Women’s Health

Posted on Autism, Women's Health

Warning signs: Data indicates that autistic mothers are at higher risk for postpartum anxiety and depression.

New guidelines for pregnancy in multiple sclerosis
New research from the Policy and Analytics Center at Drexel University’s A.J. Drexel Autism Institute looked into perinatal and postpartum outcomes among individuals with intellectual and developmental disabilities.

American women have the highest rate of maternal deaths among high-income countries, with outcomes worse for minoritized groups. In a recent study published in JAMA Network Open, researchers from Drexel University’s Policy and Analytics Center in the A.J. Drexel Autism Institute examined Medicaid data to better understand and identify perinatal and postpartum outcomes among people with intellectual and developmental disabilities, including autism and intellectual disability. 

Lindsay Shea, DrPH, director of the Policy and Analytics Center in the A.J. Drexel Autism Institute and lead author of the study, highlighted that while previous studies have reported an increased risk for challenges related to pregnancy and birth among people with intellectual and developmental disabilities, little research has been done using United States-based population-level data. Medicaid, as it covers almost half of births in the U.S. and a disproportionate share of people with intellectual and developmental disabilities, is a key system to study these risks and opportunities for policy and program improvements. The study revealed that people with intellectual and developmental disabilities were younger at the time of their first delivery and had higher risks for multiple medical and mental health conditions, such as gestational diabetes, gestational hypertension, and preeclampsia. Autistic pregnant individuals had a significantly higher probability of experiencing postpartum anxiety and postpartum depression compared to people with intellectual disabilities only and those without intellectual and developmental disabilities.

Researchers examined national Medicaid claims to compare perinatal and postpartum outcomes across groups of birthing people with intellectual and developmental disabilities (including intellectual disability and autism) and a random sample of birthing people without intellectual and developmental disabilities. The data included Medicaid claims from 2008-2019 for 55,440 birthing people with intellectual and developmental disabilities and a random sample of 438,557 birthing people without intellectual and developmental disabilities.

The study compared perinatal outcomes, including medical conditions like gestational diabetes, gestational hypertension, and preeclampsia, as well as mental health conditions such as anxiety disorders and depressive disorders, across different groups. Researchers used Kaplan-Meier and Cox proportional hazard regressions to estimate the likelihood of postpartum anxiety and postpartum depression.Co-author Molly Sadowsky, project director at the Policy and Analytics Center in the Autism Institute, explained that the findings suggest several opportunities for policymakers, providers, and researchers. It is important to tailor reproductive health education, perinatal care, and delivery services to provide comprehensive and targeted support for birthing individuals with intellectual and developmental disabilities. Policies should be designed and implemented to meet the needs of people with intellectual and developmental disabilities, with the goal of reducing maternal health disparities. Clinical guidelines and procedures should be adjusted to accommodate the specific needs and experiences of people with intellectual and developmental disabilities. Additionally, new Medicaid policies, such as the postpartum coverage extension and doula service reimbursement, should be evaluated for their impact on the health outcomes of people with intellectual and developmental disabilities.

“The findings of this study emphasize the urgent need for Medicaid to support birthing individuals with intellectual and developmental disabilities during the perinatal period,” said Sadowsky. “It’s crucial to address differences in access to postpartum care and coordination, as well as the related disparities in the risk of postpartum depression and anxiety.”Shea and Sadowsky also explained their plans for future work, stating, “In our next project, we will further this research by examining the impact of attitudinal and structural ableism on perinatal health and mental health outcomes, as well as on neonatal and postnatal outcomes, morbidity, and mortality among children of women with and without intellectual and developmental disabilities,” said Shea.

Shea and her research team have been granted a five-year, $3 million National Institutes of Health Research Project Grant (R01) to further investigate the impact of ableism on women with intellectual and developmental disabilities during pregnancy and the postpartum period. The upcoming study will involve a detailed examination and comparison of outcomes experienced by this group and their infants to those of peers without intellectual and developmental disabilities. Shea expressed her enthusiasm about the future of their work in this area, emphasizing the importance of supporting individuals and celebrating their birthing experiences and roles during these significant times in life.
Posted on Autism, Women's Health

Autistic Menopause & Ageing with Christine Jenkins

How often do you hear or read about older autistic adults and our ageing process? Not frequently, I bet. Thanks to Christine Jenkins and the Autistic Menopause research team, not only is autistic ageing coming to the forefront, but so is menopause. Finally! There are so many of us who have been privately discussing where we are in this season of our lives, going through perimenopause, and how it impacts our sensory systems and even our experience of burnout.

Posted on Exercise, Women's Health

Stay active – or get active – to boost quality of life while ageing, study suggests to middle-aged women

Stay active – or get active – to boost quality of life while aging, study suggests to middle-aged women

Data from more than 10,000 Australian women showed a significant link between regular exercise during middle age and physical health in later life, even when the exercise routine was not started until their mid-50s

Consistent adherence to physical activity guidelines throughout middle-age is associated with a higher health-related quality of life in women, according to a new study publishing May 2nd in the open-access journal PLOS Medicine by Binh Nguyen of University of Sydney, Australia, and colleagues.

The evidence for an association between physical activity and health-related quality of life has been based primarily on cross-sectional studies and short-term randomized controlled trials. Few longitudinal studies have measured physical activity at more than one-time point and examined the long-term causal effects of exercise.

In the new study, researchers used data collected at three-year intervals beginning in 1996 from 11,336 participants in the Australian Longitudinal Study on Women’s Health. Women were born from 1946 through 1951, making them 47 to 52 years old at the study outset. Participants were classified as either meeting WHO physical activity guidelines — of 150 minutes of activity a week — consistently throughout the fifteen-year exposure period, not initially meeting the guidelines but starting to meet them at age 55, 60 or 65, or never meeting the guidelines. Health-related quality of life was assessed using the physical health composite score (PCS) and mental health composite score (MCS) from the Short Form 36 Health Survey, which includes 36 questions about functional health and well-being.

On average, people who consistently met physical activity guidelines and those who first started to meet guidelines at age 55 had a three-point higher PCS (46.93 [95% CI 46.32 to 47.54] and 46.96 [95% CI 45.53 to 48.40], respectively), compared to those that did not meet physical activity guidelines (43.90 [95% CI 42.79 to 45.01]). The effect of physical activity on the PSC was significant even after controlling for socioeconomic factors and pre-existing health diagnoses. However, there was no significant association between physical activity and MCS.

“Combined with existing evidence, this study contributes to growing evidence of the benefits of maintaining or adopting an active lifestyle in mid-age,” the authors say. “An important public health message is that being active for as many years as possible, even if women start to meet physical activity guidelines in their mid-50s, could have important health benefits in terms of physical health, especially in physical functioning.”

The authors add, “Our study shows that it’s important for women to be active throughout mid-age to gain the most benefits for physical health in later life. Ideally, women should increase their activity levels to meet the guidelines by age 55.”

Posted on Exercise, Women's Health

Women get the same exercise benefits as men, but with less effort.

Smidt Heart Institute Study, published in Journal of the American College of Cardiology, shows women get more heart health benefit from exercise than men
Smidt Heart Institute Study, published in Journal of the American College of Cardiology, shows women get more heart health benefit from exercise than men

A new study from the Smidt Heart Institute at Cedars-Sinai shows there is a gender gap between women and men when it comes to exercise.

The findings, published in the Journal of the American College of Cardiology (JACC), show that women can exercise less often than men, yet receive greater cardiovascular gains.   

“Women have historically and statistically lagged behind men in engaging in meaningful exercise,” said Martha Gulati, MD, director of Preventive Cardiology in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai, the Anita Dann Friedman Chair in Women’s Cardiovascular Medicine and Research and co-lead author of the study. “The beauty of this study is learning that women can get more out of each minute of moderate to vigorous activity than men do. It’s an incentivizing notion that we hope women will take to heart.”

Investigators analyzed data from 412,413 U.S. adults utilizing the National Health Interview Survey database. Participants between the time frame of 1997 to 2019—55% of whom were female—provided survey data on leisure-time physical activity. Investigators examined gender-specific outcomes in relation to frequency, duration, intensity and type of physical activity.

“For all adults engaging in any regular physical activity, compared to being inactive, mortality risk was expectedly lower,” said Susan Cheng, MD, MPH, the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science, director of the Institute for Research on Healthy Aging in the Department of Cardiology in the Smidt Heart Institute, and senior author of the study. “Intriguingly, though, mortality risk was reduced by 24% in women and 15% in men.”

The research team then studied moderate to vigorous aerobic physical activity, such as brisk walking or cycling, and found that men reached their maximal survival benefit from doing this level of exercise for about five hours per week, whereas women achieved the same degree of survival benefit from exercising just under about 2 ½ hours per week.

Similarly, when it came to muscle-strengthening activity, such as weightlifting or core body exercises, men reached their peak benefit from doing three sessions per week and women gained the same amount of benefit from about one session per week.

Cheng said that women had even greater gains if they engaged in more than 2 ½ hours per week of moderate to vigorous aerobic activity, or in two or more sessions per week of muscle-strengthening activities. The investigators note their findings help to translate a longstanding recognition of sex-specific physiology seen in the exercise lab to a now-expanded view of sex differences in exercise-related clinical outcomes.

With all types of exercise and variables accounted for, Gulati says there’s power in recommendations based on the study’s findings. “Men get a maximal survival benefit when performing 300 minutes of moderate to vigorous activity per week, whereas women get the same benefit from 140 minutes per week,” Gulati said. “Nonetheless, women continue to get further benefit for up to 300 minutes a week.”

Christine M. Albert, MD, MPH, chair of the Department of Cardiology in the Smidt Heart Institute and the Lee and Harold Kapelovitz Distinguished Chair in Cardiology, says concrete, novel studies like this don’t happen often.

“I am hopeful that this pioneering research will motivate women who are not currently engaged in regular physical activity to understand that they are in a position to gain tremendous benefit for each increment of regular exercise they are able to invest in their longer-term health,” said Albert, professor of Cardiology.

Posted on Rheumatoid arthritis, Women's Health

Early menopause and HRT among hormonal factors linked to heightened rheumatoid arthritis risk

Having 4 or more children and fewer than 33 reproductive years also seem to be influential
Having 4 or more children and fewer than 33 reproductive years also seem to be influential

Early menopause—before the age of 45—taking hormone replacement therapy (HRT), and having 4 or more children are among several hormonal and reproductive factors linked to a heightened risk of rheumatoid arthritis in women, finds a large long term study published in the open access journal RMD Open.

Women are more susceptible to this autoimmune disease than men, note the researchers. They are 4–5 times as likely as men to develop rheumatoid arthritis under the age of 50, and twice as likely to do so between the ages of 60 and 70. And the disease seems to take a greater physical toll on women than it does on men.

While hormonal and reproductive factors are thought to contribute to women’s heightened susceptibility to the disease, it’s not entirely clear which factors might be particularly influential.

In a bid to find out, the researchers drew on 223,526 UK Biobank participants whose health was tracked for an average of 12 years.

During this time, 3313 (1.5%) women developed rheumatoid arthritis, and several hormonal and reproductive factors were associated with heightened disease risk, after accounting for potentially influential factors, such as lifestyle, level of social and economic deprivation, ethnicity and weight (BMI). 

Starting periods after the age of 14 was associated with a 17% higher risk when compared with starting them at the age of 13, while going through the menopause below the age of 45 was associated with 46% heightened risk compared with going through it at the age of 50-51. 

Fewer than 33 reproductive years—defined as the interval between starting periods and going through the menopause—was associated with a 39% heightened risk. And compared with having 2 children, 4 or more was associated with an 18% higher risk.

Hysterectomy or removal of one or both ovaries (oophorectomy) was associated with 40% and 21% higher risks, respectively, although only a few women had these procedures. 

While no clear association emerged between the use of the Pill and rheumatoid arthritis risk, HRT use and to a lesser extent, its duration, were associated with, respectively, 46% and 2% higher risks.

This is an observational study, albeit over a reasonably long period, and therefore can’t establish cause and effect, and the researchers acknowledge various limitations to their findings.

For example, the UK Biobank is made up of relatively healthy and affluent people of white ethnic background, so isn’t representative of the UK population at large.

Nevertheless, the findings prompt the researchers to suggest that hormonal and reproductive factors should be carefully evaluated in women diagnosed with rheumatoid arthritis. 

And they conclude: “The findings of this study are significant and form a basis on which novel and target-specific intervention measures to curb the risk of [rheumatoid arthritis] in women may be developed.”