In the largest study of its kind, researchers find that the risk of severe breathing problems rises significantly in babies born prematurely, even those born in the so-called late preterm period.

Health experts consider babies born at or after 37 weeks' gestation to be full term, and those born between 34 weeks and 37 weeks to be late preterm. (Preterm is defined as less than 34 weeks' gestation.) Many previous studies have shown that compared with full-term babies, those who are born too early are at higher risk of dying shortly after delivery and are more likely to suffer neonatal complications that require lengthy stays in the hospital.

In the new study, Dr. Judith Hibbard at University of Illinois also found that babies born at 34 weeks were 40 times more likely to have respiratory distress syndrome, a breathing difficulty that often requires a ventilator, than babies born at 38 weeks or later.

Even at 37 weeks' gestation — the point at which mothers may ask for an elective Cesarean section or induced delivery — babies are three times more likely than full-term infants to have respiratory abnormalities at birth. "That's a remarkably increased risk," notes Hibbard, who worked with the Consortium on Safe Labor, a group of 19 hospitals that contributed volunteers and data to the study. "And I have to admit, much higher than I was expecting."

Despite the accepted 37-week full-term cutoff, the American College of Obstetricians and Gynecologists officially recommends that babies not be delivered (unless medically necessary) until after 39 weeks. Yet some 9% of all deliveries in the U.S. still occur just shy of 37 weeks, and a recent study found that as many as 23% of late pre-term births — between 34 weeks and 37 weeks — occur for no documented medical reason.

Hibbard says she was surprised by the high rate of health problems she and her team found in this group, since advances in neonatal care have allowed more high-risk babies to survive and eventually thrive after being born too early. But the fact that respiratory distress syndrome continued to occur in premature infants at 40 times the rate in full-term babies highlighted how risky premature delivery can be. At 34 weeks, infants' lungs and respiratory systems are not fully developed, making it difficult from them to survive outside the womb.

With every week of gestation after 34 weeks, however, Hibbard found that rates of complications dropped — by 40 weeks, only 0.3% of babies showed signs of respiratory distress. While 67% of babies required admission to the neonatal intensive care unit at 34 weeks, only 7% of those born at 38 weeks required the same care. Further, 1.5% of babies delivered at 34 weeks developed pneumonia, compared with practically none of those born at 38 weeks. "To be honest, with studies like this, it's hard to justify deliveries before 39 weeks," says Dr. Richard Waldman, president of the American College of Obstetricians and Gynecologists.

Both Hibbard and Waldman stress that there may be valid medical reasons for delivering a baby early — if the mother has preeclampsia, the dangerously high blood pressure that can occur during late pregnancy, for example, or if the baby is no longer growing properly in the womb — but that doctors should discourage elective delivery before 39 weeks.

The new study adjusted for many of the major contributors to prematurity, such as the mothers' weight and history of other medical conditions, including preeclampsia and diabetes, but the relationship between early delivery and risk of respiratory distress in the babies remained. "I know mothers may request early delivery for a lot of reasons," says Hibbard. "But I hope the obstetrician will pull this study out and say, 'Look, early delivery is not a good idea unless there is really a strong medical indication.'"

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PregnancyWeekly.com

Any weight gain during the first 14 weeks of pregnancy -- or more than a pound a week between weeks 14 and 36 -- raise the odds your child will show signs of heart disease by age 9.

The findings come from the U.K. Avon study, which is following the health of nearly 14,000 children born from April 1991 through December 1992. The study, by University of Bristol researcher Abigail Fraser, PhD, and colleagues, focuses on more than 8,500 mother/child pairs for whom detailed data were available.

Women who were overweight before becoming pregnant were more likely to have overweight or obese children.

But regardless of a woman's pre-pregnancy weight, weight gain during pregnancy affected the child's weight -- and at age 9, the child's risk of having high body fat, low levels of good HDL cholesterol, a big waistline, high blood pressure, and other risk factors for heart disease.

Children's heart risk increased with any weight gain during the first 14 weeks of pregnancy, and with any weight gain over 1.1 pounds per week during weeks 14 to 36 of pregnancy. The more weight a woman gained during these times, the higher her child's heart risk.

Weight gain after week 36 of gestation was not linked to heart risk in a woman's offspring.

What's going on? Fraser and colleagues suggest that the reason why these kids already have a high heart risk by 9 years of age is their fat mass. But exactly why children tend to be fat if their mothers gain too much weight during pregnancy isn't clear.

One thing is clear, comments obstetrician/gynecologist Jennifer Wu, MD, of New York's Lenox Hill Hospital.

"In order to help ensure healthier futures for their children, women considering childbearing should try to achieve ideal body weight pre-pregnancy and to adhere to recommended weight-gain guidelines," Wu says in a statement released by the Lenox Hill press office. Wu was not involved in the Fraser study.

The Fraser study appears in the June 15 issue of Circulation, a journal of the American Heart Association.

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PregnancyWeekly.com

New Australian research has found that women can identify only a little more than one-third of their fetus's movements, usually when the movements involve more than one fetal body part.

The research has the potential to help calm anxious mothers-to-be who are worried their babies have stopped moving.

"It is terribly stressful when the baby seems to stop moving, because mothers are so in tune with their babies that to notice a change is very worrying," said Christine East, the study leader and a midwife and clinical researcher at the Royal Women's Hospital in Melbourne.

Previous studies estimated women felt up to 88 per cent of fetal movements, she wrote in the Australian and New Zealand Journal of Obstetrics and Gynecology. But often women were unaware of what they are supposed to be feeling, or were not focusing properly on the movements, she said.

"You have got lots of things happening in a stomach and it can be a bit tricky to figure out what's what," she said.

Vicki Flenady, a board member of the Australian and New Zealand Stillbirth Alliance, run through the Mater Hospital in Queensland, said about 10 per cent of women would experience reduced fetal movement late in their pregnancy.

Fetuses with reduced movements were three times more likely than others to be restricted in their growth, and might have other problems, she said.

"But the majority of babies are fine and that is the message we need to get out there," she said.

Helen Kang, who is about 34 weeks' pregnant, has had two miscarriages and said feeling the baby moving reassured her and her husband, Sam Shennan.

"I like feeling the baby is fine and growing, and it does feel like it is keeping me company as well."

But Ms Kang initially had trouble feeling her baby's movements. "My doctors asked me to be conscious of the movements, but I couldn't really feel anything," she said.

While she is relieved to be feeling the baby now, she was "thrilled" to see an image of the child at Sydney Ultrasound for Women in the city. "It was amazing … it looked like a little person."

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PregnancyWeekly.com

Children who are underweight at birth are more likely to develop health problems including difficulty breathing and jaundice.

Experts believe that they could also be more likely to develop a number of major illnesses, including diabetes and heart disease, in later life.

But new research suggests that taking a specially created supplement could cut the risk of having a small baby in half.

The multivitamin also improved the health of the pregnant women, the study found.

The research team called for larger studies to confirm their findings.

But they said that if these were consistent with their results many pregnant women could benefit from such supplements.

Dr Louise Brough, from Massey University in New Zealand, one of the co-authors of the study, said: “It is especially important to have good nutrient levels during early pregnancy as this is a critical time for development of the fetus.

“Nutrient deficiencies are correctable and they may influence birth outcomes.

“Of course a good diet during pregnancy is important for a healthy pregnancy, but for those who do not have a good diet, multivitamin and mineral supplements will help to reduce the risk of deficiency.”

At the start of the study almost three quarters of the women, 72 per cent, had low level of vitamin D, while 13 per cent were low in iron and 12 per cent were deficient in thiamin, also called vitamin B1.

Those who took the supplement achieved better levels of all three than a control group given a placebo, according to the findings, published in the British Journal of Nutrition.

They were also 50 per cent less likely to have a child with a low birth weight.

More than 400 newly pregnant women started the study, carried out by the Institute of Brain Chemistry and Human Nutrition at London Metropolitan University and the Homerton University Hospital (in East London).

But there was a high dropout rate and only 149 completed the study.

Half were given a multivitamin, Pregnacare, made by Vitabiotics, while the other half were given a placebo.

The researchers tested the women for nutritional deficiencies at the start of the study, and then when they were 26 and 34 weeks pregnant.

Babies are considered to have a low birth weight if they weigh less than 2.5kg (5.5lb).

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PregnancyWeekly.com

The rising trend of expectant mothers being involved in every aspect of planning their births has had an unintended consequence - a rise in pre-term deliveries.

"It never would have occurred to me or anyone I knew to think you had any kind of control over when the baby would come out," said Laura Crawford, who gave birth more than a decade ago.

Crawford, producer of the Kentucky Educational Television documentary "Born too Soon," said the increasing incidence of what is called late pre-term births is among the topics explored in the film.

Prematurity rates in the nation have increased quietly over the past two decades, according to public health officials. The premature-birth rate in Kentucky is 15.2 percent, and it's rising faster than the national rate, which is 12.7 percent. Kentucky has one of the highest rates of pre-term births, trailing only Louisiana, Alabama, Mississippi and South Carolina.

Some of Kentucky's rise is related to some not-so surprising subjects, including the rate of maternal smoking (more than twice the national average), poverty and environment.

Other reasons are more surprising. They include the rise in scheduling births.

It's just within the last three or four years that the scope of the problem of late pre-term births - babies born between 34 and 36 weeks' gestation - has become apparent, said Dr. Ruth Shepherd, division director for maternal and child health in Kentucky's Department of Public Health. Roughly 10 percent of all babies born in Kentucky fall into the late pre-term category.

Ideally, she said, babies shouldn't be delivered before 39 weeks.

Often, there are legitimate reasons for early delivery, especially if the health of mother or child is at risk.

Increasingly, choices are made for reasons other than health. Delivery might be scheduled to coincide with grandparents' dates of arrival from out of town, or before Dad must ship out for Iraq.

There are several complicating factors, Crawford said. The documentary states that people tend to underestimate the impact of premature births, especially late pre-term births. They tend to overestimate how accurately a due date can be determined.

Shepherd said there can be real consequences. They can include immediate physical challenges, including underdeveloped lungs and long-term problems involving learning and behavioral disabilities, for example.

And even if a mother gets an ultrasound within the first 16 weeks - the best way to accurately determine the due date - the date can be off by two weeks either way.

Those two weeks can be crucial, she said.

"It's an issue of planning and control," she said. Planning is good. The Centers for Disease Control and Prevention recommends that mothers have a birth plan. But, Shepherd said, "you can take it too far if you don't pay attention to the science."

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PregnancyWeekly.com

My story starts back in 2006.

I have a history of miscarriage. I had two early losses before giving birth to Noah, but for some reason had thought it would not happen again.

We decided to start trying for another baby in December 2005, and got pregnant right away. However, this pregnancy sadly ended in a miscarriage at the end of January, a very traumatic loss.

Since this was my third loss, despite not being consecutive, I talked my GP into referring me to the hospital for further testing. I had a ton of blood taken for various different tests, however by the time my appointment came along to see the consultant to discuss my results I was already pregnant again, after suffering a chemical pregnancy the cycle before, it turned out this time the baby was going to stick. I had about 8 scans as they monitored my pregnancy very closely this time.

However, things were not to go completely smoothly, as at 16 weeks I consented to having the triple test done for Downs/Edwards syndrome/Spina Bifida, something I regret doing as I feel very strongly against abortion apart from in extreme medical circumstances. This test came back with an elevated risk for Downs Syndrome, at 1 in 200. (The risk for my age, 29, should have been 1 in 1000.) Due to my loss history I refused an amniocentesis. The risk for losing my baby was double the actual risk of it having Downs and I could not accept those odds. So I opted for a detailed scan instead. The scan showed no soft markers for Downs and confirmed what we already suspected was true, that I was carrying another little boy.

At 34 weeks, I had another scan which also showed no markers for Downs. The consultant tried to talk me into an amnio at that stage, which I refused, as I could see little point. She said,

Do you know what risk you are taking?

I felt that was completely ridiculous, as whatever abnormalities my child might have had, we would just deal with whatever came up. I would love my child no matter what and strongly believe that we got given what we can handle and no greater than that. My gut told me though that my child was healthy and I clung onto this.

We started to plan the delivery, our local hospital had recently upgraded their birthing pool so that mothers could actually give birth in it rather than just laboring in it and then getting out before the birth itself. I fully intended on using this pool, especially after researching it and finding out that a warm bath is the second most effective form of pain relief after an epidural!

I had an epidural with Noah’s birth which had not taken properly (just down one side) and I had some horrible side effects (nausea and shaking). I was determined not to have one this time.

A good family friend of ours, Joana, is a midwife and had delivered Noah, we had her on call whenever I went into labor, although she would need some assistance as this would be her first waterbirth.

At 39 weeks, 4 days, I woke up to mild contractions, timed them as coming every 10 minutes.

As the day wore on though, they did not intensify, or get any closer together. By the time Gary got home from work I was getting very frustrated and at that point not even bothered if they stopped, I just wanted SOMETHING to happen or let me get some rest. At 9 p.m., I decided to try and get some sleep so went to bed. It was difficult as I was woken with every contraction, but I was determined I would need some sleep if I was going to have any energy to deal with labor.

Somehow I managed to get to sleep and the next thing I knew, it was 1 a.m. and I awoke having a very intense contraction. I lay there timing them again, and noticed they were coming about 3 minutes apart and lasting about 50 seconds each. I woke DH and we both got up, rang the in-laws. I got dressed and headed over to the hospital. I rang Joana on the way over.

At this point my contrax were 3 min apart, but every now and again I would have an extra one in between; they were painful but manageable. When we got there they had the pool all ready for me and they checked me before I hopped in. Joana was shocked to find I was already 9cm dilated – so I had already gone through most of labour at home!

I got into the tub and as soon as I hit the water I hit transition and started to lose it. Seconds after, I felt a huge pop and my waters broke. (Great timing!) I managed to focus on the contractions, which were getting really intense.

About 10 mins after I started to feel the urge to push, my body just took over – this part always freaks me out, how the body just does things with no input.

With my last labor, the pushing had been very, very difficult, as I was on my back wired up to machines after having an epidural, and it took over 2 hours to get him out.

This time though, I was able to get right into a good position and let gravity help me. Still, I was nervous. I also tore badly last time and was worried about it happening again.

In the end though I just realized the faster I get him out the sooner the pain is over and just pushed along with my body. I knew he was coming soon. I could feel the infamous “ring of fire”.

Joana called the other midwife in. They got me to squat right in the center of the pool as low as I could and as he came out, they told me not to touch his head, as it might stimulate him to breathe. His head popped out and very soon after the rest of his body.

When they told me the time was right I brought him up to the surface and laid him on my chest. I remember thinking how soft his skin was and what a big boy! He didn’t even cry and soon pinked right up nicely.

Seamus weighed on at 8lbs, 4oz, born at 4.50am (45 minutes after reaching the hospital) on the 24th February 2007. Perfectly healthy.

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PregnancyWeekly.com

Raging hormones during pregnancy prompt mood swings, but may also lead to a heightened ability to recognize threatening or aggressive faces. This may have evolved because it makes future mothers hyper-vigilant, yet it could also make them more vulnerable to anxiety.

Previous studies have suggested that a woman's ability to correctly identify fearful or disgusted facial expressions varies according to her stage of the menstrual cycle, with perception heightened on days associated with high levels of the hormone progesterone. Since levels of progesterone and other hormones rise dramatically in late pregnancy, Rebecca Pearson and her colleagues at the University of Bristol in the UK investigated whether the ability to read faces varies during pregnancy.

They asked 76 pregnant women to assign one of six emotions to 60 computer-generated faces before the 14th week of pregnancy, and again after the 34th week. Faces expressing happiness and surprise tended to be correctly assigned at both stages of pregnancy, but for faces expressing fear, anger and disgust, the accuracy rates were higher in late pregnancy.

This may increase the chance that the woman will spot potential threats to her and her fetus, and prime her to be hyper-vigilant once she becomes a mother. But it could have a downside. Pearson points out that people with clinical anxiety are also better at identifying negative emotions in faces. Pregnant women aren't clinically anxious, but "they might interpret negative or emotional things around them in a slightly more sensitive way", she says.

The finding builds on a recent study by Ben Jones of the University of Aberdeen in the UK who found that pregnant women - and women in stages of the menstrual cycle where progesterone levels spike - are better at identifying faces showing signs of sickness. "It's preventing them from becoming sick by interacting with people who are ill," he says.

The next step will be to examine whether pregnant women and new mothers are also more sensitive to emotional cues in babies' faces, Jones says.

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PregnancyWeekly.com