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Valium, Xanax linked to higher risk for ectopic pregnancy

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Taking benzodiazepines — drugs such as Xanax, Valium, Klonopin, Halcion or Ativan — to treat anxiety or insomnia before pregnancy boosts the risk of an ectopic pregnancy, new research suggests.

Ectopic pregnancy is a pregnancy that develops outside the uterus, typically in a fallopian tube. The risk of ectopic pregnancy was nearly 50 percent higher for women who had filled a prescription for a benzodiazepine within three months of becoming pregnant.

“There is a real gap in understanding what leads to ectopic pregnancy. Past studies on psychotropic medications like benzodiazepines in pregnancy looked at the effects on the baby,” explained study author Elizabeth Wall-Wieler, from Stanford University School of Medicine. And that’s why the researchers started looking at what effects those medications might have on women.

“We need a better understanding of how certain treatments might affect pregnancy outcomes,” she said.

But it’s important to note that due to the study design, this research cannot prove a direct cause-and-effect link between the sedating medications and ectopic pregnancy.

Ectopic pregnancies are relatively rare — affecting just 1 percent to 2 percent of pregnancies each year, according to the researchers. But these pregnancies can be associated with devastating effects. If they’re not discovered early, an ectopic pregnancy can cause a fallopian tube to burst, which triggers dangerous internal bleeding.

Ectopic pregnancies are responsible for as many as 13 percent of pregnancy-related deaths, according to the researchers. An ectopic pregnancy can also lead to infertility.

Known risk factors for ectopic pregnancy include prior fallopian tube or other abdominal surgeries, certain sexually transmitted infections, pelvic inflammatory disease and endometriosis, according to the American College of Obstetricians and Gynecologists. Other factors linked to an increased risk include smoking, a history of infertility, use of assisted reproductive technology and older age (over 35).

But about half of ectopic pregnancies have no known risk factors, the researchers noted.

The study team reviewed insurance data for almost 1.7 million pregnancies between 2008 and 2015. The women were between the ages of 15 and 44.

About 1 percent of the women in this group had filled a benzodiazepine prescription for at least a 10-day supply in the 90 days before getting pregnant.

The findings showed that nearly 2 percent of the women in the study had an ectopic pregnancy. About 1 percent of them had filled a benzodiazepine prescription before pregnancy.

Overall, the drugs were linked to a 50 percent higher risk of having an ectopic pregnancy. When the researchers looked at women with specific conditions — anxiety and insomnia — they found that the drugs were associated with an approximately 30 percent higher risk of ectopic pregnancy.

The researchers said that difference suggests that underlying conditions may play a role in the risk.

Wall-Wieler said there are plausible ways these drugs could contribute to ectopic pregnancy. One example is that they might relax the muscles that normally contract and move the embryo from the fallopian tube into the uterus.

Dr. Adi Davidov, associate chair of obstetrics and gynecology at Staten Island University Hospital in New York City, said this study “has interesting evidence that suggests that perhaps benzodiazepine use during early pregnancy increases a woman’s risk of ectopic pregnancy.”

He agreed that benzodiazepines might affect the ability of the muscles to push the embryo out of the fallopian tubes.

“It would therefore make sense that benzodiazepines may potentially increase the risk of ectopic pregnancy,” Davidov said.

But he cautioned that there are many other factors that could increase the risk of ectopic pregnancy. For example, women who are prescribed benzodiazepines may be different in some ways than women who are not, he said. Typically women who take benzodiazepines are usually older, and being older is a risk factor for ectopic pregnancy.

Wall-Wieler said these medications can be an important aspect of treatment for certain conditions, so women should talk with their doctors before making any changes. She said if you’re on one of these medications and thinking of becoming pregnant, your doctor may be able to switch you to another medication.

If that’s not possible, she said, your doctor will need to monitor you for signs of ectopic pregnancy.

“Women who are using benzodiazepines need to be aware of the symptoms of ectopic pregnancy, because what’s really dangerous is if it goes unnoticed and there is a rupture of the fallopian tube,” she said.

The findings were published June 3 in the journal Human Reproduction.

More information

Learn more about ectopic pregnancy from the American College of Obstetricians and Gynecologists.

Copyright 2020 HealthDay. All rights reserved.



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Study: Nearly half of ‘essential workers’ in U.S. at risk for severe COVID-19

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Nov. 9 (UPI) — Nearly half of those classified as “essential workers” in the United States are at increased risk for severe COVID-19, according to an analysis published Monday by JAMA Internal Medicine.

This means that more than 74 million workers and those with whom they live could be at risk for serious illness, based on disease risk guidelines developed by the U.S. Centers for Disease Control and Prevention, the researchers said.

“Many parts of the country face high and rising infection rates, [and] we should not think about work exposure and health risks in isolation, given that workers and persons at increased risk often live in the same households,” study co-author Thomas M. Selden told UPI.

“Insofar as we can reduce the prevalence of COVID-19 in our communities, we can reduce the extent to which policymakers have to choose between the economy and keeping the population safe,” said Selden, an economist with the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality.

Since the COVID-19 pandemic spread to the United States in March, states and cities across the country have instituted lockdown measures designed to limit the spread of the disease.

Many of these measures entailed closing schools and non-essential businesses, with only banks, grocery stores, pharmacies and other businesses deemed to provide vital services allowed to stay open.

For this study, Selden and his colleagues analyzed data on the U.S. workforce to examine how many people were in essential jobs, how often they were able to work at home, their risk for severe COVID-19 and the potential health risks for their household members.

Of the more than 157 million workers across the country, 72% are in jobs deemed essential — based on U.S. Department of Homeland Security criteria — and more than three-fourths of all essential workers are unable to work at home, Selden said.

Essential workers include those in the medical and healthcare, telecommunications, information technology systems, defense, food and agriculture, transportation and logistics and energy, water and wastewater industries, as well as those in law enforcement and public works, the DHS criteria stipulates.

The study notes that up to 60% of these workers have underlying health issues, placing them at increased risk for severe COVID-19 if they get infected, as defined by U.S. Centers for Disease Control and Prevention guidelines.

Those with diabetes, heart disease, high blood pressure and chronic respiratory conditions like asthma are considered to be at high risk for serious illness, the CDC says.

Based on these findings, between roughly 57 million and 74 million adults working in on-site essential jobs — and their families — are at increased risk for serious illness, Selden and his colleagues estimated.

“Policymakers face important decisions about how to balance the economic benefits of keeping workers employed and the public health benefits of protecting those with increased risk of severe COVID-19,” Selden said.

“These issues arise in the context of decisions to close segments of the economy and decisions about how to distribute vaccines, which will initially be available only with limited supply, [and] become all the more difficult when the prevalence of infection rises in parts of the country,” he said.



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Study: Hydroxychloroquine no better than placebo for hospitalized COVID-19 patients

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Nov. 9 (UPI) — COVID-19 patients treated with hydroxychloroquine showed no signs of significant improvement in “clinical status” compared with those given a placebo, a study published Monday by JAMA found.

Patients given a five-day course of the drug were scored as “category six” based on the World Health Organization’s seven-category COVID Ordinal Outcomes Scale, the same as those given a placebo, the researchers said.

Also, 28 days after they started treatment, 10.4% of those treated with hydroxychloroquine died, just slightly lower than the 10.6% fatality rate in the placebo group.

“The results show that hydroxychloroquine did not help patients recover from COVID-19,” study co-author Dr. Wesley H. Self told UPI.

“In the study, patients treated with hydroxychloroquine and those treated with a placebo had nearly identical outcomes, [so] I do not foresee any role for hydroxychloroquine in acutely ill patients hospitalized with COVID-19,” said Self, an infectious disease specialist at Vanderbilt University Medical Center.

Hydroxychloroquine is an immunosuppressive and anti-parasitic drug that is used to treat malaria.

Early in the COVID-19 pandemic, it was touted by President Donald Trump and others as a potential treatment for the virus, despite the lack of any scientific data supporting its use.

Given its effectiveness helping those sickened with malaria — a mosquito-borne infection — to recover, “there was a strong rationale for why hydroxychloroquine may have been beneficial for patients with COVID-19,” according to Self.

However, in July, the U.S. Food and Drug Administration warned against the drug’s use in the treatment of those infected with the new coronavirus, due to potentially serious heart-related side effects.

For this study, Self and his colleagues treated 433 COVID-19 patients at 34 hospitals across the United States with either the drug or a placebo for a period of five days.

Patients assigned to the hydroxychloroquine group received 400 milligrams of the drug in pill form twice a day for the first two doses and then 200 mg. in pill form twice a day for the next eight doses, for a total of 10 doses over the five days.

All of the patients were then assessed based on the WHO’s COVID Ordinal Outcomes Scale, which categorizes those infected according to disease severity.

Most of the patients in both the hydroxycholorquine group and the placebo group were in “category six,” meaning they were hospitalized and receiving extracorporeal membrane oxygenation or invasive mechanical ventilation to maintain their breathing, the researchers said.

“Our results, especially when combined from other studies conducted in the United Kingdom and Brazil, are good evidence that hydroxychloroquine does not provide benefit for patients hospitalized with COVID-19,” Self said.



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Chili peppers might extend your life

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The spice that adds punch to your favorite Kung Pao chicken, Tex-Mex chili or Indian curry may also help save your life.

Preliminary research shows that eating chili pepper may reduce your risk of death from heart disease, cancer and other causes, building on past studies that have found chili pepper to have health benefits.

“I think a lot of people are going to find this information quite new and pleasantly surprising,” said Penny Kris-Etherton, a professor of nutrition at Pennsylvania State University in College Park, who reviewed the findings.

For the study, researchers at the Cleveland Clinic in Ohio reviewed health and dietary records of more than 570,000 participants in four large studies conducted in the United States, Italy, China and Iran. The investigators compared health outcomes of people who ate chili pepper to those who rarely or never did.

The upshot: Those who ate chili pepper had a 26% reduction in death from heart-related causes, a 23% reduction in cancer death and a 25% reduction in all-cause mortality during the study period.

Even though dietary and cultural practices varied, similar trends were seen in all four countries, said senior author Dr. Bo Xu, a cardiologist. The findings highlight the impact of diet on overall health, he said.

But what’s the magic in chili peppers?

The researchers pointed to a chemical component called “capsaicin” – which is responsible for the pepper’s spiciness – as a potential explanation for chili’s benefits. It’s been studied before, Xu noted.

“People promote it as being something that is anti-inflammatory, anti-cancer and anti-obesity,” he said, speculating that capsaicin explains the chili pepper’s apparent health benefits. But Xu added that further study is needed to confirm it.

Meanwhile, Xu encourages patients in his cardiology practice to eat a Mediterranean diet, which is rich in fruits and vegetables, as well as certain types of nuts, protein, fish and olive oil.

“Pay attention to your diet because dietary factors can be both positive and negative,” Xu said. “I think it’s really important to pay attention to what you eat in terms of promoting your overall and cardiovascular health.”

Kris-Etherton noted that past studies have shown that capsaicin helps quell growth of cancer cells, which may play a role in reduction of mortality from cancer and all causes.

Chili peppers contain potassium, fiber and vitamins A, B6 and E, she said, noting these can benefit blood pressure. And adding chili pepper might replace some of the salt a person might otherwise add to food. Many people – including Americans and people from Asian cultures – eat a very high-salt diet, Kris-Etherton added.

“Rather than just cut the salt out, people are looking for seasonings and flavorings, and this may be one that has a double benefit, decreasing the sodium and adding some antioxidants and maybe some bioactive components like capsaicin,” she said.

But too much of a good thing can also cause problems. Hot pepper can cause nausea, vomiting, diarrhea and a burning feeling in the gastrointestinal tract, she explained.

If you want to add chili pepper to your diet, Kris-Etherton suggests using it as a flavoring.

“People could use them with certain foods. So, let’s just say they want to make something like guacamole, which is fine, but then pair it with healthy foods,” Kris-Etherton said. “Don’t get your chili peppers by eating a lot of avocado with a ton of chips.”

The study didn’t break down the amount and type of chili pepper that might be needed for health benefits. Xu also said it’s too early in the research to give dietary guidelines for eating chili peppers to improve health outcomes.

The researchers are continuing to analyze data and hope to publish the full paper soon. The preliminary findings are scheduled to be presented at a virtual meeting of the American Heart Association Nov. 13 to 17.

More information

Learn more about chili peppers and health from the U.S. National Library of Medicine.

SOURCES: Bo Xu, MD, cardiologist, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio; Penny Kris-Etherton, PhD, RD, professor, nutritional sciences, College of Health and Human Development, Pennsylvania State University, University Park, Pa.; American Heart Association, Scientific Sessions news release, Nov. 9, 2020

Copyright 2020 HealthDay. All rights reserved.



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