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Why do we know so little about miscarriages?

August 21, 2024
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Morning Rounds Writer and Podcast Producer
I knew that pregnancy was generally under-researched in the U.S. But until I read the first story below, I had no idea that we literally have no data on the number of miscarriages that happen each year in the U.S. (We also don't have standardized, universal definitions for pregnancy loss?) Scroll down!

reproductive health

Miscarriages too often leave us with questions. Researchers are looking for answers 

Jovelle Tamayo for STAT

We have no national data on how often pregnant people miscarry in the U.S. There are only estimates, which suggest that 10% to 25% of all pregnancies here end in miscarriage. It's a common experience, yet one that is still deeply perplexing to clinicians and scientists. Because without data, there can't be robust research. And without research, we can't fully understand why people miscarry, or why some people suffer multiple losses in a row.

Large-scale research on pregnancy loss has been conducted in Europe, where standardized medical records often make it easier to execute such studies. Experts say that it's critical to have U.S.-specific studies, but that it would be incredibly difficult to pull that off within our disjointed health care system.

In a special report published today, STAT contributor Sadia Rafiquddin writes about the lack of research in the U.S.; how that gap reinforces a long-standing culture of silence around miscarriage; and the independent researchers and advocates trying to change things. Read more.


artificial intelligence

How do Americans feel about AI in health care?

Survey says: Tentatively comfortable! In a survey of about 1,000 people around the U.S., 75% of respondents said it was important to use artificial intelligence to minimize human errors, and 71% would like AI to help reduce wait times. A similar number of respondents said they were comfortable with AI note-taking during appointments and that AI should improve work-life balance for health care workers. Still, more than half said they found AI "a little scary," and 70% are worried about data privacy, according to the Ohio State University Wexner Medical Center, which commissioned the survey. (The survey was mostly done online but did include a couple dozen phone calls.)

Both the concerns and the excitement make sense to me, a person who reads the great reporting on AI from STAT's health tech team. Sorry (not sorry) for the shameless plugs, but if you haven't read the Pulitzer Prize finalist investigation from STAT's Casey Ross and Bob Herman on the dangers of AI in medicine … please go do that.


first opinion

More cancer screenings aren't going to fix racial health disparities

Black people in the U.S. are more likely to die from cancer than white people, and increasing cancer screenings to reduce that disparity is an easy sell. The USPSTF, private companies, advocacy groups, and policymakers have all encouraged more screenings as a solution. But it's not helping, write three physicians in a First Opinion essay. The idea just serves the interest of the health care system, and not of Black Americans, they argue. 

"Why would more screening in both Black and white Americans reduce the mortality disparity between the two groups?" the authors ask. More screenings can't change the disparities between rich and poor areas. And they can't change rates of cigarette smoking, which are tied to socioeconomic status. Read more on what it will take to actually eradicate health disparities. 



state by state

U.S. life expectancy declined in 2021, per CDC data

In 2021, residents of Hawaii had the highest life expectancy at birth at 79.9 years, while Mississippi had the lowest at 70.9 years, according to newly released CDC data. As seen on the map above, residents of southern states overall tended to have the lowest life expectancies, while the highest life expectancies were reported among people in western and northeastern states. For the most part, the states with the lowest life expectancies were also the states with the largest difference between the numbers for men and women. Overall, life expectancy declined by a little more than half a year from 2020 to 2021, mostly due to the pandemic, per the agency's report.

The conclusions are based on "complete period life tables" for each state, which depict how a hypothetical cohort of people would survive if they lived every year of their life in the conditions of a particular period — in this case, the conditions we lived through during 2021. (The tables are "complete" because they include mortality data for every single year of life, rather than data in five- or 10-year intervals.) 


pregnancy

There (still) isn't enough evidence on screening for iron deficiency in pregnancy, per USPSTF

Anemia during pregnancy is fairly normal, and is often caused by iron deficiency. It makes sense — your body is producing more blood to grow a literal human being, and so it needs more iron than usual to produce those cells. But if anemia is severe, it can cause complications for both the pregnant person and the fetus. So the U.S. Preventive Services Task Force recently conducted a systematic review of existing research to see if it's worth screening asymptomatic pregnant people for iron deficiency. The group came up empty, noting in a recommendation statement published yesterday in JAMA that the current evidence is insufficient to say either way. The group also determined that there was insufficient evidence to say whether it's helpful for asymptomatic pregnant people to take iron supplements.

It's the same conclusion that the group came to in 2015, when it last reviewed the data. So what now? The recommendations say that clinicians should consider how certain factors like a low-iron diet, gastrointestinal conditions or drugs, tobacco use, and even the altitude at which people live might affect their risk. There are also likely racial disparities in who is most affected by iron deficiency anemia in pregnancy and who is screened already.

In an editorial on the recommendation also published in JAMA, two physicians write that the urgent need for more research "can only be accomplished by ceasing paternalistic approaches that have led to the exclusion of pregnant patients in research."


obesity

New, conflicting evidence on weight loss drugs and suicidal thoughts

As more and more people began turning to blockbuster weight loss medications like Ozempic and Wegovy last year, anecdotal reports of suicidal ideation began to crop up almost immediately. The European Medicines Agency, the FDA here in the U.S., and other researchers have investigated a potential link, but none has found a definitive answer. 

Now, there's a new study to add to the mix. Researchers analyzing a WHO database that tracks suspected adverse drug reactions found that people taking Ozempic and Wegovy did appear to experience suicidal thoughts at a higher rate than people on other drugs. But hold on: Experts told STAT's Elaine Chen that they have concerns about the methodology, and further study is needed. Read more on how the new paper adds to the emerging, confusing picture around GLP-1 drugs and mental health.


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What we're reading

  • Kate Cox is one of hundreds in Texas denied abortions despite serious health risks, data show, STAT
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  • What's going on in Joe Biden's brain? STAT
  • 'Boy Meets World' star says she has Stage 0 breast cancer. What does that mean? Washington Post
  • Congressional probe questions clinical trials run in China, citing army involvement, STAT

Thanks for reading! More tomorrow,


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