Friday, September 25, 2009

Antidepressants in pregnancy up heart defect risk

If you take antidepressants such as fluoxetine (marketed as Prozac) early in your pregnancy, you may be doubling the risk that your newborn will be born with a heart defect, according to a new study.

However, the vast majority of children born to women who take such antidepressants - known as selective serotonin reuptake inhibitors (SSRIs) - do not have such defects, the researchers are quick to note.

Earlier studies have tied SSRIs during pregnancy to heart defects, but also to even more serious birth defects. According to the new study of nearly half a million children born in Denmark between 1996 and 2003, however, only heart defects are likely to be associated with the antidepressants, note co-author Dr. Lars Henning Pedersen, from Aarhus University, Denmark, and colleagues.

Along with fluoxetine, sertraline (marketed as Zoloft) and citalopram (marketed as Celexa) seemed to increase the risk more than others, as did using more than one antidepressant at a time, according to the report in the September 25th Online First issue of BMJ.

Overall, SSRI use in early pregnancy, defined as 28 days before to 112 days after conception, doubled the risk of a particular kind of heart defect involving a piece of tissue that separates parts of the heart.

Sertraline more than tripled the risk, while citalopram more than doubled it. Using more than one SSRI nearly quintupled the risk of the heart defect.

However, the number of children born with such defects was still quite small: For about every 250 pregnant women who did not take SSRIs, one infant was born with the defect, while about two were born with the defect for every 250 women who took one SSRI, and four for every 200 mothers who took more than one.

Pedersen told Reuters Health that the results surprised the team.

Still, in an accompanying editorial, Dr. Christina Chambers, from the University of California, San Diego, comments that doctors and patients "need to balance the small risks associated with SSRIs against those associated with undertreatment or no treatment."


Thursday, September 24, 2009

Superfetation? You mean, I can get pregnant when I'm already pregnant?!?!

The recent story of an Arkansas woman who became pregnant two weeks after already becoming pregnant is shaking things up for pregnant women. Though controversial among medical professionals, superfetation seems to be possible in humans, although rare. Rodents, horses, sheep, monkeys and kangaroos commonly experience superfetation but records of superfetation occurring in humans are extremely limited.

Those who are thrilled about having unprotected sex during pregnancy (in a monogamous relationship that is) probably are shaking in their boots right now, as they imagine becoming pregnant amidst their already aching back and nausea. It isn't much consolation but the only way that superfetation can occur is if the menstrual cycle continues through a pregnancy (which apparently is possible as well- who knew?).

Still worried? Scientists have attempted to induce superfetation through implanting eggs and embryos in cattle and have only been successful during the first few weeks after the initial implantation. They surmised that the conditions were only ideal during those first few weeks because in all species who experience superfetation, subsequent pregnancy rates declined progressively as the embryo's developed.

Many false claims of superfetation have been discredited over the years. It is only this most recent case in addition to a case revealed last year that appear to be on record. A woman named Charlotte Mullineux was pregnant with twins but miscarried one of the twins and as a remarkable twist of fate, she became pregnant with a second baby following the loss. The second baby was 3 weeks younger than the first. Charlotte continued to ovulate every month of her pregnancy, making it possible for her to become pregnant repeatedly in theory.

The idea of a menstrual cycle during pregnancy certainly throws a wrench in things and clear answers are not easily found. Many pregnancy websites claim it is impossible to have a menstrual cycle during pregnancy, that it is impossible to have a period or even to ovulate. Apparently, it is just extremely rare. Hopefully the recent cases of Julia Grovenburg in Arkansas and Charlotte Mullineux will shine enough light on this fascinating topic for more research to be done.

You can read the study here.

Or read more about Charlotte Mullineux here.

Risk of Postpartum Bleeding Higher After Pre-labor Cesareans

The risk of severe postpartum hemorrhage increases after induction and pre-labor cesarean section, according to a study in the September issue of the American Journal of Obstetrics & Gynecology.

Iqbal Al-Zirqi, M.D., from the University of Oslo in Norway, and colleagues analyzed data on 307,415 Norwegian mothers to determine the risk of severe postpartum hemorrhage (defined as a visually estimated blood loss of greater than 1500 mL within 24 hours after delivery or the need for a blood transfusion) based on labor onset and delivery mode.

The researchers found that 1.1 percent of all women and 2.1 percent of women with a previous cesarean delivery experienced severe postpartum hemorrhage. The risk was higher for induction (odds ratio, 1.71) and pre-labor cesarean section (odds ratio, 2.05) compared with spontaneous labor. The risk of hemorrhage was 55 percent higher for emergency cesarean section and lower for vaginal deliveries (odds ratio, 0.48) compared with pre-labor cesarean section. The risk was highest in women with a previous cesarean section who had an emergency cesarean after induction compared with spontaneous vaginal delivery in women without a previous cesarean (odds ratio, 6.57).

"Induction and pre-labor cesarean section should be practiced with caution because of the increased risk of severe postpartum hemorrhage," Al-Zirqi and colleagues conclude. "Additional prospective studies are needed to measure blood loss objectively at pre-labor cesarean section delivery, to document the exact causes of severe hemorrhage at cesarean section delivery, and to establish evidence-based guidelines for the use of induction."


Air Pollution May Raise Preterm Birth Risk

Exposure to air pollution later in pregnancy may raise a woman's risk of delivering her baby too soon, a new study suggests.

The findings, reported in the journal Epidemiology, do not prove that air pollution, per se, triggers preterm labor in some women. But they do provide "limited support" for that theory, the researchers say.

Some previous studies have linked air pollution exposure in both the first and third trimester of pregnancy to an increased risk of preterm delivery.

In the current study, researchers looked at the relationship between air pollution levels and the risk of preterm delivery among more than 476,000 women who gave birth in the Atlanta metropolitan area between 1994 and 2004.

The researchers tracked daily pollution levels using data from various air-quality monitors in five counties.

They found that while there were no clear connections between preterm birth and most of the air pollutants they studied, three particular air pollutants were related to a higher risk.

Specifically, the daily rate of preterm births inched upward when levels of fine particulate matter were elevated over the previous week. The increase was seen among women who lived within 4 miles of an air-quality monitoring site.

Car exhaust is the prime source of fine particulate matter, but it is also produced by power plants and certain other industrial sources. The particles are small enough to be inhaled deeply into the lungs.

The strongest evidence was for a role of nitrogen dioxide (NO2), a marker of motor vehicle exhaust, noted lead researcher Dr. Lyndsey A. Darrow, of Emory University in Atlanta.

NO2 was linked to an increase in the daily preterm-birth rate when levels were elevated in the previous six weeks.

In theory, Darrow told Reuters Health in an email, exposure to air pollution later in pregnancy could activate an inflammatory response in the body that, in turn, might trigger early labor. She noted that there is increasing evidence that inflammation is involved in preterm birth.

Still, the role of air pollution in premature birth remains unclear.

"The scientific evidence is mixed as to whether or not urban air pollution has an effect on fetal development," Darrow said.

She suggested that pregnant women who want to "err on the side of caution" try to avoid air pollution sources like high-traffic areas.


Arkansas Pregnant Woman Is Pregnant Again

A pregnant woman in Arkansas surprised doctors twice over when she went in for a routine ultrasound this June.

Doctors successfully located Todd and Julia Grovenburg's growing baby girl Jillian, but then discovered another smaller baby -- what could be Jillian's younger brother -- growing beside her.

The Grovenburgs may have conceived their son Hudson a full two-and-a-half weeks after Jillian, according to statements given to KFSM-TV in Ft. Smith-Fayetteville, Ark.

Different from identical twins or fraternal twins, the Grovenburg babies would have separate due dates and are considered to be a rare medical occurrence.

"When the woman had her ultrasound initially, they saw one sack, one baby developing, and that baby had a certain gestational age; then they noticed a second heartbeat in a child that was much, much younger developmentally," Dr. Karen Boyle of the Greater Baltimore Medical Center, told ABC News' "Good Morning America Health."

Boyle said it's uncommon for fetuses to differ so widely in size and development early in pregnancy, even though babies may differ widely in size at birth.

"It does really sound like this is a true case of different conception times for these children," said Boyle.

Reports of superfetation, or conceiving while pregnant, are so rare that Boyle said, "There is no prevalence or incidence in the literature. I could only find about 10 reported cases."

Grovenburg's obstetrician, Dr. Michel Muylaert, confirmed to KFSM-TV that the Grovenburgs may be dealing with the extraordinarily rare case of superfetation.

"Mrs. Julia Grovenburg is pregnant with twins and there appears to be a discordant growth pattern, possibly due to superfetation," Dr. Muylaert wrote in a letter to KFSM-TV.

"This is an unusual and rare condition, but the possibility is real. It can only be confirmed after delivery by chromosomal and metabolic studies on the babies. She was evaluated at UAMS in Little Rock for this condition and they confirmed the suspicion of superfetation," he continued.

Yet, while superfetation is rarely documented, Dr. Donnica Moore said it may be impossible to tell if this happens more often -- but with a shorter time period between conceptions.

"For these sorts of cases, I have to say, most of our bodies don't read the textbook," said Moore, an obstetrician and president of New Jersey's Sapphire Women's Health Group.

"I would say [it's] extremely rare, but then again, we would never know how often this happens. If the children are born at the same time -- it might be that they were conceived at different times."

Depending on the time between the two conceptions, Boyle said superfetation could be dangerous for the younger baby, who could be born prematurely.

"It [the second conception] can happen up to 24 days later than the first conception, and then you're putting the second baby at risk for lung development problems," said Boyle.

However, in the Grovenburg's case, Boyle said the difference of two weeks would not put the younger baby at much of a risk for health problems.

"The interesting thing in this case is if these children were actually born on their due dates, the older child would be born at the end of 2009, and the younger child would be born in the beginning of 2010," said Boyle.


Woman Gives Birth to 19.2-Pound Baby

A woman in Indonesia has given birth to the country's biggest ever baby - tipping the scales at a whopping 19.2lbs (8.7kgs).

The 62cms (24.4ins) boy, who has not yet been given a name, was born by caesarean section at a hospital in North Sumatra province.

A gynaecologist who took part in the operation said the 'special delivery' was no easy feat.

"This heavy baby made the surgery really tough, especially the process of taking him out of his mum's womb. His legs were so big," Binsar Sitanggang said.

The boy's huge size was most likely the result of his 41-year-old mother having diabetes, Mr Sitanggang said.

When a diabetic mother's glucose level is high during pregnancy, the baby can receive too much glucose and grow too large, gynaecologists say.

The boy's mother had to be rushed to hospital because of complications with the pregnancy, which had reached nine months.

The baby is the woman's fourth child, but her only child not traditionally delivered by a midwife.

The boy is said to be in a healthy condition despite having to initially be given oxygen to overcome breathing problems.

Mr Sitanggang described the baby as "extraordinary" in almost every way.

"He's got strong appetite, every minute, it's almost non-stop feeding," he said.

"This baby boy is extraordinary, the way he's crying is not like a usual baby. It's really loud."

Indonesia's previous heaviest baby, weighing in at 6.9kgs, was born in 2007 on the outskirts of the capital Jakarta, according to the Indonesian Museum of Records.


Wednesday, September 23, 2009

Children May be Banned from Hospitals Due to Swine Flu

When a new baby is born, it often prompts images of gathering -- families coming together around the new mother and child, with friends joining in. But fears of infection may draw an end to that tradition, as hospitals weigh the decision whether to allow children to be near newborns and pregnant women at all.

With a potential outbreak of swine flu on the horizon, many hospitals are becoming more cautious when it comes to protecting newborn babies and their mothers -- fears that have prompted a complete ban of children from areas of one hospital where newborns and their mothers are cared for -- and that have caused more intense deliberations about the issue in other facilities.

"For pregnant women, there is a much higher risk associated with H1N1, and they wanted to err on the side of safety for pregnant women," said Mike Green, the chief executive officer of Concord Hospital in New Hampshire, which imposed the outright ban.

Immediate family of a new baby -- including spouses, grandparents and siblings of the baby -- over 18, are still welcome to visit. The hospital plans to review the policy on a monthly basis.

While an outright ban on healthy child visitors does not appear to be the norm yet, hospitals have indicated that it is a step they would consider over time.

"As an obstetrician, while I recognize the importance of the 'family' event and being family friendly, the most important concern I have is the health of the pregnant woman and later, her newborn," said Dr. Ashlesha Dayal, a maternal-fetal medicine specialist at Montefiore Medical Center in New York City. "A restriction on visitors, during the hospitalization, to me, seems like a small inconvenience, in comparison to having a pregnant woman or newborn baby become seriously ill or worse because a 'chance' was taken."

"We have not made more restrictions in our birth center areas. However, we're evaluating the situation on a daily basis," said Leslie Heying, a spokeswoman for St. Luke's Hospital in Sioux City, Iowa. She says in their neonatal intensive care unit (NICU) " we are restricting visitors who are 14 years-old or younger."

She added that children are not yet restricted from seeing healthier newborns at the hospital.

She also noted that everyone is screened for influenza.

"If somebody is exhibiting signs and symptoms of the flu, we ask that they stay out of the NICU area and they can come back 24 hours later [for rescreening]," said Heying.

Such screening instead of a full ban is the policy at some hospitals, and the full ban may be seen as an overreaction.

"Though these limitations may appear by face value to be of merit, the indiscriminate ban is rather uncalled for at this time of swine flu," said Dr. Salih Yasin, director of obstetrics at Jackson Memorial Hospital in Miami.

Yasin said a better approach would be to monitor patients who visit to see if any appear to have symptoms, and then test those particular patients before allowing them to see the new baby and mother.

While restricting access to new mothers may strike some as novel, such controls have been put in place before.

And while the restrictions may not be popular, some are in place at hospitals even when influenza is not perceived to be as great a threat.

Those restrictions include monitoring visitors for illness and making everyone wash their hands.

Many hospitals also restrict who can enter the NICU, because of the premature and other vulnerable newborns there, restrictions which can include children under 18.

At issue with some is how new mothers and their families will react to a ban of child visitors.

Green said that at Concord Hospital, reaction has been varied, with some mothers understanding and many upset.

"The H1N1 flu is hitting us hard in the southeastern U.S.A. I think people would understand," said Dr. Kevin Ault, an associate professor of gynecology and obstetrics, at the Emory School of Medicine in Atlanta.

He also recommended vaccinations for the mother and people who will be around the baby, since children that young cannot receive the vaccine.

Dr. Jeff Ecker, an obstetrician who deals with high-risk deliveries at Massachusetts General Hospital, said such drastic steps are meaningless if the family does not follow through with them afterward, keeping the new baby away from sick visitors.

Green noted that there has been one unexpected result for some new mothers that the hospital had not counted on.

"Since we've instituted the policy, mothers have reported to us that [they're] getting more rest," he said. "So that's an interesting unintended consequence."


Stella Luna is here!

"Grey's Anatomy" star Ellen Pompeo has given birth to a daughter.

Pompeo's representative, Amanda Silverman, says Stella Luna Pompeo Ivery was born Sept. 15. No other details are available.

She is the first child for Pompeo and her record producer-husband, Chris Ivery.

The couple tied the knot in 2007 after three years of dating.

The 39-year-old actress plays Dr. Meredith Grey on the ABC series.


Find the Right Childbirth Technique

To help avoid medical intervention during labor, a variety of childbirth techniques are available to help ease the birthing process. In order to ensure a smooth delivery, parents should be prepared for every possible situation. Childbirth techniques aim to help and educate expecting parents on important topics such as labor pains, delivery, and postpartum recovery.

The Alexander Technique

F.M. Alexander (1869-1955), a Shakespearean actor, created this technique after he lost his voice while performing and no other medical treatment solved his problem. Alexander's technique involved proper movement and breathing techniques for sitting, standing and moving which helped restore his voice. These breathing and movement suggestions by Alexander will help you understand and compensate for the bodily changes that are taking place. Even after delivery, the Alexander technique will teach you how to properly lift and carry your child without suffering from poor posture or back pain.


For 21st century moms-to-be, Sarah McMoyler created a realistic and modern day approach to delivering babies. In conjunction with up-to-date medical information, McMoyler's approach also combines the childbirth techniques of the Bradley and Lamaze methods. Her fast-paced courses are great for couples on-the-go who need a crash course in managing labor pains, being flexible during birth, and building confidence. Three key elements to the McMoyler technique include:

  • Being realistic; parents should be prepared to have anything ranging from a natural delivery to a high tech birth.
  • Nonjudgmental; giving birth is not a contest and the expectant parents' primary concern should be a happy and healthy mother and child.
  • Entertaining; McMoyler suggests that educational materials pertaining to birth should be engaging and fun.

The Bradley Method

Dr. Robert Bradley developed this childbirth technique in the late 1940's which focuses on a natural approach combined with proper nutrition and prenatal exercise. The Bradley Method was initially nicknamed the Husband-Coached method because it was believed that women had a more positive experience if their husbands were included in the birthing process.


The Lamaze technique is widely known for its rhythmic breathing techniques, but Lamaze also emphasizes concentration based on relaxation. This technique will also teach you to use the power of distraction to divert your attention away from your contractions. In classes, you and your partner will learn controlled deep breathing and massaging techniques to also help reduce pain perception even further. Women also learn about labor and birthing positions, communication skills, as well as information about the postpartum period. Over one million babies are born using this method each year.

Be sure to research each childbirth technique to see which philosophies and methods fit your personal preferences.


Pregnancy linked to metabolic syndrome

U.S. researchers have linked giving birth to the development of metabolic syndrome -- a cluster of symptoms leading to heart disease.

The study, published in American Journal of Obstetrics and Gynecology, also found women with gestational diabetes were nearly 2 1/2 times more likely to develop metabolic syndrome than were women without it.

"Our findings suggest that childbearing can contribute to the development of the metabolic syndrome and that part of the association may be through weight gain and lack of physical activity," Dr. Cora Lewis of the University of Alabama at Birmingham said in a statement.

"And, although women with gestational diabetes had the highest relative risk of developing the metabolic syndrome, those with non-gestational diabetes pregnancies made up the larger at-risk group."

Lewis, the study leader, and colleagues looked at 2,787 women in the 20-year Coronary Artery Risk Development in Young Adults study and included 1,451 for their study. Of these, 706 had no births and 745 had at least one birth during the 20 years following.

Of the 745, 88 had at least one birth complicated by gestational diabetes. The researchers controlled for preconception measurements of body mass index -- a measure for body fat and other metabolic syndrome components as well as for physical activity.


This Week's Celebrity Baby Bumps

Leelee Sobieski debuts her baby bump, Karolina Kurkova resembles a fairytale princess at the Met., Kourtney Kardishian bumps it up on the red carpet, Heidi Klum exposes her beautiful bump in a form-fitting dress, Rebecca Gayheart is just starting to show, and Jenna Elfman wears a gorgeous black outfit to show off her 2nd trimester bump.

Source Source

Vitamin warning for pregnant women

Pregnant women may not be getting enough vitamin D even if they take supplements, researchers said.

A lack of vitamin D in pregnancy can lead to a youngster suffering rickets and longer-term problems such as schizophrenia and Type 1 diabetes, they said.

While many people can get vitamin D from sunshine, those living in cooler countries may not be getting enough.

As a result, the body often relies on its own stores of vitamin D in the winter months. Otherwise, dietary intake or multivitamins are needed.

Vitamin D is found in small quantities in a few foods such as oily fish, eggs and liver, and in fortified foods such as margarine, breakfast cereals and powdered milk.

However, pregnant women are advised to avoid liver and liver products, raw or under-cooked eggs and to limit their intake of certain fish such as tuna.

This means they might not get enough vitamin D, although the Food Standards Agency recommends pregnant women take supplements containing 10mcg (micrograms) of vitamin D each day.

The latest study was carried out by the Northern Ireland Centre for Food and Health with researchers from Queen's University Belfast.

Levels of vitamin D were measured in 99 pregnant women in Northern Ireland at 12, 20 and 35 weeks of gestation. The results were compare with 38 women who were not pregnant.

The concentration of vitamin D in the blood was lower in pregnant women, with 35%, 44% and 16% classified as vitamin D deficient at 12, 20 and 35 weeks gestation respectively.


Pregnant women with breast cancer face good odds of recovery

Pregnant women who develop breast cancer do not have worse odds of death or of cancer returning than other young breast cancer patients, a recent study has found.

The study is one of the largest to look at whether breast cancer hits pregnant and recently pregnant women harder than other women. It contradicts some smaller, earlier studies that suggested maternity made things worse.

"If we can get them early, we can treat them aggressively and have good and promising outcomes for both woman and child," said the study's lead author, Dr. Beth Beadle of the University of Texas M.D. Anderson Cancer Center.

Frightening for any woman, a breast cancer diagnosis is particularly terrifying for a pregnant woman. It presents complicated decisions about how to treat the mother and not harm the fetus. Some doctors recommend abortion so they can focus on treating the mother.

In the new study, published earlier this year in the journal Cancer, researchers analyzed data from 652 women ages 35 and younger who were treated for breast cancer at M.D. Anderson from 1973 through 2006.

The study group included 104 women with pregnancy-associated cancers ---- 51 who had breast cancer during pregnancy, and 53 who developed the illness within a year after.

The rates of cancer recurrence, cancer spread and survival were about the same for the women with pregnancy-associated breast cancers as they were for the other women, the researchers found. The researchers calculated the rates for 10 years after the cancer diagnosis.

The women who were pregnant had tumors at a more advanced stage, probably because women and their doctors may have discounted breast changes, attributing them to breast feeding or pregnancy, the researchers believe.

Generally, breast cancers are more aggressive in younger women, and survival rates are significantly lower. While age may be a factor, it's not clear that pregnancy is: There was no evidence in the new study that tumors were faster growing in the pregnant women, said Beadle, a radiation oncologist.

Radiation ---- dangerous to a fetus ---- is commonly used in mammography and breast cancer treatment. But ultrasound can be used to look for breast tumors instead. And surgery and certain kinds of chemotherapy can treat the cancer without poisoning the womb.

However, it remains a complicated medical situation that can depend on the severity of the cancer and how far into the pregnancy the mother is, said Dr. Ruth O'Regan, an associate professor at Emory University's Winship Cancer Institute in Atlanta.


Tuesday, September 22, 2009

Working Mother 100 Best Companies 2009

The 2009 Working Mother 100 Best Companies are standing tough in their support of working families. Despite the layoffs, cutbacks and general economic maladies the country is facing, they continue to spend on health care, child care and work/life benefits.In fact, spending has actually increased at many of the winning companies, with about a third reporting that added funds have gone to new and improved programs.

How, when and where you work aren’t as important as the quality of the work you produce. That’s the clear message of this year’s Working Mother 100 Best Companies. A full 100 percent of them offer telecommuting and flextime schedules, 98 percent offer job-sharing, and 94 percent offer compressed workweeks. These companies are also committed to helping working parents with their child-care needs: 86 percent provide backup care, and 62 percent provide sick-child care. But perhaps even more important is the family-friendly culture they all continually strive to create. We salute these winners and their ongoing efforts to help employees manage their busy lives.

The list of companies below is not complete. The asterisk (*) indicates that they made it to the top 10. To see the full list and reasoning for each company, visit

  • Abbott*
  • Allstate Insurance Company
  • American Express Company
  • AOL
  • Bank of America
  • Bayer Corporation
  • Blue Cross and Blue Shield of North Carolina
  • Bon Secours Richmond Health System*
  • The Boston Consulting Group
  • Bristol-Myers Squibb
  • Capital One Financial Corporation
  • Children's Memorial Hospital
  • Chrysler
  • Cisco Systems
  • Citi
  • Colgate-Palmolive Company
  • Cornell University
  • Dell Inc.
  • Deloitte*
  • Discovery Communications*
  • Dow Corning Corporation
  • DuPont
  • Ernst & Young*
  • First National Bank
  • Freddie Mac
  • General Electric Company
  • General Mills*
  • GlaxoSmithKline
  • Goldman, Sachs & Co.
  • Grant Thornton*
  • Hallmark Cards, Inc.
  • Hewlett-Packard Company
  • IBM Corporation*
  • Intel Corporation
  • Johnson & Johnson
  • JPMorgan Chase
  • Kellogg Company
  • Kraft Foods, Inc.
  • LEGO Systems, Inc.
  • March of Dimes Foundation
  • Marriott International, Inc.
  • MasterCard Worldwide
  • The McGraw-Hill Companies*
  • Merck & Co., Inc.
  • Mercy Health System
  • MetLife, Inc.
  • Microsoft Corporation
  • Morgan Stanley
  • Novartis Pharmaceuticals Corporation
  • Patagonia, Inc.
  • Pfizer Inc
  • PricewaterhouseCoopers*
  • The Procter & Gamble Company
  • Providence Health & Services Alaska
  • Prudential Financial, Inc.
  • S. C. Johnson & Son, Inc.
  • sanofi-aventis U.S.
  • Texas Instruments Incorporated
  • Turner Broadcasting System, Inc.
  • Verizon Communications Inc
  • Yale-New Haven Hospital

More Babies Born Prematurely - Diabetes, Preeclampsia are Factors

The risk of neonatal death from premature birth more than halved during a 25 year period and there has also been a 10 per cent reduction in stillbirth associated with pre-term births.

The University of Edinburgh research analysed data relating to nearly 90,000 births in Scotland between 1980 and 2005.

Researchers hope that better understanding of the trends and causes behind premature births will help to develop better treatments for expectant mothers.

The number of babies born prematurely increased from 54 per 1,000 births between 1980 and 1985 to 63 per 1,000 births between 2000 and 2005.

Improvements in the survival rates of premature babies were greater when births were medically induced or by pre-planned Caesarean section compared with pre-term births in which labour occurred naturally.

The findings support the shift towards more medically induced early births, with these preterm deliveries up more than 40 per cent compared with a 10 per cent increase in early births from natural onset of labour.

The research, published in the journal PLoS Medicine, also found the growing number of expectant mothers with diabetes had resulted in an increase in the numbers of babies born prematurely.

Researchers found a seven-fold increase in premature births where the mothers were diabetic before becoming pregnant. Premature births linked to gestational diabetes, where expectant mothers develop diabetes during pregnancy, also increased four-fold over the study period.

High blood pressure in expectant mothers, however, remained the major factor linked to pre-term births – although the proportion of babies born prematurely as a result of this condition decreased over the 25-year study period.

A rise in the average age of women becoming pregnant was not found to have affected the incidence of premature births.

Premature births are linked to more than 66 per cent of single baby still births, 65 per cent of single baby neonatal deaths and 67 per cent of infants who have a prolonged stay in the neonatal unit.


Anti-epileptic drugs during pregnancy risky

New research suggests that it is largely the drugs used to treat epilepsy and not the condition itself that increase the risk of adverse pregnancy and birth outcomes.
"Epilepsy is the most common maternal neurologic disorder requiring medical treatment during pregnancy," Dr. Gyri Veiby, of Haukeland University Hospital, Bergen, Norway, and colleagues write. "Risks associated with medical treatment during pregnancy must be weighed against the risk for fetal or maternal complications due to epileptic seizures."
Using data from the population-based Medical Birth Registry of Norway, the researchers examined pregnancy and birth outcome in an unselected population of women with both treated and untreated epilepsy. The study included all births recorded from December 1, 1998, through 2005. The team compared 2861 deliveries by women with epilepsy to 369,267 non-epilepsy deliveries.
Of the 2861 epileptic women, 1900 (66%) did not use antiepileptic drugs during pregnancy. Overall, 961 pregnancies in the epilepsy group were exposed to antiepileptic drugs, mostly as monotherapy. Antiepileptic drugs used included carbamazepine, lamotrigine, valproate, oxcarbazepine, clonazepam, topiramate, phenytoin, phenobarbital, levetiracetam, gabapentin, and vigabatrin.
Infants who were exposed to antiepileptic drugs were more often preterm (p = 0.01), and more often had birth weight <2500 g (p < 0.001), head circumference <2.5 percentile (p < 0.001), and low Apgar score (p = 0.03) compared to non-epilepsy controls, according to the report in the September issue of Epilepsia.
Epilepsy group children were more often transferred to a pediatric ward during the neonatal period. This was especially true in antiepileptic drug-exposed infants. Small-for-gestational-age infants occurred more frequently in infants who were exposed to antiepileptic drugs (p = 0.05) and unexposed infants (p = 0.02) than in controls.
There was no significant difference in the frequency of major congenital malformations between the epilepsy group and the control group (2.8% versus 2.5%, respectively). Significantly higher rates of major congenital malformations and any congenital malformations were found in infants exposed to either valproate or polytherapy.
"Cardiovascular malformations were significantly more common in antiepileptic drug-exposed infants versus controls, and especially for valproate exposure," Dr. Veiby and colleagues explain. "In the untreated epilepsy group there was a higher occurrence of genital malformations."
Neonatal spina bifida was not significantly increased in the epilepsy group compared to the control group. Down syndrome was significantly more common in untreated epilepsy pregnancies compared to controls. Both spina bifida and Down syndrome were major indications for elective pregnancy termination among epileptic women. A higher rate of cesarean section was observed in the epilepsy group, regardless of antiepileptic drug-exposure (p < 0.001).
"Adverse pregnancy and birth outcome in women with epilepsy is mainly confined to antiepileptic drug-exposed pregnancies," the authors conclude, "although some risks are associated also with untreated epilepsy."

Monday, September 21, 2009

Flying OK for Most Pregnant Women

Pregnant women can fly with no worries, as long as they don't have any complications.

That's the message of a revised committee opinion released Sept. 21 by the American College of Obstetricians and Gynecologists (ACOG). It will appear in the October issue of Obstetrics & Gynecology.

Since 2001, "a number of observational studies have been published confirming that air travel is generally safe during an uncomplicated pregnancy. These new studies have made our previous recommendations stronger and more detailed," said Dr. William H. Barth Jr., a physician at Massachusetts General Hospital in Boston and chair of the college's Committee on Obstetric Practice, in a news release from ACOG.

"Questions from our patients about air travel during pregnancy are some of the most common during obstetric visits," Barth added. "When a patient with an uncomplicated pregnancy asks about occasional flying, we should feel comfortable saying, 'It's safe.'"

But ACOG recommends that pregnant women take some precautions that all airline passengers should observe. To avoid blood clots, they should move their legs, avoid restrictive clothing, drink liquids and get up and walk around. The experts also say that pregnant women should keep their seatbelts buckled while in their seat and avoid gas-producing foods and drinks, including carbonated soda, which could cause them to feel uncomfortable.

According to ACOG, pregnant women who might require emergency care should not fly at all during their pregnancy. Airlines may also have specific requirements. Although most commercial airlines allow pregnant women to fly up to 36 weeks of gestation, restrictions may vary and pregnant women should check with their carrier before flying.


How your birth month affects your health

People who believe in astrology are convinced that constellations and other heavenly objects prominent in their birth month guide their fates.

Those systems are hardly scientific, but scientists continue to find evidence that the month, or season, that babies are born, or conceived, may have a significant effect on their lifetime health.

Links have been made for illnesses and conditions ranging from nearsightedness and multiple sclerosis to asthma and birth defects.

Yet even when the timing is clear, researchers say it's often difficult to say what's going on in a particular part of the year that influences health often many years later. Of course, there are always theories. For MS, the suspect is low levels of vitamin D in moms peaking around the month of May; nearsightedness seems more likely to affect babies born in spring and summer, and thus exposed to more sunlight at an early age.

One of the more recent connections was made by researchers at Vanderbilt University. They reported last year that children born in early fall - about four months before the height of cold and flu season - have a 30 percent greater risk of developing childhood asthma than those born at any other time of year.

Researchers analyzed birth and medical records for more than 95,000 Tennessee children.

The researchers suspect that fall babies are more susceptible both because they run into the worst of virus season early in their lives, but that some portion of them also has a genetic trait that makes inflammation of the smallest air passage of the lungs - and asthma - more likely.

Experts say 70 percent of babies get a viral infection in the first year of life. But it might be possible for parents in families where asthma is common to either try to time births toward spring, or take extra steps like vaccines or anti-viral medicines to protect babies born in the fall.

Another study, led by a neonatologist at the Indiana University School of Medicine and published in April, found that babies conceived from April through July have higher rates of birth defects.

Dr. Paul Winchester says those months also happen to match the time of year when the highest concentrations of pesticides are found in surface water around the country, according to data from the U.S. Geological Survey and the Environmental Protection Agency.

Winchester and colleagues studied records for more than 30 million births that occurred in the United States between 1996 and 2002. The researchers found the elevated risk for women conceiving in late spring and early summer even among those who did not have other well-established risk factors for birth defects - smoking, alcohol consumption, diabetes or advanced age.

"While our study didn't prove a cause-and-effect link, the fact that birth defects and pesticides in surface water peak during the same four months makes us suspect the two are related," Winchester said.

Even more tentative, but still intriguing, is a possible connection between rainy (and snowy) seasons and autism identified in a study by researchers at Cornell University. The found a connection between autism incidence and precipitation levels among young children in California, Oregon and Washington state born between 1987 and 1999.

Although they suspect, like the birth-defect researchers, that increased runoff or deposition of chemicals from precipitation might be responsible, the Cornell team acknowledged there's no direct evidence of such an environmental trigger.

And, they note, rainy days also tend to keep children indoors, where they could be exposed to more household chemicals, get less sunshine (and vitamin D) or spend more time in front of video screens - all potential suspects for bringing on the disorders in children who might already be genetically susceptible.


Friends That Every Mom Needs to Have

The mom in the same boat

Why you need her: She gets it.

Whether the two of you are stay-at-home moms, working moms, or single moms, try to get some one-on-one time without the kids -- and make it fun, says Amy Kovarick, coauthor of "Baby on Board: Becoming a Mother Without Losing Yourself" and a mom of four.

Yes, you're busy with work, the kids, errands, the house, and other craziness, but the more time away from Chuck E. Cheese, the better. Make a date: You both deserve it -- and probably for the exact same reasons!

The no-kids pal

Why you need her: For adult conversation -- and so you can act like you're still cool.

Another plus: "They're still into the latest restaurants, fashion, and gossip."

And perhaps best of all, "They're a respite from all the mom chatter."

How to keep her: Put aside all the mommy stuff for an hour or two. Take time to find out what's new with her, and be honest with yourself about her reaction to your kid talk. She may eat up your cute stories -- or she may not be so fascinated by the embarrassing thing your 4-year-old said.

The been-there, done-that mom

Why you need her: She gets you through your "I don't know what I'm supposed to do next" moments.

How to keep her: The good news is that she probably loves giving advice as much as you love getting it.

If you've asked for help, try to remember to call and tell her how well her ideas worked out. And even though you may not know yet what it's like to be in her shoes, you can still be a sounding board for her older-kid problems.

The I'll-do-anything-for-you buddy

Why you need her: She'll help you with your garage sale, drive the kids to soccer, and bring over lasagna when you're dealing with a crisis.

How to keep her: Friendships don't come with vows, like marriages do, says Marla Paul, author of "The Friendship Crisis." It helps to remind your friends that you care.

Return the favor. Maybe you don't have the time to drop everything, as she always seems to, but make an effort. When she's going through a tough time (or even having a tough week), instead of cooking the family a homemade meal, as she might, drop off a pizza or a gift certificate for her favorite Chinese takeout.

The slightly glam girlfriend

Why you need her: For inspiration (it is possible to be a fashionable mom), advice (how does she get out the door looking so great?), and a wardrobe you can borrow.

How to keep her: You admire your friend's got-it-togetherness, so tell her. She surely works hard at it and will appreciate the compliment. Watch out for your own jealousy or embarrassment, though.

Most of us feel that way sometimes, but if she's a real friend, she's not trying to make you feel bad about your relative lack of style or organization. She likes you for you -- though if you're still wearing mom jeans, maybe she can help you trade up.

The brutally honest pal

Why you need her: We all need to hear the truth sometimes. It can sting, true, even if you asked for your friend's opinion. But if she cares enough to tell you not just what you want to hear, then she's a keeper.

For many women, sisters play this role; for others, it's a longtime friend, or a particularly outspoken newer one. The trick is distinguishing between someone who's just bossy and someone who actually puts thought about you into her opinions. You'll know the difference (one clue: If she only ever criticizes your choices, she's not helping).

How to keep her: It may take a day or two for you to digest what she's told you, but once you have done so, call your friend and thank her for being honest -- even if you don't agree.


Exercise May Lower Risk of Having Heavy Babies

For women having their first child, regular exercise during pregnancy can lower the chances of having an overweight baby, researchers say.

Working out at least three times per week reduced the odds of delivering a newborn with excessive birth weight -- above 4,000 grams (8.8 pounds) -- by about a quarter, Katrine Mari Owe, MS, of the Norwegian School of Sport Sciences in Oslo, and colleagues reported in the October issue of Obstetrics & Gynecology.

The associations with exercise weren't as strong for women who have had children previously, who were more likely than first time moms to have an overweight baby.

Research has shown that regular exercise is an important part of a healthy pregnancy. But studies of the association between physical activity and mean birth weight have been inconsistent.

To clarify the issue, the researchers analyzed data from the Norwegian Mother and Child Cohort Study of 36,869 normal singleton pregnancies. They collected data on newborn birth weight from the Medical Birth Registry of Norway.

In their study, mean birth weight was 3,682 grams (8.1 pounds), and 11% of newborns were classified as being in the 90th percentile or more of birth weight, categorizing them as "excessive."

For veteran moms, the researchers found an inverse association between regular exercise -- at least three times per week -- and excessive newborn birth weight.

Risk fell by 28% for those who were exercising at week 17 of their pregnancy (95% CI 0.56 to 0.93) and by 23% for those who worked out at week 30 (95% CI 0.61 to 0.96).

The risk of having an overweight baby trended downward with exercise among veteran moms, but the difference did not reach significance, the researchers said.

There was a decreased risk for excessive birth weight among veteran moms who used dance as a form of exercise in week 17 of their pregnancy (OR 0.75, 95% CI 0.63 to 0.90).

The association was even stronger for week 30 (OR 0.69, 95% CI 0.53 to 0.88), and at that time point, low-impact aerobics was associated with decreased risk as well (OR 0.68, 95% CI 0.47 to 0.97).

On the other hand, veteran moms women were more likely to have heavy babies if they trained in fitness centers during week 17 of their pregnancy (OR 1.16, 95% CI 1.00 to 1.35) or if they swam during week 30 (OR 1.16, 95% CI 1.04 to 1.30).

For first time moms, walking decreased risk at weeks 17 and 30 (OR 0.86, 95% CI 0.75 to 0.99 and OR 0.84, 95% CI 0.73 to 0.96), as did running at week 17 (OR 0.63, 95% CI 0.45 to 0.89).

One possible explanation for exercise lowering risk of excessive birth weight among newborns is the effect of aerobic exercise on glucose tolerance, the researchers said.

Research has shown that moderate physical activity during pregnancy can lower glucose levels in both disease-free women and those who have gestational diabetes.

The study also found that exercising for three months prior to pregnancy didn't have any effect on the odds of having heavier babies for either first time moms or veteran moms, the researchers said.

The women who elected to participate had a slightly different age distribution, lower parity, were less likely to smoke and less likely to have a preterm birth.