Pregnancy and Sleep

First of its kind statistics on pregnant women in US prisons

Pregnancy and Sleep | Johns Hopkins Medicine

In what is believed to be a first-of-its-kind systematic look at pregnancy frequency and outcomes among imprisoned U.S.

women, researchers from Johns Hopkins Medicine say almost 1,400 pregnant women were admitted to 22 U.S. state and all federal prisons in a recent year.

They also found that most of the prison pregnancies — over 90 percent — ended in live births with no maternal deaths.

Historically, say the researchers, these numbers have not been tracked by U.S. federal agencies or state prison systems, yet most of the women in American prisons are of reproductive age.

And although this particular study didn't address how pregnancy care was provided, the researchers say gathering diverse, nationally representative data such as this is a much-needed first step toward developing consistent guidelines for tracking the numbers and improving maternity care in the U.S. prison system.

“Currently, there are no mandatory standards for prenatal and pregnancy care for women in prisons,” says Carolyn Sufrin, M.D., Ph.D.

, lead author of the study, an assistant professor in gynecology and obstetrics at the Johns Hopkins University School of Medicine and author of Jailcare: Finding the Safety Net for Women Behind Bars.

“This study gives us insight into the actual numbers, which will help us better understand the scope of care needed by pregnant people behind bars. Having this information could also help inform policies to consider alternatives to incarceration for pregnant people.”

The findings of the new study, conducted by the researchers in collaboration with prison officials who reported information on a monthly basis for one year, were published online March 21 in the American Journal of Public Health.

According to the Bureau of Justice Statistics (BJS), there were more than 110,000 women in federal and state prisons in the United States at year-end 2016, with 75 percent of these women being 18-44 years old.

A 2004 BJS survey found that 3 percent of women in federal prisons and 4 percent of women in state prisons reported they were pregnant at intake.

Until this new study, this BJS survey from 15 years ago, which only accounted for self-reported pregnancies, was the only data on pregnancy prevalence in prisons.

Other and more current national health statistics databases exclude data from prisons, further contributing to the lack of maternal health and birth information about imprisoned populations.

To help close the information gap, the Johns Hopkins researchers gathered data on pregnant women in 22 state systems and all federal prisons, and tracked pregnancy outcomes over a period of 12 months from 2016-2017.

They did so by first contacting the prisons' custody and health care administrators via email or phone with an invitation to participate in the study.

For federal prisons, approval of participation was granted by the acting director of the U.S. Department of Justice and administrators at the Federal Bureau of Prisons.

The states' departments of corrections' policies allowed for participation of state prisons.

The researchers then arranged for a designated “site reporter” in each prison to use a survey form to track outcomes on a monthly basis among the pregnant patients in their prisons, reporting data on miscarriages, live births, stillbirths, maternal deaths, preterm births and abortions.

Site reporters could be wardens, prison research coordinators, women's programming coordinators, medical directors or other health care personnel.

At the end of each month during the survey year, site reporters sent their findings to the Johns Hopkins researchers using a secure, web-based program, Research Electronic Data Capture (REDCap).

In a bid to keep the data-gathering as accurate as possible, the Johns Hopkins researchers interviewed nearly half of the site reporters (43 percent) midway through the study to better understand how they tracked the data and to ensure accuracy. Data were also reviewed by research staff monthly to assess and correct inaccuracies. All data errors were corrected by site reporters during the study period.

From the data reported from each site, researchers determined that 1,396 already-pregnant women were admitted to the 22 state and all federal prisons in the study over the 12-month study period. These prisons house 57 percent of imprisoned women in the United States. For this study, no specific demographic information, such as race or age, was collected.

Of the pregnancies that ended while women were in custody, 753 resulted in live births. Six percent of the live births were preterm, and 30 percent were delivered by cesarean section, but these numbers varied greatly by state. The national statistic for preterm births and C-section deliveries in the general population are 10 percent and 31.9 percent, respectively.

Forty-six of the pregnancies ended in miscarriages, 11 ended in abortions, four ended in stillbirth and three newborns died. None of the mothers died. In the United States, there are more than 700 maternal deaths each year.

“We can't know for sure that these numbers come from the same women who were admitted who also had pregnancies that ended in prison,” says Sufrin. “They could have gotten released.”

The researchers said differences such as pre-incarceration health conditions, access to prenatal care, food, shelter and access to illegal drugs could account for the level of preterm birth rates in specific prisons that were higher or lower than the national average. In 2016, the national average for preterm births was 9.85 percent. The average for prisons in the study was 6 percent.

Access to and quality of reproductive health care varies from prison to prison, the researchers note, so the findings cannot be generalized to states that did not participate in the study. The researchers also recorded large variations in pregnancy outcomes by state.

For example, in Kansas, Vermont and Arizona, 20 or more percent of pregnancies ended in miscarriage. Additionally, Texas and Ohio had months with more than 50 pregnant women present in their prisons, while Maine and Rhode Island had some months with zero pregnant inmates.

Sufrin says that the state-by-state differences could be attributed to state sentencing laws, prison health care policies, access to public reproductive health care or other factors not measured in this study.

“We were very surprised by how willing and eager the prisons were to participate and to have better data to work with,” says Sufrin. “With the collective help of the prisons, our research team was able to take the initial steps to gather more systematic and standardized information.”

She added: “We know there are pregnant people in prison, and until now, it wasn't clear whether or not people wanted to pay attention to this particular population or do the adequate research needed to advance the quality of reproductive health care in prisons.”

The researchers cautioned that the study had several limitations: It didn't assess how far along in pregnancy the women were at intake, the size of the prisons, the pregnancy testing policies of the prisons, the type of hospital in which imprisoned women deliver and the variability in prison living conditions. All of those factors may or may not have contributed to variations in outcomes.

They also weren't able to collect pregnancy statistics from the other 28 state prison systems, including three large systems that declined participation (California, Florida and New York).

In future studies, the researchers hope to collect more information on the individual experiences of the women by interviewing, collecting demographic data and assessing the quality of their maternity care.

“Our hope is for these findings to be used to advance national standards of care for imprisoned pregnant women,” says Sufrin, “and to support those who advocate for policies and laws that guarantee acceptable and safe pregnancy care and childbirth, that consider alternatives to incarceration for pregnant people, uphold reproductive justice, and encourage more attention to the reproductive health needs of marginalized women and their families.”

Sufrin has been researching reproductive health care in jails and prisons since 2005, and the pregnancy care of incarcerated women specifically, since 2009. She is also the author of Jailcare: Finding the Safety Net for Women Behind Bars.

Story Source:

Materials provided by Johns Hopkins Medicine. Note: Content may be edited for style and length.


The First Trimester

Pregnancy and Sleep | Johns Hopkins Medicine

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  • At your first prenatal visit, you will undergo a physical exam as well as certain tests and screenings to assess the health of you and your unborn baby.
  • First trimester symptoms vary from woman to woman, with some experiencing all known symptoms and others only a few. Duration of symptoms can vary as well.
  • After eight weeks, the embryo is referred to as a fetus.
  • Although the fetus is only 1 to 1.5 inches long at this point, all major organs and systems have been formed.
  • During the first trimester, the fetus is most susceptible to damage from substances, alcohol, drugs and certain medicines, and illnesses, rubella (German measles).

Your first prenatal visit is the most thorough.

A complete medical history is taken, a physical exam is done, and certain tests and procedures are performed to assess the health of both you and your unborn baby. Your first prenatal visit may include:

  • Personal medical history. This may include taking record of any of the following:
  • Maternal and paternal family medical history, including illnesses, intellectual or developmental disabilities, and genetic disorders, sickle cell disease or Tay-Sachs disease
  • Personal gynecological and obstetrical history, including past pregnancies (stillbirths, miscarriages, deliveries, terminations) and menstrual history (length and duration of menstrual periods)
  • Education, including a discussion regarding the importance of proper nutrition and expected weight gain in pregnancy; regular exercise; the avoidance of alcohol, drugs and tobacco during pregnancy; and a discussion of any concerns about domestic violence
  • Pelvic exam. This exam may be done for one or all of the following reasons:
    • To note the size and position of the uterus
    • To determine the age of the fetus
    • To check the pelvic bone size and structure
    • To perform a Pap test (also called Pap smear) to find the presence of abnormal cells
  • Lab tests, including the following:

    • Urine tests. These are done to screen for bacteria, glucose and protein.
    • Blood tests. These are done to determine your blood type.
      • All pregnant women are tested for the Rh factor during the early weeks of pregnancy. Rh incompatibility happens when the mother’s blood is Rh-negative, the father’s blood is Rh-positive and the fetus’ blood is Rh-positive. The mother may make antibodies against the Rh-positive fetus, which may lead to anemia in the fetus. Incompatibility problems are watched and appropriate medical treatment is available to prevent the formation of Rh antibodies during pregnancy. There are also other blood antibodies that may cause problems in pregnancy that are screened for on the first visit.
  • Blood screening tests. These are done to find diseases that could have an effect on the pregnancy. One example is rubella, an infectious disease that is also called German measles.

  • Genetic tests. These are done to find inherited diseases, sickle cell disease and Tay-Sachs disease.

  • Other screening tests. These are performed to find infectious diseases, sexually transmitted diseases and urinary tract infections.

The first prenatal visit is also an opportunity to ask any questions or discuss any concerns that you may have about your pregnancy.

The First Trimester: What to Expect

A healthy first trimester is crucial to the normal development of the fetus. You may not be showing much on the outside yet, but on the inside, all of the major body organs and systems of the fetus are forming.

As the embryo implants itself into the uterine wall, several developments take place, including the formation of the:

  • Amniotic sac. A sac filled with amniotic fluid, called the amniotic sac, surrounds the fetus throughout the pregnancy. The amniotic fluid is liquid made by the fetus and the amnion (the membrane that covers the fetal side of the placenta) that protects the fetus from injury. It also helps to regulate the temperature of the fetus.
  • Placenta. The placenta is an organ shaped a flat cake that only grows during pregnancy. It attaches to the uterine wall with tiny projections called villi. Fetal blood vessels grow from the umbilical cord into these villi, exchanging nourishment and waste products with your blood. The fetal blood vessels are separated from your blood supply by a thin membrane.
  • Umbilical cord. The umbilical cord is a rope cord connecting the fetus to the placenta. The umbilical cord contains two arteries and a vein, which carry oxygen and nutrients to the fetus and waste products away from the fetus.

It is during this first trimester that the fetus is most susceptible to damage from substances, alcohol, drugs and certain medicines, and illnesses, rubella (German measles).

During the first trimester, your body and your baby’s body are changing rapidly.

The Baby-Friendly Hospital Initiative, a global program launched by the World Health Organization and the United Nations Children’s Fund, has designated The Johns Hopkins Hospital as Baby-Friendly. This designation is given to hospitals and birthing centers that offer an optimal level of care for infant feeding and mother-baby bonding.

During pregnancy, many changes will happen to your body to help nourish and protect your baby. Women experience these changes differently. Some symptoms of pregnancy continue for several weeks or months.

Others are only experienced for a short time. Some women experience many symptoms, and other women experience only a few or none at all.

The following is a list of changes and symptoms that may happen during the first trimester:

  • The mammary glands enlarge, causing the breasts to swell and become tender in preparation for breast-feeding. This is due to an increased amount of the hormones estrogen and progesterone. A supportive bra should be worn.
  • Your areolas (the pigmented areas around each breast’s nipple) will enlarge and darken. They may become covered with small, white bumps called Montgomery’s tubercles (enlarged sweat glands).
  • Veins become more noticeable on the surface of your breasts.
  • The uterus is growing and begins to press on your bladder. This causes you to need to urinate more often.
  • Partly due to surges in hormones, you may experience mood swings similar to premenstrual syndrome, a condition experienced by some women that is characterized by mood swings, irritability and other physical symptoms that happen shortly before each menstrual period.
  • Increased levels of hormones to sustain the pregnancy may cause “morning sickness,” which causes nausea and sometimes vomiting. However, morning sickness does not necessarily happen just in the morning and rarely interferes with proper nutrition for the mother and her fetus.
  • Constipation may happen as the growing uterus presses on the rectum and intestines.
  • The muscular contractions in the intestines, which help to move food through the digestive tract, are slowed due to high levels of progesterone. This may, in turn, cause heartburn, indigestion, constipation and gas.
  • Clothes may feel tighter around the breasts and waist, as the size of the stomach begins to increase to accommodate the growing fetus.
  • You may experience extreme tiredness due to the physical and emotional demands of pregnancy.
  • Cardiac volume increases by about 40 to 50 percent from the beginning to the end of the pregnancy. This causes an increased cardiac output. An increased cardiac output may cause an increased pulse rate during pregnancy. The increase in blood volume is needed for extra blood flow to the uterus.  

The First Trimester: Fetal Development

The most dramatic changes and development happen during the first trimester. During the first eight weeks, a fetus is called an embryo. The embryo develops rapidly and by the end of the first trimester, it becomes a fetus that is fully formed, weighing approximately 0.5 to 1 ounce and measuring, on average, 3 to 4 inches in length.

First Trimester Fetal Growth and Development Benchmarks

The chart below provides benchmarks for most normal pregnancies. However, each fetus develops differently.

Timing Development Benchmark
By the end of four weeks
  • All major systems and organs begin to form.
  • The embryo looks a tadpole.
  • The neural tube (which becomes the brain and spinal cord), the digestive system, and the heart and circulatory system begin to form.
  • The beginnings of the eyes and ears are developing.
  • Tiny limb buds appear, which will develop into arms and legs.
  • The heart is beating.
By the end of eight weeks
  • All major body systems continue to develop and function, including the circulatory, nervous, digestive, and urinary systems.
  • The embryo is taking on a human shape, although the head is larger in proportion to the rest of the body.
  • The mouth is developing tooth buds, which will become baby teeth.
  • The eyes, nose, mouth, and ears are becoming more distinct.
  • The arms and legs can be easily seen.
  • The fingers and toes are still webbed, but can be clearly distinguished.
  • The main organs continue to develop and you can hear the baby's heartbeat using an instrument called a Doppler.
  • The bones begin to develop and the nose and jaws are rapidly developing.
  • The embryo is in constant motion but cannot be felt by the mother.
From embryo to fetus
  • After 8 weeks, the embryo is now referred to as a fetus, which means offspring.
  • Although the fetus is only 1 to 1.5 inches long at this point, all major organs and systems have been formed.
During weeks nine to 12
  • The external genital organs are developed.
  • Fingernails and toenails appear.
  • Eyelids are formed.
  • Fetal movement increases.
  • The arms and legs are fully formed.
  • The voice box (larynx) begins to form in the trachea.

The fetus is most vulnerable during the first 12 weeks. During this period of time, all of the major organs and body systems are forming and can be damaged if the fetus is exposed to drugs, infectious agents, radiation, certain medications, tobacco and toxic substances.

Even though the organs and body systems are fully formed by the end of 12 weeks, the fetus cannot survive independently.


Nutrition During Pregnancy

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The Academy of Nutrition and Dietetics recommends the following key components of a healthy lifestyle during pregnancy:

  • Appropriate weight gain
  • A balanced diet
  • Regular exercise
  • Appropriate and timely vitamin and mineral supplementation

Dietary and Caloric Recommendations

To maintain a healthy pregnancy, approximately 300 extra calories are needed each day. These calories should come from a balanced diet of protein, fruits, vegetables and whole grains. Sweets and fats should be kept to a minimum. A healthy, well-balanced diet can also help to reduce some pregnancy symptoms, such as nausea and constipation.

Fluid Intake During Pregnancy

Fluid intake is also an important part of pregnancy nutrition. Follow these recommendations for fluid intake during pregnancy:

  • You can take in enough fluids by drinking several glasses of water each day, in addition to the fluids in juices and soups. Talk to your health care provider or midwife about restricting your intake of caffeine and artificial sweeteners.
  • Avoid all forms of alcohol.

Ideal Foods to Eat During Pregnancy

The following foods are beneficial to your health and fetal development during pregnancy:

  • Vegetables: carrots, sweet potatoes, pumpkin, spinach, cooked greens, tomatoes and red sweet peppers (for vitamin A and potassium)
  • Fruits: cantaloupe, honeydew, mangoes, prunes, bananas, apricots, oranges, and red or pink grapefruit (for potassium)
  • Dairy: fat-free or low-fat yogurt, skim or 1% milk, soymilk (for calcium, potassium, vitamins A and D)
  • Grains: ready-to-eat cereals/cooked cereals (for iron and folic acid)
  • Proteins: beans and peas; nuts and seeds; lean beef, lamb and pork; salmon, trout, herring, sardines and pollock

Foods to Avoid During Pregnancy

Avoid eating the following foods during pregnancy:

  • Unpasteurized milk and foods made with unpasteurized milk (soft cheeses, including feta, queso blanco and fresco, Camembert, brie or blue-veined cheeses—unless labeled “made with pasteurized milk”)
  • Hot dogs and luncheon meats (unless they are heated until steaming hot before serving)
  • Raw and undercooked seafood, eggs and meat. Do not eat sushi made with raw fish (cooked sushi is safe).
  • Refrigerated pâté and meat spreads
  • Refrigerated smoked seafood

Guidelines for Safe Food Handling

Follow these general food safety guidelines when handling and cooking food:

  • Wash. Rinse all raw produce thoroughly under running tap water before eating, cutting or cooking.
  • Clean. Wash your hands, knives, countertops and cutting boards after handling and preparing uncooked foods.
  • Cook. Cook beef, pork or poultry to a safe internal temperature verified by a food thermometer.
  • Chill. Promptly refrigerate all perishable food.

Prenatal Vitamin and Mineral Supplements

Most health care providers or midwives will prescribe a prenatal supplement before conception or shortly afterward to make sure that all of your nutritional needs are met. However, a prenatal supplement does not replace a healthy diet.

The Importance of Folic Acid

The U.S. Public Health Service recommends that all women of childbearing age consume 400 micrograms (0.4 mg) of folic acid each day. Folic acid is a nutrient found in:

  • Some green leafy vegetables
  • Most berries, nuts, beans, citrus fruits and fortified breakfast cereals
  • Some vitamin supplements.

Folic acid can help reduce the risk of neural tube defects, which are birth defects of the brain and spinal cord. Neural tube defects can lead to varying degrees of paralysis, incontinence and sometimes intellectual disability.

Folic acid is the most helpful during the first 28 days after conception, when most neural tube defects occur. Unfortunately, you may not realize that you are pregnant before 28 days.

Therefore, your intake of folic acid should begin before conception and continue throughout your pregnancy.

Your health care provider or midwife will recommend the appropriate amount of folic acid to meet your individual needs.

For example, women who take anti-epileptic drugs may need to take higher doses of folic acid to prevent neural tube defects. They should consult with their health care provider when considering trying to conceive.


Pregnancy and Diabetes

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During pregnancy, diabetes impacts the health of the mother and baby in many ways. Pregnant women with poorly controlled diabetes are at higher risk for miscarriage, stillbirth, premature birth, larger than average babies, and birth defects.

Fortunately, women with diabetes can take several steps to protect their health and the health of their babies before and during pregnancy.

If you’re planning to get pregnant, work with your doctor ahead of time to get your Hb A1c level as close to goal as possible.

Review your medications with your health care provider and pharmacist to make sure that they will be safe for the baby when you do conceive.

Remember these tips and be assured that mother knows BEST…

Blood glucose. Tight control of your blood glucose can dramatically lower the risk of birth defects, premature birth, and stillbirth. Work with your provider to set—and achieve—an A1c goal that’s appropriate. Often, the A1c goal in pregnancy may be stricter than in non-pregnant adults to ensure optimal health of the mother and baby.

Eyeexams. If you’re pregnant, call your eye doctor to schedule a screen for diabetic eye disease (known as retinopathy) particularly if you haven’t had an examination in the past year. Eye disease often gets worse during pregnancy.

Settreatmentgoalswithyour provider.

Women with well-controlled type 2 diabetes or gestational diabetes may benefit from a low-carb diet or pills, while women with poorly controlled blood glucose levels might require daily insulin injections to control their blood glucose.

Keep in mind that you may need more insulin than usual during your pregnancy, but your insulin requirements should return to normal after your baby is born. The abdomen is the best place for insulin injections during pregnancy. If done correctly, there is no risk to the baby.

Testingiskey. Medical tests are performed more often in women with diabetes than in other pregnant women.

Your health care provider will monitor your kidney function closely as you and your baby grow, and don’t be surprised if you’re sent for ultrasounds more often than other pregnant women.

Ultrasound images are very helpful in determining when you got pregnant, monitoring the baby’s growth, checking for birth defects, and predicting your due date as accurately as possible.

In The Delivery Room

Women who have diabetes will be carefully monitored during the last few weeks of their pregnancies.

When you go into labor, your doctor will ly administer IV insulin to make sure that your blood glucose is tightly controlled during labor and delivery.

Larger than average babies: If ultrasound images suggest your baby is larger than 10 lbs, the provider will ly recommend a cesarean section.

While a vaginal delivery may be possible, larger babies face a three times higher risk of getting lodged in the birth canal—a life-threatening condition known as shoulder dystocia.

A scheduled cesarean section can avoid this complication and ensure a healthy delivery.


Research News Tip Sheet: Story Ideas From Johns Hopkins

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Newswise — During the COVID-19 pandemic, Johns Hopkins Medicine Media Relations is focused on disseminating current, accurate and useful information to the public via the media. As part of that effort, we are distributing our “COVID-19 Tip Sheet: Story Ideas from Johns Hopkins” every Tuesday throughout the duration of the outbreak.

We also want you to continue having access to the latest Johns Hopkins Medicine research achievements and clinical advances, so we are issuing a second tip sheet every Thursday, covering topics not related to COVID-19 or the SARS-CoV-2 virus.

Stories associated with journal publications provide a link to the paper. Interviews with the researchers featured may be arranged by contacting the media representatives listed.


Media Contact: Vanessa McMains, Ph.D. 

For thousands of years, people have used psychedelic drugs found in plants, mushrooms and animals for spiritual and recreational purposes.

One such chemical, N,N-dimethyltryptamine (DMT), creates intense and unusual experiences for up to 30 minutes when inhaled via smoking or vaping.

These experiences often involve visions and changes in emotions and thinking, which are sometimes interpreted as feeling the compelling presence of another conscious entity such as an angel or even an alien.

In a study published in the May 7, 2020, issue of the Journal of Psychopharmacology, Johns Hopkins Medicine researchers reported results from an online survey of more than 2,500 participants who described their most memorable entity encounter experience after inhaling DMT. They found that 80% of respondents said their fundamental perception of reality was altered following this event. For those who declared themselves as atheists before the DMT entity encounter, more than half no longer claimed to be afterward.

“That we have the capacity and are biologically predisposed for these experiences with psychedelics suggests that this may be an evolutionarily conserved process in which we are wired to detect sentient others. Historically, such a predisposition would have a significant survival value in hostile environments,” says senior author Roland Griffiths, Ph.

D., professor of psychiatry, behavioral sciences and neuroscience at the Johns Hopkins University School of Medicine and director of the Center for Psychedelic and Consciousness Research. “Finding out why we have these experiences and how people interpret them may lead us to a better understanding of the human condition and how we perceive reality.

Most respondents reported that the entity had the attributes of being conscious, intelligent and benevolent. Almost three quarters of participants reported believing that the entity continued to exist after the encounter. The vast majority of participants attributed subsequent positive changes in life satisfaction (89%) and purpose (82%).

“Although we need to do more research in order to understand how these entity encounters exert positive changes in people’s lives, it’s possible that the metaphysical shock from questioning one's worldview occasioned by these vivid, unusual experiences may play an important role in the enduring positive life changes in attitudes, moods and behavior they inspire,” says lead author Alan Davis, Ph.D., a part-time adjunct assistant professor of psychiatry and behavioral sciences.

However, a small portion of participants (5% or less) reported negative and undesirable changes in mood, behavior or life satisfaction.

“We have to be cautious because we’re delving into experiences that appear on the psychotic end of the spectrum and there may be an unknown set of harms in certain susceptible people,” says Griffiths.


Media Contact: Valerie Mehl 

A recent randomized, multicenter study showed that a rare and lethal group of gastrointestinal cancers known as biliary tract cancers (BTCs) can be controlled in some patients with a combination of immunotherapy (a biological therapy that helps the immune system fight a malignancy) and targeted therapy (a drug that targets the specific genes, proteins or environmental factors allowing a cancer to grow and survive).

BTCs are aggressive cancers for which the standard treatment for most patients has not changed significantly in more than a decade.

The study was led by Nilofer Azad, M.D., associate professor of oncology, and Mark Yarchoan, M.D.

, assistant professor of oncology, at the Johns Hopkins Kimmel Cancer in collaboration with the National Cancer Institute and 23 cancer centers throughout the United States.

Yarchoan presented the study findings “virtually” on April 28, 2020, at the annual meeting of the American Association for Cancer Research.

The study included 77 patients with advanced BTC, a cancer that occurs in the ducts that drain bile from the liver. Participants were ages 44 to 86, nearly two-thirds female, and could have received one or two prior treatments for BTC.

Yarchoan and collaborators wanted to see if combining two drugs — one immunotherapy and one targeted therapy — resulted in improved anticancer activity in BTC.

Patients were randomized into two different groups: 39 patients who received only the immunotherapy atezolizumab (a drug that releases the brakes on the immune response to cancer), and 38 patients who received atezolizumab in combination with cobimetinib (a drug that blocks a gene signaling pathway known to be overactive in BTC).

Progression-free survival (defined by the National Cancer Institute as “the length of time during and after the treatment of a cancer that a patient lives with it but it does not get worse”) in the combination therapy group was nearly double (111 days) that of those in the single treatment group (57 days). This difference was statistically significant.

The disease control rate — the ability to keep the cancer from growing and progressing — was 14 31 patients in the combination treatment group and 11 34 patients in the single treatment group. Side effects from the combination drug therapy were manageable, and included nausea, vomiting, rash, and low blood and platelet counts.

“This is a challenging cancer, but the combination of atezolizumab with cobimetinib met its primary outcome and significantly prolonged progression-free survival as compared to atezolizumab. This combination warrants further clinical investigation,” says Yarchoan.


Media Contact: Vanessa McMains, Ph.D.

Although smoking tobacco is generally on the decline, electronic cigarette use is on the rise.

Researchers at Johns Hopkins Medicine have been interested in vulnerable populations that might potentially be harmed by e-cigarette use, including pregnant women and their babies.

As reported in the April 30, 2020, issue of the American Journal of Preventive Medicine, an analysis of a national database of more than 7,400 pregnant women in the United States found that this group is also increasing its use of e-cigarettes.

From 2016 to 2018, e-cigarette use rose from 1.9% to 3.8% among the pregnant women surveyed. Almost 42% of all pregnant e-cigarette users were young, between 18 and 24 years old. Some 46% of pregnant e-cigarette users also reported smoking combustible cigarettes, which are known to cause low birth weight in newborns.

Pregnant e-cigarette users in general were more ly to participate in risky behaviors, such as using cannabis or drinking alcohol, when compared with pregnant women who didn’t use e-cigarettes.

“Many people are under the impression that vaping is safer than traditional smoking, and that seems ly to be the case with some pregnant women as well,” says Michael Blaha, M.D., M.P.H.

, professor of medicine at the Johns Hopkins University School of Medicine and director of the Ciccarone Center for the Prevention of Cardiovascular Disease.

“We know that e-cigarette use may damage the lungs and may increase the risk of heart disease; however, we still don’t know yet the risk to unborn or newborn babies.”

As the data from this study is representative of the U.S. population, the researchers estimate that approximately 88,000 newborns are exposed yearly in the womb to e-cigarettes.

“Our data serves as justification for more research to examine the potential health effects of e-cigarette use in pregnancy on exposed newborns,” says lead author Olufunmilayo “Funmi” Obisesan, M.D., M.P.H., postdoctoral fellow at the Ciccarone Center. “The findings can inform progressive public health campaigns and clinical practice and could even help direct future regulations.”


Media Contact: Vanessa McMains, Ph.D. 

Maternal death rates are on the rise due to women becoming pregnant at a later age when they have developed heart and vascular disease, and as people with congenital heart conditions survive into adulthood to have children of their own. Racial and economic disparities in health care also contribute to more than double the mortality rate in pregnant women of color compared to white women.

To better facilitate treatment for pregnant women with cardiovascular diseases, a working group composed of a Johns Hopkins Medicine physician and American Heart Association (AHA) experts have released a scientific statement that provides best practices for how to treat mothers with cardiovascular disease. The statement was published online on May 4, 2020, in the journal Circulation.

“Our hope by issuing this guidance is that improvements in care will lead to better outcomes for mothers and babies, as well as more lives saved,” says cardiologist Garima Sharma, M.D.

, assistant professor of medicine at the Johns Hopkins University School of Medicine.

“Physicians and health care providers across many different specialties will need to work with primary care providers and cardiologists to coordinate their services to make a difference in the care that our mothers receive.”

The statement provides guidance existing scientific research for how to treat women who have preexisting conditions or newly developed conditions in pregnancy, such as heart valve disease, high blood pressure, high cholesterol, heart infections, irregular heartbeats, blocked arteries, blood clots, stroke or congenital heart disease. The statement lists what safety information is known about medications for treating specific conditions, when to counsel these high-risk patients and which experts need to be involved with them for the ultimate goal of improving care.

As adverse pregnancy outcomes such as preterm birth, gestational diabetes and high blood pressure during pregnancy (known as preeclampsia) are risk factors for cardiovascular disease, physicians should make a point to talk to their patients about how to mitigate risks and help them enact appropriate surveillance and lifestyle changes.


Debunking myths about exercise in pregnancy | WTOP

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This content is sponsored by Johns Hopkins Medicine

Pregnancy represents one of the greatest physical changes you will ever experience. To support you and your growing baby, eating healthy is key, but so is staying physically active. But what’s the safest way to exercise during the pregnancy?

Johns Hopkins maternal-fetal medicine specialists at Sibley Memorial Hospital help debunk common myths about exercise and pregnancy.

Myth #1: If you don’t usually exercise, you shouldn’t start during pregnancy.

Pregnancy is actually an ideal time to start an exercise program.  You should consider easing into an exercise routine if you did not work out before pregnancy.

The American College of Obstetricians and Gynecologists recommends moderate-intensity exercise for at least 20-30 minutes per day on most or all days of the week. The following are ideal exercises during pregnancy:

  • Walking: Walking at a moderate pace can be a great, easy way to fulfill the recommended guidelines. If you’re walking, you should be able to walk and talk at the same time. If you can’t, you should slow down.
  • Gym activities: Working out on the elliptical, doing water exercises in the pool and swimming are healthy and safe ways to stay active.
  • Pilates or yoga: Pilates and yoga can be mentally and physically beneficial. Hot yoga is not recommended–you should always stay cool and hydrated while pregnant. Also, avoid motionless postures, and certain yoga positions – especially if flat on the back.

The most important thing while performing these exercises is to keep it at a moderate level. Don’t push yourself to the point of exhaustion.

You should be careful with exercises that could cause you to lose your balance. Riding a bicycle, for example, might not be the safest form of exercise due to the increased fall risk. What’s most important is to find something you enjoy while staying safe. Talk to your doctor to see what works with your personal history.

Myth #2: Athletes can continue vigorous exercise throughout pregnancy without cause for concern.

If you’re an athlete with a healthy pregnancy, you can usually maintain your exercise regimen. You should talk with your health care provider about what’s best for you.

It is important, though, not to push yourself beyond a ‘safe’ threshold, which could affect the fetus. It is also important to avoid becoming over-heated or dehydrated. Be sure to consume enough calories as to prevent weight loss, which could affect fetal growth. Your physician can provide you with more guidance to find the right balance.

Myth #3: The only value of exercise during pregnancy is to help you lose weight more easily after your baby is born.

Exercise during pregnancy helps with weight management and may reduce the risk of gestational diabetes and C-section delivery. Exercise is a huge component of postpartum weight loss.  Your metabolic function improves and your risk of developing cardiometabolic disease decreases. Even if you don’t see immediate weight loss, you should continue to exercise for your internal health.

According to the U.S. Department of Health and Human Services, regular physical activity is one of the most important things you can do for your health. And that’s just as true during pregnancy.

­­­­­­­Rita Driggers, MD, is the medical director of maternal fetal medicine, Johns Hopkins Medicine, at Sibley Memorial Hospital and an associate professor at the Johns Hopkins School of Medicine.

Julia Timofeev, MD, is a board-certified Ob/Gyn with maternal fetal medicine, Johns Hopkins Medicine, at Sibley Memorial Hospital and an assistant professor at the Johns Hopkins School of Medicine.

To learn more about their work, visit