Scientists have found that the first stools that a baby passes after being born can actually be used to determine how much their mother smoked, or if she was exposed to tobacco smoke during pregnancy.

Meconium is a dark and tarry stool passed by a baby during the first few days after birth.

Researchers measured tobacco smoke metabolites in meconium samples from 337 babies, finding that they correlated well with reported smoke exposure and other markers of tobacco smoke exposure.

Joe Braun, from the University of North Carolina-Chapel Hill, USA, worked with a team of researchers to carry out the study.

"Prenatal active and secondhand tobacco smoke exposure is a prevalent environmental exposure that is associated with adverse infant and childhood health outcomes. Biomarkers of exposure, like serum and meconium tobacco smoke metabolites, are useful to enhance the measurement of tobacco smoke exposure, which is often under-reported," he said.

The researchers found that tobacco smoke metabolites in meconium reflected the duration and intensity of gestational exposure to tobacco smoke.

Concentrations were higher and almost universally detected among infants born to active smokers compared to women with secondhand or no exposure.

Speaking about further applications of this research, Braun said, "Although meconium was not superior to serum as a biomarker of tobacco smoke exposure, it may be useful to estimate gestational exposure to other environmental toxicants that exhibit more variability during pregnancy, especially non-persistent compounds like bisphenol A and phthalates".

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PregnancyWeekly.com

Pregnant women subjected to passive smoking give birth to babies with an increased, lifelong susceptibility to cancer, research reveals.

Passive smoking causes the same type of genetic damage in unborn infants as that found in adult smokers with cancerous tumors.

Researchers said the abnormalities in newborns were indistinguishable from those found in babies of mothers who were active smokers.

And they may affect survival, birth weight and lifelong susceptibility to diseases like cancer, according to the study published online in the Open Paediatric Medicine Journal.

Dr Stephen Grant and colleagues at the University of Pittsburgh in the U.S. found a smoke-induced mutation in an oncogene, a gene which transforms normal cells into cancerous tumors.

The mutation was the same level and type in newborns of mothers who were active smokers as those in babies born to non-smoking mothers exposed to tobacco smoke.

The mutations were also discernible in newborns of women who had stopped smoking during their pregnancies, but who did not actively avoid second-hand smoke.

The study confirms previous research in which Dr Grant discovered evidence of genetic abnormalities in babies whose mothers were exposed to environmental tobacco smoke.

There is also evidence that maternal exposure to passive smoke, as well as a history of paternal cigarette smoke exposure, is linked with an increased risk of childhood cancer, especially leukaemias and lymphomas in children under five.

Dr Grant said: 'These findings back up our previous conclusion that passive, or secondary, smoke causes permanent genetic damage in newborns that is very similar to the damage caused by active smoking.

'By using a different laboratory test, we were able to pick up a completely distinct yet equally important type of genetic mutation that is likely to persist throughout a child's lifetime.

'Pregnant women should not only stop smoking, but be aware of their exposure to tobacco smoke from other family members, work and social situations.'

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Mothers who smoke during pregnancy are more likely to have children with sleep problems from birth all the way through age 12, new research shows.

"The more cigarettes that mothers smoked during pregnancy, the more sleep problems the children had," Dr. Kristen Stone of Women and Infants Hospital in Providence, Rhode Island, one of the study's authors, told Reuters Health.

What's more, while most of the women who smoked during pregnancy used at least one other drug, Stone and her team found that nicotine was the only substance associated with sleep problems.

Stone and colleagues from centers in Miami, Detroit, and Memphis are following nearly 1,400 children born in 1993, 1994 or 1995 to investigate the long-term effects of exposure to substances during pregnancy.

The current study included children for whom data was available up to age 12. Among the 808 study participants, 374 had been exposed to cocaine or opiates such as heroin before birth, while 434 had not.

Children's mothers or other caregivers reported on whether a child had difficulty falling asleep and staying asleep during three periods: one month to four years of age; five to eight years, and nine to 12 years. Being exposed to cocaine, opiates, marijuana, or alcohol in the womb had no effect on a child's risk of having sleep problems, but nicotine did, and problems were seen at each of the three time points.

The researchers do not report what percentage of children had sleeping problems, but used a common measure of such problems that assigns points for items such as talking in one's sleep, sleepwalking, and having trouble falling asleep.

The link remained even after the researchers took into account factors such as socioeconomic status, whether or not a child had been abused, and whether the mother or caregiver smoked after the child was born.

The findings shouldn't be seen as showing that prenatal use of alcohol and drugs aside from cigarettes isn't as harmful to a child's sleep as smoking in pregnancy, Stone noted. Cigarettes are different from other substances, she explained, in that a person who smokes will typically do so much more frequently than a drug abuser uses cocaine or opiates.

Further, she said, many of the mothers in the study were using multiple substances while they were pregnancy. "When those substances are inside of us at the same time, they basically become a whole new substance because of their interactions with each other," she added. All of this makes it difficult to tease out the effects of nicotine and other drugs, according to the researcher.

When a child does have sleep problems, Stone said, "early and careful attention" to these issues can go along way toward helping that child sleep better.

"Even an emphasis on basic behavioral sleep education could serve those children well," she added. "Doing that would then likely improve the daytime experience for those children as well."

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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

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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Smoking while pregnant increases the chance of eye problems and low fertility counts in babies, according to two separate scientific studies.

Dr. Tobias Torp-Pedersen and his team of researchers at the Statens Serum Institut in Copenhagen, Denmark found that smoking while pregnant increased the risk of strabismus, a condition in which the eyes are unable to align evenly.

Dr. Torp-Pedersen said that little is known about the origin of the condition, but theorized that chemical disturbance could yield degeneration in the eye muscles and nerves. “Nicotine and other substances in tobacco, alcohol and caffeine all affect the brain in some way,” said Dr. Torp-Pedersen. “Minor disturbances to the developing brain could plausibly lead to strabismus.”

The team reviewed 1,300 cases of strabismus in children born between 1996 and 2003 using data from the Danish National Birth Cohort. Included in the data were interviews with the children’s mothers during and after pregnancy.

“We were able to show that each extra cigarette smoked per day during pregnancy exerted a 5 percent increase in strabismus risk, which is a new finding,” Torp-Pedersen told Reuters Health.

In a second, unrelated study, Professor Richard Sharpe of the Queen’s Medical Research Institute in Edinburgh performed a comprehensive review of numerous medical studies on the effects chemicals and obesity have on the sperm production of male babies.

Sharpe found that a mother’s smoking habits while pregnant had much more of an impact on a male’s sperm production than cigarette exposure outside the womb, later in life. He theorizes that the risk is greater in the womb because toxins in the blood stream reduces the number of sertoli cells, highly specialized cells needed to support the growth of young sperm all the way through to a man’s adult life.

Sharpe was skeptical, however, about how much any individual chemical in the womb contributes to poor sperm development. He did suggest that large “cocktails” of a variety of chemicals may have a combined effect, but more research was required he said.

Dr. Allan Pacey, a Sheffield University expert in male fertility, told the Daily Mail: “This review reminds us that the sperm production capacity of men is probably established quite early in life and perhaps even before they are born. This highlights the importance of women having healthy pregnancies and not exposing their baby to harmful chemicals, such as cigarette smoke.”

Dr. Torp-Pedersen’s research appears in the March issue of American Journal of Epidemiology, while Professor Sharpe’s work appears in the upcoming May 27 issue of Philosophical Transactions of the Royal Society B.

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Couples who conceive through certain types of infertility treatment may have a higher-than-normal likelihood of having a premature baby, a new study suggests.

Danish researchers found that among more than 20,000 women who gave birth at their hospital between 1989 and 2006, those who had conceived through in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) had a higher risk of preterm delivery.

Of the 730 babies born to women who underwent IVF or ICSI, nearly 8 percent were premature and 1.5 percent were very premature -- born before the 32nd week of pregnancy. A normal pregnancy lasts 40 weeks.

In comparison, roughly 5 percent of babies born to fertile mothers were premature, and 0.6 percent were born very preterm, the researchers report in the journal Fertility and Sterility.

When the researchers accounted for factors like the mother's age, weight and exposure to cigarette smoking, the IVF and ICSI procedures were still linked to a 53 percent greater risk of preterm delivery and a doubling in the odds of very premature birth.

Other forms of fertility treatment -- namely, fertility drugs and insemination -- were not related to the risk of preterm delivery.

Nor was the higher risk with IVF and ICSI explained by elevated rates of twin or higher-order births. The study included only singleton births.

Together, the researchers say, the findings suggest that something about the IVF and ICSI procedures themselves might raise the odds of preterm birth.

Both IVF and ICSI involve joining a woman's egg and a man's sperm in a lab dish, then -- if fertilization is successful -- transferring one or more embryos to the woman's uterus. ICSI is typically used for male fertility problems, including a low sperm count or poor sperm quality. It involves isolating a single sperm and injecting it directly into the egg.

"The IVF/ICSI procedures include hormone stimulation and mechanical procedures. Both of these factors may influence the risk of preterm delivery," lead researcher Dr. Kirsten Wisborg, of Aarhus University Hospital in Denmark, told Reuters Health in an email.

The fact that other forms of fertility treatment were not linked to preterm delivery suggests that infertility itself is not to blame, according to Wisborg. However, she pointed out, couples who undergo IVF or ICSI may have a different "reproductive pathology" than those who conceive via fertility drugs or insemination, as they frequently have been infertile for a longer period and have failed to conceive through those "low-tech" fertility treatments.

There may also be other factors, unmeasured in this study, that put women who undergo IVF or ICSI at greater risk of preterm delivery, Wisborg said.

Another possibility, Wisborg said, has to do with the "vanishing twin" phenomenon. Some of the singleton births to women who underwent IVF or ICSI may have begun as a twin pregnancy, with only one fetus surviving beyond the early stages. Research suggests that these surviving fetuses are at increased risk of preterm delivery and low birth weight.

The most important factor in reducing preterm birth risk with IVF or ICSI is to avoid higher-order pregnancies, according to Wisborg. But women can also lower the risk, she said, by not smoking and avoiding alcohol during pregnancy.

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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

Black women are at significantly increased risk for developing a potentially deadly weakening of the heart muscle around the time of childbirth, researchers report.

A study examining the incidence of peripartum cardiomyopathy in women who gave birth at a Medical College of Georgia's teaching hospital between July 2003 and July 2008, showed that while 55 percent of the women were white, 93 percent of those who developed cardiomyopathy were black, said Dr. Mindy B. Gentry, an MCG cardiologist.

"When it hits, it's totally unexpected because these are young, otherwise healthy women with young children. (They aren't patients) you'd expect to have any sort of health problem much less heart failure," Dr. Gentry said.

Other risk factors include hypertension, being unmarried, smoking during pregnancy and having more than two previous pregnancies, but African-American race was the most important predictor, said Dr. Gentry, corresponding author on the study published in the Journal of the American College of Cardiology.

Two previously published studies from Haiti and South Africa found a higher incidence of peripartum cardiomyopathy than in other parts of the world but essentially all the participants were black. The heterogeneous population giving birth at MCGHealth Medical Center made it easier to assess the effect of race, Dr. Gentry noted.

Further research is needed to identify potential environmental and/or genetic factors associated with African descent that explain the increased risk, the researchers said. They have begun follow up studies looking for any racial differences in healthy hearts following delivery, such as how much blood is ejected with each beat.

Peripartum cardiomyopathy typically occurs in the last month of pregnancy or the first few months after delivery. Symptoms include shortness of breath, particularly when lying down, as excess fluid congests the lungs and the rest of the body. The suffocating backlog is caused by an enlarged, stiff heart muscle that no longer pumps efficiently.

Drugs can improve pumping efficiency. About half the time, the condition spontaneously reverses but it can cause debilitation and death, with mortality rates ranging from 15-56 percent. Of the 28 women with peripartum cardiomyopathy in the MCG study, one patient died and another required a heart transplant.

In every pregnancy, the blood volume increases about 50 percent to accommodate increased demands from the placenta and baby. Heart rate increases to help circulate the extra blood, Dr. Gentry said. Black women also are at increased risk for abnormal increases in blood pressure, called preeclampsia, that can occur late in pregnancy.

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PregnancyWeekly.com

Black women are at significantly increased risk for developing a potentially deadly weakening of the heart muscle around the time of childbirth, researchers report.

A study examining the incidence of peripartum cardiomyopathy in women who gave birth at a Medical College of Georgia's teaching hospital between July 2003 and July 2008, showed that while 55 percent of the women were white, 93 percent of those who developed cardiomyopathy were black, said Dr. Mindy B. Gentry, an MCG cardiologist.

"When it hits, it's totally unexpected because these are young, otherwise healthy women with young children. (They aren't patients) you'd expect to have any sort of health problem much less heart failure," Dr. Gentry said.

Other risk factors include hypertension, being unmarried, smoking during pregnancy and having more than two previous pregnancies, but African-American race was the most important predictor, said Dr. Gentry, corresponding author on the study published in the Journal of the American College of Cardiology.

Two previously published studies from Haiti and South Africa found a higher incidence of peripartum cardiomyopathy than in other parts of the world but essentially all the participants were black. The heterogeneous population giving birth at MCGHealth Medical Center made it easier to assess the effect of race, Dr. Gentry noted.

Further research is needed to identify potential environmental and/or genetic factors associated with African descent that explain the increased risk, the researchers said. They have begun follow up studies looking for any racial differences in healthy hearts following delivery, such as how much blood is ejected with each beat.

Peripartum cardiomyopathy typically occurs in the last month of pregnancy or the first few months after delivery. Symptoms include shortness of breath, particularly when lying down, as excess fluid congests the lungs and the rest of the body. The suffocating backlog is caused by an enlarged, stiff heart muscle that no longer pumps efficiently.

Drugs can improve pumping efficiency. About half the time, the condition spontaneously reverses but it can cause debilitation and death, with mortality rates ranging from 15-56 percent. Of the 28 women with peripartum cardiomyopathy in the MCG study, one patient died and another required a heart transplant.

In every pregnancy, the blood volume increases about 50 percent to accommodate increased demands from the placenta and baby. Heart rate increases to help circulate the extra blood, Dr. Gentry said. Black women also are at increased risk for abnormal increases in blood pressure, called preeclampsia, that can occur late in pregnancy.

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