Friday, June 12, 2009

Drug Appears Safe for Morning Sickness

Morning sickness is an unavoidable part of pregnancy for most women, but many are reluctant to take medications to quell nausea and vomiting. Now one of the largest studies ever done on a commonly used anti-nausea drug, metoclopramide, has concluded it is safe and does not affect fetal development, even when taken during the first trimester, a critical period of development.

The study, released Thursday in The New England Journal of Medicine, analyzed the outcomes of more than 80,000 births in southern Israel over the course of a decade. It found that the 3,458 babies whose mothers were prescribed the drug during the first trimester of pregnancy fared just as well as other babies.

They were no more likely to be born with congenital abnormalities or to have other problems, such as being born prematurely, having a low birth weight or dying, the study found.

“Our study is about 10 times larger than all of the other studies of this drug put together,” said Dr. Rafael Gorodischer, one of the study’s authors and a professor emeritus of pediatrics at Ben-Gurion University in Israel. “We studied exposure in the first trimester because that is the most critical period for the development of the fetus, when most malformations would be caused by an external cause.”

“We can now say with a high degree of confidence that it’s a safe medication,” he said.

Metoclopramide is already used to treat severe morning sickness in the United States, where it is commonly sold under the brand name Reglan. But while physicians who care for pregnant women said the results of the new study are reassuring, they said they weren’t likely to prescribe it for run-of-the-mill morning sickness of the kind most women experience at the beginning of pregnancy.

For women with mild nausea and vomiting once or twice a day, “There are conservative measures they can try, like eating little bits of food all the time so they always have something in their stomach, using antacids to deal with indigestion, or staying away from caffeine or anything that smells bad to them,” said Dr. Peter Bernstein, a maternal-fetal medicine specialist at Montefiore Medical Center in New York.

Some 4.2 percent of the 81,703 babies born during the 10-year period were born to mothers who had been prescribed the drug, but researchers found they were not at increased risk for congenital abnormalities, prematurity, low birth weight or mortality soon after birth. While some 5.3 percent of babies exposed to metoclopramide were born with birth defects, compared with 4.9 percent of those who had not been exposed to the drug, the difference was so small that it could easily have occurred by chance.

There were also no significant differences in the risk for low Apgar scores, a series of measures done immediately after birth to assess newborn health, the researchers found.

Metoclopramide, which has been approved by the Food and Drug Administration, is used to treat gastric problems, nausea and heartburn in adults. Long-term chronic use, however, is associated with tardive dyskinesia, a movement disorder. It is considered a Category B drug, which means it is presumed to be safe to a fetus based on animal studies, though controlled studies of pregnant women have not been done. It is one of several drugs already used in the United States to treat severe nausea and vomiting during pregnancy.


Frequent Snoring in Pregnancy Could Signal Blood Sugar Trouble

Pregnant women who snore regularly are more likely to develop gestational diabetes, new research has found.

In the study, 189 healthy women completed a sleep survey when they were between six and 20 weeks pregnant, and again in their third trimester.

The researchers found that pregnant women who were frequent snorers -- defined as snoring at least three nights per week -- had a 14.3 percent chance of developing gestational diabetes, but among women who did not snore the risk was 3.3 percent.

Taking into account other factors that could increase the risk of gestational diabetes -- body-mass index, age, race and ethnicity -- the researchers found that there was still an association between frequent snoring and the disease, according to a news release from Northwestern University.

"Sleep disturbances during pregnancy may negatively affect your cardiovascular system or metabolism," study author Dr. Francesca Facco said in the news release. "Snoring may be a sign of poor air flow and diminished oxygenation during sleep that can cause a cascade of events in your body," Facco explained. "This may activate your sympathetic nervous system, so your blood pressure rises at night. This can also provoke inflammatory and metabolic changes, increasing the risk of diabetes or poor sugar tolerance."

The study also found that pregnancy increases the likelihood that a woman will snore. Early in pregnancy, frequent snoring was reported by only 11 percent of the women in the study, but by the third trimester, 16.5 percent snored frequently.

Although the cause for the link between snoring and gestational diabetes in not well understood, Facco suggested that it could be due to weight gain and fluid retention, which could cause increased airway resistance.

More study is needed to shed light on the association between snoring and gestational diabetes, which could lead to new interventions to treat pregnant women with sleep disorders.


Wednesday, June 10, 2009

Acupuncture May Relieve Heartburn In Pregnancy

Acupuncture relieves the indigestion and heartburn that bother many women as their pregnancy progresses, a new Brazilian study shows.

Indigestion is common during pregnancy, with up to 80 percent of moms-to-be suffering heartburn, stomach pain or discomfort, reflux, belching and bloating. Symptoms tend to worsen over time, and women who avoid taking medicine for fear of harming the developing fetus might welcome an alternative treatment.

For the study, the researchers randomly assigned 42 pregnant women with indigestion to dietary counseling plus antacids or to dietary counseling and antacids plus acupuncture once or twice a week. The researchers assessed the women's symptoms at the beginning of the study and every two weeks after that for eight weeks.

Heartburn, the main symptom, was reduced by half in 75 percent of the women treated with acupuncture. Women receiving acupuncture also ate and slept better, he said.

Among the 14 women who took antacids, seven in each group, those receiving acupuncture took 6.3 fewer doses, while those receiving conventional treatment upped the amount of medication they took by 4.4 doses, the researchers found. In addition, 15 women in the acupuncture group said that their eating habits improved by 50 percent, compared with fewer than one in three in the other group. Fourteen women receiving acupuncture said their sleep had improved by 50 percent, compared with just one in four women treated conventionally.


Tuesday, June 09, 2009

Multivitamins help moms avoid underweight babies

Women who take multivitamins while pregnant lower their risk of having an underweight baby.

So concludes a major new study by Canadian researchers that challenges the World Health Organization strategy of recommending iron and folic acid supplements alone.

Low birth weight is a leading cause of illness and death in newborns, and a condition that has lasting effects throughout life. Newborns weighing less than 2,500 grams — about 5 1/2 lbs. — are considered to be underweight.

In 2008, a total of 367,089 babies were born in Canada. About six per cent were low birth-weight babies. That's up from 5.7 per cent of hospital births in 2001-02. No one knows why the rate is increasing, but one theory attributes it to a greater frequency of multiple births, such as twins and triplets, from reproductive technologies. The rate also goes up significantly for women 35 and older.

Babies born weighing less than normal are at a higher risk of being admitted to the intensive care unit. They also have an increased risk of infections, feeding problems, cerebral palsy, poor growth and mortality.

And the risks continue as the child grows: Several studies have linked low birth weight to problems with thinking, learning and memory in childhood, as well as to a higher risk of heart disease, diabetes, depression and other chronic illnesses in adulthood.

The World Health Organization currently recommends, based on a review it did in 2005, that all pregnant women take iron and folic acid supplements to improve fetal growth and to prevent spina bifida and neural tube defects.

When WHO compared studies available at that time, it concluded multivitamins didn't add any extra benefit over folic acid and iron alone, the Canadian researchers say. But since then, several randomized, controlled trials have been done.

The Toronto team pooled the results of 13 studies, including more recent ones, and found that, compared to placebos, or sugar pills, "multivitamins were effective in reducing low birth weight," says lead author Dr. Prakesh Shah, a neonatologist at Mount Sinai and associate professor at the University of Toronto. Compared with iron and folic acid alone, multivitamins lowered the risk of low birth weight by 17 per cent.

Multivitamins are thought to boost immune function in women, improve their overall nutritional status and improve fetal growth.

Overall, the birth weight of babies was 54 grams higher, on average, among babies born to women given multivitamins than among those who received iron-folic acid supplements alone.

The Society of Obstetricians and Gynaecologists of Canada recommends pregnant women take folic acid in combination with a multivitamin supplement, but primarily for the prevention of neural tube defects and other congenital anomalies.

Shah says different studies used different vitamin combinations, but the components that came out consistently in his team's review included:

Vitamin A (2,640 IU, or international units), vitamin D (200 IU), vitamin E (10 milligrams), vitamin B1 (1.4 milligrams), folic acid (400 micrograms), vitamin C (70 milligrams), zinc (15 milligrams) and iron (30 milligrams). Shah says women should start taking multivitamins as soon as they know they are pregnant and continue taking them throughout their pregnancy.

But Dr. Vyta Senikas says women should start taking supplements as soon as they are thinking of conceiving.


Monday, June 08, 2009

Kegel exercises do not hinder labor and delivery

Despite some concerns, the pelvic-muscle exercises many women do during pregnancy do not seem to raise the likelihood of complications during labor and delivery, a new study finds.

Prenatal exercises for the muscles of the pelvic floor, also known as Kegel exercises, have long been advocated for preventing incontinence during and after pregnancy.

However, some doctors have expressed concern that the muscle training may make the pelvic floor too strong and less elastic, making labor and delivery more difficult.

To look into this, Norwegian researchers surveyed nearly 19,000 women who gave birth between 2000 and 2005. The investigators report in the journal Obstetrics & Gynecology that women who frequently performed Kegel exercises were no more likely to suffer tears during delivery, or to need an unplanned Cesarean section or instrument-assisted delivery.

It's important for women to know that prenatal pelvic-floor exercises can lower the risk of urinary incontinence, lead researcher Dr. Kari Bo, of the Norwegian School of Sports Sciences in Oslo, told Reuters Health.

Overall, the study found, roughly 7 percent of women who infrequently or never performed Kegel exercises suffered severe tearing during childbirth, compared with 6 percent of those who frequently performed the exercises.

Rates of delivery requiring forceps or a vacuum were 16 percent and 15 percent, respectively, while unplanned C-section rates were 9.5 percent and 7.5 percent.

Women should feel reassured that pelvic-floor training will not negatively affect childbirth, even though many health professionals seem to believe this is a possibility, according to Bo.

"That is a myth," she said.


California Senate Votes to Ban Bisphenol A in Baby Food and Beverage Products

Recently, the California state Senate passed the Toxics-Free Babies and Toddlers Act (SB 797), which would ban bisphenol A, or BPA, from food and drink containers designed for children ages three and younger. BPA, a synthetic estrogen that has been linked to breast cancer and other serious health problems, is used in some plastic baby bottles and sippy cups, as well as in the lining of infant formula cans. The bill will now be considered by and voted on in the Assembly.

The vote follows media reports of notes leaked from a May 28 meeting of BPA industry representatives, during which these representatives discussed plans to thwart the California legislation by “befriending people that are able to manipulate the legislative process.”

“Millions of babies and toddlers are exposed to the toxic hormone disruptor BPA on a daily basis through their baby bottles, formula and baby food,” said Renee Sharp, director of Environmental Working Group’s California office. “If the Pavley bill becomes law, this will finally end.”

The bill, introduced by Sen. Fran Pavley, is a response to mounting scientific evidence that exposure to even extremely low levels of BPA can impact health. More than 200 scientific studies show that BPA exposure, particularly during early infancy, is associated with a wide range of adverse health effects in later life. In addition to breast cancer, BPA has been linked to prostate cancer, birth defects, infertility in men, early puberty in girls, diabetes and obesity. A main route of human exposure is through the leaching of BPA from food and beverage containers. Once in food, BPA moves quickly into the body. Babies and young children are particularly vulnerable because their bodies are still developing.

The compelling science has led to a flurry of legislative activity. In April, Minnesota became the first state to ban BPA from baby bottles and sippy cups, and in May, the Connecticut legislature passed a similar ban, which now awaits the governor’s signature. Congress and 22 states and municipalities are also considering legislation to regulate the chemical.

There has been significant action in the marketplace as well. In March, Sunoco became the first chemical manufacturer to acknowledge health concerns when it announced it will sell BPA only to companies that guarantee the chemical will not be used to make children’s food and water containers. Leading formula companies are beginning to use packaging that doesn’t contain BPA, six baby bottle manufacturers have pledged to stop using the chemical, and retailers from Toys R Us to Kmart have announced they are phasing out BPA-containing baby bottles.