of patients and the medical community.

– Yvonne S. Thornton, MD, MPH

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Pregnant or new mom and feeling depressed? Get help now.

Tuesday, March 9th, 2010

Pregnancy and childbirth alter the hormonal balance, which may explain why depression is so common at this stage of women’s lives. Up to 23 percent of pregnant women experience symptoms of depression and that figure rises to up to 25 percent among new mothers.

Many women decide to simply suffer through it without seeking help, but that could be a big mistake. According to the American College of Obstetricians and Gynecologists:

“… untreated maternal depression negatively affects an infant’s cognitive, neurologic, and motor skill development. A mother’s untreated depression can also negatively impact older children’s mental health and behavior.”

Everyone feels sad some of the time. It’s normal to have a bad day. But if your bad day stretches into weeks, for your own sake and the sake of your baby, you need to get help. If you don’t have a therapist, ask your ob-gyn for a referral if you experience feelings of hopelessness, sadness or despair. Don’t suffer needlessly. Help is available.

– Yvonne S. Thornton, MD, MPH

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Think you don’t need health care reform if you’re covered by your employer? Wrong.

Tuesday, February 16th, 2010

You may have heard that Anthem-Blue Cross proposed raising its rates for individual health insurance policies by as much as 39 percent in California. President Obama and Secretary of Health and Human Services Kathleen Sebelius have both decried this outrageous hike. A recent report from the Associated Press shows that similarly huge rate hikes are coming to individual policies in many states including Maine, Kansas, Oregon and Indiana.

“You’re going to see rate increases of 20, 25, 30 percent” for individual health policies in the near term, Sandy Praeger, chairwoman of the health insurance and managed care committee for the National Association of Insurance Commissioners, predicted Friday.

But you might think that this has nothing to do with you if you’re employed by a company that provides you with health insurance. Unfortunately, all of us are affected, no matter where we get our insurance.

The Anthem-Blue Cross increase is the harbinger of things to come in employer-provided policies as well.

Last week, I heard from someone whose employer had to switch from a comprehensive policy to bare bones insurance because the insurer raised the company’s group rate by about 30 percent. So now, instead of offering employees a policy that covers just about anything, from a broken ankle to a liver transplant, the company will offer its employees a policy with an annual cap of just $25,000.

That’s employer-provided insurance that’s in danger now. And that means that more Americans are at risk of having either no insurance or inadequate insurance when a medical emergency strikes.

As a doctor, I am well aware of the high cost of medical care and can assure you that a policy with a $25,000 annual cap won’t cover much if you need hospitalization. I’ve dealt with that reality, not just as a physician, but as a mother. As I wrote on this blog before, when my daughter had to be hospitalized a few years ago, we learned too late that her school-provided policy had a $25,000 annual cap. Lucky for Kimmie that her parents are both doctors and could afford to pay the tens of thousands of dollars in hospital and medical bills that her insurance didn’t cover.

What would you do if one of your loved ones needed medical care and your insurance was inadequate?

This is no longer an issue for the uninsured. It’s an issue for us all. Please tell your Senators and Congressional representatives that you support health care reform. The life of someone you know, maybe someone you love, maybe your own, may depend on what happens next in Washington, DC.

– Yvonne S. Thornton, MD, MPH

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The End of the Horrible Hospital Gown?

Thursday, February 11th, 2010

The open-backed, modesty-destroying, ugly hospital gown is set for oblivion, at least in the United Kingdom:

To address the shortcomings of the much-abused medical garb, the U.K.’s Department of Health recruited designer Ben de Lisi to give the hospital gown a design overhaul, the BBC reports. De Lisi, who has outfitted stars such as Kate Winslet, came up with a solution that offers more coverage while also including “entrance points” for the necessary medical access.

It’s about time.

Back when I was on the faculty of Cornell in the 1980s, I decided that no woman who visited my Cornell practice would be forced to wear one of those open-backed monstrosities.

They always made a woman feel all exposed. As a woman myself, I was especially sensitive to the indignity of it all.

So I designed a pretty blue poncho with an opening that fit over a woman’s head. It covered everything, and allowed for easy examination.

I’m surprised that more doctors and hospitals haven’t done anything similar but I like the U.K.’s new plan. Here’s hoping the U.S. follows suit.

– Yvonne S. Thornton, MD, MPH

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Why Health Care Reform Is Essential to You and Your Family – Even if You’re Insured

Thursday, January 28th, 2010

Last night, President Obama, in his State of the Union address, reminded us why we need real health care reform.

First, I’ll quote a few of the points the president made and then I’ll explain why it matters to each of us, currently insured or not:

“The approach we’ve taken would protect every American from the worst practices of the insurance industry. It would give small businesses and uninsured Americans a chance to choose an affordable health care plan in a competitive market.  It would require every insurance plan to cover preventive care.

“… It would reduce costs and premiums for millions of families and businesses. And according to the Congressional Budget Office – the independent organization that both parties have cited as the official scorekeeper for Congress – our approach would bring down the deficit by as much as $1 trillion over the next two decades.”

When the president spoke of the insurance companies “worst practices” he didn’t elaborate. But it’s those practices that make us all, insured or not, vulnerable, and in need of reform. Too many Americans believe that they have great health insurance – right up to the moment when they get sick and find that their insurance won’t cover their medical bills.

Recently, one of the organizations advocating on behalf of health care reform shared the case histories of numerous people who, although insured, were unable to get their medical bills paid when they got sick. The following few cases are among dozens of similar stories. If we don’t think it can happen to you, you’re wrong. I speak from experience. Although I’m a doctor, when my daughter became ill, her insurance refused to cover all her medical costs and I had to pay tens of thousands out of pocket.

  • An AT&T worker from Arkansas was in a coma for three weeks after a 2004 horseback riding accident. She and her husband had to pay more than $200,000 in medical bills because UnitedHealthcare wouldn’t cover her emergency surgery.
  • A Realtor from Delaware, has a health care plan that forces her to pay for her cancer care “out of pocket.” She has turned to getting her chemotherapy medication from India in order to afford it.
  • A minister from Tennessee has almost $175,000 in medical debt due to his wife’s muscular disorder. The family had health insurance through his wife’s job as an insurance claims adjuster, but the health insurance would only cover 14 days of her 91 days in intensive care.

Don’t let anyone tell you that if you’re insured, you don’t need to support health care reform. As the above cases illustrate, this affects us all. While there is no longer any chance of passing a new bill through the United States Senate, the House can vote for the Senate bill that passed over Christmas eve now and make changes over time.  It may be our last chance for reform in a generation. Please call your Congressperson today and remind him or her what’s at stake.

– Yvonne S. Thornton, MD, MPH

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New Moms: Don’t feel guilty if you’re not breastfeeding

Thursday, January 21st, 2010

If you’re pregnant or have recently had a baby, you’ve probably heard that breastfeeding is one of the best things you can do for your baby. Other mothers will tell you so. Books extol breastfeeding’s virtues. Even the government gives mothers a nudge in this direction.

But what if your schedule doesn’t make breastfeeding a viable option?

Don’t let anyone make you feel like you’re an inadequate parent if you give your baby a bottle instead. There are no randomized clinical trials that prove the virtues of breast milk over formula feeding. And most working mothers simply don’t have the opportunity to breastfeed in our society, at least not exclusively.

When public lactation stations become the norm, and when most workplaces have specifically designated areas for breastfeeding, then it will make sense for more women to consider the breastfeeding-only option.

Until then, in a society where many women are either single parents or are the primary family breadwinners, exclusive breastfeeding must be seen as an unrealistic – and maybe even a chauvinistic — recommendation.

– Yvonne S. Thornton, MD, MPH

Posted in Women's health issues, Women's health news, Your newborn baby | 2 Responses »
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Compared to white babies, twice as many African-American babies die in their first year of life

Monday, January 18th, 2010

As we celebrate the birthday of one of America’s greatest African-American leaders, Dr. Martin Luther King, and we take pride in the leadership of our first African-American president, Barack Obama, it’s easy to assume that racial disparities are a thing of the past.

But our infant mortality rates tell us that that’s not so.

According to the Centers for Disease Control (CDC), infant mortality among African-American babies is more than twice that of white babies. Among the other troubling statistics in the CDC report:

  • African Americans had 1.8 times the sudden infant death syndrome mortality rate as non-Hispanic whites, in 2005.
  • African American mothers were 2.5 times more likely than non-Hispanic white mothers to begin prenatal care in the 3rd trimester, or not receive prenatal care at all.
  • The infant mortality rate for African American mothers with over 13 years of education was almost three times that of Non-Hispanic White mothers in 2005.

America is still a country where people of color face discrimination at every turn, even if it’s less overt than it was in our past. Bias limits educational opportunities, employment opportunities, and it even limits the opportunity of pregnant women to get access to good healthcare.

If Dr. King could see us today, I know he’d be pleased at how far we’ve come. But if we haven’t provided our youngest and most vulnerable citizens equality in medical care, we still have a long way to go.

– Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, General health news, Pregnancy, Women's health issues, Your newborn baby | 1 Response »
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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

Posted in Childbirth & delivery, Pregnancy, Women's health issues, Women's health news, Your newborn baby | 1 Response »
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The best Christmas present the Senate could give us: Health care for all

Thursday, December 24th, 2009

Despite months of bluster and disinformation from those who hope to maintain the status quo, 60 U.S. senators came together this Christmas Eve morning and voted to make health care available to virtually all Americans.

The House had passed its version of health care reform months earlier. Now the two legislative bodies will have to come together and agree to a blended version.

That blended version almost certainly won’t have a public option because it would require 60 votes in the senate to get one. But here’s what we can be assured of getting in any final combination of the two bills:

  • Insurance companies will have to cover everyone – you can no longer be turned down due to pre-existing conditions.
  • Insurance can’t be snatched away from you via “rescission” when you get sick, i.e., voiding the policy when you need it the most.
  • There will be limits on how much more insurers can charge you as you get older.
  • Your insurance won’t run out when you need it due to annual or lifetime caps.
  • Most lower and middle-income people will get subsidies to help pay for insurance.

For those who say the senate bill doesn’t do enough, remember that getting this passed was a Herculean task. This is just the start of reform. Over the years, our lawmakers can continue to improve the bill, just as they’ve done with Social Security and Medicare. This is a long overdue beginning to regulating the health insurance companies, which have been given carte blanche for so many years.

The Centers for Disease Control recently reported that 58.4 million Americans were uninsured for at least part of the year and almost 32 million had been uninsured for more than a year. The situation will only get worse if we do nothing. As President Obama is fond of saying, we can’t let the perfect be the enemy of the good. This is a good bill. And it’s the best present that the U.S. Senate could give us this holiday season.

Merry Christmas to all.

– Yvonne S. Thornton, MD, MPH

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