New Delhi: Hormonal changes caused due to pregnancy, or the use of oral contraceptives, and the longer life expectancy are some of the reasons that explain the higher incidences of strokes among women than men, said experts on World Stroke Day on Tuesday. 

Stroke is a major cause of disability and death for all people worldwide. But, it is the third leading cause of death in women and kills more females than males, according to the American Stroke Association.

Dr. Atul Prasad, Principal Director & HOD, Neurology, BLK – MAX Super Speciality Hospital, told IANS that longer life expectancy, hormonal factors that are influenced by pregnancy and childbirth, oral contraceptives, and menopause.

Hypertension and heart diseases like atrial fibrillation, an irregular heart rhythm, together with pollution are other major risk factors.

“Women with a history of migraine with aura have an increased risk for stroke, especially along with factors such as smoking or oral contraceptives. Another is preeclampsia — a complication of pregnancy — which doubles the risk of stroke after the fact but is rarely considered,” Dr. Sumit Singh, Chief-Neurology, Artemis Hospitals

The experts noted that women also often have atypical or less-recognised stroke symptoms, such as fatigue, general weakness, confusion or disorientation, nausea, or vomiting, which contributes to late diagnosis and treatment.

“Common symptoms such as slurred speech, sudden weakness, and facial drooping are established in both genders; however, the symptoms in women are more disguised in dizziness, fatigue, nausea, and even hiccups. Such uncommon symptoms often delay judgement or misdiagnosis and are critical in worsening the outcome,” Singh said.

While the treatment and prevention of ischemic stroke are generally similar for men and women, post-stroke rehabilitation programmes for women need to be more gender specific.

“Outcomes are worse, and depression and cognitive decline occur more frequently, with longer times to recover in women compared to men. Thus, stroke recovery must be approached more holistically with mental health support, social integration, and individualised physical rehabilitation,” the doctor said.

The core strategies for preventing ischemic stroke — controlling blood pressure, managing cholesterol, avoiding smoking, and maintaining a healthy lifestyle — are the same for both men and women.

However, Prasad stressed the need for women to regularly monitor for stroke risk if they are taking birth control pills, or undergoing Hormone replacement therapy (HRT). Women with a history of preeclampsia also need long-term follow-up.

CNN
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A new study found a moderately higher risk of autism spectrum disorder in children born to pregnant people exposed to tap water with higher levels of lithium, but experts caution that this association does not show a direct link between the two.

About 1 in 36 children in the US is diagnosed with autism spectrum disorder (ASD) each year, according to data from the US Centers for Disease Control and Prevention.

Scientists still don’t know the exact cause of autism, a developmental disorder. Genetics may be a factor, but some have been looking at potential environmental causes, too.

Cases may be on the rise, but that is also unclear. One study published this year on cases in the New York-New Jersey area found that autism diagnosis rates tripled among certain age groups between 2000 and 2016. A 2021 report found similar increases in cases, but the CDC says the increased number of cases is most likely linked to more doctors screening for the condition.

Lithium is an alkali metal that can be found naturally in some food and ground water. It’s used in batteries, grease and air conditioners, as well as in the treatment of bipolar disorder and some blood disorders. Its levels in US drinking water are not regulated, according to the US Geological Survey.

A new study, published Monday in the journal JAMA Pediatrics, found a small association between lithium and autism diagnosis in Denmark, where the researchers say the level of lithium in drinking water is similar to that in American water systems.

The researchers checked a database of people with psychiatric disorders for children born between 2000 and 2013 to find information on 8,842 cases of ASD and 43,864 participants who did not have ASD. They then measured the concentration of lithium in 151 public waterworks that served more than half of the Danish population and mapped out where pregnant people lived in relation.

As lithium levels in water increased, there was a modest increased risk of an ASD diagnosis. Specifically, compared with people at the lowest exposure level, those who had the second and third highest exposure during pregnancy had a 24% to 26% higher risk of ASD diagnosed in children. The group with the highest exposure had a 46% higher risk than those at the lowest level of exposure.

The researchers could not tell how much water the pregnant people drank, but they picked Denmark in part because residents there consume some of the lowest amounts of bottled water in Europe.

Experts say it’s important to note that the research can’t show that lithium exposure leads directly to an autism diagnosis.

Further study is required, said study co-author Dr. Beate Ritz, a professor of neurology in the David Geffen School of Medicine at UCLA, and a professor of epidemiology and environmental health at the UCLA Fielding School of Public Health.

“Any drinking water contaminants that may affect the developing human brain deserve intense scrutiny,” Ritz said in a news release. She added that the research would need to be replicated in other countries to look for a similar connection.

The implications of the findings are complex as far as public health policy is concerned, according to an editorial published alongside the study. Lithium levels in water, at concentrations that the study associated with a potential ASD risk, have also been linked with health benefits such as lower rates of hospitalization for psychiatric disorders and suicide.

“If all these of associations are valid, the wisdom of Solomon will be required to develop guidelines for lithium in drinking water that are maximally protective of the entire population,” wrote Dr. David C. Bellinger, a professor of neurology and psychology at Harvard Medical School. “Until the basic biology of ASD is better understood, it will be difficult to distinguish causal from spurious associations.”

Dr. Max Wiznitzer, director of the Rainbow Autism Center at University Hospitals Rainbow Babies and Children’s Hospital in Cleveland, points to other research on the effects of lithium on pregnant people who take it for mental health disorders. Those studies – which look at people exposed to much higher levels than are found in drinking water – do not show a connection with autism spectrum disorder.

“It’s an interesting association, but causation is definitely not proven,” said Wiznitzer, who was not involved in the new research. “We have to see if there’s a viable and biologically plausible mechanism by which a small amount of lithium in the water supply can somehow do this, yet pharmacologic dosing of lithium in women with bipolar disorder has not been reported to be causing increased risk of ASD.”

Other studies have also suggested connections between ASD and environmental exposures to things like pesticides, air pollution and phthalates. But none of them points to any of these factors as a direct cause of the disorder.

A link between environmental exposure and ASD is hard to prove, Wiznitzer said. With research showing that increased exposure to air pollution raises the risk of giving birth to a child with ASD, for example, he often wonders whether pollution is the determining factor or if it’s just the populations who live in more polluted areas.

“There’s a lot of speculation about about environmental factors, but how many of them are truly causally associated?” Wiznitzer said. “We are bombarded with a variety of environmental stressors in our everyday lives. We have to figure out how to basically safely navigate them, and this is probably not one that’s high on our list.”

CNN
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Tennis star Naomi Osaka announced her pregnancy on Wednesday, posting a photo of an ultrasound scan on her social media accounts.

“The past few years have been interesting to say the least, but I find that it’s the most challenging times in life that may be the most fun,” the four-time major champion wrote alongside the photo.

“These few months away from the sport [have] really given me a new love and appreciation for the game I’ve dedicated my life to.”

Osaka said she plans to return to tennis in 2024 for next year’s Australian Open, a tournament she has won on two previous occasions.

“I know that I have so much to look forward to in the future,” she added. “One thing I’m looking forward to is for my kid to watch one of my matches and tell someone, ‘that’s my mom.’”

The 25-year-old’s withdrawal from the upcoming Australian Open was announced by the competition’s organizers on Sunday.

Osaka has not played since the Toray Pan Pacific Open in Tokyo in September last year.

She took some time away from competitive tennis and made several highly publicized disclosures about her struggles with mental health following an incident in August 2021, where she was visibly stressed and emotional while addressing the media during a mandatory news conference at Roland Garros.

Osaka subsequently pulled out of the French Open that year and revealed she had “suffered long bouts of depression” since winning her first major championship in 2018.

“I don’t think there’s a perfectly correct path to take in life but I always felt that if you move forward with good intentions you’ll find your way eventually,” Osaka added in her statement on Wednesday.