Do low vitamin D levels matter during pregnancy?

By Adam Marcus

(Reuters Health) - Many women have low blood levels of vitamin D early in pregnancy, but whether that's a problem for their developing babies is uncertain, researchers have found.

The new study, by scientists in Australia, suggests that vitamin D deficiency among pregnant women may even be the norm, although defining deficiency is tricky.

However, the researchers did not find any solid evidence that it stunts fetal growth or causes other pregnancy-related complications.

The researchers analyzed 18 previous studies in which vitamin D levels were assessed in women in their first 3 months of pregnancy. Of those, five studies included information about the outcome of the pregnancy, including low birth weight and preeclampsia, a maternal complication that can be life-threatening.

The researchers, who reported their findings April 8 in the American Journal of Obstetrics and Gynecology, found no clear definition of vitamin D deficiency during early pregnancy. Rather, women in the previous studies were considered "deficient" if they fell below a certain level based the particular population of women assessed.

Definitions of vitamin D deficiency in the studies varied widely, according to the researchers, from 12.5 to 50 nanomoles (nmol) per liter. Insufficiency ranged between 37.5 and 80 nmol per liter, while sufficiency ranged from above 50 to above 80 nmol per liter.

For comparison, a 2010 Institute of Medicine report states that levels of vitamin D above 50 nmol per liter are necessary for proper bone growth in nearly all people.

"Despite the variation in cut-points applied by studies," the authors wrote, "all reported a significant proportion of their sample to be vitamin D deficient. This has serious implications for the management of pregnancy as many pregnancy care providers are considering or implementing vitamin D supplementation in pregnancy."

Indeed, the only consistent picture to emerge from the analysis was that most women have low levels of vitamin D during pregnancy. White women typically had about twice the blood levels of vitamin D as non-white women, a reflection of the fact that darker skin pigments block ultraviolet rays.

Similarly, women living in northern latitudes had lower levels of vitamin D than those living nearer to the equator, where sunlight is more intense.

If vitamin D deficiency were linked to trouble with pregnancy or fetal development, identifying the problem early on could allow women to take supplements of the nutrient and correct the deficit. To date, no conclusive randomized, controlled study of the effects of vitamin D on pregnancy has been conducted.

But whether pregnant women are getting too little, or perhaps too much, vitamin D has been controversial. In November, the Institute of Medicine issued guidelines calling for pregnant women to receive 600 international units (IUs) of vitamin D daily, with a maximum dose of no more than 4,000 IUs.

Still, a study last year by researchers in the United States suggested that pregnant women should dramatically increase their intake of vitamin D, in the form of supplements, to as much as 4,000 IUs per day. The authors said there is little danger at that level.

Bruce Hollis, a vitamin D expert at the Medical University of South Carolina, in Charleston, and a co-author of the 2010 study, said he was not surprised that vitamin D deficiency was not associated with impaired fetal growth and birth weight in the new study.

However, he said, "to me the biggest thing in pregnancy about vitamin D deficiency is that it compromises the ability to fight infection." That, in turn, could lead to serious problems that would only appear well after birth.

The authors of the new study could not be reached for comment.

SOURCE: bit.ly/jHj7jv American Journal of Obstetrics and Gynecology, April 8, 2011.

8 Early Signs You May Be Pregnant

Early Signs of Pregnancy

Can't wait to find out if you're pregnant? These first symptoms of pregnancy may clue you in on the big news even sooner than you'd think.

When you’re TTC (trying to conceive), each passing month brings the same batch of questions: Did we hit the baby jackpot? Are those cramps, that bloating, that breast tenderness early signs of pregnancy — or just signs that it’s time for your monthly tampon run? The best way to confirm that you have a baby on board is to take a pregnancy test (preferably a digital one, since they offer more reliable results earlier). But while you’re waiting, check out these early pregnancy symptoms. None is pregnancy proof positive, but they can offer intriguing (if sometimes confusing) clues.

First Signs of Pregnancy

Even early on, your body doesn’t stay mum on whether you’re about to become a mom. These conception clues may let you in on the happy secret before the home pregnancy test gives you the readout of your dreams. Keep in mind that most early pregnancy symptoms can be pretty similar to those monthly PMS symptoms (Mother Nature’s perverse sense of humor at work?), which means you’ll definitely need that HPT for confirmation:

• Tender, swollen, or painful breasts. Are your breasts yelling “Look, but don’t touch!”? Tingly, sore, full-feeling, tender, even painful-to-the-touch breasts and nipples are often one of the first symptoms of pregnancy (though, of course, they can also come along for the PMS ride, too). The blame for the pain lies with the hormones estrogen and progesterone that are starting their overtime shifts in the baby-readying department. After all, there are only nine months to go before those breasts will need to produce milk to feed your hungry newborn. 
• Darkening areolas. While other breast changes may also signal that your period’s on its way, this symptom’s pretty much owned by pregnancy. Early pregnancy hormones can cause the areolas to darken in color and increase in diameter pretty soon after sperm and egg hook up. Also, the tiny bumps on the areolas that you may never have noticed before (they look like goose bumps but are actually oil-producing glands to lubricate your nipples) may become more pronounced and increase in size. 
• Fatigue. Another one of the early symptoms of pregnancy is sheer exhaustion. Sluggishness. Sleepiness. The overwhelming urge to curl up on the couch and stay there all day — or never to get out from under the covers at all. The reason your get-up-and-go has gotten-up-and-gone? It’s those pregnancy hormones at work again, expending tons of energy to build the placenta — the life-support system for your baby. Some women find they also drag with PMS, though, making this symptom a tough one to call. 
• Nausea. Queasiness is a sign of pregnancy that can sign on early, though it probably won’t be hitting its peak for a few weeks at least. That nagging nausea – which may soon be accompanied by vomiting -- is officially known as morning sickness, but anyone who’s suffered with it knows that it’s misnamed (it can strike morning, noon, or night). Hormones are largely to blame for making you green-around-the-gills, but not every new mom-to-be experiences morning sickness. 
• Heightened sense of smell. Have you been sniffing around like a police dog lately? A heightened sense of smell – which can make even mild or formerly favorite aromas smell strong and unappealing – can appear early on the pregnancy scene. Once again (you’ll be doing this a lot), you can thank your pregnancy hormones for your more sensitive sniffer. Smell pregnancy, but keep coming up negative on those HPTs? Those PMS hormones can also put your nose on higher-than-usual alert. 
• Spotting. Light spotting (aka implantation bleeding) before you’d expect your period (around five to 10 days after conception) can be another sign of early pregnancy. This bleeding occurs when the newly formed embryo (aka, your baby!) burrows into the uterine lining, making itself at home for the next nine months. Keep in mind, however, that only 20 percent of newly pregnant women will notice the mild, light-colored spotting -- the other 80 percent will have to look for other early pregnancy clues. 
• Frequent urination. Me need to pee…again? This new gotta-go feeling is due to the pregnancy hormone hCG, which increases blood flow to your kidneys, helping them to more efficiently rid your body of fluid waste (you’ll be peeing for two, after all). Peeing up a storm, but you’re not pregnant? Check with the practitioner to see if you might have a UTI (especially it burns or hurts when you pee). 
• Bloating. Is it pregnancy bloat – or pre-period bloat? That is the question, and it isn’t an easy question to answer (either way, you’ll have a hard time buttoning your skinny jeans). Even if you are expecting, it’s too soon to attribute your swell little belly to your baby (who’s still barely the size of a sesame seed at this point) – blame it, instead, on the hormone progesterone. Among its many other baby-making jobs, progesterone helps slow down digestion, allowing the nutrients from the foods you eat more time to enter your bloodstream and reach your baby-to-be. The downside? It allowsgas to hang out in your intestines longer.

Religious women use contraception regularly

Religious women use contraception regularly, report says

Most sexually active women use contraception, regardless of their religious beliefs, says a report from the Guttmacher Institute, an organization working to advance reproductive and sexual health  in the U.S. and worldwide.

"Regardless of religious affiliation, the majority of women use highly effective contraception methods, so any efforts to restrict access to these methods is going to impact these populations," said Rachel K. Jones, the lead author.

The report was based on a U.S. government survey that represented the nation. The data came from 2006-2008 interviews of over 7,000 women aged 15-44.

It found that 69% of sexually active women from any denomination were using highly effective birth control methods including sterilization, the pill or other hormonal method, or an intrauterine device (IUD). In addition, almost all have reported contraceptive use at some point, a figure that is similar among Catholic women.

Another key finding was that 68% of Catholics use one of the highly effective methods, but only 2% rely on natural family planning. That number is comparable to 73% of Mainline Protestants and 74% of Evangelicals.

"A lot of times, religion is either not associated with contraception at all, or, in the case of the Catholic church, being against contraception." Jones added. "In the real world, women who have religious beliefs and who attend church also use contraception."

In addition, male or female sterilization was most common in the Evangelical church; more than four in 10 women of this denomination use the method.

And marital status did not change things.

"Across religious denominations, married women are using highly effective contraceptive methods," she said.

Said Cecile Richards, president of Planned Parenthood Federation of America,“These findings show yet again that birth control is a common practice — and a common need — for women of different faiths and backgrounds.

"As Congress considers yet another effort to bar Planned Parenthood from providing family planning services through federal health programs, it should listen to the message these findings convey.”

Fish During Pregnancy Reduces Preterm Birth Risk

Fish During Pregnancy Reduces Preterm Birth Risk
By Denise Reynolds

A new study, published in the journal Obstetrics and Gynecology, finds that among pregnant women at high risk of preterm birth, eating fish a few times a week appears to reduce the risk of delivering early. Researchers at the Nationwide Children’s Hospital compared the diets of 852 pregnant women who were at higher than average risk of preterm delivery. Those who ate two or three servings of fish per week were about 40 percent less likely to deliver early than women who ate fish less than monthly. The reason for the association is not clear, but it is suspected that nutrients in the fish may help lower the odds for early delivery. Even with these findings, the researchers still stress that pregnant women should avoid fish that are high in mercury, such as swordfish and king mackerel.

Over 4,000 test-tube babies born at Tu Du hospital

As many as 4,060 test-tube babies were born at Tu Du Obstetrics Hospital in Ho Chi Minh City.

Hospital Deputy Director Hoang Thi Diem Tuyet made public the figure at a ceremony held on April 24 to celebrate the 14^th founding anniversary of the hospital’s in vitro fertilisation (IVF) unit.

Established in August 1997, this was the first of its kind in Vietnam.

On April 30, 1998, Vietnam’s first three babies were born at the unit, using IVF technique and since then the number of test-tube babies has reached 9,000 nationwide.

Test-tube baby is a revolutionary treatment for those couples who can’t have a baby on their own because of various types of infertility.

According to statistics, between 7-10 percent of Vietnam’s fertility age population are infertile with about 50 percent of them being women.

Letter: Treatment is Available for Unexpected 'Leaks'

Urinary incontinence is not something to feel shame about. It is a common problem, especially for women. Treatment options are available.

By Dr. Aparna D. Shah

If you have frequent urges to use the bathroom or suffer embarrassing "leaks" after coughing, sneezing or laughing, you’re not alone. Urinary incontinence is an incredibly common problem.  It affects over 25 million adult Americans and is three times more frequent in women, with numbers expected to increase as our population ages and awareness of the condition is raised.

Risk factors associated with urinary incontinence include but are not limited to: Genetics, pregnancy and childbirth, obesity, chronic heavy lifting, prior pelvic surgery or radiation, neurological diseases, or anything that contributes to weakening of pelvic support structures.  

However, despite how common urinary incontinence is, several widespread misconceptions exist. As a result, 50 percent of women suffering from urinary incontinence do not seek medical treatment. 

An estimated 14.8 million U.S. women experience urinary incontinence.  There are many reasons why these women choose not to seek medical treatment for their condition, including feelings of embarrassment and depression. Many women tolerate incontinence by using pads, believing that it is a "normal" part of aging. Sadly, many women believe that nothing can be done for their condition. 

Fortunately, such women can get help. 

The truth is that urinary incontinence affects women of all ages, including younger women, and there are multiple treatment options, both surgical and non-surgical to help alleviate the symptoms.  Most women can be cured or their condition significantly improved with appropriate evaluation and treatment.  Potential treatments options range from behavioral treatments, consisting of Kegel exercises, dietary changes, and bladder drills, to medications and surgical procedures.

What is important to remember is that urinary incontinence is a treatable medical condition, but the condition can only be treated if you ask for help.  At Fallon Clinic’s Urogynecology Department, we help women suffering from incontinence every day and encourage every woman to speak with her primary care physician for more information. Improving the quality of your life starts with seeking treatment for urinary incontinence.  

Dr. Aparna D. Shah practices urogynecology at Fallon Clinic in Westborough and Worcester.

5 Myths about Planned Parenthood

Five myths about Planned Parenthood

By Clare Coleman

 I was a Planned Parenthood affiliate chief executive, supervising a network of clinics in New York state, during the early days of this terrible recession. We ran deficits, cut hours, closed centers and laid off staff members. In a recession, things get very difficult — more and more people are in need, while government funds lag and donations dwindle. But still we did not turn patients away, even if they could not pay. At the same time, we had to fight political battles to preserve women’s rights to basic care and information about their sexual health. Those battles continue: Thursday, the House voted to defund Planned Parenthood permanently; the Senate opposed that measure. Amid the debate, let’s address some of the misperceptions about this nearly 100-year-old health-care organization.

1. Planned Parenthood’s federal funding frees up other money to pay for abortions.

Opponents of Planned Parenthood insist that giving the organization federal dollars allows it to spend other money in its budget to provide abortions. That is not possible — there is no other money.

Title X is a federal grant program that exists solely to help low-income and uninsured people access contraceptives and sexual health care; 5.2 million people use the program annually. But Congress has never appropriated enough money to take care of the estimated 17 million Americans who need publicly funded family-planning care. There always are more patients than subsidies.

Further, a Title X grant is designed to help with costs, not to fully cover them. So family-planning programs are required to find other money to support the Title X project — not the other way around. For patients who qualify for Medicaid, reimbursement rates for reproductive health services are lower than the cost of the care. A typical family-planning visit might cost upward of $200, including the exam, lab tests and contraceptive method, but the Medicaid reimbursement rate may be as low as $20.

2. Ninety percent of what Planned Parenthood does is provide abortions.

That is what Sen. Jon Kyl (R-Ariz.) said this month in a speech against federal support for Planned Parenthood; his staff later said his assertion was “not intended to be a factual statement.”

Here is a factual statement: Planned Parenthood’s abortion care represents 3 percent of its medical services — 332,000 terminations out of a total of 11.4 million services provided in 2009. Nearly all the care offered at Planned Parenthood health centers is preventive services and screenings, including contraception, testing for sexually transmitted infections, pap smears and breast exams. Title X funds cannot be used for abortion care at any time, for any reason. Federal Medicaid funds can be used to reimburse a provider for an abortion when the pregnancy would endanger the life of the woman or resulted from rape or incest.

States can use their local tax dollars to support abortion care for low-income women, and 17 states do so under Medicaid. The capital city did, too — until last week, when Congressoverturned the District’s Medicaid abortion coverage.

3. Defunding Planned Parenthood will reduce abortions.
Contraception prevents the need for abortions, but most politicians who oppose abortion do not support birth control, either. Rep. Mike Pence (R-Ind.), the chief House sponsor of a bill to bar abortion providers such as Planned Parenthood from Title X, has praised a few elements of the program: pregnancy tests, breast cancer screening and HIV testing. He never mentions Title X’s essential work for 41 years — to provide information about and access to birth control, which 99 percent of Americans will use in their lifetime.


Opponents of Planned Parenthood insist that giving the organization federal dollars allows it to spend other money in its budget to provide abortions. That is not possible — there is no other money.

Title X is a federal grant program that exists solely to help low-income and uninsured people access contraceptives and sexual health care; 5.2 million people use the program annually. But Congress has never appropriated enough money to take care of the estimated 17 million Americans who need publicly funded family-planning care. There always are more patients than subsidies.

Further, a Title X grant is designed to help with costs, not to fully cover them. So family-planning programs are required to find other money to support the Title X project — not the other way around. For patients who qualify for Medicaid, reimbursement rates for reproductive health services are lower than the cost of the care. A typical family-planning visit might cost upward of $200, including the exam, lab tests and contraceptive method, but the Medicaid reimbursement rate may be as low as $20.

Women spend about five years either being pregnant or trying to get pregnant, and about 30 years trying not to get pregnant; the Guttmacher Institute estimates that half of the country’s unintended pregnancies end in abortion. If Pence wants to prevent abortions, he should lead the charge to triple Title X funding.

Instead, Pence has voted to eliminate Title X, and he has no answer for where the 5.2 million people served by that program would get care. Planned Parenthood centers offer contraception to nearly 2.5 million patients a year and serves 36 percent of all Title X patients.

Barring Planned Parenthood from participating in federal programs would lead to less access to birth control, more unintended pregnancies and more abortions.

4. Planned Parenthood serves only teenagers and prostitutes.
I’ve never had a chance to talk to Glenn Beck, who implied recently on his Fox radio show that only “hookers” use Planned Parenthood.But when I worked for the organization, I would ask our supporters to picture this: You’re a 22-year-old woman with a job you don’t love, a toddler you’d die for and no health insurance. You live paycheck to paycheck, and you always know to the penny how much cash you’ve got until the end of the month. You’re rushing home on Route 9 to relieve your mom, who’s with the kid, and the engine light on the car comes on. You feel a wave of panic. You know you’re always one emergency away from everything falling apart. That’s our patient — I always have her in my mind.

Inside the Beltway, it is easy to forget that millions live on that edge. Our typical patient is a working woman between 20 and 24, maybe in school, often with children. But our centers nationwide see women and men of all ages, races, income levels, and marital and social statuses. The number of men seen in Title X-funded centers has tripled in the past 10 years, and the fastest-growing group of women served by Title X is those over 44.


5. People don’t really need Planned Parenthood.

Three million patients each year visit Planned Parenthood’s more than 800 health centers in every state, in big cities and small towns. In some areas, Planned Parenthood and the Title X-funded system are the only sexual health providers for hundreds of miles.

We screen people for high blood pressure, anemia and diabetes; we counsel them about smoking cessation and obesity; we connect them to other primary-care providers and social services. The huge response to the attack on family planning and on Planned Parenthood — hundreds of thousands of Americans signing petitions, showing up at rallies, calling Congress – is extraordinary. But it doesn’t surprise me. One in five American women has gone to Planned Parenthood at some point in her life, for respectful, compassionate, quality care. And now those Americans are going to have our back.



Clare Coleman is the president and chief executive officer of the National Family Planning and Reproductive Health Association. She headed a Planned Parenthood network in New York’s Hudson Valley, and worked in the U.S. House and as a lobbyist for Planned Parenthood.

10 Things Your Bladder Says About Your Health

Bladder problems can strike adults of all ages, and they can signal a larger health problem. Learn ten possible reasons for urinary tract symptoms.

By Paula Spencer, Caring.com

Bladder problems are often associated with the very old and infirm. But guess what? Adults of all ages, including many who are seemingly healthy, can have unusual bladder symptoms -- and they can be warning signs of problematic health conditions.

"The urinary system can be a real canary in the coal mine," says Jill Rabin, chief of ambulatory care and urogynecology at the Albert Einstein College of Medicine in Hyde Park, New York, and coauthor of Mind Over Bladder. "If you have a significant change in your bladder habits, you may have a problem with the bladder itself or the pelvic organs, or it may be a sign of a larger systemic problem."

Here are ten problems that unusual bladder symptoms may signal:

1. Possible bladder message: Sleep apnea

What it is: Sleep apnea is a breathing disorder in which abnormal pauses in breathing during sleep can last a minute or longer, causing the person to abruptly wake up. (Apnea is a Greek word "meaning without breath.") "Untreated sleep apnea is becoming more and more commonly diagnosed by urologists," says Adam Tierney, a urologist with Dean Clinic in Madison, Wisconsin. That's because regular doctors can't see it during checkups; it's the night urination that's noticed first.

More than 12 million people have sleep apnea, and many more are thought to have it but not know it. In March 2011, Israeli researchers reported that in a group of men aged 55 to 75 who had benign prostate enlargement (BPE) and reported nocturia -- the need to get up at night to urinate -- more than half of their night wakings were probably actually attributable to sleep apnea.

What you may notice: Awakening at night to urinate as often as every two or three hours. With sleep apnea, the person wakes up because of the breathing lapse and then decides almost on autopilot to use the bathroom. By morning, he or she is aware that, "Gee, I'm getting up at night to pee a lot," rather than that breathing has been briefly stopping. Other sleep apnea symptoms include snoring and daytime sleepiness.

What you can do: Report excessive night urination to your doctor so its true cause can be pinpointed. Sleep apnea is treatable with several different devices designed to facilitate breathing, as well as surgery.

2. Possible bladder message: Out-of-control diabetes

What it is: When blood sugar is poorly controlled, nerve damage can result. Diabetics usually know that this can result in a loss of sensation in the extremities. But nerve signals may also be unable to appropriately reach the muscles that govern urination, Rabin says.

What you may notice: A frequent feeling of needing to use the bathroom, even when you don't, or a lack of sensation that it's time to void, which causes you to wet yourself. You may also be excreting larger-than-normal amounts of urine with poorly managed diabetes. That's because the body tries to rid itself of excess glucose through the urine.

What you can do: Talk to your doctor about ways of better controlling blood sugar through diet and exercise. Many diabetics don't think to report incontinence symptoms because they don't link them to their disease.

3. Possible bladder message: Hypothyroidism

What it is: Untreated hypothyroidism -- slow functioning of the thyroid gland, which helps regulate metabolism -- can also cause problems in the way that nerve signals reach muscles, says urogynecologist Jill Rabin. Women are affected more often than men.

What you may notice: Urge incontinence, or the need to "go," whether there's an actual need or not. This is usually a secondary symptom of hypothyroidism, the primary symptoms being extreme fatigue, a sense of being cold, weight gain, dry skin, and sometimes hair falling out.

What you can do: Report symptoms to your doctor, and be sure to mention any other unusual symptoms you are experiencing. Treating the hypothyroidism usually eases incontinence symptoms.

4. Possible bladder message: Prostate problem

What it is: The prostate, a doughnut-shaped gland that encircles the male urethra and plays a role in both urination and reproduction, tends to enlarge over time. This squeezes the urethra (urinary passage), causing a relatively harmless condition called benign prostate hyperplasia (BPH). BPH is most common in men over 50, as is prostate cancer. Another common prostate complication, more common in younger men, is prostatitis, an infection. One of these conditions doesn't necessarily lead to the next.

What you may notice: A sudden and urgent need to pee (urge incontinence), night waking to use the bathroom, dribbling urine after you think you're finished, difficulty beginning to urinate, and more frequent urination day or night.

What you can do: Because prostate problems range in seriousness but can manifest in many different ways, any change in urinary symptoms is worth reporting as soon as you start wondering or worrying about it. Prostate cancer is typically ruled out first through an exam that includes a digital exam and a prostate-specific antigen (PSA) blood test.

5. Possible bladder message: Chronic urinary tract infection

What it is: Urinary tract infections (UTIs) are the second most common kind of infection in the human body. Both men and women get them, though they're most common in women.

What you may notice: A persistent urge to urinate, a burning sensation while urinating, frequent urination, or urine that's reddish or cloudy and sometimes foul-smelling. You may also experience fever, localized pain, and a sensation of pressure.

What you can do: See your doctor. Prescription antibiotics usually clear up the infection within a day or two. When infections are continuous, a stronger drug or longer regimen may be prescribed. People who get repeated UTIs tend to have an underlying condition that predisposes them (such as diabetes or pregnancy) or have habits that promote them. Women with chronic UTIs should use sanitary pads rather than tampons; avoid douching; urinate before and after intercourse; and avoid excessive alcohol or caffeine, which are bladder irritants.

6. Possible bladder message: You weigh too much

What it is: You probably don't need your bladder to tell you what your mirror and scale already know. But the effects of obesity are sometimes easy to ignore, at least until everyday functioning is affected, all day long. Excess weight means that the pelvic-floor muscles involved in supporting a woman's urinary system are under extra pressure. Over time, they can weaken, especially the urinary sphincter, which keeps the urethra capped when you're not urinating.

What you may notice: Leaking urine when you cough, sneeze, exercise, or move the wrong way -- any kind of physical stress can produce what's known as stress incontinence.

"People don't often connect weight and urine, but there's a clear association," says urologist Adam Tierney. "And overweight people are more likely to have diabetes, which can cause urge incontinence on top of the stress incontinence."

What you can do:Pelvic floor exercises and other therapies for stress incontinence can help shore up weak musculature and lessen episodes of leakage. Not smoking is another remedy, since the cough that smoking produces further aggravates weak musculature.

But the very best remedy for stress incontinence for those who are overweight is to work to achieve a body-mass-index in the normal range. A 2009 study in the New England Journal of Medicine found that overweight women who lost an average of just 8 percent of their body weight (17pounds) saw their weekly incontinence episodes cut in half.

7. Possible bladder message: Interstitial cystitis

What it is: A chronic inflammatory disorder of the bladder, including irritation of the bladder lining and wall, interstitial cystitis (also called painful bladder syndrome and bladder pain syndrome) affects both sexes, especially women. The cause isn't fully understood.

Interstitial cystitis is often associated with sleep disorders, migraines, depression, and other pain syndromes, such as fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome, Tierney says.

What you may notice: Very frequent urination (several times an hour, all day), pain on urinating, general pain in the pelvic area. (Normally, people need to urinate no more than seven times a day, according to the American Urological Foundation Association.) Pain is usually experienced in flare-ups that can be related to menstruation, having sex, stress, and illness. It often resembles a urinary tract infection, but testing shows no evidence of bacteria.

What you can do: There are no reliable tests or remedies for interstitial cystitis, but a thorough medical exam can point to treatment of other possible causes of the symptoms. Treatment of interstitial cystitis itself often focuses on medications and lifestyle changes that can help sufferers better manage their symptoms. For example, many people have success with dietary changes, avoiding foods that irritate the bladder, such as caffeine and acidic items.

8. Bladder message: Falling organs

What it is: Especially following childbirth, women are vulnerable to a condition called bladder prolapse -- which refers to the dropping of the organ from its customary position, sometimes into the vaginal opening. This happens because the pelvic floor muscles and ligaments of the "hammock" that supports the bladder have been weakened by stress. Heavy lifting, chronic coughing (as by a smoker), obesity, and menopause (because of shifting hormones) can also lead to prolapse.

What you may notice: Frequent urination or urge incontinence; not feeling relief after urinating; discomfort or pain in the vagina, pelvis, groin, or lower back; heaviness in the vaginal area (which may ease when lying down).

What you can do: For mild cases, shoring up weak muscles with physical therapy can be effective. More extreme cases may need estrogen replacement therapy, electrical stimulation, or a pessary (vaginal support device) to provide better support for the organs. Surgery can be an effective last resort.

9. Possible bladder message: Dehydration

What it is: Dehydration simply means the body doesn't have as much liquid as it should. Anyone can become dehydrated, although older adults are especially vulnerable. Common causes: having diarrhea and/or vomiting, sweating a lot through exercise or because of fever, and being diabetic (elevated blood sugar levels lead to more frequent urination as the body tries to get rid of the excess).

What you may notice: Abnormally dark (amber to brown) or strong-smelling urine. The appearance of urine isn't a highly reliable indicator of health problems (aside from blood in the urine), says the Dean Clinic's Adam Tierney. Whether it's cloudy or fizzy or a particular hue often has more to do with diet and medication than an underlying disorder. When it looks dark and concentrated, however, dehydration is a concern.

Other symptoms of dehydration: Decreased urine output, headache, lethargy or sleepiness, dry skin and dry mouth, dizziness, and increased confusion.

What you can do: Fluid replacement resolves dehydration. The form of fluid may depend on the severity of the situation. An IV, for example, is used in advanced cases. For more mild dehydration, consuming frequent, small amounts of clear liquids helps, or a doctor may suggest an oral rehydration solution. To avoid dehydration, make sure older adults, in particular, drink six to eight cups of liquid a day or consume foods high in liquid content, such as soup and watermelon.

10. Possible bladder message: Cancer

What it is: Cancer can develop in the bladder, the kidneys, the renal pelvis (the area of the kidneys where urine is collected), or the ureter (the tubes that carry urine from the kidneys to the bladder). Transitional cell cancer of the renal pelvis and ureter is a common form of cancer, where cancerous cells in the lining of these parts travel to other parts of the body.

What you may notice: Blood in the urine (which may appear pinkish, brownish, or red), pain while urinating, or a frequent urge to urinate whether or not anything is produced. More often in men, tumors may also block the normal traffic of urine and cause overflow incontinence, in which you can't control output well.

What you can do: See a doctor. Symptoms that might signal cancer of the urinary system can mean many other things besides cancer. But they always merit medical help, to rule out other problems and to pinpoint a diagnosis.

Winter may be linked to postpartum depression

By Genevra Pittman

(Reuters Health) - Women who give birth in fall and winter may be more likely to get postpartum depression than those who deliver in the spring, suggests a new study from Sweden.

Dr. Sara Sylven and her colleagues at Uppsala University say that changes in the amount of daylight during each season may affect chemical pathways in the brain related to depression.

They note that compared to most countries, Sweden has a much bigger difference in its amount of daylight in winter versus summer. For that reason, the effect of the seasons on rates of postpartum depression might be more obvious there. But at least in similar locales, Sylven said, women who give birth in the colder, darker months should be watched more closely for symptoms of depression.

The question of whether there is a link between when a mother gives birth and her risk of depression soon after "really has flip-flopped a lot," Jennifer Jewell, who studied the association at the University of Colorado in Denver as a graduate student, told Reuters Health.

"There's a lot of mixed results out there, which I think indicates we need to know more about what we're trying to figure out," said Jewell, who was not involved in the current research.

Spurred on by that lack of concrete evidence, Sylven's team studied more than 2,000 women who gave birth at their institution over a 1-year period.

At 5 days, 6 weeks, and 6 months after giving birth, the women completed questionnaires on symptoms of depression, as well as how much social support they had and other medical and lifestyle-related topics.

Out of every 100 mothers, between 6 and 15 reported symptoms of postpartum depression, depending on how soon it was after they gave birth and in what season they gave birth.

After accounting for a variety of factors that could contribute to a new mother's stress, the authors found that women who gave birth in October through December were about twice as likely to have symptoms of postpartum depression after 6 weeks and 6 months as those who had children in April through June.

The study, published in the American Journal of Obstetrics & Gynecology, can't prove that giving birth in the fall or winter causes postpartum depression, and Sylven said the reason for the link is still unexplained.

"We guess that some hormones could differ during the year," which could be related to depression risks, Sylven told Reuters Health. Also, she said, during the winter there's very little sunlight in Sweden, so a lack of vitamin D could be playing a role.

Depression that happens only in fall and winter - known as Seasonal Affective Disorder, or SAD - has been observed in the general population.

But Jewell isn't sure the new results would apply to women in countries that are closer to the equator and have less drastic changes in daylight from season to season.

The Swedish mothers are "at a pretty high latitude," she said. "They get some pretty different seasonal changes compared to the bulk of the United States."

Jewell said that to determine if this association exists universally, data on women from different countries could be combined if researchers figured out a way to analyze depression rates by the amount of daylight hours in the early days after birth.

Sylven noted that the effects of season on depression were most noticeable in healthy women who had no mental illnesses before giving birth.

She said the link between season and postpartum depression now has enough evidence behind it - at least in countries that have large variations in sunlight during the year - that doctors should be aware of it when treating new mothers.

"If there is such a big impact of season, we could have closer follow-up (for) the women giving birth during the autumn," Sylven said. Doctors should "think about this when (they) meet the women who will give birth in October, November, (and) December."

Jewell said that while the new research still leaves some unanswered questions, it's important to "make more women aware of (postpartum depression) and make more physicians aware of it so it's not something that's hidden and not talked about."

SOURCE: bit.ly/hlnUbb American Journal of Obstetrics & Gynecology, online March 24, 2011.