Maternal Fish Consumption in Pregnancy Provides “Brain Food” For Baby’s Brain

"Seafood is the main food source of omega-3 fatty acids, which are essential for optimum neural development. However, in 2004, the FDA and the Environmental Protection Agency advised women who were pregnant or might become pregnant to limit seafood intake during pregnancy to 340 g per week (less than three portions) to avoid exposure to trace amounts of neurotoxins, especially methylmercury"

Judith Groch

Many of my patients are afraid of eating fish because of the fear that they will ingest too much mercury to affect the developing baby's brain. This deprives them of the Omega 3 Acid that is good for the development of the baby's brain. It is therefore very encouraging that a recent Lancet article summarized in Medpage Today, showed evidence to the contrary. According to many pregnant women, this is serious enough for them not to eat fish in pregnancy.

"A U.S. survey showed that two-thirds of Americans believe that 1,000 to 100,000 U.S. children are poisoned by mercury from eating fish every year. In fact, Drs. Myers and Davidson said that there has never been even one child with prenatal mercury poisoning from consuming fish documented outside Japan." Judith Groch

Joseph Hibbeln, MD of the National Institute of Alcoholic Abuse and Alcoholism and colleagues, showed that:

"After adjustment, maternal seafood intake during pregnancy of less than 340 g per week was associated with an increased risk at age eight years of the child being in the lowest quartile for verbal IQ (no seafood consumption, odds ratio [OR] 1.48, 95% CI 1.16-1.90; some seafood, 1.09, CI 0.92-1.29; overall trend, P=0.004), compared with mothers who consumed more than 340 g per week. At seven years, low maternal seafood intake was also associated with an increased risk of suboptimum outcomes for prosocial behavior 1.44 (CI 1.05-1.97) for no seafood consumption versus more than 340 g/week. Overall, the investigators said, the higher the maternal seafood intake, the less likely the infant was to have a poor score. At ages up to 3.5 years, scores were also lower for fine-motor skills, communication, and social development, they reported. Maternal seafood consumption reached a mean of 235 g a week, resulting in estimated weekly intakes of zero to 15.6 g, and a mean intake of 1.06 g of omega-3 fatty acids a week. " Judith Groch

Hence it is important that pregnant women know that fish, the major source of Omega 3 Acid is important for the development of the baby's brain. The benefits far outweigh the risks of Mercury poisoning from seafood. A risk largely attributed to fatty fish.

"Additional source: The Lancet

Source reference:

Hibbeln, JR, et al "Maternal seafood consumption in pregnancy and neurodevelopmental outcome in childhood (ALSPAC study): an observational cohort study" Lancet 2007; 369: 578-585. "



"Additional source: The Lancet

Source reference:

Myers, GJ, Davidson PW "Maternal fish consumption benefits children's development" Lancet 2007; 369: 537-539."

Cancer Of The Ovary-Screening Test for Women Is In The Horizon

Ovarian cancer is one of the most difficult cancers to diagnose in its early stages. It does not have any specific symptoms and most patients are diagnosed in the advanced stages when the results of treatment are poor. On the other hand when they are diagnosed in its early stage the five year survival rate is about 90% as compared to 20% in the late stage.

Up till now there have not been any significant screening tests such as Pap smear to screen for cervical cancer. According to Alisa Leisa, MD of Yale University, a highly sensitive blood test comprising of six biological markers can be used to detect the disease in its early stages. The positive predictive value is 93% in the test population and a negative predictive value of 99.2%. Yale University is currently enrolling women at high risk of ovarian cancer and healthy controls.

Is Testosterone Too Much of a Good Thing for Women’s Health?

I see many women in my office complaining of decreased libido. Most of these women are in the middle age with its change in hormones and life's uncertainties. In our world we are used to taking medications for anything that bothers us. Many life changes can decrease women's desire for sex. However, tell the modern woman that her stress from the fear of loosing her job is causing her decreased libido and she will seek another physician who would be prepared to slap the testosterone patch on her without much protest. A recent article in the Star Tribune shows that testosterone is not a panacea for women suffering from decreased libido.

Genital Herpes in Pregnancy-A Health Hazard for the Baby

Question:

I got married a week ago and I have missed my period. I saw my doctor who did a pregnancy test and pelvic ultrasound and told me I was 6 weeks pregnant. Two weeks ago I started having painful urination and multiple blisters on my vulva. My doctor diagnosed me with genital herpes and started me on medications. I have finished the treatment but I am supposed to take the medication throughout the pregnancy. Is my baby going to be alright?

Answer:

Genital Herpes is a common sexually transmitted disease which is under diagnosed because sometimes patients with the disease don’t have any symptoms. In your case, your doctor did the right thing by treating you and giving you medication to prevent recurrent infections during your pregnancy and after delivery. Your husband has to have blood test to ensure that he does not have the disease. If he has it he should also be treated as he may have outbreaks and transmit the disease to you again. I will suggest that even if his test is negative you should use condoms for sexual intercourse.

The effect of the infection on the new born baby is severe. About 80% of the babies may be infected by the virus at birth if untreated. Hence if you are found to have the disease at the time of your delivery, you would be delivered by cesarean section to prevent the baby from being infected by the virus. Other prevention measures include giving you prophylactic antiviral medications to suppress the infection during the pregnancy. Three medications are available for treatment. Valacyclovir and Famciclovir would be more convenient as prophylaxis than Acyclovir because of convenience in their dosing.

Since many people with genital herpes don’t know they have the disease, it will seem to be reasonable to screen all pregnant women for genital herpes with blood test. This way, if their test is positive, they would receive prophylactic medication to prevent possible herpes infection in the pregnancy and the postpartum period.

Your Pelvic Pain May not be Endometriosis

Question:

I am a thirty year old woman with 2 children. Over the past few years I have been battling pelvic pain with no help in sight. My gynecologist did a laparoscopy on me and found no endometriosis.

My symptoms include painful intercourse both at the entrance and deeper part of my vagina. I wake up at night many times to go to the bathroom. My doctor has treated me with antibiotics on many occasions for bladder infections without improvement. I have been scheduled to have hysterectomy with removal of my ovaries. What should I do?

Answer:
Your condition is not unique. I recently saw a 21 year old woman who has had hysterectomy with removal of her ovaries because of pelvic pain presumed to be pelvic endometriosis. I often see women in my practice who have been variously treated for pelvic pain without relief.

They tend to have pain with sexual intercourse, frequency of urination during the day and at night. They may have associated pain at the entrance of the vagina. Many would have been treated for pelvic endometriosis, diverticulitis or recurrent urinary tract infections without improvement of their condition. Usually these patients have Chronic Interstitial Cystitis. The pain may flare up during menstrual periods and mimic pelvic endometriosis.

We don't know the cause of the disease though some theories of its causation exist. It can affect men but it is more common in women with devastating consequences since it affects sexual activity and sometimes prevents the patients from working. Most patients I see at the office have been variously treated for pelvic endometriosis, recurrent urinary tract infections, pelvic inflammatory disease and diverticulitis.

My approach to diagnosis is to ask the patient about frequent urination, pelvic pain and painful intercourse. I then examine them specifically looking for tenderness at the entrance of the vagina and the bladder, backed by the Interstitial cystitis questionnaire (PUF). I obtain urine for culture and cytology to exclude bladder infection and cancer. I do not do the potassium sensitivity test which can be painful in the office setting. If the urine tests are negative, I treat the patient with 3 medications.

• The first is Elavil (Amitryptiline) that blocks the nerve endings and treat pain.
  
• Atarax (Hydroxyzine) that prevents allergies in the bladder.
  
• Elmiron that coats the bladder to treat the condition.
  

The last counseling I give to the patient is to draw their attention to certain foods that can cause allergies in the bladder and aggravate their condition. Most patients do well if they take their medications and avoid foods that can aggravate the bladder.