Predicting Preeclam sia Risk: Studv Identifies Ad f itional Risk‘ Factors

aving high blood pressure for H at least four years before get- ting pregnant increases a woman’s chances of developing the danger- ous condition preeclampsia, accord- ing to a study published in the September 3rd issue of the New England /ournal of Medicine.

The study, which looked at 763 women with chronic hypertension, also determined that protein in the urine very early in pregnancy increases the risk of such adverse outcomes as giving birth premature- ly, having a child who is small for gestational age, or having an infant who would need to be admitted to the newborn intensive care unit.

Preeclampsia is the leading cause of maternal death in the U.S. and is particularly troubling because it can strike without warning. The condi- tion results in high blood pressure

and protein in the urine. In turn, preeclampsia may progress to eclampsia-hypertension and gener- alized convulsions-which may prove fatal.

Preeclampsia develops in approximately 5 percent of first- time mothers and up to two percent of mothers with subsequent preg- nancies. However, even in cases were the condition doesn’t progress to eclampsia, children born.to mothers with preeclampsia may be small for their gestational age or may be born prematurely, both fac- tors that may place infants at risk for a variety of other complications. Although the high blood pressure accompanying preeclampsia can be treated with blood pressure-lower- ing drugs, the only curative treat- ment for the overall condition is immediate delivery.

The researchers also determined that women with preeclampsia were also at higher risk for development of abruptio placentae (detachment of the placenta from the uterine wall, a potentially serious complica- tion of pregnancy). In addition, infants born to women with preeclampsia were also more likely to be delivered prematurely, to require admission to a neonatal intensive care unit, to hemorrhage while in the womb, and to die short- ly before, during, or after birth.

Although having protein in the urine at the beginning of the study didn’t increase a woman’s chances for preeclampsia to develop, women who had protein in their urine early in pregnancy were more likely to have infants who were small for their gestational age, born prema- turely, require admission to a neona-’ tal intensive care unit, and have an intraventricular hemorrhage.

The researchers originally col- lected the information on the women as part of a study to deter- mine whether lowdose aspirin would reduce the incidence of hypertension in women at risk for the condition. Overall, the aspirin treatment didn’t appear to affect whether the preeclampsia devel- oped: preeclampsia developed in 26 percent of the women taking aspirin and in 24.6 percent of the women taking the placebo.

Mothers’ Lifetime Lead Exposure May Put Newborns at Risk

esults from a study conducted R jointly by U.S. and Australian scientists indicate that lead that has accumulated in a woman’s bones from earlier exposures can be released during pregnancy and transferred to breast milk during lactation. This can translate into increased exposure for breast-fed infants whose mothers have a long- term history of lead exposure.

The report was published in October 1998 in the online ver- sion of Environmental Health Perspectiues, the monthly journal of the National Institute of

(continued on page 15)

December 1998 AWWOMM L i f o l i n o s 13

Breast Cancer Overviau The National Institutes of Health recently released the following statistics and accomplishments in the war against breast cancer: .Breast cancer incidence among women increased 1.8

percent per year from 1973 to 1990, but remained level from 1990 to 1995

.An estimated 178,700 American women will receive a diagnosis of breast cancer during 1998

.Breast cancer death rates dropped 1.9 percent per year from 1990 to 1995 in white and Hispanic women

.Approximately 43,500 American women will die of breast cancer this year

Recent Advances .Mastectomy has been replaced by less radical surgery

for many women with early stage breast cancer .Chemotherapy or hormonal therapy, in addition to

surgery, has improved overall survival for many patients with breast cancer

.For early stage disease. studies have shown that long- term survival after lumpectomy plus radiation therapy is similar to survival after modified radical mastectomy

.Improved mammography screening and imaging tech- nologies, such as ultrasound and computed tomography. are now used during diagnosis, sparing some women surgical biopsies

.Scientists have found that alterations in two important genes, BRCA1 and BRCA2, are associated with most inherited breast cancers

.The first genetically engineered antibody therapy for advanced breast cancer, Herceptin (trastuzumab), has been approved by the Food and Drug Administration (FDA)

.Tamoxifen, taken for five years, has been shown to reduce the risk of recurrence of breast cancer

.The Breast Cancer Prevention Trial, a study of the use of tamoxifen as a breast cancer prevention agent, has been shown to reduce the incidence of breast cancer by 49 percent in women at high risk for the disease. On September 2, 1998, the FDA's Oncologic Drug Advisory Committee recommended approving tamoxifen for reduction of breast cancer risk in high-risk women.

Ongoing Research .Molecular markers are being developed to detect signs

of breast cancer in blood, urine, or nipple fluid .Unique, identifiable characteristics of a particular cancer

will make it easier to choose appropriate treatments and predict the outcome

.National Cancer Institute (NCIksponsored trials with Herceptin are now under way in breast and ovarian can- cer and other solid tumors

.Additional studies are planned to test the new drug in other types of cancer and in combination with other agents

.A largescale study is set to begin in early 1999 to c o n pare five years of tamoxifen with five years of raloxifene treatment for the prevention of invasive breast cancer in high-risk women

participate in the study of 22,000 postmenopausal .Nearly 200 institutions across the U.S. are expected to

women older than 35 years of age. The study is known by the acronym STAR (study of tamoxifen and raloxifene)

UNCI is comparing high-dose chemotherapy with autolo- gous bone marrow or stem-cell transplants with standard therapy to determine whether its effectiveness in treat- ing breast cancer

WNCI is funding a study, known as the Triana Community Health Initiative. to look at the possible relation between exposure to the pesticide DDT and risk for breast cancer and non-cancerous breast conditions among heavily exposed women in Triana. AL.

mNCI has established the Cancer Genetics Network, a national network of centers specializing in the study of inherited predisposition to cancer, including breast can- cer. The network will support collaborative investigations into the genetic basis of cancer susceptibility, explore mechanisms to integrate this new knowledge into med- ical practice. and identify means of addressing the asso- ciated psychosocial. ethical, legal, and public health issues. The network will also facilitate the exchange of information on cancer genetics and research resources and provide broad access to information about genetics services and educational materials

Breast Cancer Studies to collect family history information, epidemiologic and clinical data, and biological specimens from individuals at high, intermediate, and low risk for breast cancer and their families. A long-term objective of the Registry is to prevent or delay breast cancer develop- ment in genetically susceptible people through increased knowledge about the genetic and lifestyle factors modulat- ing cancer susceptibility and understanding of their interac- tions. A second objective is to identify an "at-risk" popula- tion that could benefit from novel treatment strategies

.In mammography research, NCI is funding studies to reduce the already low-radiation dosage in mammograms, enhance image quality, and develop and evaluate digital mammography as an improvement over conventional, film-based techniques. In addition, NCI is funding studies on computer-assisted interpretation of digitized images and on enabling long-distance image transmission tech- nology, or teleradiology, for clinical consultations. NCI also funds research on other imaging technologies such as magnetic resonance imaging (MRI) and breast-specific positron emission tomography (PET) to detect the disease

MNCI is organizing a multicenter t r i l of sentinel node biopsy, a surgical technique in which only one or a few underarm lymph nodes are removed during mastectomy or lumpecto- my. The t r i l will determine whether the technique is as safe and effective as more extensive lymph node removal, which is now standard. Approximately 2 million American women are survivors of breast cancer. New studies seek to understand the physical, social, and emotional issues cot+ fronting these women. That understanding will help deveC op counseling and education networks.

Additionally, a new Web site at the NCI helps women consider whether to enter a clinical trial for the treatment of their cancer. Launched in May 1998, the Web site quick- ly helps m e n and their doctors sort through the hun- dreds of research studies under way on breast cancer to find those of interest to them. The Web site address is http://cancertriak.nci.nih.gov

Source: National Institutes of Health

.NCI has established a Cooperative Family Registry for

14 A W N 0 1 1 L l f o l l n o a Volume 2. Issue 6

(continued h r n page 13)

Environmental Health Sciences (NIEHS). The study was co-fund- ed by NIEHS and the National Institutes of Health’s Office of Research on Minority Health.

The researchers were quick to point out that breastfeeding is still an important option for healthy mothers, and pointed out that “breast-fed infants are only at risk if the mother has been previously exposed to high concentrations of lead from external sources such as leaded paint, pottery, or, in many other countries, industrial sources and leaded gasoline.”

shown that as much as’40 to 70 Earlier data from this study had

percent of the blood lead in preg- nant women can come from lead that has accumulated in the bones. Because the study participants’ blood lead concentrations were rel- atively low-most had values less than 5 mcg of lead per deciliter of blood-the lead concentrations in their breast milk were also low: 0.7 parts per billion on average. These concentrations weren’t significantly different from those found in vari- ous kinds of infant formula.

Despite the low concentrations, the researchers found a strong cor- relation between the amount of lead in the mothers’ milk samples and the corresponding blood lead levels on the infants. In fact, calcu- lations based on the first 60 to 90

Is Ultra-Low-Fat Risly? hile cutting back on overall fat is a healthy way to reduce heart W disease, cutting too much fat out of a diet may be risky, accord-

ing to a recent report published in Circulation, the journal of the American Heart Association (AHA).

Dr. Linda Van Horn, co-author of the report, said researchers don’t have enough data to way whether ultra-low-fat diets are generally bet- ter at fighting heart disease, and until new research is conducted, her team is standing by the AHA recommendation that less than 30 per- cent of a person’s overal} daily calories should come from fat sources.

The average U.S. diot now contains 34 percent of its calories from fat- which translates to approximately 67 g of fat daily in an overall 2,000 calories. But ultra-low-fat diet crusader and heart researcher Dr. Dean Ornish is still standing behind his long-time belief that fat shouldn’t make up more than 10 percent of overall daily calories. “By changing lifestyle and diet, most people can avoid heart disease,” Ornish, who is president of the Preventive Medicine Research Institute of California, said. “It’s most unfortunate that Americans may get the idea that further reducing dietary fat beyond the AHA recommendations has no value.”

days postpartum indicated that 36 to 80 percent of the infants’ total blood lead was coming from breast milk or formula.

The researchers also found a sta- tistical link between the lead con- centration in the maternal cord blood and lead levels in the first breast milk samples. The study also produced preliminary evidence that suggested calcium supplementation can have a protective effect by slowing the release of lead from skeletal stores. The Australian researchers are planning additional studies to determine calcium’s effec- tiveness in pregnant and nursing mothers. Watch this column for fur- ther updates.

Folic Acid Tbk Force Or@zd

o get more American women T to consume the B vitamin folic acid every day and to reduce the number of birth defects in babies, 15 leading health care organiza- tions in the U.S., including AWHONN, the March of Dimes, the Centers for Disease Control and Prevention, and the Spina Bifida Association of America, have committed to educating women and their families about the impor- tance of daily folic acid intake.

To help prevent neural tube defects, all women capable of hav- ing a baby should consume 400 mcg of folic acid daily, beginning before pregnancy. Good sources of folic acid include a daily multivita- min supplement, enriched grain products (such as bread and pasta), and fortified breakfast cereals.

the most serious and common birth defects in the U.S. Each year, an estimated 2,500 babies are born with these defects, and many addi- tional affected pregnancies result in miscarriage or stillbirth. The most common neural tube defect is spina bifida, a leading cause of child- hood paralysis. For more informa- tion on the task force, surf to the March of Dimes WWW page (http://www.modimes.org).

Neural tube defects are among

Compiled and d i e d by Carolyn Davis Cockey

December 1998 A W H O N N L i f e l i n e s 16