User login
Cannabis and prenatal care
We know that the environment significantly impacts our health. People who live in areas prone to industrial waste, poor air or water quality, and crime have higher risks for cardiovascular disease, severe asthma, and stress-induced illnesses. Children who grow up under these conditions can experience a failure to thrive.
As ob.gyns., we also recognize that the intrauterine environment plays a key role in influencing embryonic and fetal development. For this reason, we counsel our pregnant patients to eat well-balanced diets, drink healthy amounts of water, get plenty of rest, and incorporate physical activity into their daily routines. Indeed, the seminal work by Sir David Barker demonstrated that the roots of chronic diseases – including hypertension, stroke, and type 2 diabetes – begin in utero. We truly are where we live – from before birth up through adulthood.
Because the womb environment, where we spend the first critical 9 months of life, dramatically affects our lifelong health, we advise against the use of certain medications and other substances during pregnancy. Some of these recommendations seem clear-cut: Don’t smoke and significantly reduce or abstain from alcohol consumption; illicit drugs – such as cocaine or heroin – should never be used. However, gray areas exist. For example, although anticonvulsants carry higher risks for congenital malformations, patients who experience seizures may need to continue taking antiepileptic drugs during pregnancy, especially those with long safety records.
One of the newer challenges the medical community in general must face is the broadened use and wider societal acceptance of cannabis. Currently legal in 33 U.S. states and Washington, D.C., medical marijuana now is viewed as another legitimate tool in the health care arsenal, rather than the off-limits, off-label substance it was less than a generation ago.
Although proponents may tout the health benefits of cannabis and related products like cannabidiol, it remains unclear what the long-term effects of routine use may have on development, especially fetal development. However, how we as ob.gyns. navigate conversations with our patients around substance use remains crucial to our delivery of the best possible prenatal care.
We have invited Katrina S. Mark, MD, associate professor of obstetrics, gynecology, and reproductive sciences at the University of Maryland School of Medicine, to examine use of cannabis in pregnancy and the need for maintaining trust in the patient-practitioner relationship when discussing substance use during prenatal counseling.
Dr. Reece, who specializes in maternal-fetal medicine, is executive vice president for medical affairs at the University of Maryland School of Medicine as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. He is the medical editor of this column. He said he had no relevant financial disclosures. Contact him at obnews@mdedge.com.
We know that the environment significantly impacts our health. People who live in areas prone to industrial waste, poor air or water quality, and crime have higher risks for cardiovascular disease, severe asthma, and stress-induced illnesses. Children who grow up under these conditions can experience a failure to thrive.
As ob.gyns., we also recognize that the intrauterine environment plays a key role in influencing embryonic and fetal development. For this reason, we counsel our pregnant patients to eat well-balanced diets, drink healthy amounts of water, get plenty of rest, and incorporate physical activity into their daily routines. Indeed, the seminal work by Sir David Barker demonstrated that the roots of chronic diseases – including hypertension, stroke, and type 2 diabetes – begin in utero. We truly are where we live – from before birth up through adulthood.
Because the womb environment, where we spend the first critical 9 months of life, dramatically affects our lifelong health, we advise against the use of certain medications and other substances during pregnancy. Some of these recommendations seem clear-cut: Don’t smoke and significantly reduce or abstain from alcohol consumption; illicit drugs – such as cocaine or heroin – should never be used. However, gray areas exist. For example, although anticonvulsants carry higher risks for congenital malformations, patients who experience seizures may need to continue taking antiepileptic drugs during pregnancy, especially those with long safety records.
One of the newer challenges the medical community in general must face is the broadened use and wider societal acceptance of cannabis. Currently legal in 33 U.S. states and Washington, D.C., medical marijuana now is viewed as another legitimate tool in the health care arsenal, rather than the off-limits, off-label substance it was less than a generation ago.
Although proponents may tout the health benefits of cannabis and related products like cannabidiol, it remains unclear what the long-term effects of routine use may have on development, especially fetal development. However, how we as ob.gyns. navigate conversations with our patients around substance use remains crucial to our delivery of the best possible prenatal care.
We have invited Katrina S. Mark, MD, associate professor of obstetrics, gynecology, and reproductive sciences at the University of Maryland School of Medicine, to examine use of cannabis in pregnancy and the need for maintaining trust in the patient-practitioner relationship when discussing substance use during prenatal counseling.
Dr. Reece, who specializes in maternal-fetal medicine, is executive vice president for medical affairs at the University of Maryland School of Medicine as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. He is the medical editor of this column. He said he had no relevant financial disclosures. Contact him at obnews@mdedge.com.
We know that the environment significantly impacts our health. People who live in areas prone to industrial waste, poor air or water quality, and crime have higher risks for cardiovascular disease, severe asthma, and stress-induced illnesses. Children who grow up under these conditions can experience a failure to thrive.
As ob.gyns., we also recognize that the intrauterine environment plays a key role in influencing embryonic and fetal development. For this reason, we counsel our pregnant patients to eat well-balanced diets, drink healthy amounts of water, get plenty of rest, and incorporate physical activity into their daily routines. Indeed, the seminal work by Sir David Barker demonstrated that the roots of chronic diseases – including hypertension, stroke, and type 2 diabetes – begin in utero. We truly are where we live – from before birth up through adulthood.
Because the womb environment, where we spend the first critical 9 months of life, dramatically affects our lifelong health, we advise against the use of certain medications and other substances during pregnancy. Some of these recommendations seem clear-cut: Don’t smoke and significantly reduce or abstain from alcohol consumption; illicit drugs – such as cocaine or heroin – should never be used. However, gray areas exist. For example, although anticonvulsants carry higher risks for congenital malformations, patients who experience seizures may need to continue taking antiepileptic drugs during pregnancy, especially those with long safety records.
One of the newer challenges the medical community in general must face is the broadened use and wider societal acceptance of cannabis. Currently legal in 33 U.S. states and Washington, D.C., medical marijuana now is viewed as another legitimate tool in the health care arsenal, rather than the off-limits, off-label substance it was less than a generation ago.
Although proponents may tout the health benefits of cannabis and related products like cannabidiol, it remains unclear what the long-term effects of routine use may have on development, especially fetal development. However, how we as ob.gyns. navigate conversations with our patients around substance use remains crucial to our delivery of the best possible prenatal care.
We have invited Katrina S. Mark, MD, associate professor of obstetrics, gynecology, and reproductive sciences at the University of Maryland School of Medicine, to examine use of cannabis in pregnancy and the need for maintaining trust in the patient-practitioner relationship when discussing substance use during prenatal counseling.
Dr. Reece, who specializes in maternal-fetal medicine, is executive vice president for medical affairs at the University of Maryland School of Medicine as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. He is the medical editor of this column. He said he had no relevant financial disclosures. Contact him at obnews@mdedge.com.
Using cervical length screening to predict preterm birth
One of the key indicators of a nation’s health is how well it can care for its young. Despite many advances in medical care and improvements in access to care, infant mortality remains a significant concern worldwide. According to the World Health Organization, the leading cause of death among children under age 5 is preterm birth complications. With an estimated 15 million babies born prematurely (prior to 37 weeks’ gestation) globally each year, it is vital for ob.gyns. to uncover ways to predict, diagnose early, and treat the causes of preterm birth.
While the challenges to infant health could be considered more of an issue in developing countries, here in the United States, the Centers for Disease Control and Prevention estimates that 1 in 9 babies is born prematurely. Preterm birth-related causes of death (i.e., breathing and feeding problems and disabilities) accounted for 35% of all infant deaths in 2010.
The World Health Organization (WHO) lists the United States as one of the top 10 countries with the greatest number of preterm births, despite the fact that we spend approximately 17.1% of our gross domestic product in total health care expenditures – the highest rate among our peer nations.
In the April 2014 edition of Master Class, we discussed one of the primary causes of preterm birth, bacterial infections, and specifically the need for ob.gyns. to rigorously screen patients for asymptomatic bacteriuria, which can lead to pyelonephritis. This month, we examine another biologic marker of preterm birth, cervical length.
Seminal studies of transvaginal sonography to measure cervical length during pregnancy and predict premature birth were published more than 2 decades ago. This work showed that a short cervix at 24 and 28 weeks’ gestation predicted preterm birth. Since then, clinical studies have demonstrated the utility of cervical length screening in women with prior preterm pregnancies. In the last decade, three large, randomized human trials have examined the usefulness of universal cervical length screening (Am. J. Obstet. Gynecol. 2012;207:101-6). However, the results of these trials have given practitioners a confusing picture of the predictability of this biologic marker.
Given the complexity of the “to screen or not to screen” issue, we have devoted this Master Class to a discussion on the role of cervical length screening and the prediction of preterm birth. Our guest author this month is Dr. Erika Werner, an assistant professor in ob.gyn (maternal-fetal medicine) in the department of obstetrics and gynecology at Brown University, in Providence, R.I., and an expert in the area of preterm birth.
Dr. Reece, who specializes in maternal-fetal medicine, is vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. Dr. Reece said he had no relevant financial disclosures. He is the medical editor of this column. Contact him at obnews@frontlinemedcom.com.
One of the key indicators of a nation’s health is how well it can care for its young. Despite many advances in medical care and improvements in access to care, infant mortality remains a significant concern worldwide. According to the World Health Organization, the leading cause of death among children under age 5 is preterm birth complications. With an estimated 15 million babies born prematurely (prior to 37 weeks’ gestation) globally each year, it is vital for ob.gyns. to uncover ways to predict, diagnose early, and treat the causes of preterm birth.
While the challenges to infant health could be considered more of an issue in developing countries, here in the United States, the Centers for Disease Control and Prevention estimates that 1 in 9 babies is born prematurely. Preterm birth-related causes of death (i.e., breathing and feeding problems and disabilities) accounted for 35% of all infant deaths in 2010.
The World Health Organization (WHO) lists the United States as one of the top 10 countries with the greatest number of preterm births, despite the fact that we spend approximately 17.1% of our gross domestic product in total health care expenditures – the highest rate among our peer nations.
In the April 2014 edition of Master Class, we discussed one of the primary causes of preterm birth, bacterial infections, and specifically the need for ob.gyns. to rigorously screen patients for asymptomatic bacteriuria, which can lead to pyelonephritis. This month, we examine another biologic marker of preterm birth, cervical length.
Seminal studies of transvaginal sonography to measure cervical length during pregnancy and predict premature birth were published more than 2 decades ago. This work showed that a short cervix at 24 and 28 weeks’ gestation predicted preterm birth. Since then, clinical studies have demonstrated the utility of cervical length screening in women with prior preterm pregnancies. In the last decade, three large, randomized human trials have examined the usefulness of universal cervical length screening (Am. J. Obstet. Gynecol. 2012;207:101-6). However, the results of these trials have given practitioners a confusing picture of the predictability of this biologic marker.
Given the complexity of the “to screen or not to screen” issue, we have devoted this Master Class to a discussion on the role of cervical length screening and the prediction of preterm birth. Our guest author this month is Dr. Erika Werner, an assistant professor in ob.gyn (maternal-fetal medicine) in the department of obstetrics and gynecology at Brown University, in Providence, R.I., and an expert in the area of preterm birth.
Dr. Reece, who specializes in maternal-fetal medicine, is vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. Dr. Reece said he had no relevant financial disclosures. He is the medical editor of this column. Contact him at obnews@frontlinemedcom.com.
One of the key indicators of a nation’s health is how well it can care for its young. Despite many advances in medical care and improvements in access to care, infant mortality remains a significant concern worldwide. According to the World Health Organization, the leading cause of death among children under age 5 is preterm birth complications. With an estimated 15 million babies born prematurely (prior to 37 weeks’ gestation) globally each year, it is vital for ob.gyns. to uncover ways to predict, diagnose early, and treat the causes of preterm birth.
While the challenges to infant health could be considered more of an issue in developing countries, here in the United States, the Centers for Disease Control and Prevention estimates that 1 in 9 babies is born prematurely. Preterm birth-related causes of death (i.e., breathing and feeding problems and disabilities) accounted for 35% of all infant deaths in 2010.
The World Health Organization (WHO) lists the United States as one of the top 10 countries with the greatest number of preterm births, despite the fact that we spend approximately 17.1% of our gross domestic product in total health care expenditures – the highest rate among our peer nations.
In the April 2014 edition of Master Class, we discussed one of the primary causes of preterm birth, bacterial infections, and specifically the need for ob.gyns. to rigorously screen patients for asymptomatic bacteriuria, which can lead to pyelonephritis. This month, we examine another biologic marker of preterm birth, cervical length.
Seminal studies of transvaginal sonography to measure cervical length during pregnancy and predict premature birth were published more than 2 decades ago. This work showed that a short cervix at 24 and 28 weeks’ gestation predicted preterm birth. Since then, clinical studies have demonstrated the utility of cervical length screening in women with prior preterm pregnancies. In the last decade, three large, randomized human trials have examined the usefulness of universal cervical length screening (Am. J. Obstet. Gynecol. 2012;207:101-6). However, the results of these trials have given practitioners a confusing picture of the predictability of this biologic marker.
Given the complexity of the “to screen or not to screen” issue, we have devoted this Master Class to a discussion on the role of cervical length screening and the prediction of preterm birth. Our guest author this month is Dr. Erika Werner, an assistant professor in ob.gyn (maternal-fetal medicine) in the department of obstetrics and gynecology at Brown University, in Providence, R.I., and an expert in the area of preterm birth.
Dr. Reece, who specializes in maternal-fetal medicine, is vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. Dr. Reece said he had no relevant financial disclosures. He is the medical editor of this column. Contact him at obnews@frontlinemedcom.com.
