Women’s health Institute, Rutgers RWJMS

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Research Abstracts

The Professional Development Impact of a Transitional Elective on a Dual PharmD/MD Degree Student’s Training.
Abhilasha Borad and Paul F. Weber, MD, RPh, MBA
Rutgers Robert Wood Johnson Medical School – Women’s Health Institute

The pioneering PharmD/MD dual-degree program developed by the Ernest Mario School of Pharmacy (EMSOP) and Robert Wood Johnson Medical School (RWJMS) at Rutgers University allows students to directly transition into medical school after completing pharmacy school to become interdisciplinary practitioners and leaders in patient care in a variety of settings. One way to facilitate the shift from pharmacy school to medical school is through the implementation of a transitional rotation during the final experiential year (P4) of pharmacy school. This rotation, led by a dual-licensed pharmacist and physician, serves as a bridge between the two disciplines by providing pre-matriculation experience to medical school and allowing for professional development and networking with prominent figures in the field. Through this rotation, I was able to connect with future faculty and peers as I had the one-on-one opportunity to form connections, receive career advice that made an earlier impact, and grow my professional skills to be best equipped to start medical school.

Cannabis Use: Recommendation for Women to Avoid During Fertility Treatment.
Ortiz V, Elfanagely S and Gloria Bachmann 
Rutgers Robert Wood Johnson Medical School – Women’s Health Institute

The prevalence of cannabis use in the United States continues to expand with legalization, especially in regard to medical usage. Cannabis use is prevalent in female populations as frequently as males, a factor that should be considered when counseling those women who are actively undergoing fertility treatment. Assisted reproductive technology (ART) and its associated stress may drive a woman to consider cannabis for anxiety management, especially if she had done so previously. However, women should be aware of the adverse effects of cannabis use, such as suicidal ideations and depression, which may be detrimental to the ART process. Data was gathered through systematic reviews of articles found within the Rutgers University Library, PubMed, and JAMA Psychiatry databases. The articles utilized were screened for topics involving cannabis use, depression, and suicidal ideations. The data collected involved sample size, confounding factors if present, and the outcomes related to development or worsening of depression over time. In a literature review performed, various unique articles demonstrated the adverse effects of cannabis use which include depression and suicidal ideations. It was noted that during a study of 6181 monozygotic twins, there was a higher incidence of Major Depressive Disorder (MDD) (odds ratio 1.98, 95% CI 1.11–3.53) and suicidal ideation (2.47, 1.19–5.10) being reported from the individual identified as a frequent cannabis user when compared with their non-cannabis using identical twin. Lower adverse effects were observed for participants that took part in acute cannabis use.
Conclusion: Cannabis use may add more stress and adversely affect the emotional health of women undergoing fertility management. Therefore advising women not to use this intervention during the ART process appears to be an important aspect of their overall counseling.

Mothers, Children, and Marijuana: The Implications of Marijuana Use.
Samantha Elfanagely BA, Gloria Bachmann MD, Vanessa Ortiz MS, Ariana Blum RN, Brendon Nicolas, Ruairi Floyd, Morgan Levy
Rutgers Robert Wood Johnson Medical School – Women’s Health Institute

With side effects like nausea and the growing legal and cultural acceptance of marijuana, cannabis use during pregnancy has become a common occurrence. Despite growing social acceptance of its use, both recreationally and medically, research fails to prove how marijuana is indeed “harmless” to those who use it, especially vulnerable populations like expecting mothers. A comprehensive literature search was conducted on Science Direct and Pub Meds databases of articles related to cannabis use during pregnancy and cannabis use with and without the long-term effects. Articles were included for analysis if they were written in English, underwent peer-review, and had full-text availability. A total of 56 unique articles were found that met these criteria. Various studies found that exposure to cannabis may induce suicidal ideations, cognitive impairments, and encourage substance misuse. Reproductive consequences were found and thus should be considered as part of the counseling for all women. Data suggest that cannabis use can adversely impact female fertility by mechanisms that include impairment of ovarian reserve, disruption of hypothalamic release of gonadotropin releasing hormone, and inhibition of uterine endometrial stromal cell decidualization. The literature also suggests that cannabis use enhances placental barrier permeability to xenobiotics which has the potential to endanger a developing the fetus. Further, THC, a component of cannabis, has been shown to readily cross the placenta, thus exposing the developing fetus.
Future Work: After collecting data, a 12-chapter book was written with illustrations in an effort to better inform consumers of the consequences of marijuana use and its implications on public safety. The book was organized in question format to be conversational and easy to navigate through. Looking forward, we will send our final draft to publication to be available for consumers.

Exercise and the Reduction of Cesarean Section Risks.
Eruj Ali and Gloria Bachmann
Rutgers Robert Wood Johnson Medical School – Women’s Health Institute

The C-section mode of delivery is an invasive surgery with high risks of complications such as infection, neonatal respiratory problems, and placental problems in future pregnancies. Currently, the national rate of C-sections is 31%. Most C-sections are performed under the circumstance of birth defect in the fetus or by personal choice. In other instances, C-sections are medically required due to gestational diabetes or preeclampsia which can cause preventable complications during pregnancy. A literature search was conducted using the Rutgers University library online database for published articles relating to exercise, fitness, nutrition, pregnancy, and modes of delivery. A total of 14 related articles and videos were found that provided sufficient information.The findings supported that exercise throughout pregnancy potentially decreases the risk of needing emergency C-sections by preventing gestational diabetes and preeclampsia by 30.8%. However, only 1 in 6 pregnant women in the United States follow the recommendations to exercise.
Conclusions: There is enough scientific evidence to safely recommend routine exercise with elements of aerobics, strength training and yoga for women throughout pregnancy. C-section rates are expected to decrease up to 41.06% for regularly active individuals.

A Narrative-Based Peer-to-Peer Educational Modality for Peripartum Mood and Anxiety Disorders
Jane Jacob, MPH, Kristin Blackledge, MA, Rebecca Temkin, MPH, Frederick Bosoy, BA, Katherine Schertz, MD and Gloria Bachmann, MD
Rutgers Robert Wood Johnson Medical School, Weill Cornell Medical College, New York, NY, Department of Obstetrics and Gynecology, RWJMS

Peripartum mood and anxiety disorders (PMADs) affect 10 to 21% of women in industrialized countries. While common, PMADs often carry significant stigma which prevents women from seeking the appropriate screening and treatment. This study aims to investigate peer-to-peer education as a modality to reduce stigma in the context of PMADs. Women were provided with this peer-to-peer education in a form of a book, “INSPIRE: Stories of Motherhood”, which is a collection of stories, art, and poetry contributed by women who were diagnosed with a PMAD. Participants were asked to complete a survey before and after engaging with the book, which assessed their personal beliefs, experiences, and biases regarding PMADs. Additionally, we collected demographic information such as age, race/ethnicity, and education level. While the data analysis for our project has not yet been completed, we suspect an inverse correlation between exposure to experiences of PMADs and level of interpersonal stigma, such that as exposure to information about PMADs increases, we expect a reduction in interpersonal stigma.
Conclusions: Providing women with the opportunity to engage with the stories and experiences of other mothers with PMADs may help reduce feelings of stigma and isolation which often accompany these issues, furthermore encouraging these women to reach out for resources sooner. This study will help illuminate not only the demographic and personal factors affecting women’s views on PMADs, but also the effectiveness of peer-to-peer education in reducing this stigma.

Mothers, Children and the Microbiome.
Nicole Fosko, Morgan Levy, Alexandra Schmidt, Bianca Douglas, Leslie Reyes, Blessing Ajayi, Ume Laila, Nancy Phillips, Gloria Bachmann
Rutgers Robert Wood Johnson Medical School – Women’s Health Institute

The “microbiome” is a vast ecosystem of bacteria and other microorganisms that can be found within all of us. Our team has sought to answer any questions that mothers may have regarding the microbiome and its effect on themselves as well as their children. This Q&A style publication defines the microbiome and its contents, discusses its changes throughout life, and explores various lifestyle, environmental, and medical choices that affect it.

Prevalence of zoonotic diseases among pregnant women.
Laila U and Gloria Bachmann
Rutgers Robert Wood Johnson Medical School – Women’s Health Institute

Recent studies have shown that approximately 75% of contemporary emerging infectious diseases are caused by zoonotic diseases. Infectious agents can be transmitted through domestic animals, exotic animals, and even household animals such as cats and dogs. The 2017-2018 National Pet Owners Survey recorded that about 68% of the households in the United States owns a pet. Recent studies have shown that pregnant women are at a higher risk of getting an infection compared to non-pregnant women, due to changes in hormone levels. The interplay between sex hormones, and the immune system becomes complex, which affects the organ system. Additionally, changes in progesterone levels can suppress maternal immune system due to altered levels of T-cells this, making pregnant body more susceptible to getting an infection.A meta analysis of few studies were conducted using Ovid, Ebcohost, Pubmed, and google scholar. The main focus was domestic, and household pets. Out of the five studies, four of the studies showed significant results and identified a link between disease spread from pets to pregnant women. However, rates varied by region. Egypt, Vietnam, and portugal had high prevalence compared to the United states and Canada.  Pet dogs were responsible for 13.8% of disease spread in those regions. Additionally, there is a dense population of cats in northern province of Vietnam. Therefore, prevalence rate of zoonotic disease in pregnant women is on the rise. Data derived from pubmed stated that globally, toxoplasmosis, and cryptosporidium were the most observed infections in pregnant women.
Conclusion: Further research is needed to conclude whether or not having pets can pose a threat to pregnant women. However, risk factors such as hygiene, vaccinations plays a major role in preventing zoonotic disease spread through pets. The studies were not conducted in the United States, thus making it difficult to conclude relevancy. In order to evaluate, surveys should be distributed in New Brunswick health facilities targeting residents especially pregnant women about their interactions with their pets, about vaccinations, and hygiene.

Global Perceptions Towards the Inclusion of the LGBT Community.
Sarah Chelli and Gloria Bachmann
Rutgers Robert Wood Johnson Medical School – Women’s Health Institute

The LGBT community has faced discrimination and abuse for centuries. There are countries today that still do not acknowledge the LGBT community. There are other countries that have made efforts to embrace the LGBT community by legalizing same-sex marriage and providing LGBT-inclusive curriculum in schools. As the LGBT community grows, it is important for people who are questioning and/or afraid, to have representation in their countries as well as resources available to them. However, in many countries these resources are not provided because they exclude the LGBT community from the society. Various articles and texts were researched for evidence of how/if countries include the LGBT community. Books and articles that ranged from analyzing the barriers that LGBT students face to the correlation between the exclusion of LGBT people and the economy. Besides literary evidence, countries have made advancements in other areas, such as politics. Approximately 30 countries around the world have legalized same-sex marriage. LGBT people around the world have held positions in the government as prime ministers, members of Congress, senators, and much more. Schools are beginning to provide LGBT-inclusive educational material. LGBT people are now better represented on television shows, movies, and in the media.
Conclusion: There are countries that have made advancements to include LGBT people and there are countries that still do not support LGBT rights. Overall, there was not a sufficient amount of information regarding how countries include the LGBT community. Although the books and articles provided interesting facts and arguments, researchers should investigate and conduct studies on the perceptions towards the LGBT community. Future studies can be used to help countries develop policies that can better include and embrace the LGBT community.