Friday, February 19, 2010

Airbags Don't Pose Risk For Pregnant Women

Some doctors are heralding a new study that suggests airbags pose no greater risk for pregnant women.

There's long been uncertainty among expectant mothers about the potential dangers of an airbag deploying during a crash, prompting some to even turn off the feature in their vehicles, 6News' Jennifer Carmack reported.

Researchers at the University of Washington studied more than 3,300 non-rollover crashes involving pregnant women sitting in the front seat when the airbag was deployed.

"It actually showed that no there was no increased risk in maternal or perinatal outcome in women that were involved in a car crash where an airbag was deployed," said Dr. Mary Abernathy, a maternal fetal specialist for Clarian Health in Indianapolis.

According to the data, pregnant occupants in vehicles with an airbag were not at increased risk of pregnancy complications such as Cesarean delivery, fetal distress and a low birth weight baby, compared with occupants in vehicles without an airbag.

Carisa Burrows, who is five weeks away from her due date, said she worries constantly when she gets behind the wheel.

"I actually drive slower because I'm afraid. I'm almost not able to fit under the wheel," she said. "I've been hit by (an airbag) before, and they're not fun."

Karrie Theoharis, who is expecting her first child in March, said the study eases her mind a bit, but she's still uneasy.

"It makes me a little bit nervous that I'm at the correct distance from the airbag," she said. "I would still rather have airbags than not."

Abernathy said it's also important for pregnant women to wear their seat belts correctly, across the pelvic bones and below the abdomen.

"The safest place for the unborn child in a car wreck is to be in a mother that is properly wearing her seat belt and has her airbags on," she said.


Diabetes helps explain obesity-birth defect link

While some research has suggested that obese women have an increased risk of having a baby with a birth defect, a new study shows that diabetes may at least partly account for the link.

Studies on whether obesity raises the odds of birth anomalies such as spina bifida, cleft palate and heart defects have so far come to conflicting conclusions. One question is whether obesity, per se, is the problem -- or whether certain factors associated with obesity are at work.

Type 2 diabetes, which is closely related to obesity, has been linked to a heightened risk of birth defects in a number of studies.

The new study, of nearly 42,000 women who gave birth between 1991 and 2004, found no association between mothers' obesity and the risk of any major birth defect. However, there was a link seen with diabetes.

Women who'd had diabetes before becoming pregnant showed a nearly four-fold higher risk of having a baby with a birth defect than women without the disorder.

The findings, published in the journal Obstetrics & Gynecology, do not mean that women with diabetes generally have a high risk of having a baby with a birth defect.

The vast majority of babies in the study were born with no congenital defects; across the study period, the rate of any major anomaly was less than 1 percent among all women.

What's more, past research has shown that well-controlled diabetes carries a lesser risk.

For their study, Biggio and his colleagues analyzed data on 41,902 women who gave birth at their center between 1991 and 2004; the women were largely from the inner-city and the majority were African American. When the researchers separated the data into three five-year periods, they found that maternal obesity, diabetes and birth defects all increased over time.

Between 1991 and 1994, about 0.4 percent of babies were born with a major congenital anomaly, such as a defect of the heart, spine, brain, lungs or digestive system. That rate was just over 0.8 percent between 2000 and 2004.

At the same time, the prevalence of obesity increased from 29 percent to 41 percent, while pre-pregnancy diabetes rose from just over 1 percent of all women to just over 3 percent.

Of women with obesity and diabetes in the 2000-2004 period, diabetes appeared to account for about three-quarters of the birth defect risk.

There are several theories on why diabetes is related to birth defects, Biggio said. Excess blood sugar, he explained, is delivered to the embryo early in pregnancy, and that may end up spurring an overproduction of cell-damaging substances called free radicals. The extra sugar may also result in metabolic byproducts that interfere with signaling mechanisms critical to embryonic development, Biggio noted.


Thursday, February 18, 2010

Vaginal birth can be OK after multiple C-sections

Women who attempt vaginal childbirth after having several babies by cesarean section may not have a greater risk of complications than women who've had only one prior C-section, a new study suggests.

Still, the American College of Obstetrics and Gynecology (ACOG) does not currently recommend vaginal delivery for women who have had three or more C-sections, as their risk of uterine rupture has generally been thought to be higher.

In the new study, however, researchers found that women with at least three prior C-sections showed no increased risk of uterine rupture during vaginal delivery.

In fact, none of the 89 women who opted to try vaginal childbirth had the complication, according to findings published in the British obstetrics journal BJOG.

Based on past research, the expected rate of uterine rupture among women with one prior C-section would be less than 1 percent; a large 2004 study of U.S. women, for example, found a rate of 0.7 percent.

These latest findings suggest it would be "reasonable to reconsider" the current ACOG recommendations for women with three or more prior C-sections, according to lead researcher Dr. Alison G. Cahill of Washington University School of Medicine in St. Louis.

For their study, Cahill and her colleagues reviewed the records of 25,000 women at 17 U.S. hospitals who gave birth after having at least one prior C-section. The group included 860 women with at least three prior C-sections, 89 of whom attempted a vaginal delivery; the remaining 771 elected to have a repeat C-section.

There were no cases of uterine rupture in either group, the researchers found.

The 89 women who chose to try labor also had no instances of bladder or bowel injury, or lacerations of the uterine artery -- the other main complications the researchers assessed. That compared with just over 2 percent of the women who had a repeat C-section -- though that difference, the researchers say, is not significant in statistical terms.

When it came to successful delivery -- meaning the doctor did not have to switch to a C-section during labor -- the chances were similar regardless of the number of prior C-sections.

Just over 13,600 women with one or two prior C-sections elected to try vaginal delivery, with a success rate of about 75 percent. That rate was 80 percent among women with a history of three or more C-sections.

Cahill pointed out that all of the women in the study had had C-sections done with what is called a low transverse incision -- a horizontal cut across the lowest part of the uterus. These types of incisions have a lower risk of rupture compared with the "classical" high vertical incision, an up-and-down incision made higher on the uterus.

Another factor to consider in the decision to try vaginal delivery after cesarean, according to Cahill, is whether a woman has ever had a previous vaginal birth. Previous vaginal deliveries increase the chances of success with a post-cesarean attempt at vaginal birth.


Prenatal testing curbs some genetic diseases

Some of mankind's most devastating inherited diseases appear to be declining, and a few have nearly disappeared, because more people are using genetic testing to decide whether to have children.

Births of babies with cystic fibrosis, Tay-Sachs and other less familiar disorders seem to have dropped since testing came into wider use, The Associated Press found from interviews with numerous geneticists and other experts and a review of the limited research available.

Now, more women are being tested as part of routine prenatal care, and many end pregnancies when diseases are found. One study in California found that prenatal screening reduced by half the number of babies born with the severest form of cystic fibrosis because many parents chose abortion.

More couples with no family history of inherited diseases are getting tested before starting families to see if they carry mutations that put a baby at risk. And a growing number are screening embryos and using only those without problem genes.

The cost of testing is falling, and the number of companies offering it is rising. A 2008 federal law banning gene-based discrimination by insurers and employers has eased fears.

Genetic testing pushes hot-button issues: abortion, embryo destruction and worries about eugenics - selective breeding to rid a population of unwanted traits.

Some diseases - sickle cell, cystic fibrosis, Tay-Sachs, thalassemia, spinal muscle atrophy - occur when people inherit two bad genes, one from each parent. The genes can pass quietly for generations until two carriers mate; then children have a one-in-four chance of getting the disease.

Comparisons to couples not given prenatal screening suggested that screening had cut births of babies with severe disease in half, researchers reported at a genetics conference in 2008. Studies in Canada, Italy, Australia and in Europe also found that cases dropped after screening began.

Gene testing hasn't led to declines in all diseases. Sickle cell, a blood disorder that causes anemia and pain and raises the risk of stroke, has not dropped. It mostly afflicts blacks; gene carriers are said to have sickle cell "trait," which sounds harmless.

"Now we're actually learning that it's not as benign as we thought it was," and that carriers have higher risks for certain medical problems, said Dr. Lanetta Jordan, a Florida physician and chief medical officer of the Sickle Cell Disease Association of America.

Newborn screening is finding more sickle cell carriers and cases, but this doesn't seem to affect parents' future family plans, Jordan said.

The number of fertility treatments that include embryo screening has been on the rise in recent years, with nearly 5,200 screenings in 2006, according to the Society for Assisted Reproductive Technology. Carrier testing also is rising. A California company, Counsyl, sells a $349 saliva test for genes for more than 100 inherited disorders. Several thousand people used it over the last year, the company reports.

Eliminating disease is a noble goal but also "should give us pause," Lerner, the Columbia historian, wrote recently in the New England Journal of Medicine.

"If a society is so willing to screen aggressively to find these genes and then to potentially to have to abort the fetuses, what does that say about the value of the lives of those people living with the diseases?" he asked.


Sterilization surgery not linked to sexual problems

Women who have their "tubes tied" to prevent future pregnancies do not seem to have an increased risk of sexual dysfunction afterward, according to a new study.

In fact, researchers found, women in their study who'd had the procedure showed lower risks of certain sexual problems and tended to be happier with their sex lives than other women.

The surgery, known as tubal ligation, involves blocking the fallopian tubes that connect the ovaries with the uterus. It is done either right after childbirth -- through the vagina or during a cesarean section -- or via laparoscopic surgery, where one or two small incisions are made in the abdomen.

There are no physiological reasons to believe tubal ligation would cause sexual problems, but there has been little research on the subject, said Dr. Anthony Smith of La Trobe University in Melbourne, Australia, the lead researcher on the current study.

What studies there are have generally only asked women about their general sexual satisfaction, Smith told Reuters Health in an email.

For their study, Smith and his colleagues surveyed 2,721 Australian women about various sexual dysfunction symptoms and their overall satisfaction with their sex lives. Of those women, 447 -- or about 16 percent -- had had a tubal ligation, most of whom were between the ages of 40 and 64.

Overall, women who had had the procedure were less likely to report sexual problems and more likely to say they were happy with their sex lives, according to findings published in BJOG, a British medical journal.

Just over 42 percent said they lacked interest in sex, for example, compared with 51 percent of women who had not had a tubal ligation. And while 17 percent of the latter group said they "did not find sex pleasurable," only 14 percent of women in the tubal-ligation group said the same.

When the researchers accounted for other factors -- like age, education and marital status -- women who'd had a tubal ligation were roughly one-third less likely to lack interest in sex, take "too long" to reach orgasm, have vaginal dryness during sex or find sex unpleasant.

In addition, the study found, women in the tubal-ligation group generally gave higher marks to their sex lives. Thirty-six percent reported "extremely high sexual satisfaction," compared with 30 percent of women who had not had the procedure; when the researchers considered the other factors, women in the tubal-ligation group were two-thirds more likely to give such high ratings to their sex lives.

It's possible, Smith's team notes, that the women and their partners were enjoying sex more because they were free of anxiety over a potential unplanned pregnancy.

Of course, tubal ligation is only one method of birth control. In general, experts recommend it only for women who are sure they do not want to become pregnant in the future. And like any surgery, it carries some risks -- including bleeding or infection during the procedure, and incomplete closing of the tubes; about one in 200 women who have a tubal ligation later become pregnant.

Studies have also found that anywhere from 6 percent to 20 percent of women who have the procedure later regret their decision -- with younger women being more likely to express regrets.


Very premature twins do just as well as singletons

Overall, very premature twins fare just as well as single babies born very early, and they may even face a lower risk of certain complications, new research shows.

But for twin pairs of the same sex but sharply different sizes who are born before 28 weeks, the risks of death and bleeding on the brain are higher than they are for single babies born at the same time, Dr. Jennifer Zeitlin of the Hopital Saint-Vincent de Paul in Paris and her colleagues found.

Premature birth is much more common among twins than singletons, Zeitlin and her team note; while one in every 10 twin pairs is born before 32 weeks' gestation, just one in 100 singletons is born this early. There is evidence that preemie twins do better than singles of the same gestational age, they add.

A full-term pregnancy lasts for 39 weeks, while babies born between 28 and 31 weeks are considered "very preterm." Babies born between 24 and 27 weeks' gestation are "extremely preterm."

To investigate outcomes for very premature and extremely premature twins compared to those of singletons born equally early, Zeitlin and her colleagues looked at births and stillbirths in nine European countries in 2003. Their analysis included 1,254 twins and 3,586 singletons born between 24 and 31 weeks' gestation.

The women carrying twins were less likely to develop high blood pressure during pregnancy than those with singletons, the researchers found: about 8 percent of those carrying twins, compared to about 22 percent of those carrying single babies.

They also found that severe bleeding and restrictions on the growth of the fetus were also less common in twin pregnancies.

Twins' mothers were also more likely to have been given corticosteroids before delivery; these drugs are administered to speed up premature newborns' lung development.

Among the very premature babies, the likelihood of dying in the first few weeks of life was lower for twins, who were also less likely to need oxygen. But once the researchers took factors such as mother's age, pregnancy complications, and infant health problems into account, the difference disappeared.

For the extremely premature infants, however, the researchers calculated that the risk of death or serious bleeding in the brain was about 1.5 times higher for twins than it was for single babies. While about 17 percent of singletons suffered from such bleeding, roughly 24 percent of twins did.

The greater risks were only seen for same-sex twins in which one twin weighed at least 15 percent more than the other twin at birth.

"Why the effects of these twin-specific complications were so much more pronounced for extremely preterm births is an area for further study," the researchers conclude.


Wednesday, February 17, 2010

Two languages in womb makes bilingual babies: study

Babies who hear two languages regularly when they are in their mother's womb are more open to being bilingual, a study published this week in Psychological Science shows.

Psychological scientists from the University of British Columbia and a researcher from the Organization for Economic Cooperation and Development in France tested two groups of newborns, one of which only heard English in the womb and the others who heard English and Tagalog, which is spoken in the Philippines.

To determine the babies' preference for a language, the researchers studied the newborns sucking reflex; increased sucking by a neonate indicates interest in a stimulus.

In the first experiment, infants heard 10 minutes of speech, with every minute alternating between English and Tagalog.

The English-only infants were more interested in English than Tagalog -- in other words, they "exhibited increased sucking behavior" when they heard English than when they heard Tagalog being spoken.

The infants exposed to two languages, on the other hand, showed an equal preference for both English and Tagalog, suggesting to the researchers that prenatal bilingual exposure prepares infants to listen to and learn about both of their native languages.

The researchers also tested the newborns to see if they could tell the differences between two languages -- key to becoming bilingual.

The infants listened to sentences being spoken in one of the languages until they lost interest, and then heard sentences in the other language or heard sentences in the same language, but spoken by a different person.

The infants exhibited increased sucking when they heard the other language being spoken, but their sucking did not increase if they heard additional sentences in the same language.

"These results suggest that bilingual infants, along with monolingual infants, are able to discriminate between the two languages, providing a mechanism from the first moments of life that helps ensure bilingual infants do not confuse their two languages," the authors of the study said.


Tuesday, February 16, 2010

Canadian Curler Kristie Moore is 3rd Pregnant Olympian in History

As with all curling teams, Team Canada features five members. Well, six, if you really want to get technical with it.

Alternate Kristie Moore, 30, is 5 1/2 months pregnant, making her just the third athlete known to be with child during Olympic competition. Ninety years ago, Swedish figure skater Magda Julin won a gold medal at the Antwerp Games while in her first trimester and Germany's Diana Sartor took fourth in the skeleton in 2006.

Though she is showing, Moore says that her pregnancy has not affected her ability to deliver rocks ... yet. "[In] the eighth month or so, that might be an issue," she said.

Moore found out about her pregnancy weeks before team officials invited her to join Team Canada as an alternate. When she divulged her secret, the team was more than supportive. Said team leader Cheryl Bernard, "she is young and fit. There's no reason we'll have any problems, and she'll be out there."

Barring unforeseen problems with the other four members of the team, it's unlikely Moore will see any Olympic action. During competition her role as an alternate is much like a backup quarterback in football: She'll be called on if needed. Moore has said that although she'd like to get out on the ice, doing so would mean having to play at the expense of someone else's injury.

Team Canada is the gold-medal favorite in the women's curling event, which begins Tuesday and runs through Friday of next week. Even if Moore doesn't play, she will receive any medal Canada wins.


Wanted: Volunteers, All Pregnant

The woman sent by government scientists visited the Queens apartment repeatedly before finding anyone home. And the person who finally answered the door - a 30-year-old Colombian-born waitress named Alejandra - was wary.

Although Alejandra was exactly what the scientists were looking for - a pregnant woman - she was "a bit scared," she said, about giving herself and her unborn child to science for 21 years.

Researchers would collect and analyze her vaginal fluid, toenail clippings, breast milk and other things, and ask about everything from possible drug use to depression, At the birth, specimen collectors would scoop up her placenta and even her baby’s first feces for scientific posterity.

She ultimately decided that participating would “help the next generation.”

Chalk one up for the scientists, who for months have been dispatching door-to-door emissaries across the country to recruit women like Alejandra for an unprecedented undertaking: the largest, most comprehensive long-term study of the health of children, beginning even before they are born.

Authorized by Congress in 2000, the National Children’s Study began last January, its projected cost swelling to about $6.7 billion. With several hundred participants so far, it aims to enroll 100,000 pregnant women in 105 counties, then monitor their babies until they turn 21.

It will examine how environment, genes and other factors affect children’s health, tackling questions subject to heated debate and misinformation. Does pesticide exposure, for example, cause asthma? Do particular diets or genetic mutations lead to autism?

But while the idea is praised by many experts, the study has also stirred controversy over its cost and content.

In August, the Senate committee overseeing financing for the study accused it of “a serious breach of trust” for not disclosing that the initial price tag of $3.1 billion would more than double, and said the study needed to release more information if it wanted to get “any” financing in the next budget year.

And an independent panel of experts and some members of the study’s own advisory committee say it misses important opportunities to help people and communities — emphasizing narrower medical questions over concerns like racial and ethnic health differences, leaving unresolved crucial ethical questions concerning what to tell participants and communities about test results.

“This study is of the magnitude of the accelerator in CERN, or a trip to the moon — a really big science issue,” said Milton Kotelchuck, a professor at the Boston University School of Public Health and a member of the independent panel. “But if you have a flawed beginning, then you’ve got 20 years of working on a flawed study.”

Officials are making changes, putting all but the pilot phase, to involve 37 locations, on hold while conducting an inquiry into the cost and scientific underpinnings, Dr. Collins said. Some data may no longer be collected if “we can’t afford” it, he said, and every aspect will receive “the closest possible scrutiny.”

The study is far from its plan of recruiting 250 babies a year for four or five years in each community. By December, 510 women were enrolled and 83 babies were born in the first seven locations, including Orange County, Calif., and Salt Lake County, Utah.

That was after knocking on nearly 64,000 doors, screening 27,000 women and finding 1,000 who were pregnant and in their first trimester (and therefore eligible).

The time and information required from families could also make the study “too burdensome to be conducted the way it is,” said Dr. Susan Shurin, former acting director of the National Institute of Child Health and Human Development, part of the National Institutes of Health and the study’s supervising agency. The fear is women will “go ‘Oh no, you again,’ and slam the door in your face.”

Specimens include blood, urine, hair and saliva from pregnant women, babies and fathers; dust from women’s bedsheets; tap water; and particles on carpets and baseboards. They are sent to laboratories (placentas to Rochester, N.Y., for example), prepared for long-term storage, and analyzed for chemicals, metals, genes and infections.

Participants provide the names and phone numbers of relatives and friends, so researchers can find them if they move. As children grow, scientists, including outside experts, can cross-reference information about their medical conditions, behavioral development and school performance.

Besides looking at widespread conditions, like diabetes, the study will consider regional differences. Maureen Durkin, principal investigator in Waukesha County, Wis., wonders if radium in the county’s water, and houses built on “farm fields that may be contaminated with nitrates and atrazine,” have different health consequences than pollution or industrial chemicals in Queens.

But study officials are trying to determine what information to give participants and when. Some experts say people should get results of their chemical or genetic tests only if medical treatments exist because otherwise it only causes anxiety. Others agree with Patricia O’Campo, a member of the study’s advisory committee and the independent panel, who says the study should be “less ivory towerish” and disclose more information to families and communities.


Why a Page woman traveled 350 miles to Valley to have baby

In order to deliver her baby the way she wanted, a woman said she would have to come to the Valley, 350 miles away from her home in Page.

Joy Szabo has four boys. Her first delivery was vaginal, her second a cesarean, her third a vaginal birth after cesarean or VBAC.

For her fourth... "I knew from the beginning that I wanted to deliver him vaginally, I had already had a successful VBAC and my doctor was on board with that," said Joy.

She planned to deliver at Banner's Page Hospital, until she learned the hospital would no longer allow VBAC births.

Joy spoke with the CEO.

“She told me she didn’t see any reason why I shouldn’t be able to deliver vaginally, but it wasn’t going to happen there. I needed to find some place else,” said Joy.

At this time Joy was entering her last trimester. She checked into it and home birth wasn’t an option. It’s illegal for a midwife to allow a woman to VBAC at home.

She would have to come to the Valley for a VBAC birth, 350 miles away from her Page home. With a husband and three young boys it wasn’t an easy task.

She was doing all this to avoid the risks that come along with a c-section surgery, but VBACs carry their own dangers. The biggest is the possible rupture of the C-section scar on the uterus.

OBGYN Dr. Roger Seymann has seen it and no longer handles VBACs because of it.

“Observing the horrendous outcome of opening the abdomen, seeing a baby in the belly, knowing this baby has a risk of neurologic damage, if it has in fact survived at all,” said Dr. Seymann.

Banner Hospitals say they don’t allow VBACs at their rural locations because they can’t provide the 24/7 care needed in case of a rupture.

Joy ended up delivering at Banner Gateway with a doula and a doctor that would work with her wishes.

Her doctor was Dr. Christine Brass of Mesa.

“I just carefully choose with the patient themselves you know who is going to be the best candidate for proceeding with a vaginal birth after cesarean,” said Dr. Brass.

She says there are plenty of factors that go into that consideration. Dr. Brass says women who had a c-section the first time because the baby was too big for their birth canal probably aren’t good candidates. A woman who has done a VBAC before, like Joy, is a great candidate.

Joy says she couldn’t be more happy with the outcome.

“There is an emotional side to delivering your own baby and being able to see what’s happening and participating in the process that really is valuable,” said Joy.

The ACOG guidelines recommend that both obstetrician and anesthesiologist need to be immediately available for elective VBAC in order to meet patient safety standards for laboring mothers and their infants.


Migraine drugs don't up birth defect risk: study

A study in nearly 70,000 pregnant women has found no link between migraine drugs called triptans and the risk of birth defects.

However, the researchers did find a "slight increase" in the risk of excessive bleeding during labor, and the failure of the uterus to contract normally after delivery, for women who used the drugs while pregnant.

Triptans are among the most powerful drugs used for migraine; others include aspirin, Excedrin, and ibuprofen.

While as many as three in 10 women may develop migraines during their childbearing years, women often shy away from using such drugs during pregnancy because of safety concerns, according to study co-author Katerina Nezvalova-Henriksen of the University of Oslo in Norway and her colleagues.

However, the authors of the study in Headache note, untreated migraine may itself carry risks for mother and child; some studies have linked it to pre-eclampsia, a potentially deadly pregnancy complication.

"While it is important to exert caution when using any medications during pregnancy, this study indicates" that pregnant women can either start or continue taking triptans without "any major risk" of miscarriage, premature delivery, or other bad outcomes, the authors conclude.

Nezvalova-Henriksen and her team studied nearly 70,000 women. Two percent, or 1,535, had used sumatriptan (Imitrex), rizatriptan (Maxalt), zolmitriptan (Zomig), or eletriptan (Relpax) in pregnancy.

Less than one percent -- 373 women -- had used the drugs before getting pregnant but not during pregnancy.

The overall birth defect rate, which encompasses everything from large birthmarks to serious heart problems, was the same among women who had taken triptans during pregnancy and those who didn't have migraines: 5 percent. Among those who had used triptans in the past but not during pregnancy, it was slightly higher: 6 percent.

The women who used triptans were also more likely than non-triptan users to take other drugs during pregnancy, including acetaminophen (Tylenol) with codeine and non-steroidal anti-inflammatory drugs such as ibuprofen.

However, the rate of major birth defects - such as serious problems of the limbs or internal organs -- was 3 percent for all three groups. That rate - about one in 33 births - is about what would be expected for all birth defects in the general population.

The researchers did find that women who used triptans in their second or third trimester were more likely to develop a condition called atonic uterus, in which the uterus fails to contract back to its normal size after delivery. This is the leading cause of excessive bleeding after delivery. They were also more likely to lose significant amounts of blood during labor and delivery.

And during pregnancy, they were more likely to suffer from vomiting than women who had never used the drug; they were also more likely to develop pre-eclampsia or eclampsia, and more likely to have deficiencies in the B-vitamin folate.

While many women who suffer migraines will experience improvements in their symptoms after their first trimester, Nezvalova-Henriksen and her team note, those whose symptoms don't improve by then aren't likely to get better.