Overweight and obese women are at greater risk of giving birth to a preterm baby compared with normal weight women, finds a study published online in the British Medical Journal.

The authors believe that overweight and obese women should have counseling before pregnancy so that they are aware of these risks and can try to modify their weight before pregnancy. They also stress the need for appropriate surveillance by health professionals during pregnancy.

Overweight and obesity is now the most common pregnancy complication in many developed countries and also some developing countries. For example, in the United Kingdom, 33% of pregnant women are overweight or obese. In India, 26% of pregnant women are overweight and a further 8% are obese, while in China, 16% are overweight or obese.

Preterm birth and low birth weight are the leading causes of infant death and illness throughout childhood. However, there is still uncertainty about the impact of a mother's weight on both preterm birth and low birth weight.

So a team of researchers in Canada analyzed the results of 84 studies to assess the effect of maternal weight on preterm birth (before 37 weeks) and low birth weight (below 2500g) in singleton pregnancies in both developed and developing countries.

They found that the overall risk of preterm birth before 37 weeks was not significantly different among overweight or obese women compared with normal weight women.

However, there was a 30% increased risk of induced preterm birth before 37 weeks among overweight or obese women after accounting for publication bias, which is the tendency for studies to be published only if their results are positive. The heavier the woman, the higher the risk of induced preterm birth before 37 weeks, with very obese women at 70% greater risk than normal weight women.

Overweight or obese women also had a higher risk of early preterm birth (before 32 or 33 weeks). Again, the heavier the woman, the higher the risk of early preterm birth, with very obese women at 82% greater risk than normal weight women.

Although overweight or obese women had a lower risk of delivering a low birth weight baby than normal weight women, especially in developing countries, this effect disappeared after publication bias was taken into account. "Clinicians need to be aware that maternal overweight or obesity is not protective against low birth weight and consider surveillance when indicated," warn the authors.

"Ideally, overweight or obese women should have pregnancy counseling so that they are informed of their perinatal risks and can try to optimize their weight before pregnancy," they conclude.

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PregnancyWeekly.com

Pregnant teenagers are more likely to give birth prematurely and have a small baby than women in their 20s, says an Irish research team.

Fourteen to 17-year-olds were also more likely to give birth early if they were having a second child, a study of more than 50,000 women in England found.

The findings, reported in BMC Pregnancy and Childbirth, highlighted the importance of routine medical checks.

The team said more studies were needed to find out why the young were at risk.

The study included all women aged between 14 and 29 who had given birth in north-west England over a two-year period.

In all, 3,600 of those were aged between 14 and 17, the researchers said.

More than a third of them came from the most socially deprived areas.

The study also found teenage mothers were also more likely to be underweight.

Those aged under 17 were 21% more likely to have a premature baby with their first pregnancy and 93% more likely to have their second baby early.

There was also a link with younger mothers and having a baby with a low birth weight.

Researcher Dr Ali Khashan, from University College Cork, in the Republic of Ireland, said it might be that the risk of premature birth in the young teenagers was related to "biological immaturity".

"It is also possible that the increased risk of poor pregnancy outcome in the second teenage pregnancy is related to numerous complicating factors such as greater social deprivation and less prenatal care," he added.

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A new study confirms that children conceived via infertility treatment may have a higher-than-average risk of cerebral palsy -- explained largely by their higher rates of multiple births and preterm delivery.

The study, of nearly 590,000 children born in Denmark between 1995 and 2003, found that those conceived through assisted reproduction were about twice as likely to be diagnosed with cerebral palsy as children who were conceived naturally.

The findings, reported in the journal Human Reproduction, confirm those from a number of past studies. They also suggest that the increased risk of cerebral palsy can be largely attributed to the heightened odds of twin or higher-order births, as well as preterm delivery, with assisted reproduction.

However, the absolute risk of having a baby with cerebral palsy is still quite low for couples undergoing infertility treatment.

In the U.S. and Europe, it's estimated that two or three of every 1,000 babies are affected by the disorder. So even with a relatively increased risk, the vast majority of children born via assisted reproduction techniques will not have cerebral palsy.

Still, researchers say their findings offer an argument for implanting women with only one embryo at a time, in order to cut the odds of multiple births and preterm delivery.

Cerebral palsy refers to a group of conditions, usually present at birth, that permanently impair movement, balance and posture. The impairments range from mild -- some children have only relatively minor problems with movement -- to more severe, with some children being unable to walk or having additional impairments, such as mental retardation or vision and hearing problems.

The precise cause of cerebral palsy is unknown, but it is believed to involve a disruption in normal fetal brain development. Premature and low-birthweight infants are known to have a higher risk than full-term, normal-weight babies.

For the new study, researchers led by Dr. Dorte Hvidtjorn, of the University of Aarhus in Denmark, examined national data on all 588,967 children born in the country between 1995 and 2003. That included 33,139 children conceived via in-vitro fertilization (IVF) or with the help of fertility drugs to stimulate the ovaries to produce eggs.

Overall, 0.2 percent of all children were diagnosed with cerebral palsy. The risk was more than doubled among children in the IVF group, and 55 percent higher among those conceived using fertility drugs, compared with children conceived naturally.

When the researchers factored in the effects of multiple births and preterm delivery, the link between fertility treatment and cerebral palsy disappeared -- indicating that those two factors are likely responsible for the connection.

In fact, the researchers found no increased risk of cerebral palsy among singletons born via IVF.

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Pregnant Muslim women who fast during Ramadan are likely to have smaller babies who are more prone to learning disabilities, a new study has found.

Researchers from the U.S. said this trend was most marked if mothers-to-be fasted early on in their pregnancy and during the summer when longer days meant they went more hours without food.

They also found that the women were 10 per cent less likely to give birth to a boy if they had fasted.

Ramadan is the ninth month of the Islamic calendar and a time when Muslims across the world fast from dawn until sunset.

Fasting during Ramadan is one of the five pillars of Islam and many women may fear a loss of connection with their communities if they did not observe it.

Women who request an exemption from fasting are expected to make up the days they have missed after their baby is born.

The study was based on census data from the US, Iraq and Uganda. It also revealed that the long-term effects on the adult's health impacted on their future economic success.

Study author Douglas Almond, of Columbia University said: 'We generally find the largest effects on adults when Ramadan falls early in pregnancy.

'Rates of adult disability are roughly 20 per cent higher, with specific mental disabilities showing substantially larger effects.'

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Studies have shown fathers who are active in their children's upbringing can significantly benefit their children's early development, academic achievement and well being. Now, a new study by University of South Florida researchers suggests that a father's involvement before his child is born may play an important role in preventing death during the first year of life - particularly if the infant is black.

The USF team sought to evaluate whether the absence of fathers during pregnancy contributes to racial and ethnic disparities in infant survival and health. Their findings were recently reported online in the Journal of Community Health.

"Our study suggests that lack of paternal involvement during pregnancy is an important and potentially modifiable risk factor for infant mortality," concluded the study's lead author Amina Alio, PhD, research assistant professor of community and family health at the USF College of Public Health. "A significant proportion of infant deaths could be prevented if fathers were to become more involved."

The researchers examined the records of all births in Florida from 1998 to 2005 – more than 1.39 million live births. Father involvement was defined by the presence of the father's name on the infant's birth certificate. While this measure does not assess the extent or quality of a father's involvement during pregnancy, other studies have established a link between paternal information on a birth record and prenatal paternal involvement.

Among the study's findings:

• Infants with absent fathers were more likely to be born with lower birth weights, to be preterm and small for gestational age.
• Regardless of race or ethnicity, the neonatal death rate of father-absent infants was nearly four times that of their counterparts with involved fathers.
• The risk of poor birth outcomes was highest for infants born to black women whose babies' fathers were absent during their pregnancies. Even after adjusting for socioeconomic differences, these babies were seven times more likely to die in infancy than babies born to Hispanic and white women in the same situation.
• Obstetric complications contributing to premature births, such as anemia, chronic high blood pressure, eclampsia and placental abruption, were more prevalent among women whose babies' fathers were absent during pregnancy.
• Expectant mothers in the father-absent group tended to be younger, more educated, more likely to never have given birth, more likely to be black, and had a higher percentage of risk factors like smoking and inadequate prenatal care than mothers in the father-involved group.

Paternal support may decrease the mother's emotional stress, which has been linked to poor pregnancy outcomes, or promote healthy prenatal behavior, Dr. Alio suggested. For instance, some studies, including USF's, indicate that pregnant women with absent partners are more likely to report smoking during pregnancy and get inadequate prenatal care. Barriers to expectant fathers' involvement in the lives of their pregnant partners, including issues like unemployment, relationship status, and participation in prenatal visits, must be examined to increase the role of men during pregnancy, she said.

Improving the involvement of expectant fathers holds promise for reducing costly medical treatments for the complications of premature births as well as reducing infant mortality rates, particularly in black communities, Dr. Alio said. "When fathers are involved, children thrive in school and in their development. So, it should be no surprise that when fathers are present in the lives of pregnant mothers, babies fare much better."

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PregnancyWeekly.com

It is the perfect excuse for mothers-to-be to unplug the vacuum and abandon the washing up - housework could be bad for baby.

Research suggests the 'boring and repetitive' nature of household chores raises the odds of giving birth prematurely.

Exercise, however, is good for both mother and unborn child.

Researchers asked almost 12,000 new mothers how much they had exercised during pregnancy – including housework.

The women were also asked about their jobs, the weight of their babies and whether they were born early.

And the information showed that mentally unstimulating work, including doing jobs around the house day-in day-out, increased the chances of giving birth at least three weeks early by up to 25 per cent.

Although it isn't clear why, researchers think it may be that boring tasks increase levels of stress hormones involved in triggering labor.

The study, published in the journal Perinatal Epidemiology, also threw up some other interesting results.

For instance, women who work night shifts seem to have slightly heavier babies.

Again it isn't clear why, but may simply be that those who work through pregnancy are healthier in general.

The research also showed sedentary lifestyles raised the odds of having an underweight baby, while strenuous exercise did no harm to either mother or baby.

Researcher Hajo Wildschut, of Erasmus University in Rotterdam, said: 'Pregnancy is not a disease. 'In fact, most women who are pregnant are healthy and most of them are being delivered of perfectly healthy babies.

'Women who are healthy and do not have pregnancy complications should not restrict their activities in order to achieve a better pregnancy outcome. They may safely continue their normal daily physical activities, including strenuous activities like jogging, squash and weight training even until late in pregnancy.'

The Royal College of Obstetricians and Gynaecologists says that in most cases exercise in pregnancy is safe.

Mothers-to-be are advised to avoid contact sports, cycling, ice-skating and horse-riding.

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PregnancyWeekly.com

Pregnant women who down six coffee cups' worth of caffeine every day may have smaller babies than those who consume less caffeine, a new study finds.

Researchers found that among more than 7,300 Dutch women followed from early pregnancy onward, between 2 and 3 percent said they consumed the caffeine equivalent of six cups of coffee per day during any trimester. On average, their babies' length at birth was slightly shorter than that of newborns whose mothers had consumed less caffeine during pregnancy.

Heavy caffeine consumers also had an increased risk of having a baby who was small for gestational age -- smaller than the norm for the baby's sex and the week of pregnancy during which he or she was born.

That finding, however, was based on a small number of babies, and the significance is uncertain. Of 104 infants born to women with the highest caffeine intakes, seven were small for gestational age.

The findings, reported in the American Journal of Clinical Nutrition, add to the conflicting body of research into whether caffeine during pregnancy affects fetal growth.

Some studies, for instance, have linked regular caffeine consumption during pregnancy -- even a relatively modest one or two cups of coffee a day -- to an increased risk of low birth weight. But other studies have found no such effects. Researchers have also come to conflicting conclusions as to whether caffeine affects the risk of miscarriage.

In this latest study, Rachel Bakker and colleagues at Erasmus Medical Center in Rotterdam used ultrasound scans to monitor fetal growth over the course of pregnancy in 7,346 women.

At each trimester, the women reported on their usual intake of coffee and tea. Most women consumed less than the equivalent of four cups of coffee per day at any point in pregnancy, but between 2 and 3 percent downed six or more cups' worth of caffeine.

Overall, babies born to heavy caffeine consumers were slightly shorter, on average, at birth and during all three trimesters of fetal development, based on the ultrasound tests.

"Caffeine intake seems to affect length growth of the fetus from the first trimester onwards," Bakker told Reuters Health in an email.

The implication, she said, is that pregnant women should not consume more than six cups of coffee per day. However, the findings also do not mean that less coffee is generally "safe" during pregnancy.

"We only studied the effect of caffeine on fetal growth," Bakker said. "Future studies on possible other effects of maternal caffeine intake are therefore needed."

Given the uncertainty about whether and how caffeine might affect pregnancy and fetal development, experts generally recommend that to be safe, pregnant women limit their intake.

The March of Dimes, for example, suggests that, based on research into miscarriage risk, pregnant women get no more than 200 milligrams of caffeine per day -- roughly the amount in 12 ounces of coffee.

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PregnancyWeekly.com

Taking common blood pressure drugs while pregnant significantly increases the chances of having hyperactive children, a new study shows.

Reduced blood flow to the baby while in the womb could be to blame, researchers believe.

However, experts warn that the benefits of the drugs, which can prevent women from suffering a stroke or even dying, far outweigh the risks.

Around one in every 14 women will develop raised blood pressure during pregnancy.

The condition can be extremely serious, both for mothers-to-be and their unborn children.

As well as a chance of stroke, complications can include kidney damage and preeclampsia, a dangerous illness which if left unchecked can cause seizures and even death.

Drugs commonly used to treat raised blood pressure in pregnant women include labetalol and methyldopa.

But researchers found that labetalol was linked to a fourfold increase in the risk of a child developing attention-deficit hyperactivity disorder (ADHD), compared to children whose mothers had been prescribed bed rest.

Those whose mothers were given methyldopa were more than four times more likely to have sleeping problems than those in the bed rest group.

The study looked at 202 children when they were between four and 10 years of age.

A previous study which found that labetalol was linked to smaller than average babies suggested that reduced blood flow through the placenta could be to blame.

The Royal College of Obstetricians and Gynaecologists (RCOG) described the findings as “speculative”.

“This study is interesting but it does not mean that pregnant women suffering from hypertension should be all prescribed with bed rest. Indeed, there may be serious consequences for the woman if timely drug treatment isn’t provided.”

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PregnancyWeekly.com

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

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

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

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

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

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

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

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

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

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

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PregnancyWeekly.com

Pregnant women are three times more likely to suffer from severe morning sickness if their mothers did, say Norwegian researchers,

Around 2% of women suffer excessive nausea and vomiting in pregnancy - known as hyperemesis gravidarum - which can require hospital treatment.

But a study of 2.3 million births showed a threefold higher rate in those whose mothers had the condition.

Experts said the results could help women better understand their risk.

Hyperemesis is defined as excessive sickness which starts before the 22nd week of pregnancy and in its most serious form it can lead to dehydration and weight loss because women cannot keep food or water down.

It can be extremely debilitating, women can't work, can't look after their families and they need to be admitted to hospital.

It is the most common cause of admission to hospital in early pregnancy and can be a cause of low birth weight and premature birth.

The researchers said that previous studies have attributed the condition to "psychological causes".

They analyzed birth records, which included information on pregnancy complications, from 1967 to 2006.

It found the daughters of women who had the condition during their pregnancy had a 3% risk compared with 1% in those whose mothers did not have it.

But there was no increased risk to the female partners of sons whose mothers had suffered from the illness.

The researchers said although the results suggest a genetic link between mothers and daughters, it is also possible that there are lifestyle or environmental factors shared between mother and daughter that increase the risk.

Dr Catherine Nelson-Piercy, a consultant obstetric physician at Guy's and St Thomas' Foundation Trust in London, said that better understanding of the genetic risks of hyperemesis may help clinicians when counseling women about the risk of recurrence in future pregnancies.

She said many women were undertreated because of the legacy of thalidomide - a drug given for morning sickness in the 1960s which caused birth defects - despite the availability of safe drugs.

"It is safe to take anti-sickness drugs and it's better for the baby and the pregnancy to treat this condition than let the woman get very severely ill and risk complications."

Patrick O'Brien, spokesman for the Royal College of Obstetrics and Gynaecology, said the study added to growing evidence that many conditions in pregnancy, such as diabetes or high blood pressure, were linked to a "genetic predisposition".

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