SIDS Risk : Smoking!

Smoking While Pregnant Sends SIDS Risk Soaring

Smoking during pregnancy is never a good idea, but new research shows it might double the risk of a baby dying from sudden infant death syndrome(SIDS).

“Any maternal smoking during pregnancy — even just one cigarette a day — doubles the risk of sudden unexpected infant death [SID, another term for unexplained infant deaths],” said lead researcher Tatiana Anderson. She is a fellow at Seattle Children’s Research Institute, Center for Integrative Brain Research.

Doctors should strongly encourage women to give up smoking during pregnancy, or if they can’t quit, to smoke less, she said. Each cigarette smoked increases the risk of SIDS, Anderson added.

If women didn’t smoke during pregnancy, the rate of SIDS in the United States could be cut by 22 percent, preventing some 800 infant deaths a year, according to the new report published online March 11 in the journal Pediatrics.

Although 55 percent of the women in the study who smoked didn’t stop or cut back during pregnancy, those who did markedly reduced the risk of SIDS, Anderson said.

Specifically, women who cut down on their smoking by the third trimester reduced the risk of SIDS by 12 percent. Women who quit by the third trimester reduced the risk by 23 percent, the researchers found.

For the study, Anderson and her colleagues collected data on more than 19,000 SID cases. SID cases include sudden infant death syndrome and other unknown causes of death, as well as suffocation and strangulation in bed of infants under age 1.

It’s not just smoking, said Dr. Rahul Gupta, chief medical and health officer at the March of Dimes. But the more women smoke, the greater the risk for SID becomes, he said.

Women should stop smoking before pregnancy and certainly during pregnancy, Gupta advised.

Smoking during pregnancy can impair the baby’s brain development. In addition, women who smoke are depriving their baby of oxygen, as smoking decreases the amount of oxygen in the blood and, therefore, in the placenta, he explained.

“Smoking also causes preterm birth, decreases in development of the brain and respiratory system of the baby,” Gupta said. “Nicotine has also been linked with an important part of the development of the brainstem in the infant.”

Gupta explained that if an infant stops breathing during sleep, a mechanism in the brain senses the lack of oxygen and triggers breathing to start. This is called auto-resuscitation.

Nicotine, however, alters this response, he said. “That baby may not be able to auto-resuscitate, and as a result, we end up with sudden infant death syndrome,” Gupta said.

Because e-cigarettes are a nicotine delivery device, they are not a safe alternative to cigarettes, he added.

“Nicotine is in the vaping device, so all the impacts we are talking about are still harmful when nicotine is delivered, regardless of the device,” Gupta said. “Nicotine and babies do not match.”

In addition, flavorings and other ingredients in e-cigarettes may be harmful to developing babies, he noted.

“Quitting smoking is one of the most effective actions you can take to protect yourself and your baby,” Gupta said.

 

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Dr P Carrothers

Dr  Rahul Gupta

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Household Chemicals Harm Sperm in Both Men and Dogs

Common Household Chemicals Harm Sperm in Both Men and Dogs

Two chemicals found in household products and food could harm male fertility in both dogs and people, U.K. researchers say.

The chemicals are the plasticizer DEHP — used in products such as carpets, flooring, upholstery, clothes, wires and toys — and the industrial chemical polychlorinated biphenyl 153 (PCB153). Even though it is banned worldwide, PCB153 is still widely present in the environment, including food.

For this study, researchers from the University of Nottingham conducted laboratory tests with sperm from men and dogs. Their tests revealed that levels of the two chemicals consistent with environmental exposure had the same damaging effects on sperm in both species — reduced sperm motility and increased fragmentation of DNA.

Previous studies have reported a 50 percent decline in human sperm quality worldwide in the past 80 years. Another study by the same U.K. team found a similar decline in domestic dogs, pointing to the possibility that chemicals present in the home could be a factor.

“This new study supports our theory that the domestic dog is indeed a ‘sentinel’ or mirror for human male reproductive decline, and our findings suggest that man-made chemicals that have been widely used in the home and working environment may be responsible for the fall in sperm quality reported in both man and dog that share the same environment,” study leader Richard Lea said in a university news release.

Lea is an associate professor and reader in reproductive biology at Nottingham’s School of Veterinary Medicine and Science.

“Our previous study in dogs showed that the chemical pollutants found in the sperm of adult dogs, and in some pet foods, had a detrimental effect on sperm function at the concentrations previously found in the male reproductive tract,” he said.

Lea added that the new study is the first to test the effect of DEHP and PCB153 on both dog and human sperm in the lab, in the same concentrations found in real life.

Gary England is dean of the university’s School of Veterinary Medicine and Science.

“Since environmental pollutants largely reflect a Western way of life such as the effects of industry, the chemicals present in the environment are likely to depend on the location,” he said in the news release. “An important area of future study is to determine how the region in which we live may effect sperm quality in both man and dog.”

 

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Diabetes Drugs and Flesh Eating Infection

Newer Diabetes Drugs Linked to ‘Flesh-Eating’ Genital Infection

 

Say you have type 2 diabetes and you are taking a newer class of medications to treat your disease — but one day you notice pain, redness and a foul odor in your genital area.

If this happens, new research suggests you need to see your doctor immediately, because you may be suffering from Fournier gangrene. Also known as a “flesh-eating” disease, this infection attacks your genital or anal region and can quickly kill tissue as it spreads rapidly.

Unfortunately, it has become a rare but still possible safety concern for people taking diabetes medications known as SGLT2 inhibitors, according to U.S. Food and Drug Administration scientists.

SGLT2 inhibitors are a newer class of diabetes medications, introduced in 2013. Drugs in this class include canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance).

Fournier gangrene occurred in 55 people taking these drugs between March 2013 and January 2019. For comparison, the researchers looked for cases of Fournier gangrene in people taking other diabetes medications from 1984 to 2019. They found only 19 such cases.

Still, the risk for Fournier gangrene remains very low, the researchers stressed.

“In 2017, an estimated 1.7 million patients received a dispensed prescription for an SGLT2 inhibitor,” said study author Dr. Susan Bersoff-Matcha, a medical officer in the FDA’s Center for Drug Evaluation and Research. So, “Fournier gangrene is a rare event,” she said. “While our study shows an association between treatment with SGLT2 inhibitors and Fournier gangrene, we don’t know exactly what the risk is, or if Fournier gangrene can be predicted.”

Broad-spectrum antibiotics and surgery to remove the dead tissue are treatment options, the researchers said.

SGLT2 inhibitors work in the kidneys, allowing excess blood sugar to be removed in the urine, they said.

In addition to lowering blood sugar levels, the drugs may also reduce the risk of heart disease and stroke in some people with type 2 diabetes.

But possible side effects include urinary tract infections and genital infections, such as yeast infections. Kidney problems can also be a concern with this class of medications.

All of the patients with Fournier gangrene identified in this study needed to be hospitalized. Some had several surgeries. Three of the 55 people died from Fournier gangrene.

The average age of the people with Fournier gangrene was 56. Thirty-nine were men. Forty-one cases occurred in the United States. Thirty-one of the 55 cases identified were also taking an additional diabetes medication.

Of those with Fournier gangrene, 21 were using canagliflozin, 16 were using dapagliflozin and 18 were taking empagliflozin, the study said.

Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York City, said that while the study was well-done, it cannot prove a cause-and-effect link between the drugs and the disease.

“Infections of the pubic and rectal area are quite common in people with diabetes, they don’t have Fournier’s. Fournier’s is a very aggressive, but extremely rare, disease,” said Zonszein, who wasn’t involved with the study.

When Fournier gangrene does occur, it’s hard to know if it is caused by a medication. He pointed out that a number of clinical trials have been done on SGLT2 inhibitors that have included tens of thousands of people, and there haven’t been any reports of Fournier gangrene.

“I counsel my patients about infections in the genitalia. The main concern is to be aware that they can occur. And, providers need to be more aware of Fournier’s. They have to immediately try to establish the cause of infection and aggressively treat it if they suspect Fournier gangrene,” Zonszein said.

He said a far bigger concern is uncontrolled diabetes and the risk of complications when blood sugar levels aren’t controlled. “The benefits of these medications outweigh the risks,” he said.

In a statement, Boehringer Ingelheim, the company that makes Jardiance (empagliflozin), said the company actively monitors for side effects related to their medications.

“We remain confident in the positive benefit-risk profile of empagliflozin, and empagliflozin-containing products, as outlined in the prescribing information,” the statement from Boehringer Ingelheim said.

The prescribing information of all SGLT2’s was recently changed to reflect the possible risk of Fournier gangrene, as directed by the FDA.

Janssen Pharmaceuticals, maker of Invokana (canagliflozin), and AstraZeneca, maker of Farxiga (dapagliflozin), did not respond to requests for comment.

 

 

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