Friday, December 04, 2009

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Participation Needed in Study on Decisions Made during Pregnancy

The National Institute of Health is conducting a study aimed at enhancing decisions about prenatal testing for pregnant women who are uncertain whether they want to undergo amniocentesis or CVS. The purpose of this study is to learn more about how women make decisions whether to have prenatal testing and how to best help them when they are uncertain. The study is done on-line and useful information is provided. The aim is NOT to promote testing, rather they hope to help women make good informed choices. You can take part if you are a pregnant woman eighteen years of age or older considering prenatal testing (amniocentesis or CVS), have not had amniocentesis or CVS and are uncertain whether to have testing.

To participate in the study, click here.

FDA Updates Warning for Pregnant Women on Antiepileptic Drugs

The FDA has issued a statement reminding patients and doctors that valproate sodium, valproic acid, and divalproex products increase the risk of birth defects in babies exposed to the chemicals during pregnancy.

The medications - used to treat epilepsy since 1978 and more recently for bipolar disorder and migraine - can cause neural tube defects, craniofacial defects, and cardiovascular malformations in unborn children during the first trimester. This is often before many women know they are pregnant, the FDA said in a statement.

Use of the products increases neural tube defects during the first 12 weeks of pregnancy from one in 1,500 to one in 20, on average, the FDA noted.

Babies born to women taking valproate for epilepsy are more than three times as likely to have birth defects as those born to women on a different therapy (10.7%, 95% CI 6.3% to 16.9% versus 2.9%, 95% CI 2.0% to 4.1%), according to data from the North American Antiepileptic Drug Pregnancy Registry.

The FDA cautioned women of childbearing potential to take valproate only if it is essential for managing a medical condition. Those taking the drug who are not planning pregnancy should use contraception, the agency said.

Women planning to become pregnant can reduce the risk of congenital neural tube defects by taking folic acid before and during the first trimester of pregnancy, the FDA noted.

The agency also noted a danger to pregnant mothers and their child if epilepsy or bipolar disorder is left untreated while the baby is developing. Likewise, it reminded doctors and patients of a major risk associated with ceasing valproate therapy suddenly.

The FDA recommended that women talk with healthcare professionals before stopping use of valproate products if they become pregnant.

It also recommended women who become pregnant while taking valproate or other antiepileptic drugs enroll in the North American Antiepileptic Drug Pregnancy Registry to help gather more information on the safety of the medications during pregnancy.


Thursday, December 03, 2009

Breastfeeding Could Offer Protection Against Metabolic Disorder

Breastfeeding may offer mothers long term protection against a condition linked to diabetes and heart disease, researchers report today.

The longer women breastfed, the lower their chance of developing metabolic syndrome, a cluster of risk factors such as high blood pressure and high triglycerides associated with obesity, the scientists found.

"Pregnancy may have some adverse effects on some of these cardiovascular risk factors," lead author Erica Gunderson says, "and lactation (breastfeeding) may offset some of these effects."

The impact of breast-feeding on the risk of metabolic syndrome was "slightly stronger" in women who'd had gestational — or pregnancy-induced — diabetes, says Gunderson, an epidemiologist and research scientist at Kaiser Permanente's Division of Research in Oakland. "This is the first study to really look at lactation and the metabolic syndrome in women with GDM (gestational diabetes)."

About 18%-37% of U.S. women ages 20 to 59 have metabolic syndrome, Gunderson says. A study she published in August found women with gestational diabetes are 2½ times more likely than other women to develop the condition after pregnancy.

Gunderson and her co-authors based their new findings on 704 women in an ongoing, government-funded study of heart-disease risk factors. When the women entered the study in 1985-1986, they were ages 18-30 and had never given birth; testing confirmed they didn't have metabolic syndrome.

They all went on to deliver at least one child; only 16% had more than two children. They returned for measurements of metabolic syndrome components seven, 10, 15 and 20 years after entering the study; 120 developed metabolic syndrome.

In women who didn't have gestational diabetes, breast-feeding cut metabolic syndrome risk 39%-56%. In those who did, it cut the risk 44%-86%. In both, the authors write in Diabetes: The Journal of the American Diabetes Association, the longer women breast-fed, the lower their risk.

Breast-feeding is associated with a quicker loss of pregnancy weight, but that's only "a little bit of the explanation," Gunderson says. Another possibility, she says: Breast-feeding might minimize the accumulation of belly fat, fat linked to type 2 diabetes risk.


Glucose Intolerance in Pregnancy Associated With Postpartum Cardiovascular Risk

Women who have gestational glucose intolerance (a condition less severe than gestational diabetes) exhibit multiple cardiovascular risk factors as early as three months after birth, according to a new study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).

Researchers in this study sought to evaluate the relationship between gestational glucose intolerance and postpartum risk of metabolic syndrome (defined as the clustering of several cardiometabolic risk factors including obesity, hypertension and low HDL cholesterol). Metabolic syndrome, like gestational diabetes itself, is associated with increased risk of developing type 2 diabetes and cardiovascular disease.

Researchers followed 487 women who underwent oral glucose tolerance testing during pregnancy. Each subject was classified as either having normal glucose tolerance, gestational glucose intolerance or gestational diabetes. At three months postpartum, researchers evaluated each subject's cardiometabolic characteristics, such as blood pressure, weight, waist measurement and lipid levels.

Findings support that even mild glucose intolerance during pregnancy predicts an increased likelihood of the metabolic syndrome at 3 months postpartum. The presence of cardiovascular risk factors as early as three months postpartum indicates that these risk factors may be longstanding and contribute to the long-term risk of cardiovascular disease in this patient population.


Wednesday, December 02, 2009

Sugary Soda Tied to Gestational Diabetes

Women who drink five or more servings of sugar-sweetened cola per week before they conceive increase their risk of developing diabetes during pregnancy, a new study indicates.

"Previous studies have shown an association with other chronic metabolic problems," said study author Dr. Liwei Chen, an assistant professor of epidemiology at Louisiana State University Health Sciences Center, in New Orleans. "This is the first to show an increased risk among pregnant women."

Gestational diabetes, known as glucose intolerance during pregnancy, is one of the most common complications of pregnancy. It increases the chances of lifelong diabetes for the woman and also can have permanent effects on the unborn child, Chen said. The report appears in the December issue of Diabetes Care.

"Other studies suggest that babies born to women who are diabetic during pregnancy have higher weight at birth and also higher rates of obesity and diabetes early in life," she added.

Chen, working with researchers at the Harvard School of Public Health and the U.S. National Institute of Child Health and Human Development, studied 10 years of medical records on a group of 13,475 women from the Nurses' Health Study II. After adjusting for known risk factors for gestational diabetes, such as age, family history and smoking, the researchers found that women who had more than five servings per week of sugar-sweetened cola beverages had a 22 percent higher risk of gestational diabetes than women who had less than one serving per month.

No such association was found for consumption of other sugar-sweetened beverages or artificially sweetened drinks.

It's not clear why only cola drinks are associated with the increased risk, Chen said. One explanation could be "the tremendous popularity of cola in the United States," she said.

According to the journal report, there are several potential explanations for the association. For example, sugar-rich foods or beverages can overload the body with glucose, which can impair the function of the beta cells of the pancreas, which make insulin that metabolizes glucose.

Sugar-sweetened beverages are the leading source of added sugar in the American diet, Chen said. The U.S. National Health and Nutrition Examination Survey found that soft drink intake more than doubled between 1977 and 2001 among 19- to 39-year-old Americans, going from 4.1 percent to 9.8 percent, and that those in this age group had the highest rate of soft drink consumption.


Insect Repellent Linked to Genital Defects

European researchers have found an association between expectant moms who used the repellent in the earliest phase of pregnancy and an increased rate of a condition known as hypospadias, which occurs when the opening of the penis - the urethra - is on the underside of the penis, instead of the top.

The condition, which often requires corrective surgery, affects 1-2 boys in every 500 births.

"This particular defect of the male urethra is quite common, and has been linked to environmental sources as well as genetic problems," Chris Winder, a University of New South Wales Professor of Toxicology and Occupational Health in Australia said.

"Here is more evidence that pregnant mothers, or mothers planning pregnancy, should limit their exposure to chemicals such as insect repellents," he added.


Chemicals During Pregnancy and How to Avoid Them

You'll want to take action after reading the Environmental Working Group's latest cord blood report, released today. The results are devastating but not surprising.

The EWG tested the cord blood of 10 minority newborns. (Cord blood is the blood remaining in the placenta and umbilical cord after birth. EWG would have liked to do more, but it's about $10,000 per baby and their pockets aren't that deep.) They tested for some of the same offenders they tested for in 2005. And they tested for some new ones, including:

Bisphenol A, a.k.a. BPA, a ubiquitous ingredient in plastics and coatings that's been linked to a range of health problems, including cancer. (The Food and Drug Administration, which has to date sanctioned the use of BPA as safe, was to release a new safety report on the chemical this week, but delayed its decision. BPA was found in 9 out of 10 samples.)

Perchlorate, a rocket fuel component and, according to the EWG, a potent thyroid toxin that can disrupt production of hormones essential for normal brain development.

Tetrabromobisphenol A (TBBPA), a toxic flame retardant chemical that permeates computer circuit boards, synthetic fragrances (Galaxolide and Tonalide), and common cosmetics and detergents, was also detected for the first time.

Perfluorobutanoic acid (PFBA, or C4), a member of the Teflon chemical family used to make non-stick and grease-, stain- and water-resistant coatings for cookware, textiles, food packaging and other consumer products, was also detected. 232 different chemicals, all told, were detected in the cord blood from these 10 babies.

Dr. Anila Jacob, EWG's senior scientist and co-author of the report, responded to conclusions that the only thing parents can really do is get political.

"That's accurate," she said. "There is no way to shop yourself out of this 100%. That's why we need good strong federal legislation. But there are some individual actions they can take to decrease the exposure. When Mom is pregnant she can decrease the use of canned foods, she can not microwave in plastic. Once she has her baby she can use a BPA-free baby bottle." I prefer glass. "Breastfeeding is best but if you're using formula, we recommend powder versus liquid canned infant formula. She should check with her pediatrician."

The way the current legislation is written, Jacob says, is backwards. "Chemicals are put in the marketplace without definitive safety testing. They have to be proven to be unsafe once they're on the market. During that period of time millions of people are exposed."

For the cord blood report, the babies were tested for over 300 chemicals. Most other studies only look at one or two chemicals. "We're concerned about what the mixtures are doing. I'm a physician. When I was training, we were taught about drug interactions, we have to consider those interactions. What about chemicals?" says Jacob. "Our study is showing each of these babies is exposed to at least 100 if not 200 chemicals each. We're very concerned about the individual effects but also the mixtures. Are there synergistic or cumulative effects? Our study brings these to mind. Mixture toxicity - how do these things effect us long term when all mixed up? We don't know."

The cord blood donations came from five different states. This is not a regional issue. This is the EWG's 11th biomonitoring project. They asked for minority cord blood because "in a sense our mission here is to map the degree of chemical contamination within the U.S. population," Jacob said.

"This is one segment that hasn't been tested very much for chemical exposure -- babies of racial or ethnic minority groups. We didn't look for chemicals based on mom's choices like smoking or alcohol, these are unintentional exposures with regard to consumer and home product chemicals."


Preterm Births Higher Among Poor Mothers, Despite Equal Care

Despite improvements in obstetric care services, women from deprived areas are still more likely to give birth to a very preterm baby compared with mothers from more affluent areas, finds a study published on the British Medical Journal website.

Yet survival rates and provision of care was similar for infants from all areas, suggesting that neonatal care provision is equitable. A finding in contrast to many other areas of health care where socioeconomic inequalities in survival and access to care are common.

These findings highlight an urgent need to better understand the link between deprivation and risk of preterm birth, say the authors.

Researchers at the University of Leicester tracked 7,449 very preterm infants born 1998-2007 in the former Trent region of England from the onset of labor until discharge from neonatal care. A deprivation score was calculated for each infant using postcode data.

The authors point out that the data came only from one English region, which has about 54,000 births a year, representing one in 12 UK births, so the findings can't necessarily be extrapolated to different places. However, Trent does have a particularly good prospective dataset about births.

Their results show that mothers from the most deprived areas were nearly twice as likely to have a very preterm infant compared to those from the least deprived areas and consequently there were nearly twice as many deaths due to very preterm birth in the most deprived areas.

However, among very preterm infants, survival rates and neonatal care provision showed little variation across all deprivation measures. This suggests that, although socioeconomic inequalities in preterm birth rates persist, deprivation does not seem to be a barrier to accessing and receiving neonatal care.

This study did not look at individual factors such as smoking, ethnicity, and history of previous preterm birth. They believe that future studies should focus on the interplay between very preterm birth and the wider determinants of socioeconomic inequalities in health.


MRI Can Rule Out Risky Placental Disorder

MRI may be effective at ruling out placenta accreta, a potentially life-threatening complication of pregnancy, researchers say.

The test correctly identified 88% of positive cases and 96% of negative cases in about 70 high-risk women, Michele A. Browne, MD, of the University of California San Diego, reported at the Radiological Society of North America meeting.

"MRI is a useful and accurate adjunct to ultrasound for diagnosis of placenta accreta," Brown said. "Women at high risk for placenta accreta, such as those who've had multiple cesarean sections, should undergo ultrasound. And if ultrasound is inconclusive, MRI should be considered."

Placenta accreta is an abnormal attachment of the placenta with invasion into the wall of the uterus. Brown said it usually requires a hysterectomy, and maternal death occurs in 7% of cases.

The incidence of the condition has increased at least 10 times over the last six decades, from about one in 30,000 births in 1950 to one in 2,500, or as frequently as one in 533 births now, according to different estimates.

Browne said this is likely the result of more frequent cesarean sections, because scar tissue in the uterus interferes with a specific layer of the endometrium that involves placental attachment.

Other risk factors involve any kind of uterine surgery, including abortion, as well as maternal age over 35, both of which have increased substantially over the last 60 years.

To measure the efficacy of MRI for detection of placental accreta, the researchers looked at 108 patients who'd had an MRI at their imaging center between 1992 and 2009 and who were suspected to have the condition.

Outcome results were available for 71 of those women.

Overall, Browne said, the accuracy of MRI was 90.1%.

"Early, accurate diagnosis is very important for this condition because it allows for delivery planning, which improves outcome," Browne said.

That includes a scheduled delivery at 36 to 37 weeks and arrangements for sufficient blood products to be on hand because of high blood loss associated with the condition.

Browne noted that after birth, a cesarean-hysterectomy is usually performed because trying to separate the placenta carries a high risk of complications.


Monday, November 30, 2009

Plastics Chemical Phthalate May Lead to Preterm Birth

Pregnant women who are exposed to higher levels of an increasingly controversial chemical in certain plastics may deliver their babies slightly earlier than women with less exposure, results of a study suggest.

The chemical, DEHP - short for di(2-ethylhexyl)phthalate - is a "plasticizer" used widely in consumer products to help make vinyl plastic soft and flexible.

"Exposures (to DEHP) are ubiquitous," Dr. Robin M. Whyatt from Columbia Center for Children's Environmental Health in New York City told Reuters Health. DEHP breakdown products "have been detected in 95% of the general U.S. population."

In recent preliminary studies, DEHP exposure has been linked to some health risks. In animal studies, for example, exposure to this and other so-called phthalates has been linked to lower-weight babies and shorter pregnancies.

In preliminary human studies, prenatal DEHP exposure has been shown to affect the timing of labor; however, the findings have been mixed.

They gauged DEHP exposure by measuring four DEHP breakdown products in urine samples collected from the 311 African American or Dominican women aged 18 to 35. All of the women were living in New York City and were in their third trimesters.

The team found that the higher the level of DEHP breakdown products in the mothers' urine during pregnancy, the earlier the infant was born, Whyatt told Reuters Health. Babies with the highest level of exposure were born about five days earlier than those exposed to the lowest levels.

It's important to note, the researchers say, that the women in the study delivered their babies at or near term. However, if prenatal DEHP exposure were to lead to more infants being delivered prematurely, on average, this could be cause for concern.

Steve Risotto, Senior Director, Phthalate Esters, at the American Chemistry Council industry group, noted that two earlier studies contradicted the current one, showing opposite effects. "There was also no association found between phthalate exposure and prematurity, as all of the births were full term," he told Reuters Health.


Alyson Hannigan's Homebirth Story Available for Viewing

The first two installments of Alyson Hannigan's birth story are now available for viewing. Hear how she and her husband decided on a homebirth and listen to Alyson describe her first signs of labor.

Watch the short videos on My Best Birth.

Many Pregnant Women Take Drugs Harmful to Baby

With the help of their doctors, women planning to become pregnant should take an inventory of the medications they take, researchers from Canada advise.

In a study, they found that many pregnant women still take medications long known to cause birth defects.

Some medications with known fetal risk, such as drugs that control epilepsy, are essential during pregnancy, Dr. Anick Berard, at the University of Montreal in Quebec, noted in an email correspondence to Reuters Health.

Other medications, such as those that treat severe acne, anxiety and psychiatric drugs, antibiotics, and many drugs prescribed for heart disease and medical conditions, "can and should be avoided," according to Berard.

Women should understand the side effects of any drug they are taking -- especially drugs treating a chronic condition -- and plan pregnancies to avoid or minimize risks such drugs pose to babies, Berard added.

For the 5 years between January 1998 and the last day of 2002, Berard and colleagues analyzed the prescriptions filled by pregnant women for drugs available at the time and known to pose fetal risks.

Their report, in BJOG: An International Journal of Obstetrics and Gynecology, shows 56 percent of 109,344 pregnant women filled at least one medication prescription. A total of 6.3 percent (6,871 women) did so for at least one medication known to pose a risk to the fetus.

"These pregnancies were associated with an elevated number of (pregnancy terminations) and babies born with major (birth defects) in comparison with the expected numbers in the population," they note.

Specifically, terminations occurred in 47 percent of the pregnancies exposed to drugs with known fetal risks. Six percent of these pregnancies ended in miscarriage.

By contrast, in the much larger non-exposed group about 36 percent of the pregnancies had been terminated and fewer than 5 percent ended in miscarriage.

Berard's team further identified birth defects in 8.2 percent of 2,842 infants exposed to risky drugs during gestation and available for assessment, compared with 7.1 percent of the 59,287 infants not exposed. This is "a statistically significant difference," they note.

They emphasize, however, that it cannot be concluded that the drug exposure caused the birth defects. These pregnancies may have also been exposed to other harmful agents or maternal health conditions, they point out.