Lewis.11.22.11

Lewis.11.22.11 - Reproductive Epidemiology Christina...

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Reproductive Epidemiology Christina Chambers, Ph.D., M.P.H. Professor, Pediatrics and Family and Preventive Medicine Skaggs School of Pharmacy and Pharmaceutical Sciences University of California San Diego
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Outline Range of topics covered by reproductive/perinatal (and pediatric epidemiology) Definition of a teratogen Need for specialized counseling/more research Examples of 3 ongoing research projects in this field being conducted by UCSD Opportunities to volunteer/internship
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Reproductive health Reproductive epidemiological research can cover the lifespan (and beyond) for both males and females, Multigenerational or prenatal events that affect later reproductive capacity, e.g., nutrition, diethylstilbesterol Covers the breadth of social issues surrounding reproduction, issues related to fertility, healthy pregnancy, transition to post-reproductive life, etc.
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Reproductive events that affect other health outcomes Pregnancy itself can affect risk for other diseases Risk for developing disease Risk factor for autoimmune diseases such as lupus Protective for breast cancer Pregnancy complications can increase risk for other chronic disease later in life Gestational diabetes Type II diabetes Preeclampsia cardiovascular disease Pregnancy can affect course of a pre-existing disease Remission of asthma, RA in 1/3 Increased seizure activity in epilepsy
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Common diseases that influence reproductive health Diabetes Hypertension Autoimmune diseases – psoriasis, GI diseases, rheumatoid arthritis, MS, etc. Psychiatric disorders Alcohol or other substance abuse Asthma
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Definition of a teratogen A teratogen is any environmental agent (e.g., medication, chemical, disease, medical condition) that interferes with normal development of the embryo or fetus Broadly defined, teratogens can cause structural defects, but also other adverse pregnancy outcomes, long-term neurobehavioral and other effects (DES) Estimated that 10% of birth defects are attributable to teratogenic causes (but 60% of causes yet unknown) 37-6
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Sources of information for clinicians http://otispregnancy.org http://ctispregnancy.org 37-7
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Epidemiological study designs Today Retrospective (Case-control study ) Prospective Study (longitudinal, incidence, or cohort study) Historical Prospective Past Future 37-8
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FAS – Only the tip of the iceberg Fetal Alcohol Syndrome (FAS) Alcohol-related neurodevelopmental disorder (ARND) Alcohol-related birth defects (ARBD) Clinically suspect but appear normal Normal but never reach their potential
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FAS - How common is it? Passive studies of FAS 0.37 to 0.67 per 1,000 live births in U.S.; higher in minorities Clinic-based studies with more active ascertainment in the U.S.
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This note was uploaded on 02/27/2012 for the course USP 144 taught by Professor Lewis during the Fall '12 term at UCSD.

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Lewis.11.22.11 - Reproductive Epidemiology Christina...

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