Child health news round-up (12-15 February 2009)
Contents:
* Frozen donor embryos may often go unused: study
* Migraine drugs don’t up birth defect risk: study
* Medicines not working? There’s an app for that
* Clue on condition ‘hug avoidance’
* Obesity ‘set’ before age of two
Frozen donor embryos may often go unused: study Fri Feb 12, 2010 5:18pm EST
SOURCE: Fertility and Sterility, online January 7, 2010.
NEW YORK (Reuters Health) – Many women who successfully have a baby using donated eggs do not try to achieve a second pregnancy with the excess embryos they’ve chosen to store, a study at one fertility clinic suggests.
The findings, say the researchers, suggest that more fertility treatment centers should consider offering “shared donor” programs – in which eggs from a single donor are given to two women seeking in-vitro fertilization (IVF) rather than one.
The approach means fewer eggs go to each patient, but it also means lower costs — and, the current study suggests, potentially fewer unused embryos.
The cost of IVF varies from clinic to clinic, but in the U.S., the average cost of one IVF treatment cycle is $12,400, according to the American Society for Reproductive Medicine.
The cost is higher when a woman must use donor eggs rather than her own; compensation to donors also varies, but is typically in the neighborhood of $5,000.
Insurance plans may not pay for fertility treatment, though some U.S. states have laws that require some degree of coverage.
The new study, published in the journal Fertility and Sterility, included 829 women who underwent IVF using donor embryos at the New York University (NYU) Fertility Center between 2000 and 2004.
Overall, more than half — 54 percent — had a baby, or multiples, after the first attempt. Of those women, 177 — or 40 percent — had also elected to freeze and store any extra embryos that were not implanted during the first IVF attempt.
But by August 2009, only 21 percent of those women had returned to the clinic to try for a second pregnancy using the stored embryos, according to Dr. Jaime N. Knopman and colleagues.
The picture was different, however, for women whose initial IVF attempt failed. Of the 128 who had elected to freeze their excess embryos, 87 percent returned for a second try.
The findings, according to Knopman’s team, suggest that most women who conceive using donor eggs “are satisfied after experiencing only one successful outcome.”
They add that many women who give births to multiples may be especially likely to feel this way; of 81 study patients who had twins after their first try, 74 did not return to try again with their frozen embryos.
The NYU fertility center offers patients the option of using an “exclusive” or shared anonymous donor. In the second case, two women receive eggs from one donor, as long as there are at least 12 eggs available.
According to Knopman’s team, the current findings suggest that exclusive-donor approaches, with their higher number of unused embryos, “may not be very efficient in terms of necessity or cost.”
With the number of women who want donor eggs growing, and the number of donors being limited, “centers should consider a shared donor program,” the researchers write.
Shared-donor programs, they suggest, “will maximize efficiency, reduce costs, and achieve fertility for a larger number of infertile patients.”
They add that such policies “would also markedly reduce the number of unused frozen embryos.”
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Migraine drugs don’t up birth defect risk: study Fri Feb 12, 2010 5:36pm EST
SOURCE: Headache, online January 28, 2010.
NEW YORK (Reuters Health) – A study in nearly 70,000 pregnant women has found no link between migraine drugs called triptans and the risk of birth defects.
However, the researchers did find a “slight increase” in the risk of excessive bleeding during labor, and the failure of the uterus to contract normally after delivery, for women who used the drugs while pregnant.
Triptans are among the most powerful drugs used for migraine; others include aspirin, Excedrin, and ibuprofen.
While as many as three in 10 women may develop migraines during their childbearing years, women often shy away from using such drugs during pregnancy because of safety concerns, according to study co-author Katerina Nezvalova-Henriksen of the University of Oslo in Norway and her colleagues.
However, the authors of the study in Headache note, untreated migraine may itself carry risks for mother and child; some studies have linked it to pre-eclampsia, a potentially deadly pregnancy complication.
“While it is important to exert caution when using any medications during pregnancy, this study indicates” that pregnant women can either start or continue taking triptans without “any major risk” of miscarriage, premature delivery, or other bad outcomes, the authors conclude.
Nezvalova-Henriksen and her team studied nearly 70,000 women. Two percent, or 1,535, had used sumatriptan (Imitrex), rizatriptan (Maxalt), zolmitriptan (Zomig), or eletriptan (Relpax) in pregnancy.
Less than one percent — 373 women — had used the drugs before getting pregnant but not during pregnancy.
The overall birth defect rate, which encompasses everything from large birthmarks to serious heart problems, was the same among women who had taken triptans during pregnancy and those who didn’t have migraines: 5 percent. Among those who had used triptans in the past but not during pregnancy, it was slightly higher: 6 percent.
The women who used triptans were also more likely than non-triptan users to take other drugs during pregnancy, including acetaminophen (Tylenol) with codeine and non-steroidal anti-inflammatory drugs such as ibuprofen.
However, the rate of major birth defects – such as serious problems of the limbs or internal organs — was 3 percent for all three groups. That rate – about one in 33 births – is about what would be expected for all birth defects in the general population.
The researchers did find that women who used triptans in their second or third trimester were more likely to develop a condition called atonic uterus, in which the uterus fails to contract back to its normal size after delivery. This is the leading cause of excessive bleeding after delivery. They were also more likely to lose significant amounts of blood during labor and delivery.
And during pregnancy, they were more likely to suffer from vomiting than women who had never used the drug; they were also more likely to develop pre-eclampsia or eclampsia, and more likely to have deficiencies in the B-vitamin folate.
While many women who suffer migraines will experience improvements in their symptoms after their first trimester, Nezvalova-Henriksen and her team note, those whose symptoms don’t improve by then aren’t likely to get better.
“Although the findings are reassuring, confirmation in independent studies is warranted,” the researchers conclude.
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Medicines not working? There’s an app for that Ben Hirschler, European Pharmaceuticals Correspondent (Editing by Will Waterman and David Cowell) Thu Feb 11, 2010 10:15am EST LONDON (Reuters) – Drugmakers are starting to get into bed with information technology companies as they struggle to prove the value of their medicines to governments and insurers.
By using smart gadgets to monitor patients in real time, pharmaceutical companies believe they can improve clinical outcomes and establish the cost-effectiveness of treatments.
The result, according to a report on Thursday from Ernst & Young, will be a host of new collaborations between pharmaceutical companies and businesses in non-traditional areas such as computing, telecoms and even retail.
A few such tie-ups are already happening.
Novartis, for example, signed a $24 million deal last month with U.S.-based Proteus Biomedical to create “smart pills” that can transmit data from inside the body to monitor patients’ vital signs and check they have taken medicines as prescribed.
Bayer is connecting its glucometer for diabetic children to Nintendo’s video-gaming consoles to promote consistent blood sugar testing.
And Johnson & Johnson’s Lifescan unit has an iPhone application that lets users upload readings from their connected blood glucose monitors to their Apple phone.
“We will see multiple types of collaborations in future,” Patrick Flochel, Ernst & Young life sciences leader for Europe, Middle East, India and Africa, told Reuters.
“This movement will be driven by a focus on outcomes, which pharma companies are more and more having to commit themselves to.”
DRUG DELIVERY
Non-pharma companies are looking on eagerly. Hans Hofstraat, head of healthcare partnerships at electronics group Philips, says drug delivery is one area where tech companies can clearly help.
The Dutch group is working on ultrasound-mediated delivery systems and has an intelligent pill, or iPill, that can target medicines to the right point in the digestive tract.
“We are not a pharma company but we would like to interact with pharma companies to provide solutions,” he told an Economist pharmaceuticals conference.
Mobile phone company Orange, a unit of France Telecom, has similar ambitions. Its focus is on patient communication and chronic disease management, Michael Reilly, director of Orannge Healthcare UK, told the same meeting.
Big drugmakers have traditionally relied on a few blockbuster medicines to bring in cash. But the old business model is breaking down, and companies are diversifying into new areas such as consumer health, as well as cutting costs and forging more flexible alliance with small biotech companies.
The revised model is sometimes dubbed “Pharma 2.0.”
But coming up next, Ernst & Young argues, is “Pharma 3.0,” in which pharmaceutical companies will increasingly look to sell ancillary products and services linked to their medicines by working with IT and other companies.
The new era poses some notable challenges, not least the cultural gap between fast-moving technology companies, with rapid innovation cycles, and a more ponderous drugs industry, where bringing a new product to market typically takes 10 years or more.
The prize, however, is worth fighting for. By monitoring clinical data and ensuring that patients take the right medicines at the right time, drug companies should be able to demonstrate their products really work, ensuring reimbursement by governments or insurers and helping to justify high prices.
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Clue on condition ‘hug avoidance’
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/8511100.stm
Published: 2010/02/12 00:00:08 GMT
Delays at crucial points during the development of the brain in the womb may explain why people with a condition linked to autism do not like hugs.
A study in mice with fragile X syndrome found wiring in the part of the brain that responds to touch is formed late.
The findings may help explain why people with the condition are hypersensitive to physical contact, the researchers wrote in Neuron.
It also points to key stages when treatment could be most effective.
Fragile X syndrome is caused by a mutant gene in the X chromosome that interferes in the production of a protein called fragile X mental retardation protein (FMRP).
Under normal circumstances, the protein directs the formation of other proteins that build synapses in the brain.
“ It also has implications for the treatment of autism since the changes in the brains of fragile X and autistic people are thought to significantly overlap ”
Professor Peter Kind, Study author
Boys are usually more severely affected with the condition – which is the leading known cause of autism – because they have only one X chromosome.
In addition to mental impairment, hyperactivity, emotional and behavioural problems, anxiety and mood swings, people with fragile X also show what doctors call “tactile defensiveness”, which means they do not make eye contact and do not like physical contact and are hypersensitive to touch and sound.
Connections
By recording electrical signals in the brains of mice, bred to mimic the condition, the researchers found that connections in the sensory cortex in the brain were late to mature.
This “mistiming” may trigger a domino effect and cause further problems with the correct wiring of the brain, they concluded.
The study also found these changes in the brain’s connections occur much earlier than previously thought, midway through a baby’s development in the womb.
And it suggests there are key “windows” when treatments for fragile X and autism could be most effective, they said.
Professor Peter Kind, who led the study at the University of Edinburgh, added: “We’ve learned these changes happen much earlier than previously thought, which gives valuable insight into when we should begin therapeutic intervention for people with these conditions.
“It also has implications for the treatment of autism since the changes in the brains of fragile X and autistic people are thought to significantly overlap.”
Dr Gina Gómez de la Cuesta, from the National Autistic Society, said research into fragile X syndrome could help understanding of certain aspects of autism.
“Autism is common in people with fragile X syndrome, however there are many other causes of autism, most of which are not yet fully understood.
“Understanding how the brain works when a person has fragile X syndrome could help put some of the pieces together about what is happening in the brain when a person has autism, but it is not the whole story.
“Animal research can tell us a lot about genetics and the brain, but it is only a small part of the picture and further research would be required before we fully understand any links to autism.”
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Obesity ‘set’ before age of two
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/8512102.stm
Published: 2010/02/13 00:01:46 GMT
The “tipping point” that sets children on the way to a lifetime of obesity often occurs before the age of two, say US researchers.
A study of more than 100 obese children and teenagers found more than half were overweight by 24 months and 90% were overweight by the age of five.
A quarter were overweight before they were five months old, the researchers reported in Clinical Pediatrics.
In the UK, around 27% of children are now overweight.
The children in the study – who had an average age of 12 – were all overweight or obese by the age of 10.
“ Getting parents and children to change habits that have already taken hold is a monumental challenge fraught with road-blocks and disappointments ”
Dr John Harrington, study leader
Although the reason for rapid weight gain in early life is not well understood, contributing factors are likely to be poor diet, early introduction of solid food, and not getting enough exercise, the researchers said.
Eating behaviour
They added that food preferences may be set by the age of two, so changing a child’s eating behaviour at a later stage may be difficult.
Study leader Dr John Harrington, an assistant professor at Eastern Virginia Medical School, said the results should be a “wake-up call for doctors”.
He went on: “Too often, doctors wait until medical complications arise before they begin treatment.
“Getting parents and children to change habits that have already taken hold is a monumental challenge fraught with road-blocks and disappointments.
“This study indicates that we may need to discuss inappropriate weight gain early in infancy to effect meaningful changes in the current trend of obesity.”
A Department of Health spokesman said: “What happens in the first years of a baby’s life has a big effect on how healthy they are in the future.
“Despite recent encouraging statistics which show that childhood obesity may be levelling off, obesity levels are still too high and it is important we keep the momentum going.”