UNSW Embryology

Womens Health Issues

© Dr Mark Hill (2008)

Acknowledgements

Introduction

Given the obvious importance of maternal health to embryonic development, this topic should have extensive research data and published resources, but other than some specific health issues it is not extensively covered either here or in the literature. The recent development of the embryonic origins hypothesis also suggests that we should be focussing more on maternal health during pregnancy and, in a circular type of argument, this may also influence the female newborn's future health prospects.

Where you are in the world? Just as poor maternal nutrition (including iodine, folate) is a critical issue in developing countries, a growing problem in developed countries is the increase in obesity in general, and its impact on maternal health. (More? see Bookshelf)

The first resource are materials within the UNSW Embryology site, including links to Menstral cycle.

The second resource are internet links to the Merck Manual, Home Edition (chapter 22) freely available on the WWW. These links relate to womens health issues, in particular those related to the reproductive cycle and childbirth. Please note that this section of notes use specific Medical anatomical terms that may not be suitable for children.

The third resource is from the Centre for Disease Control (USA) which provides information and statistics on reproductive health in men and women, child health, and reproductive technologies. Many of the links and documents are external and will require WWW access and the Acrobat PDF plugin or viewer.

Finally, look at a recent Science Magazine Special Issue: Women's Health where they have published a collection of articles online that focus specifically on issues of women's health, including Endometriosis, Preeclampsia, Cardiovascular diseases and clinical trials data. (Science 10 Jun 2005)

Some Recent Findings

Cervical Cancer Vaccination Vaccination for human papillomavirus (HPV) Types 6, 11, 16, and 18,; the Types 16 and 18 cause 70% of cervical cancer cases, and HPV Types 6 and 11 cause 90% of genital warts cases. "...the vaccine Gardasil will be available for a nationwide vaccination campaign commencing next year. There are three elements to the proposal. There will be an annual school vaccination program commencing, we hope, depending on the measure of co-operation by the states, in about April of next year for girls 12 to 13 years. There will be a catch-up program for girls between 13 and 18 years through the schools and for women 18 to 26 the vaccine will be available for two years through general practitioners. Joint Press Conference - Prime Minister and Minister for Health and Ageing 29 November 2006 (More? Human Papillomavirus)

UNSW Embryology Resources

Human Menstrual Cycle - describes the regular changes that occur in females as part of the reproductive cycle. Includes links to womens healt issues including Pap Smear, Endometriosis, Menopause and birth control.

Abnormal Development - Maternal Factors - describes issues that effect embryonic development that are not congenital but usually due to maternal factors.

Abnormal Development - Fetal Origins Hypothesis - research describing in utero environment having an impact on later health outcomes.

Human Papillomavirus (HPV)

Cervical Cancer Vaccination

Cervical cancer (Image: CDC HPV Brochure)

Human papillomavirus occurs in several types; Types 16 and 18 cause 70% of cervical cancer cases, and Types 6 and 11 cause 90% of genital warts cases. A new vaccine has been recently developed for Types 6, 11, 16, and 18. In Australia (2006) approval was given to add this vaccination to the Australian vaccination program.

"...the vaccine Gardasil will be available for a nationwide (Australia) vaccination campaign commencing next year. There are three elements to the proposal. There will be an annual school vaccination program commencing, we hope, depending on the measure of co-operation by the states, in about April of next year for girls 12 to 13 years. There will be a catch-up program for girls between 13 and 18 years through the schools and for women 18 to 26 the vaccine will be available for two years through general practitioners. Joint Press Conference - Prime Minister and Minister for Health and Ageing 29 November 2006

Search Pubmed: Human Papillomavirus | Papillomavirus vaccination

Merck Manual, Home Edition- Chapter 22

This is a comprehensive online resource covering many aspects of Women's health issues, both pregnant and non-pregnant. (This resource requires an internet connection)

Chapter 22 Women's Health Issues

NCBI Bookshelf

Resources available from online textbooks freely available at National Library of Medicine (USA), National Center for Biotechnology Information.

Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults.

Obesity and Women's Reproductive Health

Centre for Disease Control (USA)

Womens Reproductive Health Hazards

The CDC (USA) provides information and statistics on reproductive health in men and women , as well as information on reproductive technologies. Most documents are available as HTML pages or in PDF format for printing.

Please note that statistical information relates to US Data only. Womens Reproductive Health

Behavioral Risk Factors

Behavioral Risk Factor Surveillance System
- CDC's Behavioral Risk Factor Surveillance System is a unique, state-based surveillance system active in all 50 states. This system is the primary source of state-based information on risk behaviors among adult populations. Since the early 1980s, CDC has worked with the states to develop questions designed to gather information from adults on their knowledge, attitudes, and practices related to issues such as health status and access to care; women's health issues; tobacco and alcohol use; dietary patterns; leisure-time physical activities; injury control; use of preventive services; and HIV/AIDS.
- 1997 BRFSS Summary Prevalence Report (PDF - 473K) This is the 1997 report on selected risk factors and preventive health measures from the core questionnaires as well as optional modules that were used by at least thirteen states. There is also a section dedicated to preventive health measures that concern women.
Cigarette smoking among women of reproductive age
- MMWR November 4, 1994 / Vol. 43 / No. 43. (PDF document)
- Women who smoke cigarettes are at increased risk for lung cancer, chronic obstructive pulmonary disease, and complications of oral contraceptive use. During pregnancy, cigarette smoking increases the risks for a low birthweight infant and infant mortality.
National Campaign on Folic Acid
- Three out of four women don't take a multivitamin&emdash;a simple act that could prevent serious birth defects in 3,000 babies each year. CDC estimates that these birth defects could be prevented if women consumed folic acid before pregnancy and early in pregnancy.
Hysterectomy
- Fact sheet • surveillance • rates • surgical sterilization

Infertility

1999 Survey of Assisted Reproductive Technology: Embryo Laboratory procedures and Practices (January 29, 1999) PDF Version 473KB
1996 Assisted Reproductive Technology Success Rates National Summary and Fertility Clinic Reports
- The 1996 report of pregnancy success rates is the second to be issued. The report includes a national report that uses information from 300 U.S. fertility clinics to provide an indepth national picture of ART; fertility clinic tables that provide ART success rates for each clinic that submitted and verified its1996 data; and an appendix containing a glossary of terms and lists of reporting and nonreporting clinics in the United States.
1995 Assisted Reproductive Technology Success Rates National Summary and Fertility Clinic Report.
- This report gives consumers and potential assisted reproductive technology (ART) users an idea of a woman's average chances of having a pregnancy and a live birth by using ART. The report includes a national summary that uses the information from all reporting fertility clinics to provide an indepth national picture of ART; fertility clinic reports that provide ART success rates for 259 clinics in the United States; and an appendix containing a glossary of terms used in the national and clinic reports.
Pregnancy-related death associated with heparin and aspirin treatment for infertility, 1996.
- In 1998, CDC investigated the death of a pregnant woman who had undergone in-vitro fertilization and aspirin and heparin therapy. Although researchers could not conclude that the woman's death was caused by the therapy, the potential for bleeding associated with aspirin and heparin warrants vigorous scientific investigation and debate before it is recommended for routine use among in-vitro fertilization patients. MMWR Vol. 47, No.18 PDF version

Sexually Transmitted Diseases

1997 Sexually transmitted diseases surveillance report PDF version (2151KB)
- This annual publication is intended as a reference document for policymakers, program managers, health planners, researchers, and others who are concerned with the public health implications of these diseases.
1998 Guidelines for the treatment of sexually transmitted diseases PDF version.
- This report provides guidelines for HIV infection; diseases characterized by genital ulcers, urethritis and cervicitis, vaginal discharge; pelvic inflammatory disease, human papillomavirus infections, and others.

Violence

Key scientific issues for research on violence occurring around the time of pregnancy View PDF (60KB) | HTML

This report summarizes the collective recommendations resulting from a May 1997 CDC meeting on pregnancy-related violence. The overall goal of the May 1997 meeting was to obtain the input of researchers and victim-advocates on key scientific issues related to future research involving violence around the time of pregnancy.

Workplace Hazards

Effects of workplace hazards on female reproductive health View PDF 293KB | HTML
- Some workplace hazards can affect a woman's reproductive health, her ability to become pregnant, or the health of her unborn children. This document answers the following questions: What are reproductive hazards for female workers? How does the female reproductive system work? What reproductive problems might be caused by workplace exposures? How are workers and their babies exposed? How are families exposed? How can exposures be prevented?

CDC Pregnancy Issues

Maternal Health

Impact of multiple births on low birthweight- Massachusetts, 1989-1996 View PDF 240KB | HTML

Massachusetts has the highest multiple-birth rate in the United States. Multiple births are more likely to result in low birthweight (LBW) infants. To determine the effect of changes in the rate of multiple births on LBW rates and to characterize women who have multiple births, the Massachusetts Department of Public Health examined data on births in Massachusetts during 1989-1996. This report summarizes the results of this analysis, which indicate that the increase in LBW rates in Massachusetts was associated with changes in the rate of multiple births, especially among older, better educated women. Source: MMWR April 16, 1999 /Vol. 48 /No.14.

Pregnancy Risk Assessment Monitoring System (PRAMS) View HTML

PRAMS collects state-specific, population-based data on maternal attitudes and experiences prior to, during and immediately following pregnancy.

Diabetes during pregnancy View PDF 335KB | HTML

This report summarizes an analysis of United States birth certificates during 1993-1995 to describe maternal diabetes and associated prenatal care among racial/ethnic groups and updates a previous report. Source: MMWR May 29, 1998/Vol.47/No.20.

Smoking during pregnancy

Mothers who smoked cigarettes during pregnancy, according to mother's detailed race, Hispanic origin, age, and educational attainment: Selected States, 1989-1996 View PDF 63KB
- This table from Health, United States, 1998 provides information on mothers who smoked cigarettes during pregnancy, according to mother's detailed race, Hispanic origin, educational attainment, and age by selected states, 1989-1996.
Smoking during pregnancy, 1990-1996 View PDF 188KB
- This report presents trend data for smoking during pregnancy. Data are presented for various characteristics including age of mother, race and ethnic origin, place of birth of mother, and state of residence. The rate of smoking during pregnancy has declined each year between 1990 and 1996. In 1996 more than 400,000 women reported smoking during their pregnancies (13.6 percent of all births). The rates of smoking during pregnancy for women aged 15-19 years declined between 1990 and 1994 but increased in the last two years, and now they have the highest rates of all age groups. Source: National Vital Statistics Reports Nov. 19, 1998 /Vol.47 /No. 10.
Medical-care expenditures attributable to cigarette smoking during pregnancy View PDF 267KB | HTML
- To derive 1995 estimates of the smoking-attributable costs for direct medical expenditures (i.e., inpatient, physician, hospital outpatient, and emergency department costs) related to pregnancy outcomes, the University of California at Berkeley and CDC analyzed data from the 1987 National Medical Expenditures Survey (NMES-2). This report summarizes the findings, which indicate substantial smoking-attributable direct medical expenditures for pregnant women and newborns. Source: MMWR November 7, 1997/Vol.46/No.44.
Prenatal smoking cessation database View HTML
- Information from The Combined Health Information Database (CHID) includes journal articles, monographs, technical reports, proceedings, papers, policy documents, legislation, unpublished documents, curricular materials, and descriptions of prenatal smoking cessation programs and risk reduction interventions.

Knowledge and use of folic acid by women of childbearing age-United States, 1997 View PDF 211KB

This report summarizes findings from a survey conducted during January and February 1997 that indicate modest increases since 1995 in knowledge about and consumption of folic acid among U.S. women aged 18-45 years and highlights the need for additional public health efforts to take full advantage of this prevention opportunity. Source: MMWR August 8, 1997 /Vol.46 /No.31.

National Campaign on Folic Acid View HTML

Three out of four women don't take a multivitamin--a simple act that could prevent serious birth defects in 3,000 babies each year. CDC estimates that these birth defects could be prevented every year if women consumed folic acid before pregnancy and early in pregnancy.

World health day: safe motherhood - April 7th, 1998 View PDF 253KB | HTML

Safe motherhood begins before pregnancy with healthy lifestyles that include good nutrition, physical activity, preconception care, and avoidance of harmful substances. Safe motherhood continues with planned pregnancies; early, quality prenatal care; knowledge of warning signs of problems; and the delivery of a healthy, full-term baby with the minimum of necessary interventions. Source: MMWR March 27,1998/Vol. 47/No.11.

Pregnancy and Birth Rates

Teenage births in the United States: national and State trends, 1990-1996 View PDF
- This publication presents the latest statistics as well as trends on the important topic of teenage childbearing in the United States. Data are from the National Center for Health Statistics' National Vital Statistics System.
Teenage births in the United States: State trends, 1991-1996, an update View PDF
- This report provides state-specific birth rates for teenagers for 1991 and 1996 and the percent change, 1991-1996.
Births by method of delivery View PDF
- This table from the Monthly Vital Statistics Report provides information on live births by method of delivery and rates of cesarean delivery and vaginal birth after previous cesarean delivery, by race of mother: United States, 1989-1996.
Births by wantedness status at conception, according to selected characteristics: United States, 1995 View PDF
- This table from the 1995 National Survey of Family Growth provides information on number of births in the 5 years before interview to women 15-44 years of age at interview and percent distribution by wantedness status at conception, according to selected characteristics: United States, 1995.
Live births, birth rates, and fertility rates View PDF
- This table from the Monthly Vital Statistics Report provides information by race: United States, specified years 1940-55 and each year, 1960-1996.
Obstetrical and other procedures View PDF
- This table from Advance Data and Monthly Vital Statistics Report provides information on the number of obstetrical procedures performed, by age, in 1995 and 1996. Comprehensive data show the number of all-listed procedures for discharges from short-stay hospitals by procedure category, sex, and age: United States, 1995 and 1996.
Prenatal care View PDF
- This table from Health, United States, 1998 provides information on prenatal care for live births, according to detailed race of mother and Hispanic origin of mother: United States, selected years 1970-1996.
Breast-feeding by mothers 15-44 years of age View PDF
- This table from Health, United States, 1998, provides information on mothers 15-44 years of age by year of baby's birth, according to selected characteristics of mother: United States, 1972-1974 to 1993-1994.
State-specific pregnancy rates among adolescents - United States, 1992-1995 View PDF
- This report presents estimated state-specific pregnancy rates for 1992-1995 for adolescents aged £19 years by age and race and the percentage change in state-specific pregnancy rates for persons aged 15-19 years for 1992 to 1995. The findings indicate a downward trend in pregnancy rates for persons aged 15-19 years during 1992-1995 for all 43 states for which data were available. MMWR /Vol. 47,/ No.24 PDF.

Pregnancy-Related Illness (Morbidity) View HTML

Fact Sheet: Risk of ectopic pregnancy after tubal sterilization View HTML
- This 14-year study assessed the risk of ectopic pregnancy in women who had undergone tubal sterilization.
Use of antiretroviral drugs in pregnant women infected with HIV MMWR January 30, 1998 / Vol. 47 / No. RR-02 View PDF
- This report provides health-care providers with information for discussion with HIV-1&emdash;infected pregnant women to enable such women to make an informed decision regarding the use of antiretroviral drugs during pregnancy. Various circumstances that commonly occur in clinical practice are presented as scenarios and the factors influencing treatment considerations are highlighted in this report.

Pregnancy-Related Deaths and Maternal Mortality View HTML

Maternal mortality-United States, 1982-1996 View PDF 317KB | HTML
- The annual maternal mortality ratio remained approximately 7.5 maternal deaths per 100,000 live births during 1982-1996. Since 1982 in the United States, no progress has been made toward achieving the Healthy People 2000 goal of 3.3 maternal deaths per 100,000 live births set in 1987 (objective 14.3). Maternal deaths were defined as those deaths that occurred during a pregnancy or within 42 days of the end of a pregnancy and for which the cause of death was listed as a complication of pregnancy, childbirth, or the puerperium. Source: MMWR, September 4, 1998/Vol. 47/No. 34.
Maternal mortality ratio -United States, 1982-1996 View PDF 62 KB
- Figure 1 from "Maternal Mortality-United States, 1982-1996" provides information on maternal mortality ratios. Since 1982 in the United States, no progress has been made toward achieving the Healthy People 2000 goal of 3.3 maternal deaths per 100,000 live births set in 1987 (objective 14.3). During 1982-1996, the annual maternal mortality ratio fluctuated between approximately 7 and 8 maternal deaths per 100,000 live births. During that time, trends by race were similar to the overall ratio, and no reductions were observed for either black or white women. Maternal mortality ratios remained higher for black women than for white women. Ratios for black women generally fluctuated between 18 and 22 per 100,000 births and for white women between 5 and 6 per 100,000 live births.
Pregnancy-related death associated with heparin and aspirin treatment for infertility, 1996 View PDF 268KB | HTML
- The first case of death associated with heparin and aspirin use among in-vitro fertilization patients has been reported. CDC investigated the death of a pregnant woman who had undergone in-vitro fertilization and aspirin and heparin therapy. Although researchers could not conclude that the woman's death was caused by the therapy, the potential for bleeding associated with aspirin and heparin warrants vigorous scientific investigation and debate before it is recommended for routine use among in-vitro fertilization patients. Source: MMWR, May 15, 1998/Vol. 47/No.18.
Pregnancy-related mortality surveillance -United States, 1987-1990 View PDF 797KB
- This surveillance summary provides an in-depth analysis of data for the period 1987-1990 from CDC's National Pregnancy Mortality Surveillance System. During that time period, the surveillance system identified 1,459 pregnancy-related deaths, for a United States pregnancy-related mortality ratio of 9.2 pregnancy-related deaths per 100,000 live births. Source: MMWR, August 8, 1997/Vol. 46/No. SS-4.
Fact Sheet: Pregnancy-related deaths in the United States, 1987-1990View PDF 797KB | HTML
- This surveillance summary provides an in-depth analysis of data for the period 1987-1990 from CDC's National Pregnancy Mortality Surveillance System. During that time period, the surveillance system identified 1,459 pregnancy-related deaths, for a United States pregnancy-related mortality ratio of 9.2 pregnancy-related deaths per 100,000 live births. MMWR August 8, 1997/Vol. 46/ No. SS-4
Pregnancy-related mortality ratio, by age group and race -United States, 1987-1990 View PDF 63 KB
- Figure 1 from "Pregnancy-Related Mortality Surveillance, United States, 1987-1990" provides information on pregnancy-related mortality by age group and race. Age-specific pregnancy-related mortality ratios were higher for black women than for white women at all ages. The risk for pregnancy-related death was 10.2 times greater for black women 40 years of age or older than the risk for black women aged 20-24 years; the risk was 5.0 times greater for white women 40 years of age or older than the risk for white women aged 20-24 years. In comparison with pregnancy-related mortality ratios for white women, ratios for black women increased sharply with age, beginning with women aged 25-29 years. This difference was most pronounced at 40 years of age or greater (i.e., the ratio was 6.4 times higher for black women).