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Study shows no increased risk of breast cancer for non-carriers in families with BRCA gene mutation
A population-based analysis of more than 3,000 families including women with breast cancer has found that close relatives of women who carry mutations in a BRCA gene - but who themselves do not have such genetic mutations - do not have an increased risk of developing breast cancer compared to relatives of women with breast cancer who do not have such mutations. While these results support most previous evidence regarding risks for non-carriers of BRCA mutations, they run counter to a 2007 study that indicated first-degree relatives (mothers, sisters and daughters) of women with BRCA gene mutations are several times more likely than the general population to develop breast cancer - despite not having the mutation themselves. The new findings suggest that women who test negative for the mutation may not need extra cancer screening and other increased preventive measures.
“This new study gives reassurance to non-carriers that they do not have an increased risk due to the familial mutation, and should be regarded the same as other non-carriers with first-degree relatives who have had breast cancer,” said study first author Allison Kurian, MD, assistant professor of medicine and health research and policy at Stanford University School of Medicine. “One strength of the current study is the control women it used as a yardstick for comparing the breast cancer incidence in non-carriers of family-specific mutations. The control women were also relatives of breast cancer patients, but of patients without mutations. This is a more appropriate yardstick than average risk in the general population, since close relatives of all breast cancer patients have somewhat higher than average risks.”
Women who inherit a mutation in the BRCA1 or BRCA2 gene carry a five- to 20-fold higher risk of developing breast or ovarian cancers. First-degree relatives who have not inherited the same familial BRCA mutation have been considered to have a considerably lower risk for breast cancer.
In 2007, a study of women who tested negative for a specific familial BRCA mutation showed they had a two- to five-fold increased risk of developing breast cancer; which could be considered comparable to the risk of having a BRCA mutation. According to Kurian, the results raised concerns that non-carriers might require similar screening and preventive measures as their mutation-carrying relatives, such as annual breast MRI and prophylactic surgery, and cast some doubt on the meaning of a negative BRCA test.
Kurian said that the studies had looked at women who were in cancer family clinics and compared their breast cancer risk to that of women in the general population. Women from cancer family clinics were more likely to have intensive screening, and breast
cancer risks tend to be higher among close relatives of breast cancer patients than those in the general population.
The investigators took a different approach in this research by studying women with breast cancer in 3,047 families in three population-based cancer registries in Northern California (1,214), Australia (799) and Canada (1,034) through a consortium called the Breast Cancer Family Registry. They found 292 families in which a woman had a BRCA mutation. This is the largest analysis to date of breast cancer risk of non-carriers of family-specific BRCA mutations.
They compared the risk of breast cancer among first-degree relatives of breast cancer patients who did and did not carry a BRCA mutation and found no significant difference. This means that non-carriers of a familial BRCA mutation did not have a markedly elevated risk of developing breast cancer.
The investigators also found that a small percentage of women - 3.4 percent of women in the general populations of Australia, Canada and the U.S. - who are at highest risk for unexplained reasons (reasons other than a BRCA mutation) account for approximately 32 percent of all breast cancer cases, reflecting the wide range of factors that could play a role in breast cancer development. Recent research suggests that many different genetic variants affect breast cancer risk, and that the women at highest risk have inherited many of these variants.
“Earlier reports of higher risk among non-carriers of family-specific BRCA mutations compared to risks in the general population may reflect a comparison of women with and without a family history of breast cancer,” noted senior author Alice Whittemore, PhD, professor of epidemiology and biostatistics at Stanford University School of Medicine. “The control group we used - relatives of breast cancer patients in families without a BRCA mutation - was important. The results suggest that women who test negative for their family’s BRCA mutation have no greater breast cancer risk than a woman who also has relatives with breast cancer but no family-specific mutation.”
MU studies link depression and breast cancer outcomes
This year, more than 230,000 women will be diagnosed with breast cancer and nearly 40,000 women will not survive their battle with cancer, according to the American Cancer Society. New research from the University of Missouri shows that certain factors, including marital status, having children in the home, income level and age, affect the likelihood of depression in breast cancer survivors. Further, depressed patients are less likely to adhere to medication regimens, potentially complicating the progress of their treatment.
 Ann Bettencourt, professor of psychological sciences at MU, studied who is most likely to experience distress following breast cancer diagnosis and when depressive symptoms tend to occur throughout the course of treatment. Bettencourt found evidence that single women and women with children in the home were more likely to be depressed during the year following treatment.
“Many women receive strong support following their initial diagnoses of and treatment for cancer, but then the social support can wane,” Bettencourt said. “Our findings suggest that both single women and mothers with children in the home may need additional support across the entire year following breast cancer diagnosis and treatment.”
The research also links depression levels with income and age. Women with different incomes tend to have similar levels of elevated depression during treatment, but those symptoms decrease among women with higher incomes in the year following treatment. Younger breast cancer survivors experience more depression during treatment than older patients, but report levels similar to those of older women after treatment is complete.
Bettencourt says identifying risk factors for depression among breast cancer patients is an important part of a woman’s prognosis. In a separate study, she links depression with both intentions to adhere to treatment plans and lack of adherence to medication regimens. The research shows that more depressed breast cancer survivors have less favorable attitudes toward and perceptions of treatment regimens and thus are less likely to adhere to them.
“Depression can interfere with patients’ willingness to adhere to medication regimens,” Bettencourt said. “Deviating from the prescribed course of treatment may complicate patient outcomes and threaten prognosis.”
Keeping newborn babies with a family history of MCADD safe in the first hours of life
 The National Patient Safety Agency (NPSA) has issued guidance to NHS organisations in England and Wales, aimed at ensuring medical staff working with pregnant women take action on any mention of a family history of Medium chain acyl-CoA dehydrogenase deficiency (MCADD).
MCADD disease affects about one in 10,000 babies born in the UK, and, if both parents are MCADD carriers, there is a one-in-four chance of their child being born with MCADD. In the first two to three days of life, when regular feeding is not fully established, new born babies are heavily dependent on fat metabolism for their energy needs and those with MCADD are especially vulnerable to early neonatal death.
Over a five year period, the National Reporting and Learning System (NRLS) received two reports of deaths of newborn babies from MCADD who were born to families with a history of the disease. It appeared that although the mothers had mentioned the family history to healthcare staff when they were pregnant, the staff were not aware of the significance of MCADD, and therefore did not arrange any specialist referrals, special feeding regimen or observation. Six additional ‘no harm’ incidents reported to the NRLS indicated similar omissions, fortunately without adverse effects.
This Rapid Response Report (RRR) asks GPs and NHS organisations providing obstetric, midwifery, neonatal or paediatric services and specialist centres for inherited metabolic disease to ensure that:
- Local organisations ensure midwives, general practitioners and medical staff working with pregnant women are reminded of the importance of taking an accurate family history at booking and act on any mention of a family history of MCADD by a pregnant woman in line with UKNSPC and BIMDG guidance.
- Obstetric and midwife-led services review their patient documentation to ensure there are appropriate triggers to ask new patients about family history of inherited diseases.
- Obstetric, midwife-led, neonatal and paediatric services ensure all relevant local and /or national guidance on MCADD is available to staff.
- Specialist services for inherited metabolic disorders (adult or paediatric) ensure when a baby, child, or adult is diagnosed with MCADD there are reliable systems for routinely informing the family that any future babies will need a special feeding regimen and observation in the first hours and days of life, so that family members are equipped to self-advocate. If informed about any at risk pregnancies, a notification must be sent to the relevant obstetric and neonatal units so the appropriate guidance is followed after delivery.
Suzette Woodward, Director of Patient Safety, National Patient Safety Agency, said:
“Newborn babies with MCADD are especially vulnerable in the first few days of life. Babies born to families with a history of the disease need a special feeding regimen and observation from the moment of birth.
“NHS organisations should ensure that staff working with pregnant women are reminded of the importance of taking an accurate family history and ensuring action is taken on any mention of a family history of MCADD. Adverse outcomes can be prevented by identification and simple dietary management.”
Fat cells in abdomen fuel ovarian cancer
A large pad of fat cells that extends from the stomach and covers the intestines provides nutrients that promote the spread and growth
of ovarian cancer, reports a research team based at the University of Chicago in the journal Nature Medicine, published online.
Ovarian cancer, the fifth leading cause of cancer deaths in women, tends to spread within the abdominal cavity as opposed to distant organs. In 80 percent of women, by the time ovarian cancer is diagnosed, it has spread to the pad of fat cells, called the omentum. Often, cancer growth in the omentum exceeds the growth of the original ovarian cancer.
“This fatty tissue, which is extraordinarily rich in energy-dense lipids, acts as a launching pad and energy source for the likely lethal spread of ovarian cancer,” said study author Ernst Lengyel, MD, PhD, professor of obstetrics and gynaecology at the University of Chicago. “The cells that make up the omentum contain the biological equivalent of jet fuel. They feed the cancer cells, enabling them to multiply rapidly. Gaining a better understanding of this process could help us learn how to disrupt it.”
The researchers performed a series of experiments to identify the role of these fat cells as major mediators of ovarian cancer metastasis. The first step was to understand the biological signals that attract ovarian cancer cells to the omentum and use it for rapid growth.
The spread of ovarian cancer cells to the omentum can happen quickly. Ovarian cancer cells injected into the abdomen of healthy mice find their way to the omentum within 20 minutes. The researchers found that protein signals emitted by the omentum can attract the tumor cells. Inhibitors which disturbed these signals reduced this attraction by at least 50 percent.
Once ovarian cancer cells reach the omentum, they quickly develop the tools to devour the sustenance provided by this fatty tissue, reprogramming their metabolism to thrive on lipids acquired from fat cells. Ovarian cancer can rapidly convert the entire omentum, a soft fat pad, into a solid mass of cancer cells.
“This mechanism may not be limited to ovarian cancer cells,” the authors note. Fat metabolism may also contribute to cancer development in other environments where fat cells are abundant, such as breast cancer.
A protein known as fatty acid binding protein (FABP4), a fat carrier, may be crucial to this process and could be a target for treatment.
When the researchers compared primary ovarian cancer tissue with ovarian cancer tissue which had spread to the omentum, they found that tumor cells next to omental fat cells produced high levels of FABP4. Cancer cells distant from the fat cells did not produce FABP4.
When they inhibited FABP4, the transfer of nutrients from fat cells to cancer cells was drastically reduced. Inhibition of FABP4 also reduced tumor growth and the ability of tumors to generate new blood vessels.
“Therefore,” the authors wrote, “FABP4 emerges as an excellent target in the treatment of intra-abdominally disseminating tumors, which preferentially metastasise to adipose tissue such as ovarian, gastric, and colon cancers.”
The role of fat in assessing breast cancer risk
It is known that a high proportion of dense breast tissue, as seen with a mammogram, is associated with a high risk of breast cancer. But the role of non-dense fat tissue in the breast is less clear. New research published in BioMed Central’s open access journal Breast Cancer Research separates the breast cancer risks associated with dense, fibroglandular tissue, and fat, and shows that large areas of either are independently associated with an increased risk.
The mammograms of postmenopausal women with breast cancer were compared to controls without cancer. The study used sophisticated computer software to read the films to reduce reader error (or intuition). The software simply compared dense versus non-dense tissue and was not looking for specific irregularities.
Not surprisingly older women and women with a higher BMI have a higher percentage of non-dense tissue. The women with breast cancer tended to have a larger area of dense tissue and a larger area of non-dense tissue so that the biggest risk was for women with the largest areas of both. However this is not necessarily reflected in breast size because the risk associated with fat, though significant, is lower than the risk associated with fibroglandular tissue. Consequently women with a smaller amount of dense tissue have a lower risk than those with more dense tissue for the same breast size.
Dr Carla van Gils, from the University Medical Centre Utrecht, who lead the research explained: “Fat tissue is known to produce the hormones such as oestrogen which are known to promote the growth of ER positive cancer. However it seems that it is the local fat tissue which is important to breast cancer risk at not just general body fat (as measured using BMI). Consequently it may be important to consider both types of tissue when assessing breast cancer risk.”
Wellbeing Institute to be launched in Leeds
A centre that will tackle the issues of health and wellbeing is to be launched at Leeds Metropolitan University. The Institute for Health & Wellbeing will undertake research into the health status of individuals and communities and will investigate issues including men’s health, healthy communities, health promotion and nutrition and childhood obesity.
Speaking ahead of the launch, Institute Director Professor Richard Hogston said: “One of our key strengths is that our research is rooted in finding solutions that will have real impact on communities and businesses. Creating the Institute will bring together a range of related disciplines and make it easier for us all to work together, generate and apply our research to even higher levels of excellence.”
The Institute for Health and Wellbeing will house a related range of disciplines within a single unit allowing innovation and collaboration to thrive. The University’s research foundations and strengths are rooted in the practical implications of research (‘the doing’) and the impact the research has on communities which will be nurtured through the work of the institute.
The Institute has six distinct yet related research themes: Healthy communities, Health promotion, Men’s health, Men, gender and wellbeing, Nutrition & childhood obesity, Pain science and management.
Its key benefits will include:
- A greater focus on research and enterprise, reflecting the University’s strategic plan “Quality, Relevance and Sustainability”
- The broad definition of “Health and Wellbeing” means the Institute will bring together a wide range of relevant research without being constrained by traditional boundaries
- The creation of a critical mass across a related range of disciplines through which innovation and collaboration can thrive
- Reflecting the latest directions and priorities in funding, including key Government policy priorities (including workplace health and wellbeing)
- Presenting a cohesive portal to the external environment, making it easier for the research funding community, partners and clients to engage with our experienced researchers
Creating the Institute will build on the existing, high profile research work which the University delivers. Most recently, academics in the Centre for Men’s Health at Leeds Metropolitan University have just completed a report which put the spotlight on the health of men right across Europe.
The report, led by Leeds Met’s Professor of Men’s Health Alan White, set out to inform policy makers, health professionals, academics and the wider population of the health challenges men face across Europe. The report highlights the state of men’s health in Europe as a serious public health concern.
Patterns emerging from data taken from 34 European countries show marked differences in health outcomes amongst men both between and within countries. Poor lifestyles and preventable risk factors account for a high share of premature death and illness in men, illustrating that their health disadvantage is not necessarily written in the genes but can be remedied in part by targeted policies and actions.
Poor sleep quality in first, third trimesters linked to preterm births
A study published in the November issue of the journal Sleep shows a significant risk for preterm birth in women reporting sleep disruptions during their first and third trimesters. The connection remained even after medical risk factors and income levels were taken into account.
 “This supports the growing evidence that poor sleep is an important risk factor for preterm birth,” said Michele Okun, PhD, assistant professor of psychiatry and psychology at the University of Pittsburgh School of Medicine.
“It likely occurs in the presence of other risk factors, but sleep can be measured easily and quickly during prenatal visits.
Simply by assessing a woman’s sleep quality, we may be able to identify a risk early in the pregnancy, when there is time to intervene. The data suggest that beneficial outcomes may be possible through modifications in behaviour.” Okun said.
Sleep quality in the second trimester did not correlate with increased risk. Okun said sleep often improves modestly during this part of pregnancy, although it is unclear why. One explanation might be hormones or other biological pathways playing a role, but there is no data.
Similarly, Okun and her co-authors suggest a biological cause for the increase in preterm births with disrupted sleep. Poor sleep quality has been shown to initiate inflammation, possibly activating the processes associated with childbirth prematurely. Sleep disruption also might do this in combination with stress, a known activator of inflammation.
Okun said more research is needed, but the early results are encouraging – and important.
“The need to reduce adverse pregnancy outcomes remains high,” she said. “Despite our advanced society and medical knowledge, we still find a growing number of women having a preterm baby or other adverse outcome.”
Most women with lupus can have successful pregnancy outcomes
Promising research led by investigators at Hospital for Special Surgery may offer hope for women with lupus who once thought that pregnancy was too risky.
Results from the multicenter National Institutes of Health (NIH) funded PROMISSE initiative, presented on November 7 and then during a press conference on November 8, during the American College of Rheumatology’s 2011 Annual Scientific Meeting in Chicago, show that most women with stable lupus can have successful pregnancies.
“There was a misconception, based on outdated experience, that women with lupus should not try to have children,” said Jane Salmon, M.D., the study’s senior author and Collette Kean Research Chair at Hospital for Special Surgery in New York City. “Now that our treatments are more effective and we have a better understanding of the disease, we can identify a window when pregnancy is safe and outcomes are good for mother and fetus.”
Historically, women with systemic lupus erythematosus (also know as SLE or lupus) have been advised not to become pregnant because of risks to their own and their fetus’ health. SLE is a chronic inflammatory disease, in which the body’s own immune system attacks tissues of the body and can cause complications during pregnancy.
Drs. Salmon, together with Jill Buyon from New York University Medical Center, and their collaborators evaluated 333 pregnant women with lupus from the PROMISSE Study (Predictors of pRegnancy Outcome: BioMarkers In antiphospholipid antibody Syndrome and Systemic Lupus Erythematosus), which seeks to identify biomarkers that predict poor pregnancy outcomes. The research team found that 80 percent of lupus patients had a favourable pregnancy outcome.
Patients with lupus may be free of symptoms for long periods of time and then experience a disease “flare,” when symptoms such as rash, joint pain, chest pain, swollen legs, bruising and/or fatigue suddenly appear.
“Most women with stable lupus, defined as limited disease activity and no flares during the time of conception and the first trimester, had successful pregnancies,” explained
Dr. Salmon, who is also the principal investigator of the PROMISSE Study. “We learn from these results that timing is a most important element for successful pregnancy in women with lupus and that avoiding pregnancy during periods of increased disease activity is essential.”
In the study, two categories of pregnancy complications were evaluated: the health of the mother and of the fetus. The research team studied development of mild, moderate, or severe increases of lupus activity, or flares, in expectant mothers. For the fetus, the study examined the worst outcome – death – or situations in which the well being of the child would require extended hospitalisation in a critical care unit.
Of the 333 women with lupus studied, 63 had poor outcomes. Ten percent of mothers experienced preeclampsia, a serious complication characterised by the onset of high blood pressure and appearance of protein in the urine. Ten percent experienced mild or moderate flares at 20 weeks and eight percent experienced flares at 32 weeks. Nineteen women experienced death of the fetus and 30 women delivered before 36 weeks or had newborns of small gestational size – smaller in size than normal for the baby’s sex and gestational age, commonly defined as a weight below the 10th percentile for gestational age.
None of the women in the study was pregnant with more than one fetus, took more than 20 mg/d of prednisone, or had abnormally high excretion of protein or impaired kidney function. The women who experienced complications had more active lupus at 20 and 32 weeks and higher levels of antiphospholipid antibodies.
The PROMISSE study was funded by the National Institute of Arthritis, Musculoskeletal and Skin Diseases of the National Institutes of Health in 2003 to identify biomarkers that would predict poor pregnancy outcomes in lupus patients. To date, the PROMISSE investigative team has enrolled 647 volunteers who are monitored with monthly checkups and research laboratory studies looking at genes and circulating proteins that may predict the course of pregnancy. PROMISSE will continue through 2013 with $12.3 million in support over ten years from NIAMS and the office of Research in Women’s Health. Dr. Salmon and co-investigators from 11 academic centers will continue to examine a broad range of genes and molecular pathways that can affect pregnancy in women with lupus, and, it is anticipated that their findings will have applications for the prevention of miscarriage and preeclampsia in healthy women.
Statement regarding Dutch study into IVF and ovarian cancer
A study in Holland has found that women who have ovarian stimulation in IVF have an increased risk of developing borderline ovarian cancer later in life when compared sub-fertile women not receiving IVF.
However, it is important that this increased risk is kept in perspective, as the overall risk still remains extremely small. The cumulative life time risk for borderline ovarian cancer up to the age of 55 was just under five in 1000 in the general population compared with seven in 1000 undergoing IVF.
The researchers admit further study is needed, and indeed the HFEA has recently approved a much larger study looking at whether women in the UK undergoing IVF have an increased risk of reproductive cancers, including ovarian cancer.
In order to make sure patients understand the risks of ART we keep research of this kind under review and where it suggests there may be a greater risk we share this information with patients in a clear way to help them understand the risks associated with the choices they are making.
Revised guidelines on women seeking induced abortion published
The Royal College of Obstetricians and Gynaecologists (RCOG) has published its revised guidelines on the care of women requesting induced abortion.
 The RCOG state that abortion and contraception are an integral part of comprehensive sexual and reproductive health services.
The clinical guidelines are for all healthcare professionals and aim to ensure that all women considering induced abortion have access to a high quality service based on national standards.
The recommendations cover commissioning and organising services, possible side effects and complications, pre-abortion management, abortion procedures and follow up care.
In addition there are a number of new and improved recommendations. These include:
- Services should identify issues which make women particularly vulnerable, for example child protection needs and domestic abuse, and refer them on to appropriate support services in a timely manner.
- Services should provide women with information about the physical symptoms and sequelae that may be experienced after abortion such as pain and bleeding and gastrointestinal symptoms.
- Service providers should inform women about the range of emotional responses that may be experienced during and following an abortion.
- Providers should be aware that women with a past history of mental health problems are at increased risk of further problems after an unintended pregnancy.
- During pre-abortion assessment women should be offered screening for STIs and there should be a system for partner notification and referral to a sexual health service.
- All appropriate methods of contraception should be discussed with women at the initial assessment and a plan agreed for contraception after the abortion.
- Women should have access to counselling and decision-making support, however, women who are certain of their decision should not be subjected to compulsory counselling.
- A 24-hour telephone helpline number should be available for women to use after abortion if they have any concerns.
Latest figures show rise in number of IVF treatments
New figures released by the HFEA show that the number of IVF treatments continues to rise. They also show that the overall pregnancy and live birth rates have remained steady at a time of notable changes to clinical practice. At the same time, the overall multiple pregnancy and multiple birth rates have fallen.
These figures are contained in a new annual report from the HFEA, bringing together in an accessible way, key statistics on fertility trends in the UK.
Professor Lisa Jardine, Chair of the HFEA, said:
“The Register of all licensed treatments and outcomes for assisted reproduction held by the HFEA puts us in an unrivalled position to inform people about the performance of the fertility sector. We are now committed to publishing regular analytical reports, twice a year, one in the spring and one in the autumn. This autumn report describes general trends and figures about fertility treatments based on the latest clinic data we hold, data for 2010 and in some cases 2009.”
Key figures include:
- In 2010, 45,264 women received a total of 57,652 IVF or ICSI treatments, an increase of 5.9% on the number of cycles in 2009.
- A total of 12,386 pregnancies were reported as a result of fresh IVF or ICSI treatment which started in 2009 whilst 13,015 pregnancies followed treatment started in 2010. This translates to a pregnancy rate (per embryo transfer) of one third (33.4%) – a figure which remained constant over both years.
- The majority of women who received IVF treatment in 2010 were aged 37 years or under, with that age group making up almost two thirds of all those treated. The average age of women undergoing IVF treatment was 35.
- London has the largest number of licensed fertility clinics in the UK, with 15 clinics treating nearly 14,000 women in 2010.
- Following the trend for increasing IVF in general, the number of women receiving treatment with donated eggs and sperm each year has risen between 2009 and 2010.
- The number of donor insemination cycles rose very slightly in the last year, with 3,878 cycles in 2010 compared with 3,847 in 2009 (an increase of 0.8%). The live birth rate for DI cycles was 11%.
- Meanwhile, 2010 saw an increase in the number of women receiving IVF treatment with donor eggs or sperm. In 2009 there were 1,615 cycles of IVF treatment with donated sperm resulting in 585 babies being born; in 2010, this had increased to 1,963 cycles (a 21.5% increase). In 2009, there were 1,254 cycles of IVF with donated eggs, resulting in 550 babies being born; in 2010, this had increased to 1,320 cycles (a 5.3% increase).
- There has also been good progress made in the last year in reducing multiple births following IVF, particularly in the youngest age group. In 2009, just under a quarter (24.9%) of live births in those aged 18 – 34 years were multiple ones. This compares with 29.4% in 2008.
- Only a minority of IVF treatment cycles in 2010 were funded by the NHS, with 40% being funded by them and 60% being funded by the patients themselves.
This compares with 62% being privately funded in 2009.
Infertility Network UK welcomes HFEA decision to increase payments to egg and sperm donors
Infertility Network UK (I N UK) released a statement endorsing the HFEA’s decision to pay more to sperm and egg donors in the UK to help increase the number of people donating to fertility clinics. They said:
‘There is no doubt that there is a shortage of both egg and sperm donors in the UK and there has been much debate about the reasons, I N UK therefore welcomed the HFEA Donation Consultation.
I N UK works tirelessly to raise awareness of infertility and the issues surrounding it including the need for donation and the shortage of donors. As the UK’s national charity for those affected by fertility problems, we daily encounter the added pain and distress caused to patients when they are unable to access the treatments they need, in this case either egg donation or donor insemination.
Clare Lewis-Jones, Chief Executive of I N UK said: “We hope that today’s announcement to increase the payment to donors will help encourage more people to become donors. The balance between coercing people to donate by offering large sums of money, and paying enough to ensure donors are compensated for their expenses and the wonderful gift they are giving is a fine one.
“We do not believe this is the sole solution to recruiting donors throughout the UK and recognise the need to continually raise awareness amongst the general public of the need for egg and sperm donors and how they can help.”’
HFEA agrees new policies to improve sperm and egg donation services
The Human Fertilisation and Embryology Authority (HFEA) has made a number of important decisions on sperm and egg donation in the UK. This follows an extensive public consultation, ‘Donating sperm and eggs: have your say’, which ran from January to April 2011.
The Authority has agreed to take a proactive approach to donor recruitment, retention and care by working with the IVF sector, professional bodies and voluntary organisations to raise awareness, improve the care of donors and ensure that donation continues to take place within a safe and ethical environment.
Addressing concerns about treating donors fairly and valuing their contribution, as well as the need to retain donors and keep paperwork to a minimum, the Authority has also agreed to change the compensation that donors can receive. Moving away from the current system of out of pocket expenses and a loss of earnings allowance capped at £250, clinics will in the future be able to offer donors compensation which better reflects their expenses.
The new scheme will include:
- For sperm donors, a fixed sum of £35 per visit including expenses
- For egg donors, a fixed sum of £750 per cycle of donation including expenses
Professor Lisa Jardine, Chair of the HFEA, said:
‘In looking at donation we have focused on what it means to people – to those born of assisted reproduction, to donors, to patients wanting desperately to have a baby and to the public in general.
We are convinced that it is right to look at compensation not in terms of crude sums but in terms of the value of donation.’
‘My Authority has set a level of compensation which will not deter those interested in donation but will retain donors already in the system, without attracting those who are merely financially motivated.’
‘We have consulted widely and listened carefully to what we were told by the large number of patients, donors, donor-conceived people and clinics who responded to our consultation. My Authority has been careful to balance the interests of all involved in the donation process. We know that any one change that we make to our policies is unlikely completely to solve current problems in the donation system. That’s why we have decided to capitalise on our unique position by actively helping the sector to attract and retain donors, use their donations to their full and ensure that donors are well cared for and valued.’
Benefits in kind
The HFEA also considered benefits in kind in which people are allowed to receive treatment services in return for donation of their sperm or eggs to treatment or research, commonly known as egg sharing.
Current guidance focuses almost exclusively on egg sharing arrangements in exchange for IVF, yet treatment services which can be offered are broader than this, including storage and moving up the waiting list.
The HFEA has decided that this should be allowed to continue, but that current guidance should be reviewed with a view to making it clear to clinics what benefits might be included.
Wirral signs ground-breaking contract with pioneering maternity service
Mothers-to-be in Wirral are the first in the UK to be able to have their babies delivered by a pioneering maternity service.
One to One (North West) has signed a contract with NHS Wirral Primary Care Trust which enables expectant mothers to choose to use its service which is based around having one midwife throughout pregnancy ensuring continuity of care.
And the first mothers choosing to use One to One have already had their babies successfully delivered with the majority so far opting for home births.
Mothers-to-be choosing to use One to One will be guaranteed this unique personal service from the moment they make contact until six weeks after the birth of their baby.
Joanne Parkington, founder and clinical director of One to One, said the contract signing was probably the “biggest thing to happen in midwifery” since The Midwives Act 1902 which established the state regulation of midwives.
The company now plans to develop similar relationships with other PCTs across the North West and England and Wales as a whole.
The ground-breaking contract – initially for three years - followed a successful pilot scheme with NHS Wirral PCT in which more than 200 mothers-to-be were able to use One to One for all aspects of their pregnancy other than the actual birth.
However, with the backing of the Department of Health, the company has secured the insurance it requires to now be able to provide expectant mothers with the complete service including delivery.
Joanne Parkington said: “We are thrilled that Wirral PCT has chosen to award One to One the contract to deliver our maternity care service to mothers-to-be in Wirral.
“The pilot and now the full contract are quite simply the first of their kind in England and Wales. We believe they are the biggest thing to happen in midwifery since The Midwives Act more than 100 years ago.
“One to One aims to reinvent free midwifery services by delivering a personalised service that places women and their families at the heart of their care.
“Continuity of carer has been shown to increase the normal birth rate, reduce hospital admissions and associated interventions, improve breast-feeding rates and boost women’s satisfaction with the whole maternity service.
“For the first time, the NHS is able to give women choice in their maternity care. It will also relieve the pressure on the existing NHS system and introduce a specialised service for teenagers and the most vulnerable.”
The contract signing comes just days after the annual conference of the Royal College of Midwives was told by its chief executive Cathy Warwick that “there is a growing disparity between the increasing demands that are made on midwives and the dwindling resources that they have at their disposal.”
She added: “The reality in England is that the midwifery shortage is becoming a crisis.”
The One to One service is being delivered by a team of experienced midwives. Every woman is introduced to her named midwife following her first contact with the service.
The aim is for all women to receive an initial risk assessment and booking by 10 weeks of pregnancy and follow up care is then provided on an individual needs assessed basis.
Among the most exciting aspects of One to One’s care is the encouragement women are given to consider a home birth if this is something they would prefer to a hospital birth subject to their circumstances and needs.
Clinics are available evenings and weekends to promote access and to be responsive to the needs of women and to improve partner involvement. There will also be “drop-in” clinics.
FPA reacts to introduction of new vaccine that protects against genital warts
Reacting to the Department of Health (DoH) announcement that they are expanding the HPV vaccination programme in schools to protect young women against genital warts as well as cervical cancer, Rebecca Findlay spokesperson for FPA said:
“We are delighted with this announcement. It’s a responsible decision which will result in a radical improvement of an entire generations’ sexual health from a very common sexually transmitted infection. FPA have been campaigning and lobbying government for a different vaccination since the original immunisation programme started, so we are pleased this has been successful.”
High blood pressure and pregnancy: Short and long-term consequences
Two studies from the Mayo Clinic presented during the American Society of Nephrology’s Annual Kidney Week provide new information related to high blood pressure during pregnancy.
In one study, Vesna Garovic, MD and her team examined the potential of a test done mid-pregnancy to predict which women will later develop preeclampsia, a late-pregnancy disorder that is characterised by high blood pressure and excess protein in the urine and that affects 3% to 5% of pregnancies. Left untreated, preeclampsia can lead to serious - even fatal - complications for a pregnant woman and her baby.
Among a group of 315 patients, 15 developed preeclampsia and 15 developed high blood pressure (but not preeclampsia) during pregnancy. All of the patients who developed preeclampsia tested positive in mid-pregnancy for a test that detects the shedding of certain kidney cells called podocytes in the urine. None of those with only high blood pressure tested positive, and none of 44 women with normal pregnancies tested positive. Therefore, this test is highly accurate for predicting preeclampsia, which could alert clinicians to take steps to safeguard against the condition.
In another study, Dr. Garovic’s team looked at the long-term health effects of high blood pressure during pregnancy. They identified female residents of Rochester, Minnesota and the surrounding townships in Olmsted County who delivered between 1976 and 1982. The investigators divided the women into two groups -- those with high blood pressure during pregnancy and those without -- and followed them after they reached 40 years of age to monitor their heart and kidney health.
A total of 6,051 mothers delivered between 1976 and 1982, and 607 women had high blood pressure at the time while 5,444 did not. After the women reached age 40, women who had high blood pressure during pregnancy were much more likely to experience high blood pressure, kidney disease, and strokes than women who did not have high blood pressure during pregnancy (51% vs 31%, 14% vs 10%, and 8% vs 4%, respectively).
“Studies of the associations of hypertensive pregnancy disorders with maternal risks for future cardiovascular disease could lead to new guidelines for screening and treatment of women at risk, with the ultimate goal of improving cardiovascular health in women.” said Dr. Garovic.
Depressive symptoms and intimate partner violence in the 12 months after childbirth
Forty percent of women who report depressive symptoms following birth also re-ported intimate partner violence finds a new study published in BJOG: An International Journal of Obstetrics and Gynaecology.
The study also found that most of the women reporting postnatal depressive symptoms first reported this at six months after birth or later.
Intimate partner violence (both physical and emotional abuse) in the perinatal period is associated with a range of physical and psychological health problems including adverse pregnancy and birth outcomes, postnatal depression, and future behavioural problems for children.
This Australian study looked at 1305 nulliparous women. They were recruited from six public hospitals between six and 24 weeks of gestation. Written questionnaires were completed at recruitment and at three, six and 12 months postpartum.
Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and intimate partner violence was assessed using the short version of the Composite Abuse Scale.
Information on depressive symptoms was collected at multiple time points, while data on intimate partner violence was only collected at the 12 month follow-up.
The study found that one in six women reported intimate partner violence in the year after having their first baby. Emotional violence was more common than physical violence (14% versus 8%).
Sixteen percent of women reported depressive symptoms in the 12 months postpartum, with most women first reporting depressive symptoms in the second six months after birth. Factors associated with postpartum depressive symptoms include: emotional abuse alone, physical abuse, depression in pregnancy and unemployment in early pregnancy.
The significant associations between intimate partner violence and depressive symptoms over the course of the first postpartum year persisted after adjusting for the known confounders of prior depression and relevant socio-demographic characteristics (maternal age, relationship status, and employment status in early pregnancy).
Dr Hannah Woolhouse of the Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute in Victoria, Australia and co-author of the paper said:
“Depression after childbirth has received a lot of attention in recent decades. Known risk factors for developing postnatal depression include a history of depression, poor partner relationships, stressful life events/social health issues, low social support, and low income. Our findings indicate that intimate partner violence is very common among women reporting postnatal depressive symptoms, and may be an important factor for health professionals to consider in managing postnatal distress.
“In both the UK and Australia, universal screening for depressive symptoms in the first few months after childbirth is now recommended as part of routine perinatal care. However we found that most of the women reporting postnatal depressive symptoms first reported this at six months postpartum or later.
“This finding has major implications for clinical practice as many women who develop depression after six months will be missed. Health professionals should regularly enquire about a woman’s mental health in the 12 months after birth, rather than at one specific time point.”
Professor Philip Steer, Editor of BJOG added: “This study shows that pregnancy and the postnatal period is a good time to identify and support women who experience both depression and partner violence.”
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