Dr. Onyeije’s Maternal-Fetal Medicine Blog

Study: Babies Remember Stress and Anticipate More

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They may have barely mastered sitting up by themselves.

But six-month-old babies become stressed out when they don't get the attention they feel they deserve.

Levels of the stress hormone cortisol soar when they are ignored by their mother, and even a day later they are worried about the same thing happening again.

A baby who is deprived of its mother's love for just two minutes is anxious about being ignored again the next day, a study found.

To investigate whether six-month-olds are capable of anticipating trouble, the Canadian researchers invited 30 mothers and babies into their laboratory and divided them into two groups.

Babies were placed in car seats and their mothers played with them and talked to them as normal.

The play was then interspersed with two-minute periods in which the mother simply stared over her child's head, keeping her face free of emotion.

The next day, she took her child back to the laboratory. Levels of cortisol were measured several times on both days. Amounts of cortisol shot up when the babies were ignored.

They then fell off, before rising again when the youngsters were taken back into the laboratory, despite them not being ignored on the second day.

A second group of babies went through the same process, but without being ignored at any time, and their hormone levels barely changed.

The findings suggest that being taken back into the laboratory led the youngsters who had been ignored to anticipate there being more trouble ahead, the journal Biology Letters reports.

Researcher Dr David Haley, of the University of Toronto, said: 'The results suggest that human infants have the capacity to produce an anticipatory stress response that is based on expectations about how their parents will treat them in a specific context.'

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Immune responses during pregnancy linked to schizophrenia among offspring

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In a study published this month in Schizophrenia Research, Temple University psychologist Lauren Ellman found that exposure during pregnancy to certain immune proteins, such as those produced in response to the flu, leads to increased risk for brain abnormalities associated with schizophrenia in offspring.

The good news, says Ellman, is that not all of the women in the study who showed an increase in immune proteins gave birth to offspring who developed brain alterations. "This tells us that some other factor — perhaps a genetic vulnerability or something from the environment — must also be present for the increased immune protein levels to lead to the brain alterations we identified," she said.

Previous studies, including one by Ellman, have already established a link between maternal exposure to flu and increased risk for schizophrenia in offspring, but it was not clear why the link existed, because most infections do not cross the placenta. Researchers then began to look at maternal immune responses to infection as the possible cause for the increased risk.

Of particular interest to the researchers were proteins termed proinflammatory cytokines, which are produced by the body in response to infection.

"Now, it appears that the damaging effects to the fetus are related to these maternal responses to infection during pregnancy rather than to the infections themselves," Ellman said.

Ellman's study was conducted on archived blood samples drawn during the 1950s and 1960s from a group of approximately 12,000 pregnant women during each trimester of their pregnancies. The women and their offspring were followed after delivery, so those whose children had developed schizophrenia could be easily identified.

Her study showed a direct correlation between structural brain changes among offspring diagnosed with schizophrenia and increases in maternal levels of interleukin-8 (IL-8), one of the proinflammatory cytokines produced when fighting infection during pregnancy.

"The brain abnormalities we found are ones consistently linked with schizophrenia, suggesting that an elevated immune response during pregnancy might contribute to some of the brain abnormalities associated with the disorder," Ellman said.

Maternal IL-8 levels were not related to any brain changes among a control group of offspring, indicating that vulnerability to schizophrenia needed to be present for the fetal brain to be affected, she said.

Ellman is uniquely positioned to answer questions related to pregnancy and fetal development. An assistant professor of psychology in Temple's College of Liberal Arts, she examines how maternal stress and immune functioning during pregnancy impact fetal brain development.

"I set out to study the impact of stress during pregnancy, and it became clear pretty quickly that you couldn't study the impact of stress without looking at the immune system," she said. "The two are completely intertwined."

According to Ellman, one of the main ways pregnancy makes women susceptible to infections is that changes in the immune system during pregnancy reduce some of the body's key defenses. In addition, maternal emotional states, like stress, can alter immune functioning. This increased vulnerability to infection comes at a time when the fetal brain is experiencing enormous growth.

"In light of our study, which calls attention to a pregnant woman's increased susceptibility to infection and the potential risks to her developing fetus, it is easy to see why the medical community routinely recommends that women who are pregnant or planning to become pregnant take special precautions to prevent infection, such as getting vaccinated," she said.

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Anxiety During Pregnancy Predicts Worse Outcomes

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In treating pregnant women with mood or anxiety disorders, we tend to focus primarily on the reproductive safety of psychotropic medications; however, it must be recognized that withholding or withdrawing pharmacologic treatment for depression or anxiety during pregnancy may carry some degree of risk. Untreated psychiatric illness in the mother cannot be considered a benign [...]

‘More and more rules’ on pregnancy

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Pregnancy has become ever more "policed", with a litany of rules for parents-to-be on how to behave, a parenting conference is due to hear.

Researchers at the two-day seminar at Kent University will present fresh analysis of the decision to advise pregnant women to avoid any alcohol.

There have been mixed messages about drinking in pregnancy in recent years.

The impact of mounting efforts to involve fathers in the antenatal period will also be explored.

The Changing Parenting Culture conference next week is to explore the emergence of what it sees as new, often contradictory rules shaping pregnancy and pregnancy planning.

These include the role of stress in pregnancy, amid conflicting reports on the impact of the way a mother feels on the well-being of the growing fetus.

Some studies have suggested that stress in pregnancy can cause anything from physical abnormalities to behavioral problems.

Elizabeth Mitchell Armstrong, professor of sociology at Princeton University, will argue that maternal emotions are being "medicalized".

"To the list of pregnancy prescriptions and proscriptions comes another mandate: be happy, be calm. Pregnant women are exhorted to avoid stress and to moderate their emotions in order to produce a healthy baby.

"Yet the evidence behind this recommendation is exceedingly weak."

The conference will also look at the issue of Fetal Alcohol Syndrome (FAS) and accompanying disorders - the reason why pregnant women are advised to abstain from alcohol in many countries - including the UK, US, France and Australia.

The relationship between sustained heavy drinking in pregnancy and health problems such as growth and mental retardation is well-established - although alcoholic mothers will not necessarily have affected children - but evidence is lacking that low to moderate intake is harmful.

However concerns that some women may underestimate their drinking, as well as fears that a lack of evidence did not mean moderate consumption was safe, are thought to have informed the 2007 decision to advise pregnant women in England to abstain.

Dr Ellie Lee, a lecturer in social policy at the University of Kent, suggests that in "advocating abstinence without an evidence base, policy makers formalize a connection between uncertainty and danger".

She adds: "They have decided it is preferable that pregnant women take no risk even if there is no evidence of harm.

"But there are dangers associated with this approach, not least that such hyper risk-aversion sits uneasily with advice to parents against 'cotton wooling' or worrying too much about their children's health.

Fathers meanwhile are being increasingly encouraged to curb their drinking, stop smoking and eat well when a partner is pregnant, on the basis that his behavior is likely to influence hers.

Attendance at ante-natal sessions, as well as the birth, is now widely expected.

But research to be presented by Jonathan Ives and Heather Draper of the Centre for Biomedical Ethics at Birmingham University will question this mantra.

They suggest that involving men in the very medicalized aspects of their partner's pregnancy and labor - where their contribution is inevitably limited - is not necessarily the best preparation for all fathers.

"It's a good and positive step to promote male involvement, and we are not seeking to undermine that," says Dr Ives.

"But we are getting to a point where society has to ask if we are going about this the right way. It's time for debate."

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“Love” Hormone Released When Mom’s Voice is Heard

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The working mother who cannot be at home to cuddle a distraught child can relax - her voice on the phone soothes as much as a hug, a study suggests.

US researchers put more than 60 girls in a stressful situation and monitored their hormonal responses when they were either phoned or hugged afterwards.

Their mother's voice produced virtually the same amount of the stress-quelling hormone oxytocin as physical comfort.

The findings appear in the journal Proceedings of the Royal Society B.

The girls, aged between seven and 12, were asked to make an impromptu speech and then solve a series of sums in front of a panel of strangers - experiences which sent their hearts racing and levels of the stress hormone cortisol soaring.

For one group of girls their mother was on hand immediately afterwards to offer physical comfort - a hug, or an arm around the shoulder. Another group was handed a phone with mother on the line, while a third watched March of the Penguins - seen as an emotionally-neutral film.

Oxytocin - a hormone believed to be strongly associated with social bonding, and one which alleviates the effects of cortisol - rose in both groups to similar levels. Oxytocin levels in the film group did not increase.

"It was understood that oxytocin release in the context of social bonding usually required physical contact," said Dr Leslie Seltzer of the University of Wisconsin-Madison, who led the research.

"But it's clear from these results that a mother's voice can have the same effect as a hug, even if they're not standing there."

Previous research suggesting physical contact was necessary to produce oxytocin in stressful circumstances was primarily carried out on rodents, therefore failing to take into account the very human impact of language, the researchers said.

Research has suggested that even in the womb a fetus - at least in the later stages of pregnancy - is capable of recognizing its mother's voice.

But whether this has any emotional impact at this young age is unclear.

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Stress early in pregnancy increases risks to babies

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Stressful situations in early pregnancy can lead to the birth of babies who are underweight or born too early, new research from China shows. Timing of the stress, the researchers found, was the key.

"The findings are modest, but significant," the authors write in the American Journal of Obstetrics and Gynecology.

The risks of premature births increased two-fold in women who were exposed to severe life events during their first and second trimesters - weeks 1-12 and 13-24, respectively. Premature birth, the authors note, is the single largest contributing factor in infant deaths in the developing world.

Researchers from Anhui Medical University, led by Dr. Peng Zhu, followed 1,800 pregnant women receiving prenatal treatment in 2008 at one hospital. The participants were surveyed on financial conditions, emotional support, traumatic events and their relationships with their spouses. Were jobs or fortunes lost, were family members cheated, did the family move, did a family member die or suffer an illness, or was there fighting or divorce?

There were 96 (5.3 percent) premature births and 55 (3.1 percent) low birth-weight babies.

Earlier studies have found that future moms with stressful lives were at greater risk of delivering preterm or low birth-weight babies. This study - looking at a long list of potentially stressful events experienced during pregnancy only - concluded that the earlier in pregnancy the stress occurred, the greater the risk.

The Zhu team found that premature birth was more than twice as likely if severely stressful events occurred during the first and second trimesters, but not the third. Low birthweight was nearly three times more likely if stress happened during the first trimester, compared to if it happened during the second or third trimester.

While for the most part consistent with earlier research, the Chinese researchers caution that the reach of their findings could be limited.

For instance, they warn that faulty memories, the small number of women in some of the stress categories, and the possibility that the list of stress events was flawed could weaken the power of the results.

The Zhu team concluded that health planners seeking to reduce the incidence of pre-term and low-weight births must take maternal stress into account when designing intervention programs.

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Sex of baby drives response to pregnancy stress

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University of Adelaide research is showing that the sex of the baby determines the way it responds to stressors during pregnancy and its ability to survive pregnancy complications.

Male and female babies during pregnancy show different growth and development patterns following stressors during pregnancy such as disease, cigarette use or psychological stress.

The research is being carried out by the Robinson Institute's Pregnancy and Development Group, based at the Lyell McEwin Hospital and led by Associate Professor Vicki Clifton.

"What we have found is that male and female babies will respond to a stress during pregnancy by adjusting their growth patterns differently," said Associate Professor Clifton.

"The male, when mum is stressed, pretends it's not happening and keeps growing, so he can be as big as he possibly can be. The female, in response to mum's stress, will reduce her growth rate a little bit; not too much so she becomes growth restricted, but just dropping a bit below average.

"When there is another complication in the pregnancy - either a different stress or the same one again - the female will continue to grow on that same pathway and do okay but the male baby doesn't do so well and is at greater risk of pre-term delivery, stopping growing or dying in the uterus."

Associate Professor Clifton said this sex-specific growth response had been observed in pregnancies complicated by asthma, preeclampsia and cigarette use but was also likely to occur in other stressful events during pregnancy such as psychological stress.

She said this sex-specific growth pattern was a result of changes in placental function caused by the stress hormone cortisol.

In female babies, increased cortisol produces changes to the placental function which lead to the reduction in growth, but the increased cortisol levels in a mother carrying a male baby doesn't produce the same changes in placental function.

Associate Professor Clifton said this research could lead to sex-specific therapies in pre-term pregnancies and premature newborns. It was also important in helping obstetricians more accurately interpret growth and development of the fetus in at-risk pregnancies.

"We are looking at what events during pregnancy cause changes in how the baby grows, what's behind this and ways in which we can improve the outcomes for pregnant women and their babies," she said.

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A little stress may boost the fetal brain

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High stress during pregnancy is bad news, but it turns out that moderate stress might boost fetal brain development.

Studies in rodents suggest that stress during pregnancy inhibits neural growth, while the children of women who lived in war zones during pregnancy have a higher risk of developing schizophrenia.

To investigate the effects of moderate stress in humans, Janet DiPietro and her colleagues at Johns Hopkins University in Baltimore, Maryland, examined 112 healthy pregnant women living in the US three times during their third trimester. They asked the women about their stress levels and recorded fetal movements. They also examined the babies two weeks after birth.

Women who reported higher stress levels during pregnancy had babies that moved around more in the womb. After birth, these babies scored higher on a brain maturation test, although they were more irritable. More active fetuses had better control of body movements after birth.

The stress hormone cortisol plays a role in brain maturation, which may help explain the result (Child Development, vol 81, p 115).

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Parents ’spend more’ quality time with children

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Working parents perpetually agonize that they don't see enough of their children. But a surprising new study finds that mothers and fathers alike are doing a better job than they think, spending far more time with their families than did parents of earlier generations.

The study, by two economists at the University of California, San Diego, analyzes a dozen surveys of how Americans say they use their time, taken at different periods from 1965 to 2007. It reports that the amount of child care time spent by parents at all income levels - and especially those with a college education - has risen "dramatically" since the mid-1990s. (The findings by the husband-and-wife economist team of Garey Ramey and Valerie A. Ramey appear in a discussion paper presented in March at a Brookings Institution conference in Washington.)

Before 1995, mothers spent an average of about 12 hours a week attending to the needs of their children. By 2007, that number had risen to 21.2 hours a week for college-educated women and 15.9 hours for those with less education.

Although mothers still do most of the parenting, fathers also registered striking gains: to 9.6 hours a week for college-educated men, more than double the pre-1995 rate of 4.5 hours; and to 6.8 hours for other men, up from 3.7, according to an additional analysis by Betsey Stevenson and Dan Sacks, economists at the Wharton School of the University of Pennsylvania.

Family researchers say the news should offer relief to guilt-stricken working parents.

“Parents are feeling like they don’t have enough time with their children,” said Ellen Galinsky, president of the Families and Work Institute in New York, which conducts research on the work force. “It’s a function of people working so hard, and they are worried they’re shortchanging their children. I’ve never found a group of parents who believe they are spending enough time with their kids.”

Although previous studies have shown increases in parenting time starting in the 1990s, the study by the Rameys is important because it links so many time-use surveys and also breaks the data down by age of the child and education level.

The rise in child-centered time is just one of the ways the American family is changing. Couples are typically waiting longer to get married and begin having children. Divorce rates are dropping with each generation.

And notably, children are no longer so widely viewed as essential to a happy marriage. In 1990, 65 percent of Americans said that children were “very important” to a successful marriage, but by 2007, the number of adults who agreed with that statement had dropped to 41 percent, according to a survey by the Pew Research Center.

In fact, the surge in parenting time may say more about modern marriage than about modern child care practices, Dr. Stevenson said. She notes that among college-educated parents, two- to two-and-a-half hours of the increased time takes place when both parents are together. “Everybody gets in the car,” she said, “and mom and dad both cheer on the kid.”

That may reflect a rise in what Dr. Stevenson calls the “hedonic marriage,” in which couples share home and work responsibilities so they can spend more time together.

By contrast, couples from earlier generations typically had “specialized” roles that tended to keep them apart — the husband working at a job to support the family, the wife staying home to raise the children.

“We’re seeing a rise in marriages where we’re picking people we like to do activities with,” Dr. Stevenson said. “So it’s not surprising we’re going to see that some of the activities we want do together involve our children.”

So where is the extra time coming from? Women, in particular, are spending less time cooking and cleaning their homes, while men are putting in fewer hours at the office. A 2007 report in The Quarterly Journal of Economics showed that leisure time among men and women surged four to eight hours a week from 1965 to 2003.

Notably, the data in the Ramey study do not count the hours mothers and fathers spend “around” their children — at the dinner table, for example, or in solitary play. Instead, the survey tracks specific activities in which the parent is directly involved in the child’s care.

“It’s taking them to school, helping with homework, bathing them, playing catch with them in the back yard,” said a co-author of the leisure-time paper, Erik Hurst, an economist at the University of Chicago Booth School of Business. “Those are the activities that have increased over the last 15 to 20 years.”

Dr. Galinsky notes that although working parents typically feel guilty for not spending more time at home, children often have a different reaction. In a landmark study published as “Ask the Children” (Harper, 2000), she asked more than 1,000 children about their “one wish” for their parents. Although parents expected their children would wish for more family time, the children wanted something different.

“Kids were more likely to wish that their parents were less tired and less stressed,” Dr. Galinsky said.

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The Science of Mother-Baby Bonding

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You take your baby to the pediatrician for her regular check-ups, vaccines, and at the first sign of a fever. You keep her away from runny-nose friends and steer clear of the sun. You babyproof your home and gently bandage her boo-boos. All to make sure your child grows up healthy and strong. But compelling new research is showing that the strength of your emotional bond with your baby may well trump all of those other measures you take to help her thrive.

A close attachment can prevent diseases, boost immunity, and enhance IQ in your baby, says Deepak Chopra, M.D., the endocrinologist turned mind-body -- medicine guru, Parenting contributing editor, and coauthor of Magical Beginnings, Enchanted Lives: A Holistic Guide to Pregnancy and Childbirth. Those hugs and kisses are a force of nature more powerful than ever thought, says Dr. Chopra. Mother-child bonding has evolved to become a complex physiological process that enlists not just our hearts, but our brains, hormones, nerves, and almost every part of our bodies.

There are decades of evidence to back up Dr. Chopra's claims. In one study from Ohio State University, rabbits that were cuddled by researchers were protected against the artery-clogging effects of a high-cholesterol diet. The love and attention affected the rabbits' hormone levels, the study authors concluded, helping them withstand heart disease. Researchers at McGill University in Montreal found that some female rats took more time and care to lick their infant pups than others; the pups that were licked frequently grew up to be less stressed and more adventurous in temperament, while pups that weren't groomed as much exhibited nervous, stressed-out behavior. And yet another study, published in Pediatrics, found that premature babies who were stroked gained nearly 50 percent more weight than those who were not. Such skin-to-skin contact (known as kangaroo care) has been shown to have other health benefits for preemies, too.

It's well known that the nipple stimulation that occurs when a baby nurses causes a hormone called oxytocin to be released in the mom, which in turn triggers milk let-down. But oxytocin is also called the "love hormone" because it's produced during orgasm and other affectionate moments. In fact, oxytocin behaves in the brain much the same way that morphine does; it turns on our "reward" center, easing pain, making us feel good, and causing us to crave that emotional high again and again. Women who don't breastfeed, or choose to eventually switch to or supplement with formula, happily do not miss out on the "love drug." Simply gazing into your baby's eyes while bottle-feeding or just snuggling or massaging also unleashes the feel-good hormones in both of you.

There's more evidence that we're hardwired to connect with our kids: Pheromones -- the chemicals we secrete to attract a partner -- are also secreted by our babies, ensuring that we're similarly smitten with them. In one study, 90 percent of moms were able to identify their newborns by scent alone after having spent as little as ten minutes with them. When the moms spent an hour with their babies, 100 percent of them correctly distinguished their own baby's smell from the smell of other infants.

A baby recognizes his mother's scent, too. Last year, researchers in Japan found that infants who smelled their own mother's milk while undergoing a routine heel-stick procedure exhibited fewer signs of distress than babies who were exposed to the odor of another mother's milk, formula, or nothing at all. The mere scent of their mother's breast milk was enough to calm the newborns and ease pain. Here's an interesting aside: The act of kissing may have evolved as an affectionate gesture because it puts our nose in direct contact with the base of our partner's nostrils, where pheromones are generated.

Just as scent motivates you to care for your child and motivates your child to stay close to you, so too does a smile. In a recent study conducted at the Baylor College of Medicine, in Houston, brain MRIs were taken of women while they looked at photos of their own children and of other kids making sad, happy, and neutral faces. The scans found that when a woman saw a photo of her own child, the parts of her brain associated with rewards processing (meaning they make you feel good!) were activated, and even more so when she saw photos of her child smiling. It's all very primitive: Mom make Baby smile, Mom get reward, Mom want to make Baby smile again.

So ignore your e-mails and forget about the laundry. Don't stress about vacuuming or entertaining guests. Let bonding with your baby become your priority. Lie around with her, doing nothing. Cuddle. Play. Dr. Chopra believes in "nourishing all of your baby's senses" by holding her, massaging her, singing to her, using soothing scents (lavender, rose, vanilla), and showing her colorful, interesting shapes and objects. Remind yourself that you're building a connection that will comfort both of you for years and years. And when you need a break, take one.

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