Study Shows Vitamin D Deficiency In Pregnancy Increases Preeclampsia Risk

Dr. Enrique Jacome

Research led by investigators from the University of Pittsburgh Graduate School of Public Health suggests that women who have a vitamin D deficiency in the first 26 weeks of pregnancy are more likely to develop severe preeclampsia. This is according to a study recently published in the journal Epidemiology.

Preeclampsia is a potentially life-threatening pregnancy complication that usually occurs after the first 20 weeks of gestation or shortly after birth. According to the Preeclampsia Foundation, around 5-8% of pregnancies are affected by the condition.

Early signs of the condition include high blood pressure and albuminuria - excess protein that leaks into the urine. Some women may also experience swelling of the feet, ankles, face and hands - caused by fluid retention - as well as severe headaches, problems with vision and pain just below the ribs.

Vitamin D and pregnancy

Vitamin D is known to be important for regulating and absorbing calcium and phosphorus in the body. The majority of people are able to get all the vitamin D they need from the sun and various foods, such as oily fish, eggs and fortified fat spreads.

However, according to the Vitamin D Council, pregnancy is a known risk factor for vitamin D deficiency. Previous research has suggested that vitamin D deficiency during pregnancy may lead to gestational diabetes, increased risk of infections and cesarean section, and low offspring birth weight.

To determine whether there is an association between vitamin D deficiency during pregnancy and risk of preeclampsia, the research team analyzed the blood samples of 700 pregnant women who later developed preeclampsia, alongside the blood samples of 3,000 pregnant women who did not develop the condition.

All samples were collected between 1959 and 1965 from 12 US institutions. The researchers note that the blood samples were well-preserved and they were able to test the samples for vitamin D levels decades after they were collected.

Vitamin D deficiency linked to 40% increased preeclampsia risk

The analysis revealed that women who had insufficient levels of vitamin D during the first 26 weeks of pregnancy were 40% more likely to develop severe preeclampsia, compared with women who had adequate levels of the vitamin in the first 26 weeks' gestation.

However, the researchers did not find any association between vitamin D and mild preeclampsia.

These results were apparent after taking other factors into consideration that could impact a woman's vitamin D levels, such as pre-pregnancy body mass index (BMI), race, smoking, diet, the number of previous pregnancies, physical activity and sunlight exposure.

Commenting on the findings, senior study author Dr. Mark A. Klebanoff, of the Center for Perinatal Research at The Research Institute at Nationwide Children's Hospital and the Department of Pediatrics at The Ohio State University College of Medicine, says:

"Scientists believe that severe preeclampsia and mild preeclampsia have different root causes. Severe preeclampsia poses much higher health risks to the mother and child, so linking it with a factor that we can easily treat, like vitamin D deficiency, holds great potential."

Dr. Lisa Bodner, of the Department of Epidemiology at the University of Pittsburgh Graduate School of Public Health and lead author of the study, says that if similar results are found in a modern sample of pregnant women, then the role of vitamin D in reducing preeclampsia should be explored further.

"Until then," she adds, "women shouldn't automatically take vitamin D supplements during pregnancy as a result of these findings."

Medical News today recently reported on a study suggesting that mothers who have a higher vitamin D intake during pregnancy are more likely to have children with stronger muscles.

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Long-Living Breast Stem Cells Give Clues To Cancer Cells Of Origin

Dr. Enrique Jacome

Researchers in Australia have found that breast stem cells and their "daughters" have a longer life than previously believed. This newly discovered longer lifespan suggests that these cells could carry damage or genetic defects earlier in life that eventually lead to cancer decades later.

The researchers, from Melbourne's Walter and Eliza Hall Institute, have published their results in the journal Nature, and they say their discovery could help with the development of treatments and diagnostics for breast cancer.

Their project involved tracking the development of normal breaststem cells. By tracking these cells, they found they actively maintain breast tissue throughout a woman's life, from puberty through adulthood, contributing to all major stages of breast development.

"Given that these stem cells - and their 'daughter' progenitor cells - can live for such a long time and are capable of self-renewing, damage to their genetic code could lead to breast cancer 10 or 20 years later," says Prof. Geoff Lindeman, study author and oncologist at The Royal Melbourne Hospital.

He adds that their finding "has important applications for our understanding of breast cancer."

Potential for 'new treatment and diagnostic strategies'

Prof. Jane Visvader, another study author from the Walter and Eliza Hall Institute, says understanding how breast cells develop is crucial to establishing which cells bring about breast cancer and why.

"Without knowing the precise cell types in which breast cancer originates, we will continue to struggle in our efforts to develop new diagnostics and treatments for breast cancer, or developing preventive strategies," she says.

She explains how they used a 3D imaging technique to track stem cells and their daughter cells in the video below:

Using this 3D imaging technique in 2009, another study from the Institute showed that the "daughters" of breast stem cells were the likely origin for BRCA1-associated breast cancers, Prof. Visvader notes.

She says this previous work helped them better understand normal breast development, but it will also help them further their knowledge about breast cancer.

"Our team was amongst the first to isolate 'renewable' breast stem cells," Prof. Visvader says. "However, the existence of a common stem cell that can create all the cells lining the breast ducts has been a contentious issue in the field."

She adds:

"In this study, we've proven that ancestral breast stem cells function in puberty and adulthood and that they give rise to all the different cell types that make up the adult breast."

Prof. Lindemann says they hope their finding "will lead to the development of new treatment and diagnostic strategies in the clinic to help women with breast cancer in the future."

There have been several studies recently that have suggested diet could be a major factor in development of breast cancer. One study suggested folic acid is linked to breast cancer growth, while another found that limiting alcohol and following a healthy diet could minimize risks for the disease.

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Study Shows Women Who Practice Muscle-Strengthening And Conditioning Reduce Their Risk Of Diabetes

Dr. Enrique Jacome

Aerobic exercise is known to prevent type 2 diabetes, and muscle-strengthening alone or in combination with aerobic exercise improves diabetic control among those with diabetes. Although men who weight train have been found to have an associated reduced risk of developing diabetes, whether such an association exists for women has not been established.

In this week's PLOS Medicine, Anders Grøntved (Harvard School of Public Health, Boston, MA, USA, and University of Southern Denmark, Denmark) and colleagues prospectively followed up 99,316 middle-aged and older women for 8 years from the Nurses' Health Study ([NHS] 2000-2008) and Nurses' Health Study II ([NHSII] 2001-2009) who did not have diabetes at baseline, and determined whether their weekly time spent performing resistance exercise, lower intensity muscular conditioning exercises (yoga, stretching, toning), and aerobic moderate and vigorous physical activity (MVPA) reported at baseline and in 2004/2005 was associated with a reduced risk of new onset of diabetes. 

During the 705,869 person years of follow-up, 3,491 women developed type 2 diabetes. They found that resistance exercise and lower intensity muscular conditioning exercises were both independently associated with a reduced risk for diabetes, even after adjusting for aerobic activity and many other potential confounding factors. Women who engaged in at least 150 min/week of aerobic activity and at least 60 min/week of muscle-strengthening activities had the most substantial risk reduction compared with inactive women (pooled RR = 0.33 [95% CI 0.29-0.38]). Limitations to the study were that physical activity was self-reported by questionnaire, and the study population consisted of nurses with mostly European ancestry.

The authors state, "The findings from our study...suggest that incorporating muscle-strengthening and conditioning activities with aerobic activity according to the current recommendation for physical activity provides substantial benefit for [diabetes] prevention in women." While women who followed current recommendations for both muscle-strengthening and aerobic activity had a substantially reduced risk of diabetes, even those who engaged in muscle-strengthening and aerobic activity at levels lower than currently recommended had a reduced risk of developing diabetes.

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The Importance Of Regular Screening For Cervical Cancer

The American Cancer Society states that cervical cancer used to be the leading cause of cancer death for women in the US. But because more women are undergoing screening for the disease, the number of deaths from the condition have decreased significantly over the past 40 years.

However, it is estimated that 12,340 new cases of cervical cancerwere diagnosed in the US last year and 4,030 deaths occurred as a result of the disease, suggesting that there is still more that can be done to combat the cancer.

In line with Cervical Health Awareness Month, we highlight the signs and symptoms women need to look out for when it comes to cervical cancer, the importance of screening and what more can be done to increase awareness of the disease.

What is cervical cancer?

Cervical cancer forms in the tissues of the cervix - the organ that connects the uterus and the vagina.

There are two forms of cervical cancer. The first is squamous cell cervical cancer. This is cancer on the outer surface of the ectocervix - the area of the cervix that projects into the vagina.

The other form of cervical cancer is called adenocarcinoma of the cervix. This is cancer of the endocervix - the inner area of the cervix.

According to the American Cancer Society, cervical cancer is most common in women under the age of 50, and it rarely occurs in women under the age of 20.

The risks for cervical cancer

Cervical cancer is most common in women between the ages of 21 and 50.

The National Institutes of Health states that almost all cases of cervical cancer are caused by certain types of human papilliomavirus (HPV).

There are over 100 types of HPV, and around 40 of these can be sexually transmitted. Of these, approximately 15 are thought to be cancer-causing viruses, with two types - HPV-16 and HPV-18 - being responsible for around 70% of cervical cancer cases globally.

Studies have shown that other risk factors for cervical cancer include a family history of the disease, smoking, a weakened immune system and long-term mental stress.

Research has also shown that taking contraceptive pills can increase a woman's risk of cervical cancer.

Ignoring the signs

In the past, health professionals have referred to cervical cancer as the "silent killer." Spotting cervical cancer in its early stages can prove difficult, as early forms of the disease do not usually present symptoms.

It is not until the cancer becomes invasive that symptoms occur, such as abnormal bleeding after sexual intercourse, during menopause or between periods, heavy or prolonged periods, unusual discharge and/or pain during sex.

Given the absence or subtleness of early symptoms of the disease, it is a concern that some women may not realize they have it, and some may even ignore the signs or confuse them with symptoms of other conditions.

Debbie Saslow, director of breast and cervical cancer at the American Cancer Society, told Medical News Today:

"Bleeding and pain are symptoms that women sometimes do ignore, but women also identified abnormal bleeding as the most likely symptom to be associated with cancer.

There are also a range of reasons that people ignore symptoms - one major explanation is denial. Other reasons can be related to culture. For example, some cultures are very fatalistic and believe that if you have cancer, there is nothing you can do about it so there's no reason to see a doctor."

The importance of screening

The fact that cervical cancer rarely presents any symptoms in its early stages highlights the importance of regular screening for the disease.

There are two main screening methods for cervical cancer. The first is liquid-based cytology (LBC).

This involves the doctor or nurse scraping the cervix with a small brush to collect cells. The head of this brush is then detached and preserved in liquid, before being sent to a laboratory to be analyzed for cell abnormalities.

During a Pap test, cells are collected from a patient's cervix and sent to a lab to be tested for abnormalities, from which cancerous cells (pictured) may be detected.

The second screening method is the Papanicolaou (Pap) test, also referred to as a cervical smear test.

This involves a doctor or nurse scraping the outer opening of the patient's cervix in order to collect a sample of cells. These cells are then analyzed under a microscope for any abnormalities.

Current recommendations from the US Preventive Services Task Force (UPSTF), which were updated in March 2012, state that women aged between 21 and 65 years should undergo a Pap test every 3 years.

Women aged between 30 and 65 years can choose to have the Pap test every 3 years, or the Pap test and an HPV test (carried out the same way as a Pap test) every 5 years.

Due to increased usage of the Pap test, the American Cancer Society states that between 1955 and 1992, the death rate as a result of cervical cancer reduced by almost 70% - meaning the screening may have saved hundreds of thousands of lives.

Saslow explained that in most areas of the US, cervical cancer screening rates are very high - at over 80%. But she notes that in some places, screening rates are very low and so there should be focus on increasing awareness in these areas.

She told Medical News Today:

"Awareness efforts should include education about what the Pap test and HPV test is. While many women get screened regularly, a good many of these women do not know what the test is for.

Women often do not know the difference between a pelvic exam and a Pap test, and often think that Pap tests look for sexually transmitted diseases and/or ovarian cancer. Awareness about HPV tests is much lower than for Pap tests, since the latter have been in use for many more decades."

Too many 'unnecessary' screenings

However, Saslow noted that in some areas of the US, women are getting screened too often - an issue that has caused debate in the past.

Last year, Medical News Today reported that research from the Centers for Disease Control and Prevention (CDC) revealed that Pap tests are frequently wasted on women who do not need to undergo screening for cervical cancer.

In 2012, the US Preventive Services Task Force (UPSTF) updated their screening recommendations based on "sufficient evidence" suggesting that cervical cancer screening does not reduce the incidence of the disease in certain groups of women.

The updated guidelines recommend against cervical cancer screening for women under the age of 21, women over the age of 65 who have had adequate prior screening and who are not at high risk for the disease, and women who have had a hysterectomy with removal of the cervix and have no history of a precancerous lesion or cervical cancer.

A spokesperson for the National Cervical Cancer Coalition (NCCC) supports the UPSTF recommendations.

They told Medical News Today:

"There is a worry that perhaps by screening women under age 21, and by screening women more often than every few years, we expose them to expense, inconvenience and unnecessary follow-up procedures with no real benefit. Cervical cancer typically takes many years to develop, so the longer screening intervals make sense."

Saslow noted that although health professionals should inform patients of the benefits of cervical cancer screening, they need to shift their focus onto screening women who are at high risk for the disease.

"Their efforts should focus on less screening of the overscreened, explaining why they don't need to be screened, and more screening of women who have not been screened in the past or who have not been screened recently," Saslow explained.

Experts say health professionals should better discuss cervical cancer screening with their female patients, focusing on women who are at higher risk for the disease.

A spokesperson for the NCCC said that there should also be more discussion surrounding HPV infections and the HPV vaccination, considering the virus is the leading cause of cervical cancer.

"The fact is virtually everyone who has sex will at some point have an HPV infection, and doing so is normal. Most HPV infections are harmless and the immune system clears them up OK, but it's not always so simple, of course," they said.

"Health professionals can do a tremendous service by counseling their patients about the near-universal nature of HPV, that cervical cancer is largely preventable and that regular screening as appropriate is the key."

Current guidelines for the HPV vaccination state that the vaccine should be administered for girls in a series of three shots at age 11 or 12, or for girls aged 13 to 26 who have not yet been vaccinated.

Potential for better detection

Although it is clear that current cervical cancer screening methods have dramatically reduced death rates from the disease over the years, researchers are always on the hunt for better methods to detect the cancer.

Last year, Medical News Today reported on a study from researchers in India suggesting that a vinegar test may be a cheap and effective way of detecting cervical cancer.

The test would involve swabbing the cervix with vinegar, which causes precancerous cells to turn white - a result that can be seen in a matter of minutes.

The study authors estimated that this test could prevent 72,600 deaths from cervical cancer worldwide.

But for now, according to the CDC:

"The most important thing you can do to help prevent cervical cancer is to have regular screening tests starting at age 21."

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Study Reaffirms That Diet And Exercise Lowers Cancer Risk In Postmenopausal Women

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In a large study of women's health, postmenopausal women who followed a healthy lifestyle were at a third lower risk of death, including a 20% smaller chance of dying from cancer, than women who did not follow guidance on diet, weight, physical activity, and alcohol intake.

"While it is well recognized that tobacco cessation is the lead behavioral change to reduce cancer risk," the authors write, they analyzed the effect of other cancer prevention recommendations.

The researchers used data gathered by the observational study in the women's health initiative of the US National Institutes of Health, which was launched in 1992 with a $140 million, 15-year contract: "the largest coordinated study of women's health ever undertaken."

Cynthia Thomson PhD and her colleagues analyzed data from 65,838 postmenopausal women age between 50 and 79 years.

The participants were enrolled in the women's health initiative between 1993 and 1998 at 40 clinical centers across the country, and the team's analysis represents the "largest study of postmenopausal women in the US."

Those women who adhered most to lifestyle recommendations had a 22% lower risk for breast cancer and a 52% lower risk for colorectal cancer, compared with women who did not closely follow guidance.

The recommendations being followed were the American Cancer Society (ACS) guidelines on nutrition and physical activity, which have four central planks:

1. "Achieve and maintain a healthy weight throughout life"
2. "Be physically active"
3. "Eat a healthy diet, with an emphasis on plant foods"
4. "If you drink alcohol, limit your intake."

Dr. Thomson, professor of public health at the Mel and Enid Zuckerman College of Public Health at the University of Arizona in Tucson, says:

"The message is simple and clear: If you want to reduce your risk for cancer, even later in life, eat a healthy diet, be active daily, avoid or limit alcohol, and don't smoke."

"Our results support the ACS guidelines for cancer prevention," Thomson adds, but she calls for more support for other factors that can reduce the risks further, "because diet and activity alone do not account for the majority of risk."

Ratings for women's response to advice

The researchers scored women's adherence to the lifestyle advice on cancer prevention. Zeroes were given for "behaviors least consistent with the recommendations" and scores of one or two were given for healthy lifestyle actions, adding these up to a maximum level of compliance represented by a total score of eight. Most of the women in the study had final scores between three and six. Fewer than 1% of the women scored eight after following all of the recommended lifestyle choices.

Analysis of almost 9,000 cancers

Data on the women were collected over an average of 8.3 years, a period that witnessed the diagnosis of 8,632 cancers and 2,356 cancer-related deaths.

The women whose lifestyles were rated the healthiest (a score of seven or eight) showed a lower risk of overall cancer compared with those given low scores (from zero to two).

This included a reduction by a fifth in their risk for breast cancer, and by half for colorectal cancer.

The healthier lifestyles were also associated with a lower risk of death from other causes not related to cancer. The authors note that guidelines for healthy lifestyle in the prevention of cancer have been based on evidence from few such prospectively identified associations.

The researchers' conclusions are drawn from the women's health initiative, which was a study designed at the outset to track future health changes over time. Such prospective studies result in comparisons that are controlled and more reliable than can be drawn retrospectively, by looking back on data that was not collected for the purpose.

Lifestyle effect was greater in some groups of women

The analysis found an even lower incidence of cancers and lower overall death rate among women from certain ethnic groups as a result of the lifestyle measures, and the paper calls for more research into this difference.

Dr. Thomson says:

"We found that the association was stronger for Asian, African-American, and Hispanic women, compared with non-Hispanic white women.

It is possible that different ethnic groups may have differential disease course with varied response to environmental and/or behavioral exposures."

Other research into lifestyle changes

The cancer-protective effect of exercise was the subject of other recent research, published in October 2013, which found that postmenopausal women could derive benefit from relatively modest activity, with walking tied to lower risk for breast cancer.

For women who already have cancer, exercise may have other benefits - older breast cancer survivors benefit from exercise programs, concluded research published on December 9, 2013.

Meanwhile, with respect for dietary lifestyle choices, news regularly appears of research into nutrition and cancer prevention.

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Higher Mortality Linked To RA, Antibodies In Postmenopausal Women

Dr. Enrique Jacome

Mortality rates are two times higher in postmenopausal women with rheumatoid arthritis and anti-cyclic citrullinated peptide antibodies, researchers from the University of Pittsburgh claim. According to the Centers for Disease Control and Prevention (CDC), rheumatoid arthritis (RA) is a systemic inflammatory disease that affects the joints in the body.

The organization also states that patients with RA have a shortened life expectancy and are more susceptible to cardiovascular diseases than healthy individuals. Publishing their results in Arthritis & Rheumatism, the researchers note that rheumatoid arthritis affects 1.3 million adult Americans, with 75% of these being women.

The synovial membrane, which lines the joints, becomes inflamed, which in turn can lead to the cartilage and bone eroding or deforming the joint. Although the exact causes remain unknown, RA is believed to result from a faulty immune response. Typically, the onset of the disease is highest among people in their 60s.

The progress of the disease varies from person to person. Some people may experience "flares" when their symptoms worsen, followed by periods of remission. The more severe form of the disease is active all the time and causes serious joint damage and disability.

Current treatment programs focus on relieving pain and reducing inflammation. This may be achieved through lifestyle changes, medications or surgery.

Selecting participants from the Women's Health Initiative

For this study, doctors from the University of Pittsburgh measured anti-cyclic citrullinated peptide (anti-CCP) antibodies, antinuclear antibodies (ANA) and rheumatoid factor in almost 10,000 women who had reported suffering from RA as part of the Women's Health Initiative.

This is a set of clinical trials and observational studies designed to address the most common causes of death among postmenopausal women. The study participants had a mean age of 64 and the ethnic mix was 65% white, 25% black and 10% Hispanic. The researchers followed them for 10 years.

The results showed that anti-CCP antibodies were prevalent in 8.1% of the women - and 58% of these women reported using disease modifying anti-rheumatic drugs (DMARD). Only 7.3% of the remaining women with negative anti-CCP were using DMARD.

Over the course of the study, 13% of the women died.

Further analysis of the collected data revealed that cardiovascular disease, including stroke and coronary heart disease, and cancer were the main causes of death.

The researchers also found that women with positive anti-CCP faced a significantly higher mortality rate that was independent of DMARD use and modifiable risk factors, such as obesity or smoking.

Dr. Lewis Kuller, one of the study leaders, says:

"Our study is the first large longitudinal study to evaluate anti-CCP, RF, risk factors and mortality. Further investigation to determine specific causes of excess mortality, particularly among RA patients with positive anti-CCP, are needed."

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