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.

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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.

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PregnancyWeekly.com

Dozens of human embryos with three parents have been created by British scientists, ushering in an era of designer babies.

The embryos - which effectively have two mothers and one father - have been genetically engineered to be free from incurable muscle, brain, heart and digestive illnesses, some of which kill within hours of being born.

The Newcastle University researchers say that within as little as three years, it could allow women whose families are blighted by disease the chance of bringing a healthy child into the world.

But critics say the breakthrough is a step on the slippery slope towards human cloning and erodes the sanctity of human life.

The cutting-edge research centers around mitochondria - sausage-shaped powerhouses inside cells which turn food into energy to be used by the brain and body.

Each mitochondrion has is own DNA which gives instructions on how to build and operate the powerpack, or battery, and is passed down from mother to child.

Serious defects in this DNA affect one in 6,500 babies and cause around 50 genetic diseases, some of which kill in infancy.

With no cure for the conditions, which include some forms of diabetes, blindness and heart problems, women carrying diseased mitochondria often face the heartbreaking choice of whether it would be kinder to remain childless.

The scientists have found a way of swapping the diseased DNA with healthy genetic material, creating embryos free of mitochondrial disease.

The 'transplant' technique, which is described in the prestigious journal Nature, begins by using IVF techniques to fertilize an egg from a healthy donor.

When the resulting embryo is just a few hours old, the 'pronuclei', or nuclear DNA from the sperm and egg are removed, leaving the healthy mitochondria behind.

The would-be mother's egg is then fertilized with her partner's sperm and the pronuclei removed and popped into the donor egg.

This creates an egg where the genetic material comes overwhelmingly from the prospective parents and the mitochondria are healthy.

If the method is successful, the disease should be eradicated from future generations of the family.

Professor Alison Murdoch, head of the Newcastle Fertility Centre, whose patients donated eggs for the study, said: 'It would be hype to say we are going to get rid of mitochondrial disease but I think it's realistic to say you could get rid of it in an individual family.'

Eighty embryos were created in the Newcastle labs, each effectively with three parents - two mothers and a father.

A fourth parent - the man whose sperm was used to fertilize the donor egg - was involved, but none of his DNA was passed on.

Some of the embryos lived for six days, before they were destroyed to comply with fertility laws, which also forbid such embryos from being implanted in a woman.

But updated fertility laws which came into effect last year leave the door open for the legislation to be amended, allowing the technique women to give birth to disease-free babies.

Lead researcher Professor Doug Turnbull said that if this happened, the first babies could be born in as little as three years.

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PregnancyWeekly.com

Dozens of human embryos with three parents have been created by British scientists, ushering in an era of designer babies.

The embryos - which effectively have two mothers and one father - have been genetically engineered to be free from incurable muscle, brain, heart and digestive illnesses, some of which kill within hours of being born.

The Newcastle University researchers say that within as little as three years, it could allow women whose families are blighted by disease the chance of bringing a healthy child into the world.

But critics say the breakthrough is a step on the slippery slope towards human cloning and erodes the sanctity of human life.

The cutting-edge research centers around mitochondria - sausage-shaped powerhouses inside cells which turn food into energy to be used by the brain and body.

Each mitochondrion has is own DNA which gives instructions on how to build and operate the powerpack, or battery, and is passed down from mother to child.

Serious defects in this DNA affect one in 6,500 babies and cause around 50 genetic diseases, some of which kill in infancy.

With no cure for the conditions, which include some forms of diabetes, blindness and heart problems, women carrying diseased mitochondria often face the heartbreaking choice of whether it would be kinder to remain childless.

The scientists have found a way of swapping the diseased DNA with healthy genetic material, creating embryos free of mitochondrial disease.

The 'transplant' technique, which is described in the prestigious journal Nature, begins by using IVF techniques to fertilize an egg from a healthy donor.

When the resulting embryo is just a few hours old, the 'pronuclei', or nuclear DNA from the sperm and egg are removed, leaving the healthy mitochondria behind.

The would-be mother's egg is then fertilized with her partner's sperm and the pronuclei removed and popped into the donor egg.

This creates an egg where the genetic material comes overwhelmingly from the prospective parents and the mitochondria are healthy.

If the method is successful, the disease should be eradicated from future generations of the family.

Professor Alison Murdoch, head of the Newcastle Fertility Centre, whose patients donated eggs for the study, said: 'It would be hype to say we are going to get rid of mitochondrial disease but I think it's realistic to say you could get rid of it in an individual family.'

Eighty embryos were created in the Newcastle labs, each effectively with three parents - two mothers and a father.

A fourth parent - the man whose sperm was used to fertilize the donor egg - was involved, but none of his DNA was passed on.

Some of the embryos lived for six days, before they were destroyed to comply with fertility laws, which also forbid such embryos from being implanted in a woman.

But updated fertility laws which came into effect last year leave the door open for the legislation to be amended, allowing the technique women to give birth to disease-free babies.

Lead researcher Professor Doug Turnbull said that if this happened, the first babies could be born in as little as three years.

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PregnancyWeekly.com

Obese pregnant women are at increased risk of having a baby with a congenital heart defect, a new study finds.

On average, obesity is associated with a 15 percent increased risk of having a baby with a heart defect. But the risk rises with the level of obesity. Compared to normal-weight women, the risk is 11 percent higher in moderately obese women and 33 percent higher in morbidly obese women.

In general, women who were overweight but not obese had no increased risk, said the researchers at the U.S. National Institute of Child Health and Human Development (NICHD) and the New York State Department of Health.

"The trend is unmistakable: the more obese a woman is, the more likely she is to have had a child with a heart defect," study first author Dr. James L. Mills, of the NICHD's Division of Epidemiology, Statistics and Prevention Research, said in a news release.

For this study, researchers compared the records of mothers of 7,392 children born with major heart defects and more than 56,000 mothers of infants born without birth defects. Because the study looked at the records of infants after they were born, it doesn't conclusively prove that obese women who lose weight before becoming pregnant will reduce their risk of having a baby with a heart defect, the researchers noted.

However, "if a woman is obese, it makes sense for her to try to lose weight before becoming pregnant," Mills said. "Not only will weight loss improve her own health and that of her infant, it is likely to have the added benefit of reducing the infant's risk for heart defects."

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PregnancyWeekly.com

Babies born between April and July are more likely to have a certain heart defect, doctors reported on Monday, and they believe a common infection such as strep throat may play a role.

The condition, called hypoplastic left heart syndrome, affects the entire left side of the heart and usually requires at least three operations to reconstruct it.

Dr. Pirooz Eghtesady and colleagues at Cincinnati Children's Hospital in Ohio studied 1,500 newborns from 38 children's hospitals in the United States who had left-sided congenital heart diseases between 1996 and 2006.

They found a clear seasonal pattern to hypoplastic left heart syndrome but not other diseases, they told a meeting of the American College of Cardiology in Orlando.

"Strong seasonality is a clue that environmental factors may play an important role in this disease, as we see, for example, with such common childhood illnesses as asthma and croup," Eghtesady said in a statement.

They are now conducting a study to see whether strep throat, an infection caused by Streptococcus bacteria, may be to blame. Untreated infections of this strain of strep cause rheumatic fever, and sometimes lifelong heart disease.

Strep throat is more common in the winter months and may affect a developing fetus.

Studies have suggested that the body's immune response to strep can damage the left side of the heart. Eghtesady said preliminary evidence suggests that many mothers whose newborns had left-sided heart injury had a significant history of problems related to strep throat.

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PregnancyWeekly.com

Mothers who smoke during pregnancy put their children at greater risk of developing psychotic symptoms as teenagers, British scientists said on Thursday.

Researchers from four British universities studied 6,356 12-year-olds and interviewed them for psychotic-like symptoms such as hallucinations or delusions. Around 19 percent had mothers who smoked during pregnancy.

Just over 11 percent, or 734 of the total group, had suspected or definite symptoms of psychosis.

Many previous studies have shown cigarettes can harm the fetuses of mothers who smoke while pregnant. The risks include causing babies to be born smaller and increasing the risk of sudden infant death syndrome or heart defects.

Stanley Zammit, a psychiatrist at Cardiff University's School of Medicine who led the study, said the more the mothers smoked, the more likely their children were to have psychotic symptoms.

"We can estimate that about 20 percent of adolescents in this cohort would not have developed psychotic symptoms if their mothers had not smoked," he said.

Despite countless studies flagging up the risks to babies, it is estimated that between 15 and 20 percent of women in Britain smoke during pregnancy.

The researchers also found drinking during pregnancy was associated with increased psychotic symptoms, but only in children whose mothers had drunk more than 21 units of alcohol a week in early pregnancy.

The reasons for the link between maternal smoking and psychotic symptoms are not clear, but Zammit and colleagues suggested that exposure to tobacco in the womb might affect a child's impulsivity, attention or cognition.

Only a few mothers in the study, which was published in the British Journal of Psychiatry, said they had smoked cannabis during pregnancy, and this was not found to have any significant link with psychotic symptoms.

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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.

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PregnancyWeekly.com

Three out of five women who have given birth to a child with a congenital heart defect (CHD) -- the number-one birth defect and leading killer of infants and newborns -- were never tested for the defect during pregnancy. This is according to a survey just released by Little Hearts, Inc.

These findings come just as CHD Awareness Week begins (Feb. 7 - 14). The Little Hearts survey found that 60 percent of parents did not know their child had a CHD until after giving birth -- because the mothers were not tested for heart defects during pregnancy.

Of these parents, nearly three out of four (71.6 percent) wished they had known their child had a CHD during pregnancy -- mostly because they would have given birth at a hospital more equipped to handle the care of newborns with a CHD (41.6 percent).

"Congenital heart defects kill more children than childhood cancer, and yet, pregnant women are not routinely tested -- and newborns are not routinely screened -- for this defect," says Lenore Cameron, President and Executive Director, Little Hearts, Inc. "Early detection is absolutely critical to the successful treatment of congenital heart defects and, in countless cases, it saves lives."

Those families that did know their child had a CHD before giving birth (40.0 percent) reaped tremendous benefits from knowing in advance:

• Three out of five (59.5 percent) said they gave birth at a hospital more equipped to handle the care of newborns with a CHD
• One in five (19.8 percent) prepared themselves mentally and emotionally for the arrival of a seriously ill child
• Others did their homework: 14.9 percent of respondents said they arranged for a pediatric cardiologist in advance of their baby's arrival, and 5.8 percent said that knowing in advance was most beneficial because it gave them time to do research on CHDs during the pregnancy

More Survey Results

• Four out of five respondents (81.7 percent) said neither parent of the heart child had any family history of CHDs
• Giving birth to a child with a CHD was more common for women in their 30s (65.2 percent) than in any other age group
• Three out of four respondents (76.1 percent) said the mother did not take prescription drugs (which is considered a CHD risk factor) while pregnant with the heart child
• Almost all respondents (96.4 percent) have only one child with a congenital heart defect; 3.6 percent have two or more children with a CHD
Nearly three out of five respondents (58.0 percent) said their heart child has two or more CHDs; 42.0 percent said their heart child has one CHD
• The most common CHD among children of respondents was Hypoplastic Left Heart Syndrome (30.3 percent), a very serious heart defect that occurs when the left side of the heart does not develop completely

There are approximately 35 different types of CHDs. Some may be treated with surgery, medicine and/or devices, such as artificial valves and pacemakers. In the last 25 years, advances in the treatment of heart defects have enabled half a million U.S. children with serious CHDs to survive into adulthood. However, many cases of sudden cardiac death in young athletes are caused by undiagnosed CHDs and childhood-onset heart disease.

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PregnancyWeekly.com

New study findings offer reassurance to pregnant women that acetaminophen does not appear to raise the risk of birth defects.

Acetaminophen is the active ingredient in Tylenol and certain other painkillers, and is often found in over-the-counter cold and flu remedies. Taken as directed, acetaminophen is considered safe during pregnancy, making it the medication of choice for pregnant women's body aches and fevers.

However, there are still some questions about whether the drug can contribute to birth defects. Studies looking at birth defects as a broad group have either found no link to acetaminophen use or have yielded inconclusive findings.

Some research, meanwhile, has suggested that the drug may be linked to a higher risk of a birth defect called gastroschisis -- but other studies have found no such connection. Gastroschisis refers to a defect in the abdominal wall that allows the intestines to protrude; it has been linked to aspirin use during pregnancy.

In the new study, researchers analyzed data from a large U.S. study that included more than 11,600 children born with congenital defects such as spina bifida, cleft lip and various defects affecting the brain, heart, lungs, limbs and gastrointestinal system. They were compared with 4,500 children born with no major anomaly.

Overall, the study found, there was no evidence linking mothers' acetaminophen use in the first trimester to a heightened risk of any birth defect.

In fact, women who took the medication to treat a first-trimester fever had a lower risk of certain birth defects -- including gastroschisis -- than women who did not treat their fevers with acetaminophen.

Among women who had fevers in early pregnancy, babies born to those who used acetaminophen had a 65 percent to 83 percent lower risk of certain birth defects of the brain, a 56 percent lower risk of cleft lip and a 59 percent lower risk of gastroschisis.

The researchers note that hyperthermia, or excessively high body temperature, has been implicated in the risks of certain birth defects. More studies, they conclude, are needed to confirm whether treating fevers with acetaminophen does in fact prevent some birth defects.

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PregnancyWeekly.com