Thursday, December 31, 2009

Prompt treatment beneficial for pregnant and postpartum women with H1N1

Delayed treatment of suspected influenza A (H1N1) illness among pregnant women may result in a four-fold risk of intensive care admission or death, according to results of a recent study.

Regardless of rapid antigen test results, prompt evaluation and antiviral treatment should be considered for pregnant or postpartum women displaying influenza A (H1N1)-like symptoms, according to researchers from the California Department of Public Health.

The study was a review of records for women of reproductive age who had been hospitalized or died from influenza A (H1N1) between April 23 and August 11, 2009.

The study involved 94 pregnant women, 137 non-pregnant women and 8 postpartum women who had delivered <2 weeks prior. False negative results for rapid antigen tests were observed in 38% of patients.

Among 94 pregnant women, 95% were in the second or third trimester. Risk factors for complications from influenza other than pregnancy were observed in 32 of 93 (34%) of those pregnant women.

Early antiviral treatment was defined as treatment <2 days after the onset of symptoms. Pregnant women treated later than this had an RR of 4.3 for admission to an ICU or death.

Intensive care was required for 18 pregnant women and four postpartum women (total, 22 of 102 [22%]). There were eight deaths (8%).

Of six deliveries which took place in the ICU, four were emergency cesarean deliveries.

The specific mortality ratio associated with influenza A (H1N1), which the researchers defined as the number of maternal deaths per 100,000, was 4.3.


Hormone testing may help doctors predict abnormal childbirth

Testing for low levels of a thyroid hormone shortly before childbirth may help physicians identify women who will require special care during delivery, new research indicates.

Specifically, a study published in the December 23 issue of Clinical Endocrinology, sought to examine whether thyroid hormone levels in the late stages of pregnancy are associated with the head position of a fetus shortly before childbirth, Health Day News reports.

The team of researchers examined the thyroid levels of 960 expectant Dutch mothers and found that those with higher levels of the hormone T4 about 9 months into pregnancy were more likely deliver a baby in the normal delivery position - head first with the fetus facing the mother's back at the start of labor.

Women with lower levels of the hormone more commonly needed assisted delivery because of an abnormal fetal head position, according to the news source.

"We believe that the relationship between thyroid hormone levels and fetal presentation at birth may be explained by recent findings that motor development in children is related to low maternal thyroid hormone concentration during pregnancy," Victor Pop, professor at the University of Tilburg in the Netherlands, told HealthDay News.

According to the Coalition for Improving Maternity Services, almost 32 percent of U.S. births in 2007 took place via cesarean section - a 50 percent increase since 1996.


Tuesday, December 29, 2009

Aspirin During Pregnancy May Help Preemies

The children of women who take low-dose aspirin during pregnancy because they are at high risk for delivering prematurely might have fewer behavioral problems at age 5, new research suggests.

Obstetricians sometimes give low-dose aspirin to pregnant women who are apt to have such complications as fetal growth restriction (when a fetus doesn't grow properly in the womb) or preeclampsia (high blood pressure that's dangerous to both mother and the fetus), said Dr. Ashley Roman, a clinical assistant professor of obstetrics and gynecology at NYU Langone Medical Center. Roman was not involved in the research.

In the study, French researchers used data on 656 children born before 33 weeks of gestation to 584 women from nine regions in France. A full-term birth is at 40 weeks' gestation. The women had a history of placental vascular disease, fetal growth restriction, chronic hypertension, and renal or autoimmune diseases.

About 21 percent of the women took low-dose aspirin during pregnancy.

At age 5, children whose mothers had taken aspirin were slightly less likely to have behavioral difficulties or hyperactivity, though the results were not statistically significant, according to the study.

In addition, the babies whose mothers had taken aspirin faced no increased risk for death, cerebral lesions or cerebral palsy.

One of the fears of giving aspirin to women during pregnancy is that aspirin interferes with platelet function, which is important for blood clotting. Because of that, it could raise the risk for brain bleeds in already susceptible premature infants, Roman said. The study found no increase in the risk for brain bleeds.

The study findings are published online Dec. 21 and in the January print issue of the journal Pediatrics.

Still, much remains unknown about the role of aspirin in pregnancy, including exactly how well or why aspirin works, Roman noted. One theory is that fetal growth restriction might be caused by tiny blood clots in the placenta, and aspirin helps blood flow between the placenta and the fetus. Low-dose aspirin is also taken by adult men and women at risk for heart attack and stroke.

Dr. Michael Katz, senior vice president for research and global programs at the March of Dimes, said the study is intriguing, but the findings are too preliminary to be of much help to women or their physicians. Many women in the study were also given other drugs, including corticosteroids, and it's unknown how much that affected the outcomes.

"Behavioral difficulties," as cited in the study, is a broad term that could encompass everything from excessive temper tantrums to learning disabilities to hyperactivity to autism, he said, each of which could have very different underlying causes.

Premature babies are at higher risk for neurological problems, including learning disabilities, cerebral palsy, and hearing and vision problems.


Birth defects in babies linked to mother's job

Women working as scientists and pharmacists run a greater risk of having babies with birth defects as compared to women in other professions, suggests a new study by the New York State Department of Health.

The study, published in the journal Occupational and Environmental Medicine, involved 8,977 cases of birth defects and 3,833 healthy controls from the National Birth Defects Prevention Study.

On analyzing mothers of around 9,000 children with birth defects, the researchers observed that certain abnormal birth conditions were more likely to be found in children of janitors, pharmacists or biological and chemical scientists.

"Given those job titles, one would expect those women to work with different chemicals or something that could possibly be an exposure," said lead author Michele Herdt-Losavio from the New York State Department of Health.

Depending on the profession of the mother, the baby could be born with any of the physical defects, which are not related to the DNA, found Dr. Herdt-Losavio and her colleagues after studying 45 specific birth defects among mothers with 24 different occupations.

Women working as janitors were found to be more likely to give birth to a child with one or more of the defects including ear and eye defects, musculoskeletal problems, gastrointestinal problems, oral clefts and various other defects.

However, not all women working as janitors face similar risks, as Dr. Herdt-Losavio said, "There's lots of questions that can be asked.... What do you do as a janitor? What products do you use? What hours do you work? How many hours do you work?"

The researchers, however, did not probe the probable reasons for this association between the birth defect of a child and his mother’s profession but they did offer a possible reasoning.

"What we can guess by looking at these job titles is that ... it's possible that they work with chemicals," said Dr. Herdt-Losavio. "It's not possible to say what those chemicals might be, or how much they might work with. But what we can do is point other [researchers] in the direction and give them some idea of where they might want to dig further and collect more data."


Embryo screening test is 'safe'

An embryo screening test called pre-implantation genetic diagnosis (PGD) is safe for the children of singleton pregnancies, Belgian researchers say.

They looked at 581 children born at one Belgian centre over 13 years who had been screened using the PGD technique.

They found that rates of birth defects and deaths were similar to those of children born using other IVF methods.

However, significantly more deaths just after or before the birth were seen in multiple pregnancies following PGD.

The findings come after concerns that the PGD screening technique, which involves removing some of the embryo's cells at an early stage, could lead to problems.

But the researchers, writing in the journal Human Reproduction, found no significant difference in birth defect rates when compared to 2,889 children born using IVF but who did not undergo the screening.

In total, 2.13% of PGD children had birth defects compared with 3.38% of the other children.

The perinatal death rate - the period immediately before and after birth - was also similar at just over 1% for singleton children in both groups.

However, for multiple pregnancies there was a difference. In the PGD group it was 11.73%, whereas among the others it was 2.54%.


U.S. military drops ban on soldiers getting pregnant

The U.S. military has dropped a controversial rule that called for punishing soldiers in northern Iraq for becoming pregnant or impregnating another soldier.

The updated policy "does not include a pregnancy provision," said Maj. Joe Scrocca, spokesman for U.S. Forces-Iraq.

The military also said that any unit must get the permission of the commander of U.S. Forces-Iraq before creating new rules restricting the activity of troops, Scrocca said.

Maj. Gen. Anthony Cucolo created the rule about pregnancy, covering 22,000 people under his command in northern Iraq, including 1,682 women.

Cucolo said he designed the rule to make his soldiers "think before they act."

It prohibited "becoming nondeployable for reasons within the control of the soldier," including "becoming pregnant or impregnating a soldier ... resulting in the redeployment of the pregnant soldier."

Cucolo made the rule part of General Order No. 1.

While violation of any rules in the general order could lead to court-martial, Cucolo insisted that he never intended such a drastic punishment for pregnancy.

All units have a general order that outlines a code of conduct. Commanders have been allowed to add to those rules but not allowed to make the rules any more lax.

But in an e-mail Friday to CNN, Scrocca wrote that from now on, "all requests by subordinate units to impose further restrictions of activities addressed in General Order No. 1 will require approval of the USF-I commander."

Cucolo had no immediate response. His division said he was spending Christmas Day visiting soldiers.

To date, he said, there have been eight cases of women getting pregnant while deployed under his command. Four were given letters of reprimand that were put in their local files, which means the letters wouldn't end up in their permanent files and they wouldn't be a factor under consideration for promotions.

The four others found out they were pregnant soon after deployment; no disciplinary action was taken since they were not impregnated while deployed.

In all cases, the women were sent back to the United States for medical care, as is military policy. Each has the right to submit a letter in her own defense to be included in her file.

Of the men involved, three were reprimanded, Cucolo said. One, a sergeant, was given a more severe punishment of a written reprimand in his permanent file because he fraternized with a subordinate and committed adultery. A letter in the permanent file can affect a person's career because it is evaluated when a service member is considered for promotion.

A fourth man was never reprimanded because the pregnant soldier refused to identify who the father was, and Cucolo did not pursue the issue.


Father's presence at birth seems to have little effect

A father's presence during childbirth seems to have neither a positive nor negative effect on the process, according to a study by a Germany medical society.

Achim Woeckel of the DGGG (German Association for Gynaecology and Birth Aid) said studies of childbirths showed that a partner's presence had little impact on the length of labor, the need for painkillers or the likelihood of medical intervention. At the same time, the father's presence had no correlation with the rate of complications.

But Woeckel says it might help for fathers to attend men-only courses - not couple's child preparation courses. Doing so can have positive effects for the couple's happiness, since fathers might pose questions in such sessions that they wouldn't when their partner is around.

Attending such a course also means fathers tend to have a more positive memory of the birth experience. Properly prepared men are more comfortable in their role. They know that, in the delivery room, their job is not to provide guidance or do work, but simply to be there and trust in the medical staff to do their job.

Additionally, men should exercise their right not to be in the delivery room, if they so choose, says Klaus Vetter of the DGGG.

'A woman in labor does not need an uncertain or nervous partner around,' he said.


New Rules for Baby Product Manufacturers After Several Product Recalls

A rash of recent baby product recalls may have prompted the Consumer Product Safety Commission to impose new regulations on manufacturers.

The CPSC recently held a unanimous vote for new rules that will require hefty regulations for baby product manufactures. The regulations will require all manufacturers to keep track of product owners. Manufactures will be required to provide consumers with a postage-paid registration form. Once the consumer fills out and returns the form, the manufacturer must keep their information on file.

The CPSC hopes this will help consumers find out about recalls faster. Recalls that may be life threatening to their infant or toddler.

Three major recalls were in issued in 2009 after serious injuries occurred in infants and toddlers. The CPSC issued a recall for nearly 500,000 infant car seats after a defective handle was found to put children at serious risk for injury during car accidents. Another recall involving cribs was issued after the defective product caused injuries and bruising to infants and toddlers. The third recall was issued after several children suffered finger amputations. In that recall over two millions strollers were affected.

Hopefully the new regulations imposed by the CPSC will help parents keep their children safe from dangerous and defective products.