Publisher Health

Genetic predisposition to attention-deficit/hyperactivity disorder (ADHD) can predict cognitive decline and Alzheimer’s disease later in life, revealed an analysis published today in Molecular Psychiatry by University of Pittsburgh School of Medicine researchers.
Although recent large epidemiological studies have hinted at a link between ADHD and Alzheimer’s, this is the first to tie genetic risk of ADHD to chances of developing late-onset Alzheimer’s disease.
“This study highlights what many in the field are already discussing: The impact of ADHD can be observed throughout the lifespan, and it might be linked to neurodegenerative conditions, such as Alzheimer’s disease,” said lead author Douglas Leffa, M.D., Ph.D., psychiatry resident at UPMC.
Senior author Tharick Pascoal, M.D., Ph.D., assistant professor of psychiatry at Pitt, added that “with new treatments becoming available at earlier stages of Alzheimer’s progression, it is important to determine risk factors to help better identify patients who are likely to progress to severe disease.”
According to the U.S. Centers for Disease Control and Prevention, individuals with ADHD report feeling restless and impulsive and have difficulty maintaining their attention, which leads to reduced quality of their social, school or work lives. For a long time, ADHD was considered a childhood disease that people grow out of after entering adulthood. Doctors now know that ADHD is a childhood disease that may persist into adulthood. The symptoms of ADHD in adults may be more diverse and subtle when compared to children and adolescents, and it can be particularly difficult to diagnose in older adults.
Not unlike other behavioral disorders, ADHD has a genetic component. But there is no one single gene that will dictate whether its carrier will go on to develop ADHD. Rather, that risk is determined by a combination of small genetic changes.

A three-month pilot study of patients with hypertension appearing in the Canadian Journal of Cardiology, published by Elsevier, demonstrates that adding yoga to a regular exercise training regimen supports cardiovascular health and wellbeing and is more effective than stretching exercises. Incorporation of yoga reduced systolic blood pressure and resting heart rate and improved 10-year cardiovascular risk.
Yoga is part of spiritual and exercise practices for millions of people worldwide. With yoga practice becoming a widely accepted form of exercise, the body of yoga research is growing. It is a multifaceted lifestyle activity that can positively enhance cardiovascular health and wellbeing. Physical exercises such as stretching exercises and the physical components of yoga practices have several similarities, but also important differences.
“The aim of this pilot study was to determine whether the addition of yoga to a regular exercise training regimen reduces cardiovascular risk,” explained lead investigator Paul Poirier, MD, PhD, Quebec Heart and Lung Institute — Laval University, and Faculty of Pharmacy, Laval University, Quebec, Canada. “While there is some evidence that yoga interventions and exercise have equal and/or superior cardiovascular outcomes, there is considerable variability in yoga types, components, frequency, session length, duration, and intensity. We sought to apply a rigorous scientific approach to identify cardiovascular risk factors for which yoga is beneficial for at-risk patients and ways it could be applied in a healthcare setting such as a primary prevention program.”
Investigators recruited 60 individuals with previously diagnosed high blood pressure and metabolic syndrome for an exercise training program. Over the 3-month intervention regimen, participants were divided into 2 groups, which performed 15 minutes of either structured yoga or stretching in addition to 30 minutes of aerobic exercise training 5 times weekly. Blood pressure, anthropometry, high-sensitivity C-reactive protein (hs-CRP), glucose and lipids levels as well as the Framingham and Reynolds Risk Scores were measured. At baseline, there was no difference between groups in age, sex, smoking rates, body mass index (BMI), resting systolic and diastolic blood pressure, resting heart rate and pulse pressure.
After 3 months, there was a decrease in resting systolic and diastolic blood pressure, mean arterial blood pressure and heart rate in both groups. However, systolic blood pressure was reduced by 10 mmHg with yoga vs 4 mmHg with stretching. The yoga approach also reduced resting heart rate and 10-year cardiovascular risk assessed using Reynold’s Risk score.
While yoga has been shown to benefit hypertensive patients, the exact mechanism underlying this positive effect is not fully understood. This pilot randomized study shows that its benefits cannot be simply attributed to stretching alone.
“This study provides evidence for an additional non-pharmacologic therapy option for cardiovascular risk reduction and blood pressure control in patients with high blood pressure, in the setting of a primary prevention exercise program,” noted Dr. Poirier. “As observed in several studies, we recommend that patients try to find exercise and stress relief for the management of hypertension and cardiovascular disease in whatever form they find most appealing. Our study shows that structured yoga practices can be a healthier addition to aerobic exercise than simply muscle stretching.”
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Materials provided by Elsevier. Note: Content may be edited for style and length.

Thanks to new University of Colorado Boulder research, scientists see the impact of flushing the toilet in a whole new light — and now, the world can as well.
Using bright green lasers and camera equipment, a team of CU Boulder engineers ran an experiment to reveal how tiny water droplets, invisible to the naked eye, are rapidly ejected into the air when a lid-less, public restroom toilet is flushed. Published in Scientific Reports, it is the first study to directly visualize the resulting aerosol plume and measure the speed and spread of particles within it.
These aerosolized particles are known to transport pathogens and could pose an exposure risk to public bathroom patrons. However, this vivid visualization of potential exposure to disease also provides a methodology to help reduce it.
“If it’s something you can’t see, it’s easy to pretend it doesn’t exist. But once you see these videos, you’re never going to think about a toilet flush the same way again,” said John Crimaldi, lead author on the study and professor of civil, environmental, and architectural engineering. “By making dramatic visual images of this process, our study can play an important role in public health messaging.”
Researchers have known for over 60 years that when a toilet is flushed, solids and liquids go down as designed, but tiny, invisible particles are also released into the air. Previous studies have used scientific instruments to detect the presence of these airborne particles above flushed toilets and shown that larger ones can land on surrounding surfaces, but until now, no one understood what these plumes looked like or how the particles got there.
Understanding the trajectories and velocities of these particles — which can transport pathogens such as E. coli, C. difficile, noroviruses and adenoviruses — is important for mitigating exposure risk through disinfection and ventilation strategies, or improved toilet and flush design. While the virus that causes COVID-19 (SARS-CoV-2) is present in human waste, there is not currently conclusive evidence that it spreads efficiently through toilet aerosols.

Antibodies produced against the commonly used antibiotic, gentamicin, appear to increase the risk of type 1 diabetes in children already genetically at risk, scientists say.
When Medical College of Georgia scientists compared the blood of nearly 300 individuals with type 1 diabetes to healthy controls, they found that a higher level of antibodies against gentamicin was associated with increased risk of progression to type 1 diabetes. G418 and sisomicin, analogs of gentamicin, also showed a similar association.
Their study analyzed samples from the Diabetes Autoimmunity Study in the Young (DAISY) and Phenome and Genome of Diabetic Autoantibody (PAGODA). The databases studied did not state whether study participants had been given gentamicin. However, anywhere between 5-10% of newborns receive the broad-spectrum antibiotic to treat potentially lethal sepsis.
They report in the journal Nature Communications that a similar percentage, 5.3% of the participants, had high levels of these antibodies and a high percentage of this group later developed type 1 diabetes, says Sharad Purohit, PhD, a biochemist in the MCG Center for Biotechnology and Genomic Medicine.
To compound the scenario, it’s known that premature babies are considered at higher risk for both sepsis and type 1 diabetes. The current standard of care for newborns with sepsis is giving gentamicin, per World Health Organization guidelines.
“These infections are common, and the babies need the antibiotic,” says corresponding author Purohit, noting that their own immune systems are not well developed at that juncture, and the drug may be a lifesaving therapy.

The availability of foods based on plant proteins to substitute for meat has increased dramatically as more people choose a plant-based diet. At the same time, there are many challenges regarding the nutritional value of these products. A study from Chalmers University of Technology in Sweden now shows that many of the meat substitutes sold in Sweden claim a high content of iron — but in a form that cannot be absorbed by the body.
A diet largely made up of plant-based foods such as root vegetables, pulses, fruit and vegetables generally has a low climate impact and is also associated with health benefits such as a reduced risk of age-related diabetes and cardiovascular disease, as has been shown in several large studies. But there have been far fewer studies of how people’s health is affected by eating products based on what are known as textured* plant proteins.
In the new study from Chalmers, a research team in the Division of Food and Nutrition Science analysed 44 different meat substitutes sold in Sweden. The products are mainly manufactured from soy and pea protein, but also include the fermented soy product tempeh and mycoproteins, that is, proteins from fungi.
‘Among these products, we saw a wide variation in nutritional content and how sustainable they can be from a health perspective. In general, the estimated absorption of iron and zinc from the products was extremely low. This is because these meat substitutes contained high levels of phytates, antinutrients that inhibit the absorption of minerals in the body,’ says Cecilia Mayer Labba, the study’s lead author, who recently defended her thesis on the nutritional limitations of switching from animal protein to plant-based protein.
The body misses out on necessary minerals
Phytates are found naturally in beans and cereals — they accumulate when proteins are extracted for use in meat substitutes. In the gastrointestinal tract, where mineral absorption takes place, phytates form insoluble compounds with essential dietary minerals, especially non-heme iron (iron found in plant foods) and zinc, which means that they cannot be absorbed in the intestine.

An examination by the Democratic staff of the Senate homeland security committee portrayed a government wholly unprepared for the arrival of the coronavirus.WASHINGTON — A new examination by Senate Democrats of how the federal government bungled its early response to the coronavirus pandemic faults President Donald J. Trump and his administration for numerous missteps while also laying blame on “multiple systemic problems” that long predated his time in office.The 241-page report was produced by the Democratic staff of the Senate Homeland Security and Governmental Affairs Committee. The report relied on documents and interviews with key Trump administration officials, including Dr. Deborah L. Birx, the White House coronavirus response coordinator, and Dr. Robert R. Redfield, who served as director of the Centers for Disease Control and Prevention.Many issues covered in the report, such as serious problems with data collection and insufficient testing capacity, had already been explored by news organizations, but the study painted a sweeping portrait of a government that was wholly unprepared for the arrival of a deadly new pathogen.The report cited inadequate funding, supply chain vulnerabilities, overlapping government roles and other problems that it said “have been flagged by experts and oversight agencies for years, yet have been largely overlooked by all branches of the federal government.”It found, for example, that a public health emergency fund created to support state and local health systems had received no new appropriations since 1999 and had been “virtually empty” since 2012.While the federal preparedness apparatus had been in place for decades, the report noted that planning from 2005 through 2019 had been “narrowly focused on influenza and failed to adequately incorporate other potential infectious disease threats.”The report is not the first analysis of the coronavirus outbreak to come out of Congress.The top Republican on the Senate health committee, Senator Richard M. Burr of North Carolina, recently released a report asserting that the pandemic was likely the result of a laboratory accident in China — a theory that is popular with his party but not with scientists. The House subcommittee on the coronavirus crisis, controlled by Democrats, has produced a series of scathing reports about the Trump administration’s response.The Senate homeland security committee’s analysis was narrow in scope. It focused on the chaotic first few months of the pandemic, after the coronavirus was first identified in China in December 2019. At the beginning of the outbreak, the United States “failed to heed critical public warnings that foreshadowed the severity and transmissibility of the virus,” the report said.As the crisis unfolded, the report said, the White House barred the C.D.C. from holding news briefings. Though experts repeatedly recommended the use of face masks, the administration did not formally do so until April 3, 2020 — and even then, Mr. Trump declined to wear one. He also insisted the virus would disappear.“There’s no question that political decisions were being made and that those decisions were unfortunately considered more important than what was being put out by public health officials,” Senator Gary Peters, Democrat of Michigan and the chairman of the homeland security committee, told reporters on Wednesday.He added, “And so that got politicized in a way that it should have never been politicized — and lives would have likely been saved.”But at the same time, Mr. Peters said, there was “no question that there were systemic problems that were unaddressed for decades.”

Published23 minutes agoSharecloseShare pageCopy linkAbout sharingBy Elaine JungBBC World ServiceThousands of women in Greenland, including some as young as 12, had a contraceptive device implanted in their womb – often without consent – as part of a Danish campaign to control Greenland’s growing Inuit population in the 60s and 70s. The Danish government has announced an independent investigation into this so-called “Coil Campaign”. But the BBC has gathered accounts from women about recent involuntary contraception, amid growing calls for the investigation to go further.When Bebiane was 21 years old, she went to have a coil fitted – only to hear the shocking news that there was already one inside her. “I remember the tears rolling down my cheeks, and I told them that I couldn’t understand how I already had a coil in me… How could I not remember when I had it put in?”Bebiane believes the only time the coil could have been inserted without her knowing was when she had an abortion at the age of 16, in the early 2000’s.For the next four years she suffered from crippling spells of abdominal pain so severe that they left her unable to climb stairs. “I went to the hospital so many times and they didn’t know what was wrong with me… [The pain] came when I had my period, but it also came when I didn’t have my period.”She wanted to get pregnant, but had still not conceived after more than a year. “Every time I would get my period… I would cry,” Bebiane tells me.She decided to take a break from trying for a few months, and to get a coil fitted, as friends had advised her – wrongly – that this would boost her fertility.This was when she made the discovery that one had already been fitted. She had it taken out, abandoned plans for a new one, and fell pregnant within months.The experience of Mira [not her real name] is even more recent. In 2019, she discovered she had a coil inserted when a doctor found it during a medical examination. “I was so shocked,” she says. The only time it could have been inserted without her knowledge, Mira thinks, would have been during minor uterine surgery she had in 2018. She suffered intense pain for a year after the surgery. She says this was continuously dismissed by her doctor until a thorough check-up revealed the coil.Mira, now 45, says the doctor told her the coil had pierced her uterus. Exhausted by medical complications that she believes were caused by the coil, she opted to have her uterus removed entirely.But she says the operation was not a success – she can no longer have sex because every time she does so it leads to more bleeding and excruciating pain. Image source, Getty ImagesThe coil isn’t the only contraceptive device that appears to have been inserted in some of Greenland’s female population without their knowledge.Annita [not her real name] woke up from an abortion in 2011 with what she describes as a “limp feeling” in her arm, which she saw had been covered by a bandage. After asking the Danish doctor about it, he explained that it was a contraceptive implant – a small, flexible plastic rod that is placed under the skin of the upper arm. Annita, now 31, says the doctor explained that the implant had been inserted because this was her fourth abortion. “It was so horrible… he really crossed the line,” she tells me. “I felt violated.”She demanded to have it removed, which she says he was reluctant to do. It was only when she began pulling off the bandage, threatening to take the implant out herself, that the doctor agreed to remove it. Twenty-eight-year-old Saara, whose name we’ve also changed, says she, too, regained consciousness after an operation to make a shocking discovery. It was 2014, and she had been put under general anaesthetic for a procedure following a miscarriage, but woke to a Danish nurse injecting her with the contraceptive Depo Provera. “I didn’t know what it was and she didn’t ask me if I wanted it,” she tells me, “just that I should come back to the hospital to get it every three months.” She says the nurse didn’t even tell her the name of the drug. And once she did find it out, she had to look it up online to learn more.Saara decided to continue using it for a few years, but she says that when she stopped taking the drug so she and her husband could have a baby, it took several years for her to fall pregnant. She says she had not been told that Depo Provera could affect her menstrual cycle for up to 12 months after her last injection. In September, Denmark and Greenland agreed to launch a two-year investigation. It aims to establish what happened until 1991, when Greenland took control of its health system from Denmark. But the women I spoke to say their relatively recent experiences suggest its current scope is too limited. “I would like that the investigation doesn’t stop with 1991, and that the investigation into giving contraception to women without their consent continues to the present day,” says Bebiane.Mira says she knows of other women this has happened to.Greenland’s Health Minister Mimi Karlsen told the BBC that she was unaware of more recent cases of women being given contraception without informed consent. “If there has been a practice by individuals… which contravenes the law and general ethics and care, it is of course something that we must react to.”To determine an appropriate course of action, she said she would forward the BBC’s findings to the national health board and the chief medical officer to make a full assessment of the cases and clarify if this is a widespread issue and connected to historic policies. Naja Lybeth is one of the women who were forcibly fitted with a coil as part of the Danish Coil Campaign – in her case, in 1975. “I was about 13 years old. It felt like I was stabbed with knives.”Her school friend Holga, now 62, was 14 when the coil was inserted. “I blocked so much out,” she says, “but I’ll always remember the pain. There was so much pain for many years.”An early IUD version called the Lippes Loop was used for the campaign. It had been designed for adults who had already gone through childbirth, but was inserted into girls as young as 12. “I could not imagine the pain you would have from placing this thing into a small cavity,” says gynaecologist Aviaja Siegstad as she shows me a model of a young woman’s uterus next to a Lippes Loop. The complications that arose from the Lippes Loop being fitted in girls and young women ranged from severe bleeding, to infection, persistent pain and infertility. As recently as the mid-1990s, Dr Siegstad found IUDs in patients who were being assessed for infertility. “They didn’t know they had it,” she says. “They’d tried to become pregnant for like 10 to 15 years without knowing what the problem was.”Naja, who works as a trauma therapist, says the fact that the experience of having the coil inserted was for some people a harrowing one, coupled with the absence of basic information, meant that many women like her had blocked the experience from memory. “I am part of a traumatised generation of women.”The aftermath was too difficult to deal with. It’s like we collectively forgot about it.” In fact, Naja – who is on the BBC’s list of this year’s 100 inspiring and influential women from around the world – says she herself only confronted the memory when she began working through personal traumas as part of her training. She began reaching out to other women through Facebook to find out who else had experienced something similar. In the following years, some 200 people from all over Greenland replied to her post to say they had. She now campaigns for the rights of other women affected by the scandal.But it wasn’t until a Danish podcast about the scandal aired earlier this year that the sheer scale of the campaign was revealed. It led to a national outcry. The podcast, called Spiralkampagnen (“Coil Campaign” in English), found records indicating that around 4,500 Greenlandic women and girls were fitted with the Lippes Loop between 1966 and 1970. That was about half of the 9,000 women of fertile age living in the country at the time. The campaign was designed to control the population growth in Greenland, which had ballooned since the 1950s – aided by modernisation and better healthcare. This growth, in addition to an increasing rate of teenage pregnancies, had alarmed the Danish authorities. In 1970, the campaign was considered a “success” as fertility rates had fallen sharply, though the rate continued to fall for some time after that. In the eight years from the campaign’s inception in 1966 until 1974 when it levelled off, Greenland’s fertility rate plunged from seven children per woman, to 2.3. Magnus Heunicke, Denmark’s acting health minister, says there are no records of when the campaign stopped, so finding that out is one of the remits of the current investigation.”What I fear is that it could have been something that continued for decades,” he told me.After years of pain, Naja had her coil removed at the age of 17. She finally managed to have one child at the age of 35 after several years of trying to conceive.As for her friend Holga, she says she visited the doctor many times afterwards about the pain, and later, about struggling to fall pregnant. She says she was repeatedly told that nothing was wrong, but was never examined. She can’t remember at exactly what age the coil was finally discovered and removed, but she never managed to have a child. Holga had her uterus removed in 2018 on the advice of her doctor, due to various complications as a result of the Lippes Loop. The most shocking historic case I encountered was that of Susanne Kielsen, now 75. After a routine check-up when she was five months’ pregnant with her second child, the doctor told her he wanted to abort the baby because of a previous gynaecological complication. She says the “complication” had been addressed before the pregnancy, and was in good health. Nevertheless she says they went ahead and induced an abortion – she says this required no less than 31 injections – but the baby did not die. Finally, at seven months, she went into labour and her baby died within an hour of being born. Within hours she says there were four attempts to insert a coil before she finally told the doctor to stop.She says that she used to imagine hearing the baby, whom she later learned was a little boy, crying in her house.”My sadness just overcomes me.”She says she wants an apology from the Danish authorities before it’s too late.Photographs and illustration by Elaine JungMore on this storyBirth control scandal of Greenland’s young women30 SeptemberInuit seek Denmark compensation over experiment23 November 2021

A patient’s own immune cells, multiplied into an army of billions of immune cells in a lab, can be used as a living medicine against metastatic melanoma, an aggressive form of skin cancer, as the TIL trial has shown. The TIL trial is the world’s first comparative phase 3 trial looking into the effect of T cell therapy in melanoma, and solid tumors in general. Now that the results have come in , the Dutch National Health Care Institute will assess whether TIL therapy () could become a standard treatment, meaning that it will be covered by basic health insurance. The results are published in The New Engeland Journal of Medicine (NEJM) on December 8. The trial was headed by the Netherlands Cancer Institute in collaboration with the National Center for Cancer Immune Therapy in Copenhagen.
Powerful immunotherapy for metastatic melanoma
Medical oncologist John Haanen from the Netherlands Cancer Institute, who is leading the TIL trial, is very happy with the results: “Remember: these are patients with metastatic melanoma. Ten years ago, melanoma was so deadly that I would be seeing an entirely new patient population every year. Now I’ve been seeing some patients for ten years. This is largely due to the discovery of immunotherapy, which has revolutionized treatment for melanomas. But we still find that about half of people diagnosed with metastatic melanoma lose their lives within five years, so we’re still not where we want to be — not by a long shot. The TIL trial has shown that cell therapy using the patient’s own immune cells is an extremely powerful immunotherapy for metastatic melanoma, and that this therapy still offers a high chance of improvement, even if other immunotherapies fail.’
World’s first phase 3 study T cell therapy for melanoma
A melanoma is an aggressive form of skin cancer with a high rate of occurrence Ten years ago, a diagnosis with metastatic melanoma would almost certainly lead to death within the same year. In early clinical trials, cell therapy using the patient’s own T cells as a “living drug” showed promising results. However, a comparative phase 3 trial would be necessary to include TIL therapy in the arsenal of regular treatments, and no such trial had ever been conducted. Medical oncologist John Haanen from the Netherlands Cancer Institute decided to take on this task by initiating an international trial in 2014: the TIL trial, which compared TIL therapy to standard immunotherapy with the checkpoint inhibitor ipilimumab. The results of the TIL trial will now be presented at the annual conference of the European Society for Medical Oncology.
Metastases smaller in half of the patient group
In almost half (49%) of the patients with metastatic melanoma who received TIL therapy, the metastases had shrunk. In 20% of patients, the metastases had even disappeared completely. This also proved to be the case in patients who had already received another treatment prior to their trial participation. These percentages were significantly higher than those among the patient group receiving standard immunotherapy (ipilimumab). In the latter group, metastases had shrunk in 21% of patients, while 7% saw a disappearance of the condition.

As an anesthesiologist, Adeel Faruki, MD, MBA, works with patients to manage not just pain, but also anxiety. It can be a particular concern for patients receiving a nerve block, rather than sedation or general anesthesia, for upper extremity procedures such as hand surgery.
“If a nerve block is done and blocks the nerves innervating the area a surgeon is working on, what we’re generally managing intraoperatively is anxiety and hemodynamic changes,” explains Faruki, an assistant professor of anesthesiology in the University of Colorado School of Medicine. “Patients may feel fear, they may feel claustrophobia, so we started asking how we can reduce the amount of sedative medications given intraoperatively for patients who receive nerve block for upper extremity surgery. We thought, ‘Why don’t we offer them a distraction?'”
This led to recently published research studying virtual reality (VR) immersion compared to monitored anesthesia care for hand surgery.
“As VR has continually grown into the medical sphere, we realized that immersive experiences through VR have the potential to benefit patients as much as the intraoperative treatments we currently use,” Faruki says. “We decided to look at patient satisfaction in a pilot study comparing the two groups’ experiences.”
Virtual reality immersion during surgery
Faruki began this research as a resident at Beth Israel Deaconess Medical Center at Harvard Medical School, working with his faculty mentor Brian O’Gara, MD, who had an interest in reducing the associated effects of sedation with patients who may not need it to manage pain.

The fetuses of women working in the fields in extreme heat can show signs of strain before their mothers are affected, new research has shown.
The study, which involved 92 pregnant subsistence farmers in The Gambia, is the first to measure the impacts of heat stress on the fetuses of manual workers.
Findings include that for every degree Celsius increase in heat stress exposure there was a 17% increase in fetal strain as indicated by raised fetal heart rate and slower blood flow through the umbilical cord.
Overall, the team led by researchers at the Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine (LSHTM) and LSHTM found that even a modest rise in body temperature from performing manual tasks in extreme heat produced evidence of physiological strain in both mother and fetus.
The research is published in The Lancet Planetary Health.
Dr Ana Bonell, Wellcome Trust Global Health Clinical PhD Fellow at LSHTM and lead author, said: “Climate change has led to increasingly extreme temperatures worldwide and Sub-Saharan Africa is particularly vulnerable to climate impacts. Our study found that pregnant subsistence farmers in The Gambia commonly experience levels of extreme heat above recommended outdoor working limits, and that this can have significant effects on their health and the health of their babies. The results suggest we have to find effective interventions to protect these women and reduce adverse birth outcomes.”
Study author Jainaba Badjie from MRC The Gambia at LSHTM said: “Despite the growing scientific evidence linking maternal heat exposure to adverse birth outcomes, including premature birth, low birth weight, and still birth, up until now there has been little research into the physiological mechanisms responsible for these outcomes. We urgently need to understand these mechanisms so that we can find better ways to support mothers and babies in these conditions.”
For the study, participants in West Kiang, The Gambia, were encouraged to perform their usual daily tasks during field visits and were fitted with a wearable device to record maternal heart rate, skin temperature and estimated energy expenditure.
Portable ultrasound devices were used to record fetal heart rate, umbilical artery blood flow at the start of each visit (used as the baseline), at a mid-point during a worker’s shift, and then at the end of the shift.
Maternal symptoms of heat illness were also collected. Nausea, vomiting, headache, dizziness, weakness, muscle ache, fatigue and dry mouth, were common among participants, with over half of the women reporting that they experienced at least one symptom during field visits.
Analysis of the data showed strong links between heat stress exposure and maternal heat strain, which was also found to be associated with fetal strain. Maternal heat stress was also strongly linked to fetal strain even when controlling for maternal heat strain, indicating that other biological factors need to be considered.
The researchers suggest that an important physiological factor to consider in future work is the diversion of blood from the placenta to the skin which appears to occur at lower core temperatures than highlighted by previous studies. The findings also highlight the need for further work to identify and evaluate interventions that will help pregnant agricultural workers in Sub-Saharan Africa to adapt to working in extreme heat.