Surgery-saving prenatal intervention or nefarious anti-lesbian plot? You decide.

First do no harm?

If you’re in the mood for a science-wonky tale of hormones, gender roles, a possible anti-lesbian plot, and a ‘medical intervention-versus-human experimentation’ controversy,  skip on over to a post I wrote for Our Bodies Ourselves (OBOS) in December.

The subject? Prenatal treatment of congenital adrenal hyperplasia (CAH), a rare inherited defect in hormone production that leads to an overproduction of male hormones in utero. CAH can cause deformity of the developing female genitalia (male genital development is unaffected), and can also lead to more “masculinized” behavior in affected girls and women. Though most are heterosexual, women with CAH are more likely to be lesbian or bisexual than the general population.

The prenatal treatment of CAH, in which mothers take very high doses of a steroid medication their entire pregnancies, is primarily intended to prevent genital deformity in girls. But some critics suspect a hidden agenda–the prevention of masculinized behavior and, by extension, lesbianism.

Other critics point out that very few affected girls really need the very aggressive genital surgery performed in the past, and that very high doses of prenatal steroids appear to increase the risk of serious consequences for treated children, including poor growth, learning disabilities, and even mental retardation. Such alarming reports have led many researchers in the United States and Europe to call for an end to the practice.

Still, Dr. Maria New, a pediatric endocrinologist in New York–by far the most prominent advocate of prenatal treatment–has declared the practice to be effective and “safe for mother and child.” Problem is, she and her colleagues haven’t been very diligent in following the babies they’ve treated over the last three decades, so the real risks of the prenatal steroid therapy aren’t yet completely known.

There’s much more detail in the post, and if you’re not feeling science-y enough to tackle that one, fear not. I’ll be back with lighter fare soon!

PS: Even if you’re not feeling science-y today, head to OBOS and donate money to that very worthy organization! Start racking up those 2013 tax deductions!

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Photo credit: Jason Pratt

Good news: Fewer teen births, fewer abortions

A welcome trend continues.

Encouraging news on the U.S. teen pregnancy front:

The teen birth rate continues to decrease. It’s now the lowest it’s been since the government began tracking it in 1940.

Ah, a dedicated Planned Parenthood foe might think. Must be all those abortions, right?

Well, no…

Teen abortion rates are the lowest they’ve been since 1972–the year before Roe vs. Wade made abortion legal.

Lower teen birth rates and lower abortion rates?? How is that possible? There’s a straightforward explanation, according to Leslie Kantor, vice president of education for Planned Parenthood Federation of America: more teens are using birth control, and using it properly. Here’s Kantor’s recipe for continued success:

“We can continue this progress by doing what we know works, including expanding access to high-quality sex education and making long-acting types of birth control, such as IUDs and implants, more accessible to teens.”

All of which is politically vulnerable next month, of course…

I’m going to miss me…

A world in mourning

So I woke up this morning to find tons of hits on my website (www.marksloanmd.com), way more than I’ve had in many a moon. What in the world is up, I wondered. Did some big shot celebrity finally recommend Birth Day? Some book award left over from 2010? Did I win the lottery? (Tough to do without a ticket, but still…)

So I Googled references to my book, and searched Amazon to see if there’d been a sales “bump,” but no. Hmmm…a mystery.

Then I thought of my alter ego, Dr. Mark Sloan (aka “McSteamy) on Grey’s Anatomy, the source of many a snicker when I’m introduced at conferences and talks. (It got so bad a few years back that I’d start my talks with a photo of McSteamy and just wait for the laughter to die down.) Had something happened to him?

RIP: Me

Sure enough. When I Googled “McSteamy” there it was: hundreds of posts and tributes, and millions of grieving fans. Last night, right there in the middle of the season opener, they went and killed me…er, him, off.

Not sure how he died, as I haven’t seen the show in years, but from the tear-stained posts it apparently involves a smash-up, a coma, and a pre-crash wish not to remain on life support for more than 30 days. Or something. Whatever the case, they granted his wish, and a bit of me went with him when they pulled the plug.

An accurate portrayal

Please: no flowers, no sympathy cards. I’ll carry on somehow. I’ve been through this before, you know, back when they cancelled Diagnosis: Murder. Just when I thought the pain would never end, in walked McSteamy with his pecs and his bath towel. Who knows where Dr. Mark Sloan will pop up next?

I’m betting on a reality show: Who Wants to be the Next Dr. Mark Sloan? Maybe I’ll enter, though they might disqualify me on the grounds of a pre-existing condition: I’m already him.

American childbirth: Some good news (for a change)

A number of encouraging news items on the childbirth front to report:

1) The U.S. cesarean rate leveled off in 2010 (32.8% of all births) compared with 2009 (32.9%), the first time there hasn’t been a significant increase since the mid-1990s. It isn’t all good news, though, as the rate for Hispanic mothers–the fastest growing childbirth demographic in the U.S.–inched up from 31.6% to 31.8%.

Programs aimed at decreasing cesarean births, like the one I described in Michigan which will hopefully become a model of hospital care in the near future nationwide, are responsible in some part for the stalling out of the cesarean rise. Whether the trend continues and the cesarean rate actually starts to move downward in the near future remains to be seen.

2) The preterm birthrate dropped for the 4th consecutive year. Though still too high, this is obviously an encouraging trend.

The greatest decline was seen in babies born in the late preterm period, from 34-36 weeks gestation. This may be due in part to attempts to decrease the high rate of labor induction seen in the U.S. in recent years; a combination of wrong dates and early induction has “created” a lot of premature babies.

The improvement was almost across the board, state-wise. No state saw an increase in preterm births (although 4 states had no change from previously), New Mexico led the way with a drop in preterm births of 16% (!).

3) Teen birth rates continue to fall for all age groups.

• The birth rate for 10-14 year olds decreased 20% to an all-time low.
• Rates for 15-17 year olds fell by 12%
• Rates for 18-19 year olds fell by 9%, and are now 38% below 1991.

A combination of factors, from fewer teens having sex to higher rates of contraceptive use, are responsible for what can only be seen as an encouraging trend. Long way to go, though, as I posted here a few days ago.

CDC: Fewer teens are having sex

Welcome to the minority...

News from the Centers for Disease Control and Prevention (via the NY Time’s Science Times section): Teenagers in the U.S. who have had intercourse at least once are now in the minority.

In the study, 43% of unmarried teen girls and 42% of unmarried teen boys reported having had intercourse by age 19. Compare that to 2002, the last year the CDC published such a report, when the numbers were 51.1% and 60.4%, respectively.

Other highlights of the report:

• The birth rate for girls 15-19 was 39/1,000, the lowest ever recorded in the United States.
• Use of contraception with first intercourse increased by 3 percentage points for both girls and boys (to 78% for girls and 85% for boys).
• The percentage of teenage girls who have had sex was the same for all ethnic groups. This is the first time this has been reported; the change is mainly due to fewer African-American girls reporting having had intercourse.

BUT (and yes, there is always a “but”)…

Before we go applauding ourselves for a public health job done well, consider these factoids:

• The teen birth rate in Canada is less than half of ours – 14/1,000; Germany’s is 10/1,000, and Italy’s rate is less than one-fifth of the U.S. at 7/1,000
• If 78% of teen girls used contraception with their first intercourse, then by definition 22% did not. That’s a lot of unprotected girls.
• Chlamydia and gonorrhea are more common in teen girls than in any other age group.
• Syphilis rates, though still lower in teens than in other age groups, have increased every year since the early 2000s.

So…nice to see progress, but still a long way to go.