A new study confirms that children conceived via infertility treatment may have a higher-than-average risk of cerebral palsy -- explained largely by their higher rates of multiple births and preterm delivery.

The study, of nearly 590,000 children born in Denmark between 1995 and 2003, found that those conceived through assisted reproduction were about twice as likely to be diagnosed with cerebral palsy as children who were conceived naturally.

The findings, reported in the journal Human Reproduction, confirm those from a number of past studies. They also suggest that the increased risk of cerebral palsy can be largely attributed to the heightened odds of twin or higher-order births, as well as preterm delivery, with assisted reproduction.

However, the absolute risk of having a baby with cerebral palsy is still quite low for couples undergoing infertility treatment.

In the U.S. and Europe, it's estimated that two or three of every 1,000 babies are affected by the disorder. So even with a relatively increased risk, the vast majority of children born via assisted reproduction techniques will not have cerebral palsy.

Still, researchers say their findings offer an argument for implanting women with only one embryo at a time, in order to cut the odds of multiple births and preterm delivery.

Cerebral palsy refers to a group of conditions, usually present at birth, that permanently impair movement, balance and posture. The impairments range from mild -- some children have only relatively minor problems with movement -- to more severe, with some children being unable to walk or having additional impairments, such as mental retardation or vision and hearing problems.

The precise cause of cerebral palsy is unknown, but it is believed to involve a disruption in normal fetal brain development. Premature and low-birthweight infants are known to have a higher risk than full-term, normal-weight babies.

For the new study, researchers led by Dr. Dorte Hvidtjorn, of the University of Aarhus in Denmark, examined national data on all 588,967 children born in the country between 1995 and 2003. That included 33,139 children conceived via in-vitro fertilization (IVF) or with the help of fertility drugs to stimulate the ovaries to produce eggs.

Overall, 0.2 percent of all children were diagnosed with cerebral palsy. The risk was more than doubled among children in the IVF group, and 55 percent higher among those conceived using fertility drugs, compared with children conceived naturally.

When the researchers factored in the effects of multiple births and preterm delivery, the link between fertility treatment and cerebral palsy disappeared -- indicating that those two factors are likely responsible for the connection.

In fact, the researchers found no increased risk of cerebral palsy among singletons born via IVF.

---

PregnancyWeekly.com

Using the antiseizure medication valproic acid (Depakote) in the first trimester of pregnancy significantly increased the risk of six types of birth defect, European researchers found.

In an analysis of more than 98,000 pregnancies, the risk of the serious spinal defect known as spina bifida was increased more than 12 times for children of mothers on the drug, according to Lolkje T.W. de Jong-van den Berg, of the University of Groningen in the Netherlands and colleagues.

The risks of another five defects were increased between two and seven times, the researchers reported in the June 10 issue of the New England Journal of Medicine.

Those findings support recommendations by the American Academy of Neurology to avoid the use of the drug in pregnancy, the researchers wrote. In the clinic, they continued, the risks of birth defects associated with valproic acid should be routinely considered in women of childbearing age.

Looking at past studies and comparing them against an antiepileptic-study database set up by the European Surveillance of Congenital Anomalies (EUROCAT), the researchers found that six malformations were significantly linked to a woman's valproic acid use in her first trimester of pregnancy. In addition to spina bifida, the children of these women faced a more than doubled risk of a heart condition known as an atrial septal defect and a five-fold risk of cleft palate.

The risk of hypospadias -- a condition in which the opening of the urethra in boys is on the underside of the penis rather than the end -- went up nearly five times with a mother's use of the drug. Craniosynostosis, a condition in which the bones of the skull close too early, was nearly seven times as common in these children, and polydactyly, a condition in which a child has more than five fingers per hand, was more than twice as common.

On the other hand, the researchers found, absolute risks of malformations remained low, ranging from 0.1 percent for craniosynostosis to 0.7 percent for hypospadias. The absolute risk for spina bifida associated with valproic acid was 0.6 percent, they found.

The researchers also cautioned that the study was observational, so it could not indicate anything about cause and effect. They were also unable to say anything about possible confounding by indication, since the drug is used for several clinical indications, or the effects of varying dosages.

---

PregnancyWeekly.com

Happy Friday! Here's a feel-good moment to send you off into the holiday weekend. You might want to have a tissue handy.

---

PregnancyWeekly.com

Happy Friday! Here's a feel-good moment to send you off into the holiday weekend. You might want to have a tissue handy.

---

PregnancyWeekly.com

A North Carolina State University researcher has discovered that bacteria transmitted by fleas-and potentially ticks-can be passed to human babies by the mother, causing chronic infections and raising the possibility of bacterially induced birth defects.

Dr. Ed Breitschwerdt, professor of internal medicine in the Department of Clinical Sciences, is among the world's leading experts on Bartonella, a bacteria that is maintained in nature by fleas, ticks and other biting insects, but which can be transmitted by infected cats and dogs as well. The most commonly known Bartonella-related illness is cat scratch disease, caused by B. henselae, a strain of Bartonella that can be carried in a cat's blood for months to years. Cat scratch disease was thought to be a self-limiting, or "one-time" infection; however, Breitschwerdt's previous work discovered cases of children and adults with chronic, blood-borne Bartonella infections-from strains of the bacteria that are most often transmitted to cats (B. henselae) and dogs (B. vinsonii subsp. berkhoffii) by fleas and other insects.

In his most recent case study, Breitschwerdt's research group tested blood and tissue samples taken over a period of years from a mother, father and son who had suffered chronic illnesses for over a decade. Autopsy samples from their daughter-the son's twin who died shortly after birth-contained DNA evidence of B. henselae and B. vinsonii subsp. berkhoffi infection, which was also found in the other members of the family.

Both parents had suffered recurring neurological symptoms including headaches and memory loss, as well as shortness of breath, muscle weakness and fatigue before the children were born. In addition, their 10-year-old son was chronically ill from birth and their daughter died due to a heart defect at nine days of age.

Results of the parents' medical histories and the microbiological tests indicated that the parents had been exposed to Bartonella prior to the birth of the twins, and finding the same bacteria in both children, one shortly after birth and the other 10 years later, indicates that they may have become infected while in utero.

"This is yet more evidence that Bartonella bacteria cause chronic intravascular infections in people with otherwise normal immune systems, infections that can span a decade or more," Breitschwerdt says. "Also this new evidence supports the potential of trans-placental infection and raises the possibility that maternal infection with these bacteria might also cause birth defects."

---

PregnancyWeekly.com

Women who use the antidepressant bupropion during early pregnancy may have an increased risk of having a baby with a particular type of heart defect, a new study suggests.

Researchers caution that it is not clear whether the medication, marketed as Wellbutrin, is the cause. And even if it is, they say, the absolute risk of the heart defect would be small -- affecting just 2 out of every 1,000 infants born to women who used bupropion during the first trimester.

But the findings, published in the American Journal of Obstetrics & Gynecology, do add to questions about the risks of using antidepressants during early pregnancy.

Some studies have already linked other antidepressants -- including some of the commonly used selective serotonin reuptake inhibitors (SSRIs) -- to higher-than-average, though small, risks of certain birth defects.

A study last year, for example, found that among nearly half a million Danish children born between 1996 and 2003, the risk of heart defects was elevated among those whose mothers had used SSRIs such as fluoxetine (Prozac), sertraline (Zoloft) and citalopram (Celexa) during early pregnancy.

In this latest study, researchers found that among more than 12,700 U.S. infants born between 1997 and 2004, those whose mothers used bupropion during early pregnancy had more than double the risk of heart defects known as left outflow tract defects, compared with infants whose mothers had not used the drug.

Left outflow defects affect the flow of blood from the heart's left chambers to the rest of the body. In this study, the most common type of this defect was coarctation of the aorta -- a narrowing in the body's main artery that, in children, typically requires surgical repair.

The findings do not mean, however, that depressed women on bupropion should stop taking it if they are planning a pregnancy, according to the researchers.

"I think it's important that women understand that they should not just stop taking their medication," said Dr. Jennita Reefhuis, a senior epidemiologist at the U.S. Centers for Disease Control and Prevention and one of the researchers on the study.

Instead, she told Reuters Health, women should talk with their doctors, ideally when they are planning a pregnancy rather than after they conceive.

The potential risk of birth defects from using antidepressants must be weighed against the risks of a woman stopping her current depression therapy, Reefhuis said.

"This study needs to be replicated before we can say anything conclusive," Reefhuis said, noting that the findings point to an association between bupropion and left outflow defects, but cannot by itself prove cause-and-effect.

If the association is causal, she said, the absolute risk to any one woman would be small. For every 1,000 births, there are an estimated 0.8 cases of left outflow tract heart defects; based on the current findings, that rate would be 2 per 1,000 among women who use bupropion in the first trimester.

Reefhuis also pointed out that with any pregnancy, the overall risk of having a baby with some form of birth defect is 3 percent.

Guidelines released last year by the American Psychiatric Association and the American College of Obstetricians and Gynecologists state that psychotherapy may be an effective alternative to antidepressants for pregnant women with mild to moderate depression.

However, the guidelines say, women with a history of more severe depression, or other major psychiatric disorders, may need to continue with their medication.

Bupropion is also prescribed for smoking cessation, under the brand-name Zyban. In the case of smoking cessation, Reefhuis said, it may be easier for women to find an effective alternative to the drug.

---

PregnancyWeekly.com

Citizens of Kettleman City have long suspected that the largest waste treatment plant west of the Mississippi that shares their zipcode is the cause of the surge of birth defects and infant deaths in their town. Finally, the truth has been revealed:

A federal investigation has found that a hazardous waste facility at the center of a birth defects controversy improperly disposed of a chemical known to cause cancer and reproductive problems.

Officials with the Environmental Protection Agency sent a notice of violation Thursday to Chemical Waste Management in Kettleman City. The company runs the largest hazardous waste dump in the West.

At issue is the facility's handling of PCBs, or polychlorinated biphenyls, a banned transformer fluid.

Nearby residents have blamed the facility for at least 11 birth defects since 2007. Company officials have said there's no evidence linking the dump to the birth defects.

Company officials did not immediately return calls for comment Thursday.

---

PregnancyWeekly.com

More than 30 years after the world greeted its first "test-tube" baby with a mixture of awe, elation and concern, researchers say they are finding only a few medical differences between these children and kids conceived in the traditional way.

More than 3 million children have been born worldwide as a result of what is called assisted reproductive technology, and injecting sperm into the egg outside the human body now accounts for about 4 percent of live births, researchers reported Sunday at the annual meeting of the American Association for the Advancement of Science.

The majority of assisted reproduction children are healthy and normal, according to researchers who have studied them. Some of these children do face an increased risk of birth defects, such as neural tube defects, and of low birth weight, which is associated with obesity, hypertension and Type 2 diabetes later in life, the researchers said.

Carmen Sapienza, a geneticist at Temple University School of Medicine in Philadelphia, noted that few of these test tube children are older than 30, so it's not known if they will be obese or have hypertension or other health problems at age 50 or older.

Sapienza said researchers found differences in 5 percent to 10 percent of chromosomes between assisted reproduction children and other kids.

What's not clear is whether these differences result in some way from assisted reproduction techniques or if they stem from other factors, perhaps ones that caused the couple's infertility in the first place.

One factor in low birth weight may be that in many cases assisted fertility results in multiple births, which tend to be early and of lower weight.

Sapienza noted that women seeking assisted reproduction tend to be older than those who conceive naturally, but said that had been controlled for in the studies comparing the two groups of children.

Dolores J. Lamb of the Baylor College of Medicine in Houston urged more testing of males for the reason for infertility.

"There are correctable causes of male infertility and a couple can then have children the natural way," she said. Also, infertility can be the first symptom of diseases such as testicular cancer, Lamb said.

As of 2008, the most recent data available, the United States reported that 361 clinics did 140,795 treatment cycles leading to the birth of 56,790 babies.

---

PregnancyWeekly.com

More than 30 years after the world greeted its first "test-tube" baby with a mixture of awe, elation and concern, researchers say they are finding only a few medical differences between these children and kids conceived in the traditional way.

More than 3 million children have been born worldwide as a result of what is called assisted reproductive technology, and injecting sperm into the egg outside the human body now accounts for about 4 percent of live births, researchers reported Sunday at the annual meeting of the American Association for the Advancement of Science.

The majority of assisted reproduction children are healthy and normal, according to researchers who have studied them. Some of these children do face an increased risk of birth defects, such as neural tube defects, and of low birth weight, which is associated with obesity, hypertension and Type 2 diabetes later in life, the researchers said.

Carmen Sapienza, a geneticist at Temple University School of Medicine in Philadelphia, noted that few of these test tube children are older than 30, so it's not known if they will be obese or have hypertension or other health problems at age 50 or older.

Sapienza said researchers found differences in 5 percent to 10 percent of chromosomes between assisted reproduction children and other kids.

What's not clear is whether these differences result in some way from assisted reproduction techniques or if they stem from other factors, perhaps ones that caused the couple's infertility in the first place.

One factor in low birth weight may be that in many cases assisted fertility results in multiple births, which tend to be early and of lower weight.

Sapienza noted that women seeking assisted reproduction tend to be older than those who conceive naturally, but said that had been controlled for in the studies comparing the two groups of children.

Dolores J. Lamb of the Baylor College of Medicine in Houston urged more testing of males for the reason for infertility.

"There are correctable causes of male infertility and a couple can then have children the natural way," she said. Also, infertility can be the first symptom of diseases such as testicular cancer, Lamb said.

As of 2008, the most recent data available, the United States reported that 361 clinics did 140,795 treatment cycles leading to the birth of 56,790 babies.

---

PregnancyWeekly.com

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.

---

PregnancyWeekly.com