Gardasil Vaccine Protects Older Women.

Gardasil, the new Human Papilloma Virus vaccine approved for use in women aged 9 -26 years, in recent studies has been found to effective in women older than 27 years. It is effective up to age 45 years. I have had many of my older patients inquiring about the use of the Gardasil vaccine in older women. This is good news for those older women who are not already infected by the Human Papilloma Virus.

Raloxifene (Evista) Approved for Lowering Breast Cancer Risk in Postmenopausal Women

The FDA has approved Raloxifene to be used in two groups of women, namely those with osteoporosis and those at high risk of having breast cancer. This drug is like Tamoxifen that is currently used as prophylaxis in women with breast cancer. However, unlike Tamoxifen, Raloxifene does not cause cancer of the uterus. Both of them can cause hot flashes and clots in the veins. Unlike drugs like Fosamax or Actonel, Raloxifene does not prevent hip fractures. This is a boon to women with a history of osteoporosis in their spine and with a family history of breast cancer.

Loop Electrosurgical Procedure (LEEP) and the Risk of Premature Labor.

Abnormal Pap smear can be classified as low grade disease or high grade disease or cancer of the cervix. The treatment of the low grade disease may involve observation with Pap smears or freezing of the cervix. The high grade diseases are usually treated with removal of the affected area of the cervix by LEEP (Loop Electrosurgical Procedure). The treatment of cancer of the cervix is radical hysterectomy depending on the stage of the disease.

The benefit of the LEEP procedure in the treatment of precancerous disease of the cervix is that it removes the diseased cervix which is examined by a pathologist to determine the severity and the extent of the disease.

I had a patient who had severe dyspalsia on the cervix for which she had LEEP procedure. She got pregnant. At 13 weeks, I discussed cervical cerclage with her becasue of her short cervix. She had to see another physician because of insurance issues. The new physician refused to place the stich in the cervix. At 24 weeks she went into premature labour and had to stay off work throughout the pregnancy.

It is therefore interesting that a recent study in Danish pregnant women looking at the relationship between previous LEEP procedure and subsequent risk of preterm labor showed that women who had LEEP procedure had 2x chance of having premature labor.

If you have had LEEP procedure, you should let your obstetrician or midwife know about it. Your caregiver may measure the length of your cervix in early pregnancy with ultrasound to determine whether your cervix needs to be stitched or not. If your cervix is long enough to hold the baby, you may still have your baby early and hence you need to be followed up closely.

Reference:
Acta Obstet Gynecol Scand. 2007; 86(5):596-603

Antidepressants In Pregnancy. Are they Safe?

Depression is a common condition that afflicts women. Depressed pregnant women are at risk of preterm labor and worsening of their depression. Hence, treatment of these patients is important. That is why two recent articles that appeared in the New England Journal of Medicine about drug treatment of depression in pregnancy are important.

Previous studies implicated the selective serotonin reuptake inhibitors (SSRI's) like Paxil, Prozac and Zoloft in causing birth defects. These two new studies agree that the SSRI's have low risk of causing fetal abnormalities. Pregnant women who have depression should take comfort that they can take the SSRI's without having to worry about having abnormal babies. The abnormalities found in previous studies are rare.

Reference: New England Journal of Medicine.

Depressed Women May Have Premature Babies

A study done in England on depressed pregnant women showed the severely depressed women who were not taking medications had premature labor.

That depression produces stress hormones is exemplified by this study. Dr. O'Keane, a perinatal psychiatrist at the King's College in London measured corticotrophin releasing hormone (CRF) in 25 depressed pregnant women who were not on any antidepressant medications and 35 pregnant women who had no depression.

Levels of CRF and cortisol, hormones related to stress and also produced  by the placenta in pregnancy were found to be higher in women with depression.

While none of the mothers that were not depressed had premature deliveries, on the average, the depressed mothers had their babies 2 days earlier and 3 of them had premature deliveries.

During the follow up visit, the babies whose mothers had depression had high levels of cortisol in their saliva, a sign that their mothers' stress had effect on them..

The study involved a few patients. More studies are needed to elucidate the findings of this interesting small study. The take home message is that depressed pregnant patients' stress may have effect on their unborn babies. The effect may even continue after delivery. Hence pregnant women who are depressed should be treated with antidepressants despite the fear that some of the antidepressants may have effect on the newborn babies.

 

Reference: From issue 2599 of New Scientist magazine, 14 April 2007, page 18