American College Of Gastroenterology Offers Tips To Ease The Heartburn Of Pregnancy

Heartburn symptoms are
one of the most commonly reported complaints among pregnant women.
Heartburn usually starts during the first trimester and tends to worsen
during the second and third trimesters.


Studies have shown elevated levels of the hormone progesterone
accompanied by increased intra-abdominal pressures from the enlarging
uterus, may lower esophageal sphincter (LES) pressure in pregnant women
contributing to heartburn symptoms, according to research highlighted in
the newly updated "Pregnancy in Gastrointestinal Disorders" monograph by
the American College of Gastroenterology (ACG).



From the monograph, physician experts from ACG have compiled important
health tips on managing heartburn symptoms, and importantly, identifying
which heartburn medications are safe for use in pregnant women and those,
which should be avoided.



Strategies to Ease Heartburn Symptoms during Pregnancy



According to the ACG, pregnant women can treat and relieve their
heartburn symptoms through lifestyle and dietary changes. The following
tips can help reduce heartburn discomfort:



-- Avoid eating late at night or before retiring to bed. Common
heartburn triggers include greasy or spicy food, chocolate, peppermint,
tomato sauces, caffeine, carbonated drinks, and citrus fruits.



-- Wear loose-fitting clothes. Clothes that fit tightly around your
waist put pressure on your abdomen and the lower esophageal sphincter.



-- Eat smaller meals. Overfilling the stomach can result in acid reflux
and heartburn.



-- Don't lie down after eating. Wait at least 3 hours after eating
before going to bed. When you lie down, it's easier for stomach contents
(including acid) to back up into the esophagus, particularly when you go to
bed with a full stomach.



-- Raise the head of the bed 4 to 6 inches. This can help reduce acid
reflux by decreasing the amount of gastric contents that reach the lower
esophagus.



-- Avoid tobacco and alcohol. Abstinence from alcohol and smoking can
help reduce reflux symptoms and avoid fetal exposure to potentially harmful
substances.



The Do's and Don'ts of Using Heartburn Drugs during Pregnancy



Pregnant women with mild reflux usually do well with simple lifestyle
changes. If lifestyle and dietary changes are not enough, you should
consult your doctor before taking any medication to relieve heartburn
symptoms.



According to ACG President Amy E. Foxx-Orenstein, DO, FACG, "Heartburn
medications to treat acid reflux during pregnancy should be balanced to
alleviate the mother's symptoms of heartburn, while protecting the
developing fetus."



Based on a review of published scientific clinical studies (in animals
and humans) on the safety of heartburn medications during pregnancy,
researchers conclude there are certain drugs that are considered safe for
use in pregnancy and those which should be avoided.
















Antacids are one of the most common over-the-counter medications to
treat heartburn. As with any drug, antacids should be used cautiously
during pregnancy.



Antacids



-- Antacids containing aluminum, calcium, or magnesium are considered
safe and effective in treating the heartburn of pregnancy.



-- Magnesium-containing antacids should be avoided during the last
trimester of pregnancy because it could interfere with uterine contractions
during labor.



-- Avoid antacids containing sodium bicarbonate. Sodium bicarbonate
could cause metabolic alkalosis and increase the potential of fluid
overload in both the fetus and mother.



Histamine-type II (H-2) Receptor Antagonists



While limited data exists in humans on the safety of histamine-type II
(H-2) receptor antagonists, ranitidine (Zantac(R)) is the only H-2
antagonist, which has been studied specifically during pregnancy.



In a double-blind, placebo controlled, triple crossover study,
ranitidine (Zantac(R)) taken once or twice daily in pregnant heartburn
patients not responding to antacids and lifestyle modification, was found
to be more effective than placebo in reducing the symptoms of heartburn and
acid regurgitation. No adverse effects on the fetus were reported. (Larson
JD, et al., "Double-blind placebo-controlled study of ranitidine for
gastroesophageal reflux symptoms during pregnancy." Obstet Gynecol 1997;
90:83-7.)



A study on the safety of cimetidine (Tagamet(R)) and ranitidine
(Zantac(R)) suggests that pregnant women taking these drugs from the first
trimester through their entire pregnancy have delivered normal babies.
(Richter JE., "Gastroesophageal reflux disease during pregnancy.
Gastroenterol Clin N Am 2003; 32:235-61.)



Proton Pump Inhibitors



Proton pump inhibitors should be reserved for pregnant patients with
more severe heartburn symptoms and those not responding to antacids and
lifestyle and dietary changes. Lansoprazole (Prevacid(R)) is the preferred
PPI because of case reports of safety in pregnant women. Limited data
exists about human safety during pregnancy with the newer PPIs.


American College of Gastroenterology

acg.gi




View drug information on Cimetidine Hydrochloride Oral Solution; Ranitidine Capsules.

Health Experts React To Report Linking 7% Drop In Breast Cancer Incidence With Decrease In HRT Use

Health experts reacted from a "fury to disbelief to a kind of complacency" to a study presented Thursday at the 29th Annual San Antonio Breast Cancer Symposium that said a 7% drop in breast cancer incidence among U.S. women from 2002 to 2003 was possibly because of a decrease in hormone replacement therapy use, the New York Times reports (Kolata, New York Times, 12/18). Peter Ravdin, a research professor in the Department of Biostatistics at M.D. Anderson Cancer Center, and colleagues examined records from nine regions across the U.S. that supply data to the National Cancer Institute's Surveillance Epidemiology and End Results. According to the study, age-adjusted breast cancer incidence decreased by 7% by the end of 2003, compared with 2002. There were about 124 breast cancer cases per 100,000 women in 2003, compared with about 134 cases per 100,000 women in 2002. Breast cancer incidence decreased by 6% in the first half of 2003 and by 9% in the second half of the year. The study found that breast cancer rates dropped by 15% among women ages 50 and older. The study -- which was funded by NCI and M.D. Anderson -- concluded that about 14,000 fewer women were diagnosed with breast cancer in 2003 than 2002. The decline in incidence was the largest since 1990, the researchers found. According to researchers, the decrease in breast cancer rates is most likely associated with a drop in both HRT use and mammography rates. HRT use decreased by about 30% in 2002 after the Women's Health Initiative found that breast cancer risk increased for women who used the treatment for an extended period of time. In addition, mammography rates between 2000 and 2003 dropped by 1% overall and by 3% among women between ages 50 and 64, which could in part explain why fewer breast cancer cases were detected. Ravdin said that it is possible that other factors -- including anti-estrogen drugs, such as raloxifene; statin drugs that reduce cholesterol; or drugs used to treat pain -- also might have contributed to the decrease (Kaiser Daily Women's Health Policy Report, 12/15).

Reaction
The study's findings are "very good news," Elsa Ford, president of Brentwood/Bay Shore Breast Cancer Coalition, said, adding, "It was so easy to embrace [HRT] without close attention to potential side effects, especially on a long-term basis." Julia Smith, director of the New York University Cancer Institute's Breast Cancer Screening and Prevention Program, said, "We believe that HRT contributes to hormone receptor positive cancers in postmenopausal women, but it's hard to believe that HRT would play the sole role in such a significant decline." She added, "Further study is necessary to see if this drop is a trend, a blip or if other factors played a role" (Ricks, Long Island Newsday, 12/18). Wyeth -- maker of combination HRT Prempro -- in a statement Sunday said that the "potential impact of hormone therapy on breast cancer has long been warned in product labels." The new research does not prove cause and effect, the company said, adding that "caution and further examination over a longer period of time is advised before these data can be fully understood" (New York Times, 12/18). The statement also said that the study included short-term and incomplete data and that the decline in breast cancer incidence might be explained by other factors (Agovino, AP/Houston Chronicle, 12/15). Ronald Strickler, chief of women's health services at the Henry Ford Health System, said, "My concern is that these statistics bounce around from year to year," adding, "We will be hearing from the same 10[%] to 20% of patients who react to every report in the news media that is negative, and they ask, 'Does this say you have put me at increased risk of cancer?'" (Anstett, Detroit Free Press, 12/15). JoAnn Manson, a women's health expert at Brigham and Women's Hospital in Boston said she worries that some women as a result of the study who "really require" HRT "will be talked out of it" (Marchione, AP/Charlotte Observer, 12/15).

Other Research Presented at Symposium
The following highlights other studies presented at the San Antonio Breast Cancer symposium.














E-75 compound: Col. George Peoples, a staff surgeon at Brooke Army Medical Center, and colleagues tested the compound E-75 -- a peptide derived from the protein HER-2/neu, which is found at elevated levels in one-fourth of breast cancers -- on 101 military and civilian women whose breast cancer had been treated and who had high levels of HER2/neu. Researchers aimed to determine if it would boost the immune system at certain times. Eighty-five additional women without HER2/neu were followed as a control group. The study found that after two years of treatment, the women who received the compound had a 50% lower risk of their cancer recurring, compared with women in the control group (Tumiel, San Antonio Express-News, 12/15).

Fat intake, Journal of the National Cancer Institute: Researchers at the National Cancer Institute at 39 sites nationwide examined 2,437 women with early-stage breast cancer who were an average age of 58 years old. All of the women had undergone surgery followed by chemotherapy, as well as five years of tamoxifen if their tumors were fueled by hormones, the AP/Yahoo! News reports. The study found that 66% of women without hormone-fueled breast cancer tumors who reduced their fat intake to about 20% of daily calories had a 66% lower risk of death, compared with women without hormone-fueled tumors who were told to continue their normal diet. Among women who had hormone-fueled tumors, there was a 24% lower risk of death five years later for women who reduced fat intake (Marchione, AP/Yahoo! News, 12/16).

Inflammatory breast cancer: Massimo Cristofanilli, associate professor in the Department of Breast Medical Oncology at M.D. Anderson, and colleagues tested 35 women with inflammatory breast cancer using the experimental drug lapatinib by itself and also in combination with chemotherapy to determine the drug's effectiveness in treating inflammatory breast cancer, the San Antonio Express-News reports. The study found that 80% of the women who took the drug alone and then in combination with chemotherapy saw a reduction in their breast tumors by 50%. There was no evidence of remaining cancer in three women who later had surgery, the study found (Tumiel [2], San Antonio Express-News, 12/15).

Post-chemotherapy menstruation: Michael Gnant of the Medical University of Vienna and colleagues reported results from a study that found women whose menstrual cycles returned after they underwent chemotherapy had higher breast cancer relapse rates than those who did not resume menstruation. Gnant said, "Additional hormone suppression may be advisable" to keep periods from returning (Marchione, AP/ABC7Chicago, 12/16).

NPR's "All Things Considered" on Friday reported on the connection between declining breast cancer incidence and the use of hormone replacement therapy. The segment includes comments from Deborah Armstrong, a medical oncologist at Johns Hopkins University's Kimmel Cancer Center; Mary Daly, a researcher at Fox Chase Cancer Center; and Manson (Palca, "All Things Considered," NPR, 12/15). Audio of the segment is available online.


"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Married women have more sexual difficulties than single women or married men

Married women are more likely to have sexual difficulties than either single women or married men, suggest the findings of a national survey in Sexually Transmitted Infections.


The nationally representative survey (Natsal 2000) involved over 11,000 men and women between the ages of 16 and 44, who were asked about their sex lives between 1999 and 2001.


Older age was associated with reporting sex life problems for both men and women, but otherwise there were considerable differences between the sexes.


Women were significantly more likely than men to say that they had experienced a short or longer term problem with their sex lives over the past year.



While married or cohabiting men were significantly less likely to say they had sexual problems than single men, the reverse was true for women.


Married women were significantly more likely to report a problem with their sex lives than single women, as were mothers with young children at home.


Men who drank more than the recommended weekly units of alcohol, or who had had a sexually transmitted infection within the previous five years, were also more likely to report problems with their sex lives.


And the quality of the first sexual experience was also identified as important for both men and women, with those reporting a poor first experience more likely to report subsequent problems.


The responses also revealed the importance of good communication. Men and women who felt they could not talk to their partner about sex were around twice as likely to report problems with their sex lives.


The authors of an accompanying editorial comment: "Despite its prevalence, sexual dysfunction is often endured in silence." And they go on to say that studies suggest that as many as 54% of women and 35% of men have problems, but fewer than 11% of men and 21% of women seek help.


Who reports sexual function problems? Empirical evidence from Britain's 2000 National Survey of Sexual Attitudes and Lifestyles Sex Transm Infect 2005; 81: 394-9


Emma Dickinson

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Alaska Gov. Palin Voices Support For State Parental Consent Bill

Alaska Gov. Sarah Palin (R) on Thursday voiced support for legislation (H.B. 35, S.B. 6) that would require parental consent for a minor to receive an abortion in the state, the AP/Fairbanks Daily News-Miner reports. The House and Senate bills were introduced in their respective chambers at the beginning of the session. The House version, sponsored by Rep. John Coghill (R), would revise the 1997 Parental Consent Act, which the Alaska Supreme Court overturned in a 3-2 vote in 2007. The court said the parental consent requirement was unconstitutional because it infringed on pregnant teenagers' right to reproductive freedom. According to the AP/Daily News-Miner, the court is "more conservative now with a Palin-appointee replacing a justice who cast a vote to overturn" the act.

Although Palin "voiced strong antiabortion views" as Sen. John McCain's (R-Ariz.) running mate in the 2008 presidential election, she "has not pushed that agenda in the Legislature until now," the AP/Daily News-Miner reports. Palin said she did not propose her own bill this year because she did not want to create competing legislation (Sutton, AP/Fairbanks Daily News-Miner, 2/27). According to the Anchorage Daily News, the bill might have "trouble in the state Senate," after Senate President Gary Stevens (R) said months ago that "far left and far right issues" would not be on the table in the Senate. Sen. Hollis French (D), who chairs the Senate Judiciary Committee, said that he has not yet analyzed the bill but would give it a hearing (Demer, Anchorage Daily News, 2/27). The AP/Daily News-Miner reports that an identical bill passed the House in 2008 but ultimately failed because it did not have a Senate hearing. Sen. Charlie Huggins (R), a supporter of the bill, said a citizen's initiative would be filed if the bill failed to pass this year (AP/Fairbanks Daily News-Miner, 2/27).

Palin said, "Wherever you fall on the abortion issue, right or left, this legislation is about family, and it's about parents' rights and protecting our children." She added that legislators "on both sides of the aisle" support the bill (Anchorage Daily News, 2/27). Palin also said the "most important thing is the right of Alaska children to receive support and the ability for them to receive the support and input of their parents as they face a life-changing decision."

Clover Simon, executive director of Planned Parenthood of the Great Northwest, said the bill violates the constitutional rights of pregnant teens. She said that although the group wants parents to be included in decisions regarding abortion, it does not "believe you can mandate parental communication with their teens." She added parental involvement "has to be something that starts long before the unintended pregnancy." PPGN also said it is concerned with a section of the bill that would allow teens to bypass parental consent by petitioning a court. Smith said the requirements are difficult for teens who might be in abusive situations at home (AP/Fairbanks Daily News-Miner, 2/27).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


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