Postpartum depression (PPD) is a cross-cultural form of major depressive disorder that affects so... more Postpartum depression (PPD) is a cross-cultural form of major depressive disorder that affects some 13% of women and can have serious health consequences for both the mother and her child. Easy-to-use, reliable, self-administered screening tools are available. PPD may have a variety of etiologies, which include changing plasma levels of estrogen and progesterone, postpartum hypothyroidism, sleep deprivation, or difficult life circumstances. Standard treatments for PPD include psychotherapy and antidepressants. However, treatment of a thyroid condition or insomnia, or even regular exercise or massage may also be beneficial. PPD is underdiagnosed, therefore more screening is needed. Obstetricians and pediatricians have a unique opportunity to test women for PPD, but general practitioners may encounter patients with undiagnosed PPD, too. These physicians could positively impact the lives of depressed mothers and their children by identifying them, then treating or providing referrals for care as appropriate.
Attention deficit and hyperactivity are known possible symptoms or correlates of obstructive slee... more Attention deficit and hyperactivity are known possible symptoms or correlates of obstructive sleep apnea (OSA). However, these associations may be missed in children, because children often fail to report excessive daytime sleepiness, and attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) are common primary diagnoses in themselves. We report on a 17-year-old, slender, non-snoring male who presented to his pediatrician with a prolonged history of four complaints: inattention, fidgeting, frequent sinusitis, and somnolence. He was diagnosed with ADHD, while the somnolence, which often abated somewhat upon use of antibiotics for sinusitis, was attributed to the sinus infections. A later sleep study revealed OSA, and thorough additional testing proved that the original ADHD diagnosis was in error. All four conditions were allayed with proper use of a continuous positive airway pressure (CPAP) machine.
Preeclampsia is a disorder of pregnancy characterized by hypertension with proteinuria after twen... more Preeclampsia is a disorder of pregnancy characterized by hypertension with proteinuria after twenty weeks gestation. The condition is an important cause of both maternal and infant mortality worldwide. One potential risk factor for preeclampsia that has been studied in a variety of countries and climates is time of the year of delivery. Several studies have reported a significant seasonality to preeclampsia, but their specific findings are contradictory. Interestingly, the places where much of this research occurred were comprised of populations whose race was fairly homogeneous. Further, a recent large scale study of preeclampsia in the United States separated out the women by race and reported a seasonality for white women, but not for black women. We performed a retrospective review of three years of hospital records for a medical center in Tulsa, Oklahoma, in order to search for evidence of a possible correlation between incidence of preeclamptic deliveries and month of the year. Our population was comprised of various ethnicities, but race was not included in the charts and could not be taken into consideration. Although the study was sufficiently powered, neither analysis of variance nor contingency table analysis revealed a significant seasonality of preeclamptic deliveries, (P = 0.9489 and 0.9549, respectively). Given the reported contradictory findings for various homogeneous populations, the finding of differences of seasonality of preeclampsia between blacks and whites in a large US study, and the lack of evidence for seasonality of preeclampsia in our diverse sample study, we conclude that the seasonality of preeclampsia deliveries may be influenced by genetic differences related to race. Future research should focus on separating out study participants by racial and ethnic backgrounds. If another identifiable risk factor for this dangerous condition exists, even for only a particular subset of a population, its identification can help physicians to more quickly recognize and respond to the disorder.
The aim of the study was to perform a retrospective review of records to test a possible signific... more The aim of the study was to perform a retrospective review of records to test a possible significant association between sudden, modest weight loss (≤2 lb) between the last two prenatal appointments in the late 3rd trimester and onset of labour. Hospital and clinic records were searched for women who delivered a term baby after the onset of natural labour between 2006 and 2008, in Tulsa, OK. High-risk pregnancies were excluded. Patients were categorised by whether they lost or gained weight between their last two prenatal appointments. The groups' average times to onset of spontaneous labour were compared. A total of 149 records were obtained. Mothers who lost weight had an average onset of spontaneous labour in 2.30 days; their counterparts' average was 2.34 days. Student's t-test and Wilcoxon test p values were 0.95 and 0.61, respectively. A Kolmogorov-Smirnov test p value was 0.2139. A one-half standard deviation difference in time to delivery, approximately 2.5 days, was detectable with 0.95 probability. It was concluded that these data may be the first time this question has been investigated and provide evidence that sudden, modest weight loss at the end of pregnancy is not associated with shorter time to onset of natural labour.
I developed Graves' Disease four months postpartum. After one year on propylthiouracil, I learned... more I developed Graves' Disease four months postpartum. After one year on propylthiouracil, I learned that omega-3 fatty acids may reduce inflammation associated with certain autoimmune disorders, although no investigations for thyroiditis have been reported. Within eight weeks of beginning flaxseed oil supplements, TSH levels normalized, but fell somewhat when flaxseed was decreased and PTU discontinued. During another pregnancy, plasma TSH normalized, but was again suppressed by four weeks postpartum, then undetectable by four months. This time, flaxseed supplementation alone coincided with TSH normalization. Omega-3 fatty acids should be investigated as a potential treatment for autoimmune thyroid disease.
Postpartum depression (PPD) is a cross-cultural form of major depressive disorder that affects so... more Postpartum depression (PPD) is a cross-cultural form of major depressive disorder that affects some 13% of women and can have serious health consequences for both the mother and her child. Easy-to-use, reliable, self-administered screening tools are available. PPD may have a variety of etiologies, which include changing plasma levels of estrogen and progesterone, postpartum hypothyroidism, sleep deprivation, or difficult life circumstances. Standard treatments for PPD include psychotherapy and antidepressants. However, treatment of a thyroid condition or insomnia, or even regular exercise or massage may also be beneficial. PPD is underdiagnosed, therefore more screening is needed. Obstetricians and pediatricians have a unique opportunity to test women for PPD, but general practitioners may encounter patients with undiagnosed PPD, too. These physicians could positively impact the lives of depressed mothers and their children by identifying them, then treating or providing referrals for care as appropriate.
Attention deficit and hyperactivity are known possible symptoms or correlates of obstructive slee... more Attention deficit and hyperactivity are known possible symptoms or correlates of obstructive sleep apnea (OSA). However, these associations may be missed in children, because children often fail to report excessive daytime sleepiness, and attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) are common primary diagnoses in themselves. We report on a 17-year-old, slender, non-snoring male who presented to his pediatrician with a prolonged history of four complaints: inattention, fidgeting, frequent sinusitis, and somnolence. He was diagnosed with ADHD, while the somnolence, which often abated somewhat upon use of antibiotics for sinusitis, was attributed to the sinus infections. A later sleep study revealed OSA, and thorough additional testing proved that the original ADHD diagnosis was in error. All four conditions were allayed with proper use of a continuous positive airway pressure (CPAP) machine.
Preeclampsia is a disorder of pregnancy characterized by hypertension with proteinuria after twen... more Preeclampsia is a disorder of pregnancy characterized by hypertension with proteinuria after twenty weeks gestation. The condition is an important cause of both maternal and infant mortality worldwide. One potential risk factor for preeclampsia that has been studied in a variety of countries and climates is time of the year of delivery. Several studies have reported a significant seasonality to preeclampsia, but their specific findings are contradictory. Interestingly, the places where much of this research occurred were comprised of populations whose race was fairly homogeneous. Further, a recent large scale study of preeclampsia in the United States separated out the women by race and reported a seasonality for white women, but not for black women. We performed a retrospective review of three years of hospital records for a medical center in Tulsa, Oklahoma, in order to search for evidence of a possible correlation between incidence of preeclamptic deliveries and month of the year. Our population was comprised of various ethnicities, but race was not included in the charts and could not be taken into consideration. Although the study was sufficiently powered, neither analysis of variance nor contingency table analysis revealed a significant seasonality of preeclamptic deliveries, (P = 0.9489 and 0.9549, respectively). Given the reported contradictory findings for various homogeneous populations, the finding of differences of seasonality of preeclampsia between blacks and whites in a large US study, and the lack of evidence for seasonality of preeclampsia in our diverse sample study, we conclude that the seasonality of preeclampsia deliveries may be influenced by genetic differences related to race. Future research should focus on separating out study participants by racial and ethnic backgrounds. If another identifiable risk factor for this dangerous condition exists, even for only a particular subset of a population, its identification can help physicians to more quickly recognize and respond to the disorder.
The aim of the study was to perform a retrospective review of records to test a possible signific... more The aim of the study was to perform a retrospective review of records to test a possible significant association between sudden, modest weight loss (≤2 lb) between the last two prenatal appointments in the late 3rd trimester and onset of labour. Hospital and clinic records were searched for women who delivered a term baby after the onset of natural labour between 2006 and 2008, in Tulsa, OK. High-risk pregnancies were excluded. Patients were categorised by whether they lost or gained weight between their last two prenatal appointments. The groups' average times to onset of spontaneous labour were compared. A total of 149 records were obtained. Mothers who lost weight had an average onset of spontaneous labour in 2.30 days; their counterparts' average was 2.34 days. Student's t-test and Wilcoxon test p values were 0.95 and 0.61, respectively. A Kolmogorov-Smirnov test p value was 0.2139. A one-half standard deviation difference in time to delivery, approximately 2.5 days, was detectable with 0.95 probability. It was concluded that these data may be the first time this question has been investigated and provide evidence that sudden, modest weight loss at the end of pregnancy is not associated with shorter time to onset of natural labour.
I developed Graves' Disease four months postpartum. After one year on propylthiouracil, I learned... more I developed Graves' Disease four months postpartum. After one year on propylthiouracil, I learned that omega-3 fatty acids may reduce inflammation associated with certain autoimmune disorders, although no investigations for thyroiditis have been reported. Within eight weeks of beginning flaxseed oil supplements, TSH levels normalized, but fell somewhat when flaxseed was decreased and PTU discontinued. During another pregnancy, plasma TSH normalized, but was again suppressed by four weeks postpartum, then undetectable by four months. This time, flaxseed supplementation alone coincided with TSH normalization. Omega-3 fatty acids should be investigated as a potential treatment for autoimmune thyroid disease.
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