Month: November 2024

Categories : GeneticsTags :

CRISPR ‘Molecular Scissors’ can Leave Gaping Holes in the Chromosome

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CRISPR-Cas9 is a customisable tool that lets scientists cut and insert small pieces of DNA at precise areas along a DNA strand. This lets scientists study our genes in a specific, targeted way. Credit: Ernesto del Aguila III, National Human Genome Research Institute, NIH

The CRISPR molecular scissors have the potential to revolutionise the treatment of genetic diseases. This is because they can be used to correct specific defective sections of the genome. Unfortunately, there is a catch: under certain conditions, the repair can lead to new genetic defects – as in the case of chronic granulomatous disease. This was reported in the journal Communications Biology by a team from the University of Zurich (UZH).

Chronic granulomatous disease is a rare hereditary disease that affects about one in 120 000 people. The disease impairs the immune system, making patients susceptible to serious and even life-threatening infections. It is caused by the absence of two letters, called bases, in the DNA sequence of the NCF1 gene. This error results in the inability to produce an enzyme complex that plays an important role in the immune defence against bacteria and moulds.

The CRISPR tool works…

The research team has now succeeded in using the CRISPR system to insert the missing letters in the right place. They performed the experiments in cell cultures of immune cells that had the same genetic defect as people with chronic granulomatous disease. “This is a promising result for the use of CRISPR technology to correct the mutation underlying this disease,” says team leader Janine Reichenbach, professor of somatic gene therapy at the University Children’s Hospital Zurich and the Institute for Regenerative Medicine at UZH.

… but unfortunately, it’s not perfect

Interestingly however, some of the repaired cells now showed new defects. Entire sections of the chromosome where the repair had taken place were missing. The reason for this is the special genetic constellation of the NCF1 gene: it is present three times on the same chromosome, once as an active gene and twice in the form of pseudogenes. These have the same sequence as the defective NCF1 and are not normally used to form the enzyme complex.

CRISPR’s molecular scissors cannot distinguish between the different versions of the gene and therefore occasionally cut the DNA strand at multiple locations on the chromosome – at the active NCF1 gene as well as at the pseudogenes. When the sections are subsequently rejoined, entire gene segments may be misaligned or missing. The medical consequences are unpredictable and, in the worst case, contribute to the development of leukaemia. “This calls for caution when using CRISPR technology in a clinical setting,” says Reichenbach.

Safer method sought

To minimise the risk, the team tested a number of alternative approaches, including modified versions of CRISPR components. They also looked at using protective elements that reduce the likelihood of the genetic scissors cutting the chromosome at multiple sites simultaneously. Unfortunately, none of these measures were able to completely prevent the unwanted side effects.

“This study highlights both the promising and challenging aspects of CRISPR-based therapies,” says co-author Martin Jinek, a professor at the UZH Department of Biochemistry. He says the study provides valuable insights for the development of gene-editing therapies for chronic granulomatous disease and other inherited disorders. “However, further technological advances are needed to make the method safer and more effective in the future.”

Source: University of Zurich

Categories : Cardiovascular Disease ExerciseTags :

An Extra Five Minutes of Exercise a Day could Reduce Blood Pressure

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Photo by Teona Swift on Unsplash

New research suggests that adding a small amount of daily physical activity, such as uphill walking or stair-climbing, may help to lower blood pressure. The findings were published in Circulation. 

Just five minutes of activity a day was estimated to potentially reduce blood pressure, while replacing sedentary behaviours with 20–27 minutes of exercise per day, including uphill walking, stair-climbing, running and cycling, was also estimated to lead to a clinically meaningful reduction in blood pressure. The study was done by experts from the ProPASS (Prospective Physical Activity, Sitting and Sleep) Consortium, an international academic collaboration led by the University of Sydney and University College London (UCL)

Joint senior author Professor Emmanuel Stamatakis, Director of the ProPASS Consortium said: “High blood pressure is one of the biggest health issues globally, but unlike some major causes of cardiovascular mortality there may be relatively accessible ways to tackle the problem in addition to medication.”

“The finding that doing as little as five extra minutes of exercise per day could be associated with measurably lower blood pressure readings emphasises how powerful short bouts of higher intensity movement could be for blood pressure management.”

The research team analysed health data from 14 761 volunteers in five countries to see how replacing one type of movement behaviour with another across the day is associated with blood pressure.

Each participant used a wearable accelerometer device on their thigh to measure their activity and blood pressure throughout the day and night. 

Daily activity was split into six categories: sleep, sedentary behaviour (such as sitting), slow walking, fast walking, standing, and more vigorous exercise such as running, cycling or stair climbing.

The team modelled statistically what would happen if an individual changed various amounts of one behaviour for another in order to estimate the effect on blood pressure for each scenario and found that replacing sedentary behaviour with 20-27 minutes of exercise per day could potentially reduce cardiovascular disease by up to 28 percent at a population level.

First author Dr Jo Blodgett from UCL said: “Our findings suggest that, for most people, exercise is key to reducing blood pressure, rather than less strenuous forms of movement such as walking.

“The good news is that whatever your physical ability, it doesn’t take long to have a positive effect on blood pressure. What’s unique about our exercise variable is that it includes all exercise-like activities, from running for a bus or a short cycling errand, many of which can be integrated into daily routines.

“For those who don’t do a lot of exercise, walking did still have some positive benefits for blood pressure. But if you want to change your blood pressure, putting more demand on the cardiovascular system through exercise will have the greatest effect.”

Professor Mark Hamer, joint senior author of the study and ProPASS Deputy Director from UCL, said: “Our findings show how powerful research platforms like the ProPASS consortium are for identifying relatively subtle patterns of exercise, sleep, and sedentary behaviour, that have  significant clinical and public health importance.”

Source: University of Sydney

Categories : Healthcare Politics and RegulationsTags :

SAHPRA Encourages the Safe Use of Medicines and Reporting of Suspected Side Effects This #MedSafetyWeek

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The South African Health Products Regulatory Authority (SAHPRA) encourages members of the public to always report any suspected side effects they may experience from taking medicines, vaccines and/or using medical devices, to help make medicines safer for everyone.  While humanity benefits greatly from medicines in the treatment of illness and management of certain conditions, medicines may at times cause side effects. However, the risk of side effects and severe harm can be drastically reduced by taking medicines correctly and following the advice of a healthcare practitioner.

SAHPRA, together with over 90 other medicines and health products regulators as well as healthcare organisations globally, is participating in the annual #MedSafetyWeek awareness initiative, which takes place between 4 and 10 November 2024, under the theme “the importance of using medicines in the right way to prevent side effects, and to report side effects when they do occur”.

The awareness initiative is spearheaded by the Uppsala Monitoring Centre under the auspices of the World Health Organisation (WHO) Programme for International Drug Monitoring, a programme whose member organisations work nationally and collaborate internationally to monitor and identify adverse effects of medicines and vaccines, to reduce risks to patients, and to establish worldwide pharmacovigilance standards and systems.

During this #MedSafetyWeek and beyond, SAHPRA is calling upon patients, caregivers and healthcare professionals to utilise its reporting tools to report all suspected side effects and adverse reactions.

SAHPRA Chief Executive Officer, Dr Boitumelo Semete-Makokotlela, indicates that handling and storing as well as taking medicines as directed by a healthcare professional is key in reducing the incidence of adverse reactions. “Research shows that about half of all side effects are preventable. Patient safety is our top priority and during #MedSafetyWeek, we wish to remind patients to take their medicines as instructed and healthcare professionals to review therapies as well as each patient’s unique health conditions before prescribing or dispensing medicines,” says Dr Semete-Makokotlela.

SAHPRA calls upon the South African public and healthcare professionals to use either the MedSafety App or the eReporting portal both accessible on the SAHPRA website to report suspected side effects from health products. All reports are assessed and examined by SAHPRA to determine the correct steps to protect medicine users in South Africa from harm. The purpose is to gain better knowledge about known side effects and to discover new ones. This can result in warnings and changes to how a medicine is used. SAHPRA’s MedSafety App and eReporting portal can be used for reporting suspected adverse drug reactions from medicines, vaccines, herbal products, biological medicines and any quality issues relating to health products.

Source: SAHPRA

Categories : AgeingTags :

Standing on One Leg is a Good Indicator of Ageing

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Photo by RDNE Stock project

How long a person can stand on one leg is a more tell-tale measure of ageing than changes in strength or gait, according to new Mayo Clinic research published in the journal PLOS ONE.

Good balance, muscle strength and an efficient gait contribute to people’s independence and well-being as they age. How these factors change, and at what rate, can help clinicians develop programs to ensure healthy ageing. Individually, people can train their balance without special equipment and work on maintaining it over time.

In this study, 40 healthy, independent people over 50 underwent walking, balance, grip strength and knee strength tests. Half of the participants were under 65; the other half were 65 and older.

In the balance tests, participants stood on force plates in different situations: on both feet with eyes open, on both feet with eyes closed, on the non-dominant leg with eyes open, and on the dominant leg with eyes open. In the one-legged tests, participants could hold the leg they weren’t standing on where they wanted. The tests were 30 seconds each.

Standing on one leg, specifically the nondominant leg, showed the highest rate of decline with age.

“Balance is an important measure because, in addition to muscle strength, it requires input from vision, the vestibular system and the somatosensory systems,” says Kenton Kaufman, PhD, senior author of the study and director of the Motion Analysis Laboratory at Mayo Clinic. “Changes in balance are noteworthy. If you have poor balance, you’re at risk of falling, whether or not you’re moving. Falls are a severe health risk with serious consequences.”

Unintentional falls are the leading cause of injuries among adults who are 65 and older. Most falls among older adults result from a loss of balance.

In the other tests:

  • Researchers used a custom-made device to measure participants’ grip. For the knee strength test, participants were in a seated position and instructed to extend their knee as forcefully as possible. Both the grip and knee strength tests were on the dominant side. Grip and knee strength showed significant declines by decade but not as much as balance. Grip strength decreased at a faster rate than knee strength, making it better at predicting aging than other strength measures.
  • For the gait test, participants walked back and forth on an 8-metre, level walkway at their own pace and speed. Gait parameters didn’t change with age. This was not a surprising result since participants were walking at their normal pace, not their maximum pace, Dr Kaufman says.
  • There were no age-related declines in the strength tests that were specific to sex. This indicates that participants’ grip and knee strength declined at a similar rate. Researchers did not identify sex differences in the gait and balance tests, which suggests that male and female subjects were equally affected by age.

Dr Kaufman says that people can take steps to train their balance. For example, by standing on one leg, you can train yourself to coordinate your muscle and vestibular responses to maintain correct balance. If you can stand on one leg for 30 seconds, you are doing well, he says.

“If you don’t use it, you lose it. If you use it, you maintain it,” Dr Kaufman says. “It’s easy to do. It doesn’t require special equipment, and you can do it every day.”

Source: Mayo Clinic

Categories : Cancer New Compounds and TreatmentsTags :

New Anti-cancer Agent Works Without Oxygen

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Human colon cancer cells. Credit: National Cancer Institute

Tumours often contain areas of oxygen-deficient tissue that frequently withstand conventional therapies. This is because the drugs applied in tumours require oxygen to be effective. An international research team has developed a novel mechanism of action that works without oxygen: polymeric incorporated nanocatalysts target the tumour tissue selectively and switch off the glutathione that the cells need to survive. The team published their findings in the journal Nature Communications.

Why tumours shrink but don’t disappear

Study leader Dr Johannes Karges from Ruhr University Bochum, Germany, explained: “As tumours grow very quickly, consume a lot of oxygen and their vascular growth can’t necessarily keep pace, they often contain areas that are poorly supplied with oxygen.” These areas, often in the centre of the tumour, frequently survive treatment with conventional drugs, so that the tumour initially shrinks but doesn’t disappear completely. This is because the therapeutic agents require oxygen to be effective. 

The mechanism of action developed by Karges’ team works without oxygen. “It’s a catalyst based on the element ruthenium, which oxidises the naturally present glutathione in the cancer cells and switches it off,” explains Karges. Glutathione is essential for the survival of cells and protects them from a wide range of different factors. If it ceases to be effective, the cell deteriorates. 

Compound accumulates in tumour tissue

All cells of the body need and contain glutathione. However, the catalyst has a selective effect on cancer cells as it is packaged in polymeric nanoparticles that accumulate specifically in the tumour tissue. Experiments on cancer cells and on mice with human tumours, that were considered incurable, proved successful. “These are encouraging results that need to be confirmed in further studies,” concludes Johannes Karges. “Still, there’s a lot of research work to be done before it can be used in humans.”

Source: Ruhr-University Bochum

Categories : Genetics IT in HealthcareTags :

Researchers Find Persistent Problems with AI-assisted Genomic Studies

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Photo by Sangharsh Lohakare on Unsplash

In a paper published in Nature Genetics, researchers are warning that artificial intelligence tools gaining popularity in the fields of genetics and medicine can lead to flawed conclusions about the connection between genes and physical characteristics, including risk factors for diseases like diabetes.

The faulty predictions are linked to researchers’ use of AI to assist genome-wide association studies, according to the University of Wisconsin–Madison researchers. Such studies scan through hundreds of thousands of genetic variations across many people to hunt for links between genes and physical traits. Of particular interest are possible connections between genetic variations and certain diseases.

Genetics’ link to disease not always straightforward

Genetics play a role in the development of many health conditions. While changes in some individual genes are directly connected to an increased risk for diseases like cystic fibrosis, the relationship between genetics and physical traits is often more complicated.

Genome-wide association studies have helped to untangle some of these complexities, often using large databases of individuals’ genetic profiles and health characteristics, such as the National Institutes of Health’s All of Us project and the UK Biobank. However, these databases are often missing data about health conditions that researchers are trying to study.

“Some characteristics are either very expensive or labour-intensive to measure, so you simply don’t have enough samples to make meaningful statistical conclusions about their association with genetics,” says Qiongshi Lu, an associate professor in the UW–Madison Department of Biostatistics and Medical Informatics and an expert on genome-wide association studies.

The risks of bridging data gaps with AI

Researchers are increasingly attempting to work around this problem by bridging data gaps with ever more sophisticated AI tools.

“It has become very popular in recent years to leverage advances in machine learning, so we now have these advanced machine-learning AI models that researchers use to predict complex traits and disease risks with even limited data,” Lu says.

Now, Lu and his colleagues have demonstrated the peril of relying on these models without also guarding against biases they may introduce. In their paper, they show that a common type of machine learning algorithm employed in genome-wide association studies can mistakenly link several genetic variations with an individual’s risk for developing Type 2 diabetes.

“The problem is if you trust the machine learning-predicted diabetes risk as the actual risk, you would think all those genetic variations are correlated with actual diabetes even though they aren’t,” says Lu.

These “false positives” are not limited to these specific variations and diabetes risk, Lu adds, but are a pervasive bias in AI-assisted studies.

New statistical method can reduce false positives

In addition to identifying the problem with overreliance on AI tools, Lu and his colleagues propose a statistical method that researchers can use to guarantee the reliability of their AI-assisted genome-wide association studies. The method helps remove bias that machine learning algorithms can introduce when they’re making inferences based on incomplete information.

“This new strategy is statistically optimal,” Lu says, noting that the team used it to better pinpoint genetic associations with individuals’ bone mineral density.

AI not the only problem with some genome-wide association studies

While the group’s proposed statistical method could help improve the accuracy of AI-assisted studies, Lu and his colleagues also recently identified problems with similar studies that fill data gaps with proxy information rather than algorithms.

In another recently published paper appearing in Nature Genetics, the researchers sound the alarm about studies that over-rely on proxy information in an attempt to establish connections between genetics and certain diseases.

For instance, large health databases like the UK Biobank have a ton of genetic information about large populations, but they don’t have very much data regarding the incidence of diseases that tend to crop up later in life, like most neurodegenerative diseases.

For Alzheimer’s disease specifically, some researchers have attempted to bridge that gap with proxy data gathered through family health history surveys, where individuals can report a parent’s Alzheimer’s diagnosis.

The UW–Madison team found that such proxy-information studies can produce “highly misleading genetic correlation” between Alzheimer’s risk and higher cognitive abilities.

“These days, genomic scientists routinely work with biobank datasets that have hundreds of thousands of individuals; however, as statistical power goes up, biases and the probability of errors are also amplified in these massive datasets,” says Lu. “Our group’s recent studies provide humbling examples and highlight the importance of statistical rigor in biobank-scale research studies.”

Source: University of Wisconsin-Madison

Categories : Exercise GastrointestinalTags :

Study Suggests that High-intensity Exercise Suppresses Appetite – Especially in Women

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Photo by Ketut Subiyanto on Unsplash

A vigorous workout does more to suppress hunger levels in healthy adults than does moderate exercise, and females may be especially susceptible to this response, according to a small study published in the Journal of the Endocrine Society.

The study examines the effects of exercise intensity on ghrelin levels and appetite between men and women. Ghrelin is known as the “hunger hormone” and is associated with perceptions of hunger.

“We found that high intensity exercise suppressed ghrelin levels more than moderate intensity exercise,” said lead author Kara Anderson, PhD, of the University of Virginia. “In addition, we found that individuals felt ‘less hungry’ after high intensity exercise compared to moderate intensity exercise.”

Ghrelin circulates in acylated (AG) and deacylated (DAG) forms, which are known to affect appetite. Data on the impact of exercise intensity on AG and DAG levels, and their effects on appetite, is sparse and primarily limited to males, the study noted.

To address this shortfall, the study examined eight males and six females. Participants fasted overnight and then completed exercises of varying intensity levels, determined by measurements of blood lactate, followed by self-reported measurements of appetite.

Females had higher levels of total ghrelin at baseline compared with males, the study noted. But only females demonstrated “significantly reduced AG” following the intense exercise, according to the findings.

“We found that moderate intensity either did not change ghrelin levels or led to a net increase,” the study noted. These findings suggest that exercise above the lactate threshold “may be necessary to elicit a suppression in ghrelin.”

Researchers also acknowledged that more work is needed to determine the extent to which the effects of exercise differ by sex. Ghrelin has been shown to have wide-ranging biological effects in areas including energy balance, appetite, glucose homeostasis, immune function, sleep, and memory.

“Exercise should be thought of as a ‘drug,’ where the ‘dose’ should be customised based on an individual’s personal goals,” Anderson said. “Our research suggests that high-intensity exercise may be important for appetite suppression, which can be particularly useful as part of a weight loss program.”

Source: The Endocrine Society

Categories : Expert Opinion Healthcare Politics and RegulationsTags :

Building a Patient-centric Healthcare Ecosystem in SA: A Bold New Vision

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Bada Pharasi, CEO of The Innovative Pharmaceutical Association of South Africa (IPASA)

Imagine a healthcare system which ensures that every patient’s voice helps shape their treatment, where barriers to life-saving care are dismantled, and where innovation is driven by meaningful collaboration. In South Africa, this vision is no longer a distant aspiration; it’s an urgent mission to create a system that truly serves its people, writes Bada Pharasi, CEO of the Innovative Pharmaceutical Association of South Africa.

South Africa’s healthcare system stands at a critical crossroads. Despite remarkable medical advancements, countless patients remain on the sidelines, hindered by financial, regulatory, and logistical barriers. Today, there’s an opportunity to reshape this reality by building a patient-centred healthcare model that expands access, amplifies patient voices, and creates strategic partnerships.

Empowering patient voices

In a truly inclusive healthcare system, patients aren’t just recipients of care; they are active contributors. By integrating patient perspectives into decision-making, healthcare becomes more responsive to those it serves. 

Through collaborations with patient advocacy groups, educational campaigns, and year-round initiatives, there’s a growing movement to create an environment in which patients feel heard and empowered to influence the care they receive. While events such as World Patient Safety Day help highlight the importance of prioritising patient needs, the goal is to make this a constant focus, not just an annual observance.

Key prerequisites for achieving this are efficient regulatory frameworks, impactful public-private partnerships, rare disease management, and a true commitment to innovation. 

Streamlined regulatory partnerships

Timely access to groundbreaking treatments depends on efficient regulatory frameworks. Collaborating closely with regulatory authorities such as the South African Health Products Regulatory Authority (SAHPRA) is pivotal in expediting access to new therapies. 

Such partnerships ensure that treatments meet rigorous safety standards while streamlining approval processes so that life-changing therapies reach patients without unnecessary delays. Maintaining high standards for post-market safety also strengthens public trust and reinforces the resilience of the healthcare system.

Public-private partnerships: Catalysts for innovation

Expanding access to quality healthcare in South Africa demands strong public-private partnerships (PPPs) that leverage both public resources and private sector innovation. 

Collaborative efforts with the Department of Health and other key stakeholders maximise impact by ensuring that resources are effectively allocated and that patients benefit from the latest treatments. These alliances are vital for achieving universal health coverage (UHC) under the National Health Insurance (NHI) framework, helping to ensure that equitable, high-quality healthcare becomes a reality for all.

Closing gaps in rare disease management

For patients with rare diseases, access to treatment is often riddled with obstacles, from limited therapies and high costs to a lack of awareness. Multi-stakeholder collaborations, including advisory boards initiated by organisations such as Rare Diseases South Africa, bring together patients, healthcare professionals, and industry experts to advocate for better support and access to treatments. 

This prioritisation of open communication and patient-centred outcomes offers hope to rare disease patients who, through these partnerships, gain better access to essential treatments and the support they deserve.

Breaking down barriers to innovation

The drive for a more accessible healthcare system also requires addressing policy barriers. Streamlined processes, simpler registration pathways for new drugs, and patient-centred reimbursement policies ensure that patients receive the right treatment at the right time. 

Working alongside policymakers, healthcare providers, and civil society, a concerted effort is being made to create a system in which innovation and equity go hand-in-hand to provide better outcomes and quality of life for all South Africans.

Shaping the future of healthcare

The future of South Africa’s healthcare lies in a system that prioritises patients, breaks down barriers, and capitalises on partnerships to make innovation accessible. 

The call to action is clear: build a healthcare ecosystem that is dynamic, inclusive, and adaptable to ensure that every South African has access to the care they need. By promoting patient voices and ensuring collaboration across sectors, we can transform South Africa’s healthcare system to be more responsive, resilient, and equitable – a system that truly serves its people.

Categories : Diseases, Syndromes and ConditionsTags :

Research Shines a Light on Emerging Virulent Streptococcus Subspecies

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This illustration depicts a 3D computer-generated image of a group of Gram-positive, Streptococcus pneumoniae bacteria. The artistic recreation was based upon scanning electron microscopic (SEM) imagery. Credit: CDC on Unsplash

A concerning increase in global rates of severe invasive infections becoming resistant to key antibiotics has a team of infectious disease researchers at the Houston Methodist Research Institute studying a recently emerged strain of bacteria, Streptococcus dysgalactiae subspecies equisimilis (SDSE). SDSE infects humans via the skin, throat, gastrointestinal tract and female genital tract to cause infections ranging in severity from pharyngitis to necrotising fasciitis. The findings of this study are described in a paper appearing in the journal mBio. 

Though closely related to group A streptococcus (also commonly known as Streptococcus pyogenes), which has been very well studied, little is known about SDSE.

“Given its great emerging importance to human health, our limited understanding of SDSE molecular pathogenesis is remarkable,” said Jesus M. Eraso, PhD, an assistant research professor of pathology & genomic medicine with Houston Methodist and lead author on the study.

To close this knowledge gap, the Houston Methodist team used a sophisticated integrative approach to study 120 human isolates of a particular SDSE subtype, called stG62647. They analysed the subtype’s genome, where the information of its DNA is stored, its transcriptome, which provides a snapshot of the complete gene expression profile at the time the SDSE cells were collected, and its virulence, which refers to the degree of damage it causes to its host. The stG62647 SDSE strains are important to study because they have been reported to cause unusually severe infections, and understanding the relationships and interplay between these three entities gave the researchers a richer understanding of how it causes disease.

The data from this integrative analysis provided much new data about this important emerging human bacterial pathogen and are useful in vaccine research. It also raised many new questions and generated new hypotheses to be studied in this ongoing line of investigation.

Source: Houston Methodist Research Institute

Categories : Obstetrics & GynaecologyTags :

Having the Choice of Birth Position is Key in Satisfaction of Expectant Mothers

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Photo by Duda Oliveira

Whether supine, all-fours position, sitting upright or squatting – women adopt different birthing positions during childbirth. But until now, how the final birthing position affects the satisfaction of the woman giving birth had not been known. Researchers in Germany investigated the relationship. In particular, they also took into account whether the choice of birthing position was voluntary. The results, which appear in Archives of Gynecology and Obstetrics, showed that having the choice counted the most for mothers’ satisfaction.

Around three quarters of those surveyed were lying during the birth and were particularly dissatisfied if they felt that they had not made this choice themselves. But if the expectant mothers had chosen the supine or lateral supine position themselves, the position actually tended to make them more satisfied.

For a long time, the supine position was the most common birth position in Western countries, giving obstetricians unhindered access to the woman and child.  In various cultures, however, upright birthing positions, such as sitting or squatting, are also widespread. Which position is best for expectant mothers and the unborn child is controversial in the literature.

“Until today, international guidelines usually only recommend that women should adopt their preferred birthing position,” explains Prof Dr Nadine Scholten, professor in psychosomatic and psycho-oncological health services research at the University of Bonn. With regard to birthing positions, the German guideline also states that women should adopt the position that seems most comfortable to them. However, they should also be encouraged to adopt an upright position in the final phase of birth.

“In reality, whether they ultimately lie, sit or squat depends on the wishes of the expectant mothers themselves, but also on the suggestions of the midwives, obstetricians and sometimes necessary medical measures,” explains Prof Dr Brigitte Strizek, Director of the Clinic for Obstetrics and Prenatal Medicine at the University Hospital Bonn (UKB).

Focus on women’s satisfaction

A team led by Prof Scholten, who carried out the study at the Institute for Medical Sociology, Health Services Research and Rehabilitation Research (IMVR) at the University of Cologne and the UKB, wanted to find out which birthing position women were most satisfied with afterwards. Almost 800 mothers were asked about their final birthing position and how satisfied they were with the birth overall using an anonymous questionnaire. All of the data analysed here was from women who had given birth vaginally in a hospital without the use of a vacuum extraction or forceps, and who had given birth eight to twelve months previously at the time of the survey. In their study, the researchers also asked about the satisfaction of the mothers – depending on whether the birth position was freely chosen or not. The reasons for not choosing a free position were also asked.

It was found that over three quarters of mothers gave birth to their child lying on their side or on their back. Of these women, up to 40% stated that they had not chosen the birth position voluntarily. “The most common reason given by respondents was instructions from medical staff,” explains Prof Scholten, first and corresponding author. The most common position assigned by obstetricians was the supine position. It was striking that women were more satisfied with their birth if they were allowed to choose the position voluntarily – especially if they chose the supine position themselves. Women who were not free to choose their birthing position were particularly dissatisfied if the medical staff specified this and not the CTG to record the heart rate of the unborn child and labour activity or the epidural, the anaesthetic to relieve pain, prevented the desired position.

Self-determination not always given in the delivery room

“The number of women who did not choose the birth position themselves is particularly striking, as is the associated lower level of satisfaction with the birth,” summarises co-author Prof Strizek. However, the team cannot confirm whether an increased voluntary choice of birth position in the future would result in fewer women giving birth in the supine position. “In order to increase women’s subjective satisfaction with their birth experience, they should be given the opportunity to adopt their preferred position,” appeals lead author Prof Scholten. “The first step is to increase the awareness of medical staff and empower women to understand and better communicate their preferences.”

Prof Strizek adds: “If a certain position would be advantageous for the woman giving birth from a medical point of view, we as obstetric teams need to explain this better to the women so that they rarely have the feeling that they have not determined the birth position themselves.”

Source: Universitatsklinikum Bonn