What should midlife women know about preventive cardiology?

We are all aware that sex and gender differences are important in the diagnosis and management of cardiovascular diseases. A woman’s risk of a cardiac event and stroke sharply increases after the onset of menopause. Here is an informative video regarding preventing and managing the increased risk of a cardiac event after menopause.

Dr. Beth Abramson is a preventive cardiologist and helps women manage the risk of heart disease.  In this video by North American Menopause Society (NAMS), she answers many vital questions about menopausal hormone therapy, midlife weight gain, smoking, alcohol, and aspirin therapy.  

Landmark cancer prevention report puts forth a blueprint to reduce the risk of cancers

The American Institute for Cancer Research (AICR) and the World Cancer Research Fund (WCRF) recently issued an evidence-based blueprint for healthy living that could prevent nearly half of all cancer cases.

This is the 3^rd report in the series of expert reports Diet, Nutrition, Physical Activity, and Cancer: A Global Perspective, and updates the two previous comprehensive reports, which were published in 1997 and 2007.

The report has distilled evidence of 30 years of research into 10 recommendations that could help prevent cancer by lifestyle modification. The report is based on a review of data from 51 million people, including 3.5 million cancer cases in 17 cancers.

The evidence shows that a modification in your diet, staying physically active, having a healthy body weight and other health-related choices can prevent 12 cancer diagnoses. These include breast, colorectal, pancreatic, endometrial, ovarian, prostate, liver, gallbladder, kidney, bladder, stomach and esophageal cancers.

In 2012, an estimated 14.1 million new cases of cancer occurred worldwide, with nearly 1 in 6 deaths due to cancer.

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“The evidence is clear that making changes to diet and exercise and maintaining a healthy weight cuts cancer risks, regardless of age. The message may not be glamorous, but these changes can save your life,” said Kelly Browning, Chief Executive Officer of AICR.

The ten recommendations are:

1) Maintaining a healthy weight is the most important thing you can do to reduce your risk of cancer. Aim to be in the lower end healthy Body Mass Index (BMI) range.

2) Be physically active-incorporate physical activity as a part of your daily life. Walk more and sit less, for maximum health benefits, aim for 150 minutes of moderate, or 75 minutes of vigorous, physical activity a week.

3) Eat a diet rich in vegetables, fruits, whole grains, and beans. AICR recommends a plant-based diet that forms at least two-thirds of your plate.

4) Limit the intake of fast food. There is strong evidence that consuming "fast-foods" and a "Western-type" diet are causes of weight gain, overweight and obesity, which are linked to 12 cancers. Glycemic load also increases the risk for endometrial cancer.

5) Limit red meat and avoiding processed meat - red meat includes beef, pork and lamb and processed meat includes ham, bacon, salami, hot dogs, sausages.

6) Limit consumption of sugar-sweetened beverages- Whenever you feel thirsty drink water or unsweetened beverages.

7) Limit alcohol consumption- alcohol in any form is a potent carcinogen. It's linked to 6 different cancers. The best advice for those concerned about cancer is not to drink.

8) Do not take the supplement for cancer prevention-Aim to obtain nutrition from diet instead of popping the supplements. The panel doesn’t discourage the use of multivitamins or specific supplements for those sub-sections of the population who stand to benefit from them, such as women of childbearing age and the elderly. But, dietary supplements will not avoid cancer.

9) Mothers, please breastfeed your baby- There is a strong evidence that breastfeeding your baby protects against breast cancer later in life.

10) If you are already diagnosed with cancer, you should follow the nutritional advice from an appropriately trained professional. For breast cancer survivors, there is persuasive evidence that nutritional factors and physical activity reliably predict important outcomes from breast cancer.

The report emphasizes the need for knowledge about the link between lifestyle and cancer. In a 2017 AICR Cancer Risk Awareness Survey more than 50% of the population who responded was not aware of the link between obesity and cancer.

The report provides robust evidence for healthcare professionals and government officials to advise the patients about healthy eating and making policies that make healthy eating more affordable.  

AICR today launched Cancer Health Check – an easy-to-use tool, which shows how your lifestyle stacks up against known cancer risks and outlines the changes you can make to follow AICR’s evidence-based Cancer Prevention Recommendations.

ACIR News Release

Cancer Health Check – an easy-to-use tool

Diet, Nutrition, Physical Activity, and Cancer: A Global Perspective, the Second Expert Report

Ob/Gyn Updated Facebook page

Here is a video about AICR 10 recommendations for cancer prevention.

The Dos and Don’ts in Pregnancy: An evidence-based review

Every Pregnant woman receives tons of advice regarding precautions she needs to take to optimize the pregnancy outcome. In this digital age, she is constantly exposed to ideas and suggestions about the dos and don’ts in pregnancy, a lot of which is confusing and conflicting, as a result, the woman is often unsure of what is correct for her and the baby. She often turns to her healthcare provider to direct her regarding her daily routine in pregnancy, but the healthcare provider is also exposed to myriads of opinion on this topic.

This recent article published ahead of print as a part of clinical expert series in the Journal of Obstetrics and Gynecology provides an evidence-based review on things routinely advised or avoided during pregnancy.

The author has looked upon Cochrane systematic reviews, guidelines from the American College of Obstetricians and Gynecologists(ACOG) and other international organizations to formulate the recommendations that can be used to direct a pregnant woman on this confusing and much-advised topic.

Prenatal Vitamins

The necessity of taking or not taking a prenatal vitamin for women has not yet been proven, especially in women taking a balanced diet. But, they are not harmful and may be consumed during pregnancy. Any simple multivitamin will suffice and there is no ideal formulation for a prenatal vitamin. A woman needs to take:

• Folic acid 400–800 micrograms (until the end of the first trimester)
• Iron 30 mg (or be screened for anemia)
• Vitamin D 600 international units
• Calcium 1,000 mg

Nutrition and weight gain

According to the National Academy of Medicine, weight gain in pregnancy is determined by pre-pregnancy BMI. A woman should consume an additional 350–450 calories per day in the second and third trimesters but it also depends upon her activity levels, height and weight and her metabolism rate.

So, the exact calories required should be individualized.

Alcohol consumption

The safe threshold for alcohol intake is not known and higher alcohol consumption is known to cause fetal alcohol syndrome. It is best avoided in pregnancy.

Artificial sweeteners

Artificial sweeteners are safe in pregnancy as no evidence exists to link them with an increase in birth defects, but it is advisable to keep the intake at the lowest possible level.

Caffeine

Low to moderate caffeine intake is presumed to be safe during pregnancy based on most human studies. It is advisable to limit the intake to less than 300 mg/day. An 8-ounce cup of brewed coffee has about 130 mg of caffeine while a cup of tea or soda has about 50 mg of caffeine.

Eating Fish

Fish intake during pregnancy is associated with improved neurodevelopment in children and is also linked to decreased risk of preterm birth. But, because of increased mercury content, the fetus may suffer neurological damage.

Women should try to eat 2-3 servings of fish/week that is low in mercury and high in omega-3 long-chain polyunsaturated fatty acids and docosahexaenoic acid (DHS).

Raw fish should be avoided during pregnancy.

Other Food choices

Food restrictions are mainly put in place to avoid toxoplasmosis and listeria infection.

To prevent toxoplasmosis, pregnant women should avoid eating raw and undercooked meat, and should wash all fruits and vegetables before consumption.

To avoid Listeria, pregnant women should avoid unpasteurized dairy products, raw sprouts, unwashed vegetables, and unheated deli meats. However, Listeria outbreaks can happen from many other food sources and are difficult to compile a list of foods to be avoided. Pregnant women are in general asked to be aware of local outbreaks of food poisoning and listeriosis and avoid those specific foods.

Smoking, Nicotine patch and vaping

Women are advised against smoking in pregnancy but the use of nicotine patch or gum to help quit smoking is acceptable while pregnant.

Marijuana

No long-term data about fetal neurodevelopmental outcomes after Marijuana consumption is currently available, hence women are advised against Marijuana use in pregnancy.

Physical activity and bedrest

Women with uncomplicated pregnancies are advised to have regular aerobic and strength conditioning exercise during pregnancy. They should aim at average 20–30 minutes of moderate-intensity exercise four to five times per week.

Bed rest or activity restriction has no role in pregnancy and has not shown to prevent preterm birth or pregnancy loss nor does it benefit women with hypertensive disorders of pregnancy, premature rupture of membranes, fetal growth restriction, or placenta previa.

Precautions while driving

Women are advised to continue using three-point seat-belts while pregnant, the belt should be placed low in lap, below the uterus. ACOG recommends against disabling the airbags, but the benefits or harm of airbag is unclear in pregnancy.

Oral Health

The importance of maintaining good dental hygiene should be emphasized during prenatal visits. Routine preventive dentistry should be practiced while pregnant and procedures like cleanings, extraction, scaling, root canal, radiographs and restoration and fillings should be carried out while taking appropriate precautions for exposure to X-rays.

Swimming and Hot-tub baths

Hot-tub baths are not advisable in pregnancy because they raise the risk of miscarriage and birth defects as they increase the maternal temperature.  On the other hand, a woman can continue to enjoy swimming while pregnant.

Travel

Air travel is safe during pregnancy as the cosmic and screening radiation exposures are below the threshold for any sort of fetal risk. Women should be aware of their travel destination and the necessary information on potential infections prevalent in those areas.

But, as the pregnancy progresses, it is difficult to adjust to the demands of traveling. There is no specific cut-off for gestational age after which travel is not advisable. Each woman should take her decision keeping in mind the benefits and harms of the proposed travel.

Intimacy

Sexual intimacy and orgasm are not associated with increased risk of pregnancy complications. In women with placenta previa, intercourse is avoided after 20weeks of pregnancy, although no data exists. In cases of vaginal bleeding or PROM, it is not known whether intimacy increases the risk of bleeding or infection.

Sleeping position

Currently, no data exists to advice a pregnant woman about exact gestational age at which she should start sleeping on her side.

Hair-dye and insect repellents

Hair-dye results in minimum systematic absorption and hence presumed to be safe during pregnancy. Topical insect repellents can be safely used in pregnancy, especially in areas where mosquito-borne illnesses, including West Nile and Zika virus, are rife.

All these are general guidelines and can be appropriate for a broad class of pregnant women, but still, each case needs to be evaluated at an individual level and the advice should be tailored to the specific circumstances.

Abstract

Media courtesy: http://www.webfeed360.com/health-fitness/pregnancy-tips/

ASRM and SREI issues guidelines to optimize natural fertility in absence of evidence of infertility.

 

Courtesy:Pixabay

American Society for Reproductive Medicine(ASRM) in collaboration with the Society for Reproductive Endocrinology and Infertility(SREI) issued counseling guidelines for achieving pregnancy in couples who are perfectly normal or no abnormality is detected in any test results.

These guidelines were published in January,2017 issue of Fertility and Sterility. [1]

The guidelines and recommendations are:

1) Fertility declines with increasing age in women and women > 35 years of age should be advised to consult a physician if they do not achieve pregnancy after 6 months of uninterrupted intercourse. For women < 35 years the time window is 12 months.

2) Specific recommendations regarding frequency of intercourse brings in unnecessary tension among couples. But, reproductive efficiency is maximum if intercourse occurs every 1-2 days, but the couple should be counseled about it and advised to follow “their own preference” within the context.

3) The fertile window in the cycle is best defined as the 6 days’ period that ends on the day of ovulation, because viability of both sperms and ovum is maximum during that time. Chances of fertilization is highest if intercourse occur on the day prior to ovulation.

4) Most postcoital practices adopted by couples like lying supine after intercourse and avoiding using the bathroom has no scientific backup. Some commercially available vaginal lubricants inhibit sperm motility by as much as 60- 100% in vitro but no results in vivo. But if needed mineral oil, canola oil, or hydroxyethylcellulose-based lubricants should be recommended during this time.

5) Fertility decreases at the extremes of BMI but, variations in daily diet or any specific diet does not have an effect on the fertility. Healthy eating may help improve fertility and diet high in mercury because of seafood consumption is known to be associated with infertility.

6) Women who are trying to conceive should receive 400 mcg of folic acid daily.

7) Smoking has very deleterious effect on fertility with the odds decreasing by 60% in women who smoke and increasing the rates of miscarriage. Smoking also causes rapid follicular atresia accelerating the occurrence of menopause.

8) Alcohol and caffeine in heavy doses have a deleterious effect on pregnancy and should be avoided. That amounts to > 2 drinks/day, with 1 drink >10 g of ethanol for alcohol and 500 mg; >5 cups of coffee/day per day. Moderate coffee consumption of 1-2 cup per day have no effect.

9)Similarly, recreational drugs, environmental pollutants and toxicants are all recognized to decrease fertility and exposure to them should be avoided.

The full text of the article can be accessed from here.

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[1] http://www.fertstert.org/article/S0015-0282(16)62849-2/fulltext