Abby Lippman

Human papillomavirus, vaccines and women's health: questions and cautions

The federal governments recently announced

Embodied Knowledge and Making Sense of Prenatal Diagnosis

300 million investment toward a program for vaccinating girls and women with the currently available human papillomavirus (HPV) vaccine Gardasil, framed by some as a way to prevent cervical cancer in Canada, has generally been welcomed by a wide range of

Maternal age and primary cesarean section rates: A multivariate analysis

Open-ended, qualitative interviews with women to whom amniocentesis was offered were analyzed to understand how women made sense of these tests. We found that women, whether tested or not, negotiated with biomedical information. They transformed it through identifiable processes, then wove it with their own instincts and beliefs and with their personal experiences, thereby creating “embodied” knowledge on which their decisions were based. Women who were and were not tested may have differed from each other when categorized on the basis of a final, binary choice, but they were more alike than unalike in reaching this point. The apparent importance of embodied knowledge suggests the critical role of the listening activities of the genetic counselor and of awareness of the validity and importance of womens complementary ways of knowing and doing in understanding the uses and meanings of prenatal genetic testing.

Egg harvesting for stem cell research: medical risks and ethical problems

To study the effect of maternal age on primary cesarean section rates, 3458 consecutive deliveries were analyzed. The cesarean section rates in primiparous women less than 25, 25 to 34, and over 34 years of age were 13.1%, 18.5%, and 28.2%, respectively. A similarly dramatic rise with advancing maternal age was seen in multiparous women with rates of 3.4%, 4.7%, and 10.1%, respectively, in the three age groups. The strong association between cesarean section and maternal age persisted after multivariate adjustment for induction of labor, epidural anesthesia, meconium-stained amniotic fluid, and fetal distress, and thus these factors do not explain the relationship.

Psychological Aspects of Ultrasound Imaging during Pregnancy

Increasingly, researchers are seeking eggs from young women to be used for embryo cloning procedures. The harvesting of multiple eggs often involves the administration of drugs that have not been approved for this purpose. Also these drugs have not been adequately studied for their long-term effects on women despite research providing some evidence of significant harm to women in both the short and long term. Current practices follow a historical pattern of exposing women to risks that ultimately prove unacceptable. In addition, egg harvesting is taking place in a research climate marked by conflicts of interest, the misleading use of language to describe research goals, and a commercial push that may lead to the exploitation of young women. In this article, we outline these matters and explain how they are leading to an international campaign for a moratorium on egg harvesting for cloning purposes.

Resistance and adherence to the norms of genetic counseling

The psychological impact of ultrasound examination on expectant parents is assessed through direct observation, interviews and the administration of a questionnaire to a large group of parents. The examination was a positive and reassuring experience for most parents. Among a wide array of variables that could account for the effects of the exam, the results were the most important. Women viewing their first ultrasound, specially primiparae were more moved. The results did not confirm that there is a traumatic effect when viewing precedes quickening. Contrary to previous reports, fathers were as emotionally involved as the mothers. The presence of the father seemed also to have a beneficial effect on the mother. One-half of parents wanted to know the sex of the fetus before birth. These findings are discussed, along with implications for problems arising from introduction of new technologies during pregnancy.

Unmet need for assistance to perform activities of daily living and psychological distress in community-dwelling elderly women.

Genetic counseling for women of advanced maternal age who are considering prenatal testing continues to be based on a principle of nondirectiveness. We interviewed 11 genetic counseling students and four counselors about how they experience and manage, in practice, the tensions between the ideology of nondirectiveness and the acknowledged reality that one can never be truly nondirective. We found that our respondents creatively resolve this tension—simultaneously resisting and adhering to the values of nondirectiveness and information-giving—in individual and situation-specific ways. This resolution is facilitated by the extent to which information given to counselees is fluid, mobile and context-dependent, but these very features of “information” also have critical implications for both the norms and the practice of genetic counseling.

Informed Consent to Donate Embryos for Research Purposes

De plus en plus, les aînés vivant dans les communautés ont besoin d’une assistance physique pour les activités de la vie quotidienne (AVQ). L’association de ce besoin, que ce soit atteint ou non satisfaits, avec la détresse psychologique est inconnue. Nous avons mené une étude prospective des cohortes sur des résidents vivant dans les communautés âgées de 75 ans et plus à Montreal, au Canada. Nous rapportons les résultats pour les femmes seulement (n = 530). On a utilisé une régression lineaire multivariable pour examiner l’association entre les besoins satisfaits et ceux qui restent insatisfaits dans les activités déterminantes de la vie quotidienne (ADVQ) et les activités personnelles de la vie quotidienne (APVQ) et la détresse psychologique concomitante. Alors que les besoins ADVQ non satisfaits ont été associés à une détresse psychologique élevée, [β = 0.19 (95% CI: 0.06, 0.33)], comme cela a été avec les besoins ADVQ satisfaits [β = 0.42 (95% CI: 0.26, 0.60)], les besoins APVQ satisfaits et non satisfaits ne l’étaient pas. Le modèle complet explique 32,8 pour cent de la variance totale de la détresse psychologique. Recevoir de l’aide pour répondre aux besoins ADVQ est associé à une détresse psychologique élevée. Ne pas recevoir d’aide, cependant, est associé à une détresse encore plus élevée. Community-dwelling seniors increasingly require physical assistance to perform the activities of daily living (ADL). To examine the possible association of this need with psychological distress, we conducted a prospective cohort study of community-dwelling people age 75 and older in Montreal, Canada. We report the results for women only (n = 530). Multivariable linear regression was used to examine the association between met and unmet need in instrumental ADL (IADL) and personal ADL (PADL) with concomitant psychological distress. Unmet IADL need was associated with elevated psychological distress [β = 0.42 (95% CI: 0.26, 0.60)], as was met IADL need [β = 0.19 (95% CI: 0.06, 0.33)], but not met and unmet PADL need. The full model explained 32.8 per cent of the total variance in psychological distress. Receiving assistance to meet IADL needs is associated with elevated psychological distress. Not receiving assistance, however, is associated with even greater distress.

Fetal mortality in sibships of cases with neural tube defects.

OBJECTIVE To develop guidance for clinicians participating in the informed choice process with respect to the donation of human embryos for research purposes. RECOMMENDATIONS 1. As indicated in the Canadian Institutes of Health Research Guidelines and the Assisted Human Reproduction Act, specific consent from both the gamete and embryo providers is required before embryos can be used for research purposes. The gamete donors may be different individuals than the embryo providers when donated gametes are used to create embryos. 2. The consent process should inform potential donors of the possible types of (and for final consent, the specific) research project(s) for which the embryos will be used; the risks involved in donating embryos to research, such as not having these embryos available for their reproductive purposes; the fact that the woman/couple will not benefit personally from donating embryos to research; the potential for commercial gain by others; the possibility that they will be contacted in future about the disposition of the embryos; the fact that confidentiality cannot be absolutely guaranteed. 3. Designation of cryopreserved embryos no longer be required for reproductive purposes to be donated to research, donated to another couple, or discarded should be discussed prior to gamete retrieval and made at the time of cryopreservation, with the understanding that in the future, final consent will be requested. The final decision as to the donation of cryopreserved embryos research should not be made until after the woman/ couple decide they no longer require the embryos for their reproductive purposes. The decision to end cryopreservation should be made separately from the decision regarding disposition of the embryos. The woman/couple will have to be re-contacted regarding the final disposition of their embryos. 4. As a result of lack of scientific data regarding the predictability of microscopic characterization of embryos and potential for pregnancy, it is recommended that all women/couples be offered the opportunity to cryopreserve all embryos not transferred during the treatment cycle and be informed that a failure to cryopreserve all embryos may increase the chance of having to undergo an additional in vitro fertilization cycle to achieve reproductive goals. 5. Research participants should be informed that they may withdraw their consent at any time before the embryos are thawed for research purposes, or, in the case of stem cell research, before a stem cell line is created. 6. Potential donors should be informed that their medical care will not be affected by their decision regarding embryo donation.

EUGENICS AND PUBLIC HEALTH

It has been suggested that rates of fetal mortality in sibships of probands with a malformation inherited as a multifactorial threshold trait may reflect their liability to the malformation. If so, spontaneous abortion rates should be more frequent in sibships thought to have greater liability. For anencephaly and spina bifida (ASB), then, spontaneous abortion should be higher in the sibships of male probands and in families with more than one affected case (multiplex families).