FACSaware aims to raising global awareness of Fetal Anti Convulsant Syndromes and other teratogen-related issues
FACSaware aims to raising global awareness of Fetal Anti Convulsant Syndromes and other Teratogen related syndromes. The Fetal AntiConvulsant Trust (F.A.C.T.) was set up in 2011 to campaign for responsibility from the government and drug company.
Watch the video from the UK Parlement Private Members Debate Fetal anti-convulsant syndrome with Anas Sarwar
The majority of DES-exposed women do not perform monthly breast-self examinations
DES Follow-up Study Summary
The purpose of this paper was to determine if women exposed in utero to Diethylstilbestrol (DES) are more likely than unexposed women to receive recommended or additional breast cancer screening examinations.
Data from the study cohort were used to assess the degree of recommended compliance of breast cancer screenings was found in 3,140 DES exposed and 826 unexposed women. Participants were enrolled at four sites: Houston, Boston, Rochester, and Los Angeles. The data from the mailed questionnaires that included the reported frequency from 1990 through 1994 of breast-self examinations (BSEs), clinical breast examinations (CBEs), and mammograms was analyzed.
The results showed that the DES-exposed women exceeded annual recommendations for CBEs among women without a history of benign breast disease compared with unexposed women. There were no other statistically significant differences between exposed and unexposed women who reported performing BSEs, CBEs (less than 40 years of age), and mammographies, regardless of benign breast disease history.
Although this study showed that the majority of DES-exposed women receive breast cancer screenings at least at recommended intervals, it also showed that over two thirds do not perform monthly BSEs. It is recommended that Future efforts should be focused on further educating this and other at-risk populations through mailed reminders and during patient consultations on the benefits of screening examinations.
2009 Study Abstract
To determine if women exposed in utero to diethylstilbestrol (DES) are more likely than unexposed women to receive recommended or additional breast cancer screening examinations.
1994 Diethylstilbestrol-Adenosis (DESAD) cohort data are used to assess the degree of recommended compliance of breast cancer screenings found in 3140 DES-exposed and 826 unexposed women. Participants were enrolled at four sites: Houston, Boston, Rochester, and Los Angeles. Logistic regression modeling was used to analyze mailed questionnaire data that included reported frequency over the preceding 5 years (1990-1994) of breast-self examinations (BSEs), clinical breast examinations (CBEs), and mammograms.
DES-exposed women exceeded annual recommendations for CBEs (aOR 2.20, 95% CI, 1.04-4.67) among women without a history of benign breast disease (BBD) compared with unexposed women. There were no other statistically significant differences between exposed and unexposed women who reported performing BSEs, CBEs (<40 years of age), and mammographies, regardless of BBD history.
The majority of DES-exposed women receive breast cancer screenings at least at recommended intervals, but over two thirds do not perform monthly BSEs. Future efforts should be focused on further educating this and other at-risk populations through mailed reminders and during patient consultations on the benefits of screening examinations.
Breast cancer screening in women exposed in utero to diethylstilbestrol,NCBI, PMID: 19361323, 2009 Apr;18(4):547-52. doi: 10.1089/jwh.2007.0580. Full text PMC2857514.
Autism and mental retardation among offspring born after in vitro fertilization
” A study of more than 2.5 million children found no link between in vitro fertilization (IVF) and autism, but a slight increase in risk for mental retardation, or intellectual disabilities. Certain treatments used to specifically target male factor infertility – in particular, intracytoplasmic sperm injection, or ICSI – carried higher risks, but the overall risk of children being born with intellectual disabilities, defined as an IQ as under 70, was quite small. ”
Between 1978 and 2010, approximately 5 million infants were born after in vitro fertilization (IVF) treatments. Yet limited information on neurodevelopment after IVF exists, especially after the first year of life.
To examine the association between use of any IVF and different IVF procedures and the risk of autistic disorder and mental retardation in the offspring.
DESIGN, SETTING, AND PARTICIPANTS
A population-based, prospective cohort study using Swedish national health registers. Offspring born between 1982 and 2007 were followed up for a clinical diagnosis of autistic disorder or mental retardation until December 31, 2009. The exposure of interest was IVF, categorized according to whether intracytoplasmic sperm injection (ICSI) for male infertility was used and whether embryos were fresh or frozen. For ICSI, whether sperm were ejaculated or surgically extracted was also considered.
MAIN OUTCOMES AND MEASURES
Relative risks (RRs) for autistic disorder and mental retardation and rates per 100,000 person-years, comparing spontaneously conceived offspring with those born after an IVF procedure and comparing 5 IVF procedures used in Sweden vs IVF without ICSI with fresh embryo transfer, the most common treatment. We also analyzed the subgroup restricted to singletons.
Of the more than 2.5 million infants born, 30,959 (1.2%) were conceived by IVF and were followed up for a mean 10 (SD, 6) years. Overall, 103 of 6959 children (1.5%) with autistic disorder and 180 of 15,830 (1.1%) with mental retardation were conceived by IVF. The RR for autistic disorder after any procedure compared with spontaneous conception was 1.14 (95% CI, 0.94-1.39; 19.0 vs 15.6 per 100,000 person-years). The RR for mental retardation was 1.18 (95% CI, 1.01-1.36; 46.3 vs 39.8 per 100,000 person-years). For both outcomes, there was no statistically significant association when restricting analysis to singletons. Compared with IVF without ICSI with fresh embryo transfer, there were statistically significantly increased risks of autistic disorder following ICSI using surgically extracted sperm and fresh embryos (RR, 4.60 [95% CI, 2.14-9.88]; 135.7 vs 29.3 per 100,000 person-years); for mental retardation following ICSI using surgically extracted sperm and fresh embryos (RR, 2.35 [95% CI, 1.01-5.45]; 144.1 vs 60.8 per 100,000 person-years); and following ICSI using ejaculated sperm and fresh embryos (RR, 1.47 [95% CI, 1.03-2.09]; 90.6 vs 60.8 per 100,000 person-years). When restricting the analysis to singletons, the risks of autistic disorder associated with ICSI using surgically extracted sperm were not statistically significant, but the risks associated with ICSI using frozen embryos were significant for mental retardation (with frozen embryos, RR, 2.36 [95% CI, 1.04-5.36], 118.4 vs 50.6 per 100,000 person-years]; with fresh embryos, RR, 1.60 [95% CI, 1.00-2.57], 80.0 vs 50.6 per 100,000 person-years).
CONCLUSIONS AND RELEVANCE
Compared with spontaneous conception, IVF treatment overall was not associated with autistic disorder but was associated with a small but statistically significantly increased risk of mental retardation. For specific procedures, IVF with ICSI for paternal infertility was associated with a small increase in the RR for autistic disorder and mental retardation compared with IVF without ICSI. The prevalence of these disorders was low, and the increase in absolute risk associated with IVF was small.
AntiDepressant use during Pregnancy and Childhood Autism Spectrum Disorders
To study the association between parental depression and maternal antidepressant use during pregnancy with autism spectrum disorders in offspring.
Population based nested case-control study.
Stockholm County, Sweden, 2001-07.
4429 cases of autism spectrum disorder (1828 with and 2601 without intellectual disability) and 43 277 age and sex matched controls in the full sample (1679 cases of autism spectrum disorder and 16 845 controls with data on maternal antidepressant use nested within a cohort (n=589 114) of young people aged 0-17 years.
Main outcome measure:
A diagnosis of autism spectrum disorder, with or without intellectual disability.
Parental depression and other characteristics prospectively recorded in administrative registers before the birth of the child. Maternal antidepressant use, recorded at the first antenatal interview, was available for children born from 1995 onwards.
A history of maternal (adjusted odds ratio 1.49, 95% confidence interval 1.08 to 2.08) but not paternal depression was associated with an increased risk of autism spectrum disorders in offspring. In the subsample with available data on drugs, this association was confined to women reporting antidepressant use during pregnancy (3.34, 1.50 to 7.47, P=0.003), irrespective of whether selective serotonin reuptake inhibitors (SSRIs) or non-selective monoamine reuptake inhibitors were reported. All associations were higher in cases of autism without intellectual disability, there being no evidence of an increased risk of autism with intellectual disability. Assuming an unconfounded, causal association, antidepressant use during pregnancy explained 0.6% of the cases of autism spectrum disorder.
In utero exposure to both SSRIs and non-selective monoamine reuptake inhibitors (tricyclic antidepressants) was associated with an increased risk of autism spectrum disorders, particularly without intellectual disability. Whether this association is causal or reflects the risk of autism with severe depression during pregnancy requires further research. However, assuming causality, antidepressant use during pregnancy is unlikely to have contributed significantly towards the dramatic increase in observed prevalence of autism spectrum disorders as it explained less than 1% of cases.
” Six years ago, a California environmental group learned that certain baby bibs were made with potentially dangerous amounts of lead. A lawsuit followed, asserting that the bibs violated California’s sweeping environmental toxins law. As a result, Wal-Mart and Toys R Us pulled the bibs from their stores, not just in California but around the country. This is just one of many cases in which California’s strong environmental standards have protected health nationwide.
But such protections could be undermined by a bill in Congress that is intended to replace the ineffectual, decades-old federal law governing industrial chemicals. In its current state, the bill would do more to harm public health than to protect it. ”
A total of 143 exposed women and 49 unexposed women in the DES Combined Cohort Follow-up Study were diagnosed with cancer as of 2001.
Compared with breast cancer rates in the general US population, there was no overall higher risk among DES exposed women. Comparing exposed with unexposed women within the study, there was about a 30% increase in cancer risk but this finding could be due to chance. As reported in a previous article (Palmer 2006), breast cancer risk was elevated but only among women over 40 years of age. Exposed women had a risk of CCA that was nearly 40% higher than the general population, however; the incidence of CCA decreased substantially after age 25 compared with women 20 to 24 years old. Excluding CCA and breast cancer, the higher risk of cancer among the DES exposed women was about 20%, a result that could be due to chance. DES was not associated with higher risks of either endometrial or ovarian cancer. These data suggest that the DES associated increase in CCA rates remains elevated through the reproductive years. There was no consistent evidence of a higher risk for cancers other than CCA, and breast in older women.
Given that the population is still young, continued follow-up is necessary to assess the overall cancer risk associated with prenatal DES exposure.
Cancer risk in women prenatally exposed to diethylstilbestrol,NCBI, PMID: 17390375, 2007 Jul 15;121(2):356-60.
New efforts to reveal the ties between doctors and drug firms
The earnings picture may be cloudy today in the drug business, but sun is shining in from another quarter. Today is the first day of data-gathering for the newly implemented Physician Payments Sunshine Act.
A Review of Controversies in the Endocrine Disruptors Field
In 1991, a group of 21 scientists gathered at the Wingspread Conference Center to discuss evidence of developmental alterations observed in wildlife populations after chemical exposures. There, the term “endocrine disruptor” was agreed upon to describe a class of chemicals including those that act as agonists and antagonists of the estrogen receptors (ERs), androgen receptor, thyroid hormone receptor, and others. This definition has since evolved, and the field has grown to encompass hundreds of chemicals. Despite significant advances in the study of endocrine disruptors, several controversies have sprung up and continue, including the debate over the existence of nonmonotonic dose response curves, the mechanisms of low-dose effects, and the importance of considering critical periods of exposure in experimental design. One chemical found ubiquitously in our environment, bisphenol-A (BPA), has received a tremendous amount of attention from research scientists, government panels, and the popular press.
In their review, The Endocrine Society has covered the above-mentioned controversies plus six additional issues that have divided scientists in the field of BPA research, namely:
mechanisms of BPA action
levels of human exposure
routes of human exposure
pharmacokinetic models of BPA metabolism
effects of BPA on exposed animals
links between BPA and cancer
Understanding these topics is essential for educating the public and medical professionals about potential risks associated with developmental exposure to BPA and other endocrine disruptors, the design of rigorously researched programs using both epidemiological and animal studies, and ultimately the development of a sound public health policy.
Special Cancer Therapy, Previously Only Available Abroad, Comes To The UK
Cancer patients who currently travel abroad for a special type of radiotherapy will be able to get it in the UK from 2018. Public health minister Anna Soubry said £250 million of Government funding is being committed to hospitals in Manchester and London to deliver proton beam therapy. This type of cancer treatment targets tumours more precisely, causing less damage to surrounding tissue and fewer side-effects.
In utero exposure to DES is associated with a 50 % higher risk of preeclampsia
DES Follow-up Study Summary
Women exposed to Diethylstilbestrol (DES) in utero experience a greater risk of adverse reproductive events including infertility, ectopic pregnancies, spontaneous pregnancy losses and premature births. These complications may in part be due to prenatal effects of DES on the structure of the uterus or cervix. Preeclampsia, a common pregnancy complication characterized by maternal hypertension, and high levels of uric acid and protein, frequently involves the placenta not entirely attaching to the mother’s endometrium (implantation). DES-associated uterine abnormalities and possible alterations in immune function may adversely affect successful implantation.
The hypothesis that prenatal DES exposure is associated with preeclampsia risk was previously addressed in a small case-control study that reported a greater than two-fold risk in women who reported a history of DES exposure compared with those who did not. We used data from the National Cancer Institute DES Combined Cohorts Follow-up Study to readdress this issue. A total of 285 preeclampsia cases (210 exposed and 75 unexposed) occurred in 7313 live births (4759 DES exposed and 2554 unexposed). Prenatal DES exposure was associated with nearly a 50% elevation in preeclampsia risk in the daughters’ pregnancies. Taking into account differences in DES exposed and unexposed women in preeclampsia risk factors including age at the pregnancy, number of pregnancies, education, smoking, a measure of body fatness, and year of preeclampsia diagnosis, the risk was slightly lower, about 40%. The increased risk of preeclampsia associated with prenatal DES exposure was concentrated among women who developed preeclampsia in their first pregnancy (80% higher risk), those who were exposed to DES before 15 weeks of pregnancy (57% higher risk) and those who were treated with magnesium sulfate (over two times the risk). Among DES-exposed women who had a prior hysterosalpingogram (a procedure that allows physicians to view the reproductive organs), preeclampsia prevalence was higher in those with uterine abnormalities (12.4%) than in those without (7.7%). Our data suggest that prenatal DES exposure is associated with a slightly elevated risk of preeclampsia that is possibly due to a higher prevalence of uterine abnormalities in DES daughters.
Women exposed to diethylstilbestrol (DES) in utero experience a greater risk of adverse reproductive events including infertility, ectopic gestations, spontaneous pregnancy losses and premature births. These complications may in part be mediated through teratogenic effects, namely the structural uterine and cervical abnormalities that have been associated with in utero DES exposure. Preeclampsia, a common pregnancy complication characterized by maternal hypertension, hyperuricemia, and proteinuria frequently involves shallow placentation. Placental establishment requires cytotrophoblast invasion of the underlying stroma and blood vessels of the maternal endometrium, a process involving immune and angiogenic mechanisms. DES-associated uterine abnormalities and possible alterations in immune function (4-7) may adversely affect successful implantation.
The hypothesis that prenatal DES exposure is associated with preeclampsia risk was previously addressed in a small case-control study that reported a greater than two-fold risk in women who reported a history of DES exposure compared with those who did not.
2007 Study Abstract
To assess whether preeclampsia risk is elevated in pregnancies of diethylstilbestrol (DES)-exposed daughters.
This study used data from the National Cancer Institute DES Combined Cohorts Follow-up Study. A total of 285 preeclampsia cases (210 exposed and 75 unexposed) occurred in 7,313 live births (4,759 DES exposed and 2,554 unexposed). Poisson regression analysis estimated relative risks and 95% confidence intervals (CI) for preeclampsia adjusted for age at the index pregnancy, parity, education, smoking, body mass index, year of diagnosis, and cohort.
In utero DES exposure was associated with nearly a 50% elevation in preeclampsia risk. Adjustment for preeclampsia risk factors attenuated the relative risk slightly (1.42, 95% CI 1.04-1.94). The excess risk with DES was concentrated among women who developed preeclampsia in their first pregnancies (relative risk 1.81, 95% CI 1.17-2.79), who were exposed before 15 weeks of gestation (relative risk 1.57, 95% CI 1.11-2.23), and who were treated with magnesium sulfate (relative risk 2.10, 95% CI 0.82-5.42). Among DES-exposed women who had a prior hysterosalpingogram, preeclampsia prevalence was higher in those with uterine abnormalities (12.4%) than in those without (7.7%).
These data suggest that in utero exposure to DES is associated with a slightly elevated risk of preeclampsia, and that one possible biological mechanism involves uterine abnormalities.
Preeclampsia risk in women exposed in utero to diethylstilbestrol,NCBI, PMID: 17601905, 2007 Jul;110(1):113-20.