Father's smoking during pregnancy tied to asthma in kids

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(Reuters Health) - Children who are exposed to tobacco smoke from their fathers while they’re in the womb may be more likely than those who are not to develop asthma by age 6, according to a study of chemical changes to DNA.

While prenatal smoke exposure has long been linked to an increased risk of childhood asthma, the current study offers fresh evidence that it’s not just a pregnant mother’s smoking that can cause harm.

Researchers followed 756 babies for six years. Almost one in four were exposed to tobacco by fathers who smoked while the child was developing in the womb; only three mothers smoked.

Overall, 31% of kids with fathers who smoked during pregnancy developed asthma by age 6, compared with 23% of kids without fathers who smoked, the study found.

Asthma was also more common among kids whose fathers were heavier smokers, senior study author Dr. Kuender Yang of the National Defense Medical Center in Taipei said by email.

“Children with prenatal paternal tobacco smoke exposure corresponding to more than 20 cigarettes per day had a significantly higher risk of developing asthma than those with less than 20 cigarettes per day and those without prenatal paternal tobacco smoke exposure,” Yang said.

About 35% of the kids with fathers who were heavier smokers developed asthma, compared with 25% of children with fathers who were lighter smokers and 23% of kids with fathers who didn’t smoke at all during pregnancy.

Smoking by fathers during pregnancy was also associated with changes in methylation - a chemical code along the DNA strand that influences gene activity - on portions of genes involved in immune system function and the development of asthma.

Researchers extracted infants’ DNA from cord blood immediately after birth and examined methylation along the DNA strand. The more fathers smoked during pregnancy, the more methylation increased on stretches of three specific genes that play a role in immune function.

Children who had the greatest methylation increases at birth, affecting all three of these genes, had up to almost twice the risk of having asthma by age 6 as other kids in the study.

While smoking by fathers during pregnancy was linked to childhood asthma, it didn’t appear to impact children’s sensitivity to allergens or total levels of IgE, an antibody associated with asthma.

This suggests that the risk of asthma from tobacco exposure is unlike allergic asthma, which is driven by allergies or allergic sensitization via IgE antibody, said Dr. Avni Joshi, a researcher at the Mayo Clinic Children’s Center in Rochester, Minnesota, who wasn’t involved in the study.

The study wasn’t designed to prove whether or how prenatal smoking exposure might directly cause so-called epigenetic changes, or how those changes cause asthma in children.

It’s not yet clear how the alterations seen along the DNA strand where methylation increased might cause asthma, the study team notes in Frontiers in Genetics.

Still, the message to parents should be clear, Joshi said by email.

“Smoking is bad at ANY point in time: before the baby is born and after the baby is born,” Joshi said. “Many parents defer quitting until the baby is born, but this study stresses that the prenatal exposure to tobacco creates changes to the unborn child’s immune system, hence it is best to quit as a family decides to have children, even before the conception happens.”

SOURCE: bit.ly/2WG9lhM Frontiers in Genetics, online May 31, 2019.

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Female soldiers wanting to suppress periods face barriers

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(Reuters Health) - Military women wanting to stop menstruating while they are deployed may face a number of barriers, a new commentary suggests.

The majority of surveyed military women say they would like to suppress menstruation during deployment but very few are doing so, according to the paper in Obstetrics & Gynecology that explores why more military women are not accessing that option.

One answer may be that not enough military women and their health providers even know that hormonal contraceptives used continuously will suppress menstruation.

“Women are counseled to stop taking contraceptives before deployment and that negates all the valuable health benefits, including suppression, that come with them,” said the commentary’s author, Sheena Eagan, an assistant professor at the Brody School of Medicine at East Carolina University in Greenville, North Carolina, and a specialist in military medicine ethics. “There’s a recurring theme in surveys: women want to access cycle control and they want to suppress menstruation before they are deployed.”

Unfortunately, there are many barriers blocking women’s access to menses suppression in the military, Eagan said, including the instructions to stop taking contraceptives before deployment because there is a rule against sexual intercourse while deployed. “I wanted to highlight the misconception I saw throughout the literature that equates contraceptive use with pregnancy prevention,” she said.

After reviewing the medical literature on the topic of menses suppression in the military, Eagan found that 66% to 86% of women surveyed wanted the ability to stop menstruating during deployment. In contrast, a mere 7% reported having done so.

Part of the problem may be lack of education among both the women and their health providers, Eagan said. A 2009 report found that only a third of service women had received any pre-deployment counseling on menstrual regulation and suppression. Moreover, nearly 70% of women reported that their primary healthcare providers were medics or corpsmen. Although training varies depending on the branch of service, these types of providers normally do not hold professional or graduate degrees, Eagan noted.

Eagan said she isn’t suggesting that menses suppression be mandated for all female soldiers, but “it should be part of women’s autonomous choice.”

The issues of menses regulation and control aren’t limited to military women, said Dr. Charles Ascher-Walsh, director of gynecology for the Mount Sinai Health System in New York City. “Obviously, when women are deployed it’s more convenient not to be menstruating,” he said. “But there are many women who would have the same kinds of benefits, such as when they are traveling for work.”

In general, Ascher-Walsh said, “there’s a lack of education among women and their doctors that this is a possibility - and a safe possibility. And doctors don’t offer it as much as I think they should.”

Still, the article may have made the process sound more straightforward than it sometimes is, Ascher-Walsh said. “It’s not as simple as: do this and you are guaranteed not to bleed,” he explained.

That’s because not all women will stop cycling on hormonal contraceptives, Ascher-Walsh said. With some methods, “you can end up with spotting every day and that’s worse than having your period,” he added. “So you don’t want to do it right before you are deployed since that can make it worse rather than better.”

The best option if a female soldier wants to try a method to halt menstruation is to experiment with it well before deployment, Ascher-Walsh said. Among the possible options, continuous birth control is “the most likely to stop a woman’s periods and be reliable,” Ascher-Walsh said.

SOURCE: bit.ly/2F89nsS Obstetrics & Gynecology, online June 11, 2019.

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