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

Researchers say women who drink probiotic milk during and after pregnancy could reduce the chances their baby will develop eczema. Babies of women who drank probiotic milk beginning at week 36, and then during breast-feeding, were found to have almost half the incidence of eczema compared to babies whose mothers were given placebo milk.

The findings are part of a bigger project from the Norwegian University of Science and Technology (NTNU) called the Prevention of Allergy Among Children in Trondheim, or PACT, focused on childhood allergies that have been on the rise.

The researchers are also trying to find out if probiotic milk during pregnancy and breast-feeding could reduce the asthma in children but the study failed to find any benefit up to age 2.

Christian Kvikne Dotterud, a student in the Medical Student Research Programme at the Department of Community Medicine at NTNU explains, “The results showed that probiotic bacteria reduced the incidence of eczema in children up to age two years by 40 percent. And the kids in ‘probiotics group’, who did have eczema, had less severe cases.”

Past studies have shown that children who consume probiotics have fewer allergies. “Our study is the first to show that certain probiotic bacteria given to the mother during pregnancy and breast-feeding prevents eczema,” says Dotterud.

Included in the study were 415 pregnant women and their children who the Norwegian scientists followed until age 2. The researchers note the probiotics given to mothers during and after pregnancy were responsible for the 40 percent reduction in eczema seen in the children. Neither the mothers nor the researchers knew who was receiving probiotic milk and who was given placebo milk.

There has been some skepticism about giving probiotics to infants, leading the researchers to give it to the mothers instead. All of the women planned to breastfeed. The scientists say they believe probiotics have a "positive" effect on breast milk.

The type of bacteria added to the pregnant mothers’ milk was the Norwegian product Biola from Tine SA that contains LGG ®, Lactobacillus acidophilus (La-5) and Bifidobacterium lactis (Bb-12). Of the three probiotic types LGG ® is the most widely used on the market and the most studied for its health benefits. The study suggests the benefits of probiotics likely come from consuming a variety of strains, even those that have been less extensively studied.

The scientists plan to screen the children at age 6 to find out if probiotic milk consumed during pregnancy followed by breast-feeding reduces asthma as well as eczema. The study is part of an impetus to find interventions that can reduce allergies in children.

The current findings show that mothers of babies given probiotic milk during and after pregnancy reduced the incidence of eczema in their babies by 40 percent. The mothers drank one glass of probiotic milk a day during pregnancy and breast-feeding to reduce the chances of eczema in their babies.

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PregnancyWeekly.com

Indeed, occasional air travel is safe for healthy pregnant women, according to a new committee opinion issued by the American College of Obstetricians and Gynecologists.

That holds true even in the last month of pregnancy, although most doctors generally prefer that women stop air travel around 36 weeks in case they go into early labor, said Barth, chairman of ACOG's Committee on Obstetric Practice.

"Exercise normal precautions" by drinking lots of water, getting up and walking, wearing support stockings and keeping your seat belt fastened while seated, he advises soon-to-be moms who choose to fly. Because pregnant women are at increased risk of blood clots, these measures are "even more important," Barth said.

If your stomach has been on a roll during pregnancy, consider taking an anti-nausea pill before getting on a plane. Also, avoid consuming foods or drinks that can cause gas because gas will expand in your stomach at high altitudes.

Some airlines require a note from a doctor if a pregnant woman wants to travel up to a month before her due date. "It's not that flying is particularly dangerous at that time," Barth said. "It's that the probability of going into labor is higher," and airlines want to avoid that possibility.

If you have control over your schedule, traveling by plane in mid-pregnancy (14 to 28 weeks) is preferable because that's when the risks of miscarriage and premature labor are lowest, according to the Mayo Clinic.

The outlook is more restrictive for pregnant women with underlying medical issues such as heart disease or lung disease that could be exacerbated by air travel. They shouldn't fly at any point because of physiological changes — an increased heart rate, higher blood pressure and less oxygen in the blood — that take place at high altitude, the ACOG statement noted.

It updates a previous 2001 committee opinion with information from new studies that found air travel is generally safe for healthy pregnant women.

Also, air travel isn't recommended, even occasionally, for women who are at risk of premature labor or have other obstetric complications such as pregnancy-induced hypertension, Barth said.

He recollects a patient carrying twins who wanted to travel to London for an art show. In her 28th week of pregnancy, she thought she'd made plans far enough in advance to avoid any problems. But when the doctor examined her, her cervix was 2 centimeters dilated, a sign she might go into labor prematurely. The woman canceled her reservations and stayed home.

For pregnant women who travel constantly for work, flying can present a risk because of the exposure to cosmic radiation. This form of radiation comes from the sun and outer space and is more intense at higher altitudes. At one point it was thought the mother's body reduced a fetus's exposure to radiation; currently, this isn't believed to be the case, however.

Any passenger can calculate his or her exposure to cosmic radiation from a specific flight by visiting the Federal Aviation Administration's Web site http://tinyurl.com/cosmicrad.

Pregnant women who travel occasionally don't have to worry about radiation, even if they take long trips, the new ACOG statement said. Even the longest international flight will expose a passenger to no more than 15 percent of the recommended annual radiation limits.

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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

Life doesn't stop just because you're pregnant. So if you are leaving town for either work or pleasure during your pregnancy, follow these tips for a safe and comfortable trip:

The safest time to travel is between weeks 14 and 28 of your pregnancy, according to the American Congress of Obstetricians and Gynecologists.

Nausea and other discomforts common to the first trimester can make traveling uncomfortable, and unexpected medical situations are more likely to occur during the first and third trimesters.

Traveling by air

WHAT TO PACK: Snacks! Because most airlines don’t provide food, pack some balanced mini-meals to keep your blood-sugar levels steady. Try cheese and crackers, nuts or bags of fruit or veggies. Buy a bottle of water before boarding the plane to stay hydrated.

NEED-TO-KNOW: Most airlines allow pregnant woman to fly until their 36th week, although that standard varies by airline, and with international travel. Flying during the final weeks may require permission from your doctor. If you travel internationally, discuss immunizations with your doctor and bring along copies of relevant health records.

Occasional travelers need not worry about air pressure changes or cosmic radiation at high altitudes, according to the ACOG. Frequent fliers should consult their doctors. No studies yet exist on how full-body scanners might affect a fetus. However, American Pregnancy Association president Brad Imler says the X-rays are so weak they are unlikely to cause problems. He suggests requesting a physical scan by a female security agent if you are concerned.

BONUS TIPS: Choose an aisle seat to make restroom trips easier. Remember that airplane lavatories are small, so wear comfortable clothing. Stretch your legs periodically on longer flights, and remember to hold on to seat backs as you walk up and down the aisle. Unexpected turbulence creates a risk of falling.

Lengthy car travel

WHAT TO PACK: A pillow to help you sleep or maintain comfortable positions while confined to the car.

NEED-TO-KNOW: Never, ever skip your seat belt. Lap and shoulder belts are vital to protect both you and your baby. Lap belts should be worn below the belly, with the shoulder strap across the center of your chest and to the side of your stomach. Keep vehicle airbags turned on; the added safety benefits far outweigh any risks, according to the ACOG.

If you are driving, tilt the steering wheel up, away from your stomach, and keep the seat as far back as possible while being able to reach the foot pedals.

BONUS TIPS: Try to keep travel time to six hours or less. Sitting for more than four hours doubles the risk of deep vein thrombosis, or dangerous blood clots, according to the ACOG.

Being pregnant is an additional risk factor, so remember to stay hydrated and make frequent stops to stretch your legs.

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PregnancyWeekly.com

It is important that pregnant women see a physician more often than just to confirm their pregnancies and to have their babies delivered. Quality prenatal care by an established OB/GYN or nurse practitioner throughout the entirety of the pregnancy is the best way to monitor a baby's growth and to identify any problems or complications early on, before they become a health threat to the future mother or her unborn child. During these prenatal visits, a mother-to-be is also educated on how to care for herself during a healthy pregnancy, and also how to manage unique circumstances-such as gestational diabetes-that can emerge during pregnancy. Statistics show that women who make regular visits to health care providers during their pregnancy have healthier babies, are less likely to give birth prematurely, and are less likely to have other serious pregnancy-related issues. A pregnant woman's OB/GYN will often refer her and her partner to helpful support groups or Lamaze classes. These health care practitioners also connect low-income pregnant women with referrals to much-needed government services, such as WIC.

During a normal, low-risk pregnancy, it is recommended that a woman make prenatal visits about once a month during her first 28 weeks; twice a month from week 28 to week 36; and up to once a week after week 36, according to helpful information compiled by the March of Dimes. Those with higher-risk pregnancies may need to make more frequent visits with their doctor.

Knowing the approximate due date is another reason prenatal visits are useful because this helps women determine how much time they will have to prepare for a new baby. Prenatal visits also provide an opportunity to receive an ultrasound to determine the sex of the baby after it has reached the appropriate point of development.

The education a woman receives about pregnancy and childbirth during prenatal visits is invaluable. Women will learn the important role prenatal vitamins play in the healthy development of the baby, how to manage their weight during pregnancy, and answer any tricky questions they may have about their pregnancy. Topics a pregnant woman may want to discuss with a health care practitioner during a prenatal visit might include: sexual activity during pregnancy, exercise during pregnancy, the risk factors associated with being pregnant as a teen or older adult, what changes to expect in your body during pregnancy, and how to manage discomfort during pregnancy.

This guest post is contributed by Jennifer Johnson, who writes on the topics of NP Schools. She welcomes your comments at her email Id: j.johnson19june@gmail.com.

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PregnancyWeekly.com

Regular exercise during pregnancy doesn't change a mother's body weight but does lead to a small reduction in the baby's weight, a new study shows.

The findings are important because larger birth size is associated with higher risk for childhood obesity.

In a randomized trial of 84 first-time mothers, participants were assigned to either an exercise or a control group. Exercisers rode stationary bikes for 40 minutes, five days a week, while the other women just maintained their regular activity. The women began exercising in the 20th week of pregnancy and continued until at least week 36.

The exercise didn’t make any difference in the mother’s weight compared to mothers who weren’t exercising. But among mothers who didn’t exercise, their babies were an average of five ounces heavier than babies born to women who exercised during pregnancy. There also was no difference in the average length of the babies, according to the study published in the Journal of Clinical Endocrinology and Metabolism.

The study shows that moderate, regular aerobic exercise can have a meaningful effect on a baby’s birth weight without putting the pregnancy or child at risk.

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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

Omega-3 fatty acid supplements are believed to have many health benefits, but the one thing they can't do is help women with a history of delivering their babies early carry their next child to full term, new research finds.

"The omega-3 did not add any benefit," said study author Dr. Margaret Harper, an associate professor of obstetrics and gynecology at Wake Forest University School of Medicine, Winston-Salem, NC. The study appears in the February issue of Obstetrics & Gynecology.

Harper and her colleagues randomly assigned 852 pregnant women with a history of a preterm birth either to get a daily omega-3 supplement or a placebo beginning about week 16 to 22 and continuing through week 36 of gestation.

All women also received weekly intramuscular hormone injections of hydroxyprogesterone caproate, which has been shown to improve the chances of carrying a baby to term, Harper said.

Her team followed up to see which women delivered before 37 weeks. Full-term is defined as 37 weeks of completed gestation.

Delivery before 37 weeks occurred in 37.8 percent of those taking omega-3, and 41.6 percent of those in the placebo group, a small difference.

Prematurity is the leading cause of newborn death, the authors write in the report, and it is increasing in the United States. A woman who delivers one baby before term is more likely to deliver future babies early.

Harper's team decided to study the value of the omega-3 supplements after conflicting findings about the value of the supplements for women at high risk of premature delivery. For those at low-risk, she said, the findings seem to agree that omega-3 supplements don't further reduce the risk of preterm birth.

A recent large review of published studies found only one that showed benefit of the supplements in high-risk women, she said.

According to Harper, omega-3 fatty acids, when metabolized, are converted to much less potent biochemicals called prostaglandins, which make the uterus contract, than are omega-6 fatty acids -- also essential fatty acids but typically over-eaten in Western diets. Adding omega-3s to an omega-6-heavy diet, so the thinking went, might result in better chances of carrying the baby to term.

Omega-3 supplements, in other research, have been found to help heart health, to lower blood pressure and to reduce the risk of abnormal heartbeats.

But in Harper's study, she also noted that women getting omega-3 supplements were more likely to give birth to a baby with respiratory distress syndrome (RDS). While 59 babies (13.9 percent) of those in the omega-3 group had RDS, only 35 (8.7 percent) of those in the placebo group did. In other words, the omega-3 mothers' babies were 1.6 times more likely to get RDS than infants born to mothers taking placebo. It's the first time such a finding has been reported in clinical trials, the authors wrote.

"While the study's results showed no difference, there is early evidence that omega-3 fatty acids are beneficial for fetal brain development, so women should still consider taking them, in conjunction with their doctor's advice, despite what seems to be little benefit for the reduction of spontaneous preterm birth."

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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