Teenage Fathers Are More Likely To Have Babies Affected By Birth Problems Than Fathers Over 40

Daily Science Journal (Feb. 10, 2008) — Teenage fathers are at increased risk of having babies born with birth problems ranging from pre-term delivery or low birth weight, through to death in or near to the time of delivery, according to new research.*

In contrast, the study also found that older fathers, aged 40 and over, were not at increased risk of having babies affected by these problems. The results were independent of the age of the mother or other maternal factors that might be expected to have an impact on birth outcomes.

The research is the largest study on the effects of paternal age on adverse birth outcomes. The researchers, from the Ottawa Health Research Institute, Canada, used data from the National Center for Health Statistics for nearly all the births (99%) in the USA between 1995-2000 -- a cohort of more than 23.6 million births. From these, they looked at 2,614,966 singleton babies born live to married women without previous childbearing histories, aged between 20-29, where there was complete information on paternal age, race, maternal education, prenatal care, and gestational and birth weight.

They chose women aged between 20-29 because they were the least likely to be affected by fertility problems, some of which can have an impact on birth outcomes. Since it is already known that fathers aged between 20-29 have the lowest risk of adverse birth outcomes, the researchers used this age group (the reference group) to compare all the other age groups against.

Compared to the reference group and after adjusting for confounding factors (such as race, education, smoking and alcohol drinking during pregnancy, adequacy of prenatal care and the sex of the baby), babies born to teenage fathers (aged less than 20) were more likely to be born early (a 15% increased risk), have low birth weight (13% increased risk), be small for gestational age (17% increased risk), have a low Apgar score (13% increased risk) or to die within the first four weeks after birth (22% increased risk) or to die in the period from four weeks to one year after birth (41% increased risk), although in all cases the absolute risk of death remained less than 0.5% . Fathers aged 40 or over did not have an increased risk of these adverse birth outcomes.

One of the authors of the study, Professor Shi Wu Wen, senior scientist at the Ottawa Health Research Institute and professor at the University of Ottawa, said: "Our study indicated that being a teenage father was an independent risk factor for adverse birth outcomes, whereas advanced paternal age was not. The paternal influence of younger fathers on adverse birth outcomes clearly warrants further investigation, and may lead to a deeper understanding of the causes of such outcomes.

"Although the increased relative risks for most outcomes were small, the magnitude of the risks to society could be huge, given the number of births worldwide, if the increases we found are truly attributable to paternal age."

The study looked at babies born to fathers in seven age groups, from teenagers through to those aged 50 and over, and Prof Wen said this, together with the large size of the study and the limited age range of the mothers, meant that the findings were unlikely to be affected by chance or confounding factors. However, there was no information available on the socio-economic status and lifestyle of the fathers, and this could have an impact.

"The mechanisms by which being a teenage father may contribute to an increased risk of adverse birth outcomes are not clear," said Prof Wen. "Both biological and socio-economic status might play some roles in the observed findings."

Previous studies have shown that younger men can have lower sperm counts, semen volume, total numbers of spermatozoa and percentage of motile sperm. Immature sperm may be associated with adverse birth outcomes, possibly as a result of the abnormal formation of the placenta in the uterus (placentation).

"It is biologically plausible that paternal age might play a role in the risk of adverse birth outcomes associated with abnormal placentation," said Prof Wen.

However, there are also possible social explanations too. "Young fathers are more likely to come from economically disadvantaged families and to have lower educational attainment. Socio-economic factors such as education and occupation are known to be associated with a number of health outcomes. People from less affluent backgrounds are less likely to utilise prenatal care services, which is associated with an increased risk of adverse birth outcomes," explained Prof Wen.

Other social factors that might play a role, perhaps by adversely affecting the mother's health, include domestic violence, lack of financial or emotional support, paternal illicit drug use, smoking and alcohol drinking. "These are more prevalent in teenage fathers, and previous studies have found associations between paternal smoking and alcohol and adverse reproductive outcomes," he said.

Of the finding that older fathers were not more likely to have babies affected by adverse birth outcomes, Prof Wen said: "In our present study, we did not find an association between older fathers and the increased risk of adverse birth outcomes. We could not exclude the possibility that older fathers who married women aged 20-29 years without childbearing history might have a higher socioeconomic status than our control groups. The advantaged socioeconomic conditions might offset some biological risk of adverse birth outcomes associated with older fathers."

Prof Wen said he and his colleagues were planning a pre-conception study to look at various paternal and maternal factors that might have an effect on the health of babies, including paternal age.

*Paternal age and adverse birth outcomes: teenager or 40+, who is at risk? Human Reproduction. doi:10.1093/humrep/dem403.

Adapted from materials provided by European Society for Human Reproduction and Embryology, via EurekAlert!, a service of AAAS.

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Review Compares Latest Birth Control Options

Daily Science Journal (Jan. 25, 2008) — With many women still searching for the perfect birth control method, a systematic review analyzes a host of studies comparing the contraceptive skin patch or vaginal ring to the pill. Although perfection remains elusive and choices are equally effective, the review authors were able to pinpoint some preferences.

Women using the patch were more likely to use the medication as prescribed than those on the pill were. However, patch users experienced more side effects and were more likely to abandon their method eventually than pill users were. (Credit: iStockphoto/Tomasz Trojanowski)

“Basically, all of these methods were similar in preventing pregnancy,” said lead investigator Laureen Lopez, Ph.D., research associate at Family Health International in Research Triangle Park, N.C.

Recently, the U.S. Food and Drug Administration added warning data to the drug label for the contraceptive skin patch, advising users that the women using the patch have a greater risk of blood clots than pill users. The study prompting the FDA action was not part of the review.

For the review, the researchers looked at 11 randomized controlled trials — three comparing the patch to the pill, and eight comparing the ring to the pill — comprising more than 6,000 women.

Women using the patch were more likely to use the medication as prescribed than those on the pill were. However, patch users experienced more side effects and were more likely to abandon their method eventually than pill users were.

Ring users generally had fewer serious side effects than pill users, but had more vaginal irritation and discharge. Despite this, vaginal ring users tended to stick with their approach longer than the pill group.

The patch is a small adhesive square that dispenses hormones and which a woman must replace every week for three weeks, and then leave off for a week. The Ortho Evra contraceptive patch is the only patch approved for use to date.

The NuvaRing, which Organon manufactures, releases hormones into the vaginal cavity. A woman inserts the ring, a flexible piece of plastic tubing, where it remains for three weeks; she then removes it for one week. Many consider the ring and patch easier to use than birth control pills because women do not have to attend to them every day.

Compared with pill users, patch users had more bleeding breakthroughs, breast discomfort, painful periods, and nausea and vomiting. Rings users, on the other hand, had more vaginal irritation and discharge. Of the two, patch users tended to discontinue the method more readily.

The contraceptive review updates one done in the past, for which only two studies of the patch versus the pill were available. The ring data are new. For all methods, several studies had women drop out, which can limit the value of the results according to the researchers.

“Women who used the ring had fewer bleeding problems than those on the pill, but they did have irritation,” Lopez said. “But discontinuation was similar for the ring and the pill in most of the studies.”

Clinicians have seen the ring increase in popularity, Lopez added.

Mitchell Creinin, M.D., professor and director of gynecological specialties at the University of Pittsburgh, is familiar with all of the review studies. “It all comes back to compliance.” Creinin said. “Once a week versus once a day, twice as much hormone entering the body (with the patch), or half as much (with the ring).”

Creinin, who was not involved with the review, said it is important to understand the people who would enter these studies: “These studies were done primarily when only the pill was available. Women who were unhappy with their present method of birth control were the ones likely to enter them.” He noted that the results differ among studies between European and American women. “North American women tend to have more complaints and are less compliant,” he said.

Overall, Creinin said, women are happy with their birth control because they are not getting pregnant.

Lopez said that women have to consider many issues when choosing a method of birth control. Ease of use, side effects and life situation are each important. For a contraceptive to be effective, the woman must be willing and able to follow the prescribed regimen.

“Women are finally beginning to understand that taking a pill every day is difficult.” Creinin said. He is working on an upcoming study comparing the ring to the patch.

Reference: Lopez LM, et al. Skin patch and vaginal ring versus combined oral contraceptives for contraception (Review). Cochrane Database of Systematic Reviews 2008, Issue 1.

Adapted from materials provided by Center For The Advancement Of Health.

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Implantable Birth Control New Option For Women

Daily Science Journal (Nov. 11, 2007) — A single-rod implantable contraceptive that has been available in other countries since 1998 is now being used in the United States, including in the Cincinnati area.

Implantable birth control is injected underneath the skin of the upper arm during an in-office procedure that takes about one minute. (Image courtesy of University Of Cincinnati)

The implant is injected underneath the skin of the upper arm during an in-office procedure that takes about one minute. The implant, the size of a matchstick, releases a steady stream of the female hormone etonogestrel (Implanon) over a three-year period.

"This is a great option for women who can't take pills or don't easily tolerate other birth control options like IUDs and the patch," says University of Cincinnati (UC) fertility expert and contraceptive researcher Michael Thomas, MD.

Etonogestrel works by thickening the cervical mucus, which prevents sperm from fertilizing an egg and also stops any egg that does get fertilized from implanting itself in the uterine wall. Etonogestrel completely inhibits the release of eggs from the ovaries during the first two years. In the third year, it begins to lose its effectiveness.

"Women who use this form of birth control don't have to worry about taking a pill every day or changing their birth control ring every month," says Thomas. "It's a great long-term option."

Thomas cautions, however, that the implant is not for everyone. "Unfortunately, irregular bleeding is a side effect. Women have to be willing to tolerate this possibility. Also, women who experience heavy bleeding or are significantly overweight may want to consider other birth control options."

Thomas is a physician with UC's Center for Reproductive Health, which has expertise in infertility, menopause and endocrinological disorders. Established in 1988, it's the only comprehensive patient care and research unit focused on women's health in the Cincinnati area. To contact the center, call (513) 585-2355. To learn about birth control studies at UC, visit http://www.researchforwomen.com or call (513) 584-4100.

Thomas has no financial interest in Organon USA, the manufacturer of Implanon.

Adapted from materials provided by University Of Cincinnati.

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Kinsey Study Finds Adverse Sexual, Emotional Side Effects Of Birth Control Pills

Daily Science Journal (Oct. 25, 2007) — BLOOMINGTON, Ind. -- The birth control pill can have significant adverse effects on sexuality and mood in some women, increasing the likelihood of early discontinuation, according to a study by the Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University. Results of the study will be reported in the July issue of the journal Contraception.

Stephanie Sanders, associate director of the Kinsey Institute and an IU faculty member in gender studies, directed the study of 80 women. The research team included John Bancroft and Jennifer Bass of the Kinsey Institute and Cynthia Graham of the IU Department of Psychology.

Of the women in the study who started on the pill (randomly assigned to either orthocyclen or orthotricyclen), 38 percent were still taking it after one year, 47 percent had stopped, and 14 percent had switched to another pill. The women who stopped or changed to another pill were four times as likely to report adverse sexual, emotional and physical side effects as the women who continued with their oral contraceptive. Some of these effects included decrease in sexual thoughts, less frequent intercourse and negative mood changes.

"It is clear in our results that the women who stopped or changed to another pill had more sexual, emotional and physical side effects than the women who continued with their oral contraceptive," Sanders said.

The authors noted that, despite 40 years of use, there is no way of predicting which women are likely to experience adverse mood or sexuality effects from oral contraceptives, or which oral contraceptive formulations are more likely to be responsible.

"Studies on the male contraceptive pill, still in the developmental phase, have already included evaluation of possible effects on sexuality, but women have not had the benefit of such information in making contraceptive decisions," Sanders said.

The authors called for further research to identify predictors of such adverse effects and to understand the hormonal mechanisms responsible for such effects. In the meantime, they said, women should be fully informed, and clinicians should discuss potential effects of oral contraceptives on sexuality and mood with their patients.

Adapted from materials provided by Indiana University.

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Emergency Contraception Does Not Reduce Unintended Pregnancy Rate

Daily Science Journal (Oct. 20, 2007) — The "morning after pill" may be a good option for individual women in crisis, but advance access to emergency contraception is no antidote for the national problem of unintended pregnancy. Contrary to the fears of critics, the presence of Plan B does not provoke riskier sexual behavior.

According to a new review of studies, women who received an advance supply of birth control pills for emergency contraception had an equal chance of becoming pregnant as women who did not have early access to the pills.

The review draws conclusions from eight studies of more than 6,000 women in the United States, India and China.

Plan B is a well-known brand of emergency contraception pills, but many different types of birth control medication taken at higher doses can prevent pregnancy after sex. Treatment must begin within five days after unprotected sex -- and sooner is better when it comes to EC.

"We had expected that easier access to emergency contraception could help women use the pills more quickly when they needed them, and that in turn -- since EC is a time-relevant medication -- this could help women avoid unintended pregnancy," said lead reviewer Chelsea Polis.

"Our review is really about the effectiveness of advance provision as a strategy to reduce unintended pregnancy at a population level," Polis said. "The review is not about the effectiveness of EC; that is a separate matter."

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

In 2001, about half of pregnancies in the United States were unintended, according to the Centers for Disease Control and Prevention. Now, the United States is working to lower the unintended pregnancy rate to 30 percent by 2010. Princeton University demographer James Trussell says easier access to emergency contraception will not slow the rate of unintended pregnancy in the United States.

"For individual women, it is definitely a last chance to prevent pregnancy after unprotected sex. But it is not going to have a major population impact because people will never use it enough," he said.

The review found that emergency contraception use was higher among women given an advance supply of the birth control pills, but that increase in use did not translate to a drop in the pregnancy rate.

"Even though advance provision increased use, we don't know if women were using EC at the times when they were at risk for pregnancy, when it was really needed," Polis explains.

"If women aren't going to use Plan B when they are given it for free in a clinical trial and are counseled beforehand about using it every single time they have unprotected sex, then having to go to CVS and having to pay $45 each time -- it isn't going to happen," Trussell said.

Nonetheless, Polis said her review is not an argument against easier access to emergency contraception.

"Women deserve the chance to protect themselves from unintended pregnancy and EC is a safe, effective way to do that. Emergencies like rape, contraceptive failure and unprotected sex occur, and easier access to EC eliminates a medically unwarranted barrier to taking emergency contraception within the recommended timeframe," she said. "So steps like making EC available over the counter are still incredibly important."

When advanced access to emergency contraception was first proposed, critics worried that a medicine cabinet stocked with pills to prevent pregnancy would lead some women to be more promiscuous, have riskier sex or not use condoms.

The Cochrane review counters those concerns. "We found there was absolutely no difference in sexually transmitted infection rates between the two groups. There's absolutely no difference in terms of unprotected sex, condom use or changes in use of other contraceptive methods," Polis said. "So it appears that advance provision of EC has no harmful effects in terms of risky sexual behaviors."

Reference: Polis CB, et al. Advance provision of emergency contraception for pregnancy prevention. (Review). Cochrane Database of Systematic Reviews 2007, Issue 2.

Adapted from materials provided by Center for the Advancement of Health.

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Postpartum Treatment Key For Depression; Prenatal Efforts Ineffective

Daily Science Journal (Oct. 18, 2007) — The key to preventing postpartum depression may be individual support provided after birth by a health professional and tailored to a mother's needs, says a University of Toronto researcher.

"Health professionals want to identify pregnant women who may be at risk for postpartum depression in hopes of initiating preventive strategies," says U of T nursing professor Cindy-Lee Dennis. "But in my review of studies from around the world, I found no preventive effect of any strategy initiated before birth, including prenatal classes specifically targeting postpartum depression. It's not because the interventions are theoretically weak, but it's because compliance is low -- women are busy and don't attend the classes."

After sifting through hundreds of studies, Dennis conducted a systematic review and meta-analysis of 15 randomized control trials focusing on prevention of postpartum depression. The trials involved 7,697 women. Her study is published in the July 2 issue of the British Medical Journal.

The evidence suggests postpartum depression may be preventable, says Dennis. In analyzing the prevention strategies used, Dennis found an overall 19 per cent reduction in postpartum depression. Individual assessment and intensive support provided by a health professional to at-risk women after they give birth was the most successful approach to preventing postpartum depression; group-based strategies weren't as effective. Risk factors for postpartum depression include past psychiatric history, a significant number of life stressors and lack of support.

"Individual, flexible postpartum care provided by a health professional and based on maternal need may have a preventive effect," Dennis says. "You must have a structured assessment within the first four weeks after birth with referrals to appropriate services that are accessible."

Dennis says her findings have implications for clinicians. "This systematic review tells us what type of strategy we can use to help prevent postpartum depression, when and how we should implement the strategy and with which clients," she says. "It's a nice summary of current research that health professionals can use as a tool when seeking to treat new mothers."

Adapted from materials provided by University Of Toronto, via EurekAlert!, a service of AAAS.

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IUDs Safe And Effective In High-risk Patients, Study Finds

Daily Science Journal (Aug. 6, 2007) — Virginia Commonwealth University researchers have found that intrauterine devices are safe and effective in a population of women previously not considered as good candidates for this method of birth control.

The findings may help physicians develop improved guidelines for providing intrauterine devices (IUDs) to patients.

The IUD is the most common form of reversible birth control used by women worldwide. While IUDs offer a high level of long-term contraceptive efficacy, they have been associated with health risks, including pelvic inflammatory disease and upper genital tract infections. Women who are at high risk for both sexually transmitted infections and pregnancy have been classified as poor candidates for this method of contraception.

In a study published in the August issue of the American Journal of Obstetrics and Gynecology, researchers concluded that IUDs were acceptable and not associated with a significant increase in occurrence of gynecologic infections in women who are at high risk for both sexually transmitted infections and pregnancy.

"We once thought that IUDs could only be used in married, monogamous women because of a perceived increase in the risk of pelvic infections," said lead investigator, Catherine A. Matthews, M.D., assistant professor in the Department of Obstetrics and Gynecology at VCU.

"From our study, we now know that IUDs are safe to use in all women who don't have an acute infection of the cervix. Therefore, young, unmarried, sexually active women can now be considered good candidates for this contraceptive option, which doesn't require taking a pill, patch, or injection," she said.

The team conducted a medical chart review of approximately 200 women who had IUDs inserted between 2000 and 2005. Researchers compared the efficacy and complication rates of the Paragard IUD and Mirena intrauterine system (IUS). Both are T-shaped devices placed in the uterus to prevent pregnancy, however, the Mirena IUS releases a hormone.

According to Matthews, a third of women who received an IUD had a history of STD prior to insertion. Additionally, 32 percent of women had a history of other gynecological infections such as bacterial vaginosis, and almost half were unmarried. Matthews said that the Mirena IUS had lower rates of complications and greater acceptability than the Paragard IUD.

Matthews collaborated with VCU colleagues Samuel J. Campbell, M.D., with the Department of Obstetrics and Gynecology; and Karen L. Cropsey, PsyD., with the L. Douglas Wilder School of Government and Public Affairs.

Adapted from materials provided by Virginia Commonwealth University.

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