Trusted Information for Healthy Pregnancies
asthma
Wanted: Volunteers, All Pregnant
Feb 16th
The woman sent by government scientists visited the Queens apartment repeatedly before finding anyone home. And the person who finally answered the door - a 30-year-old Colombian-born waitress named Alejandra - was wary.
Although Alejandra was exactly what the scientists were looking for - a pregnant woman - she was "a bit scared," she said, about giving herself and her unborn child to science for 21 years.
Researchers would collect and analyze her vaginal fluid, toenail clippings, breast milk and other things, and ask about everything from possible drug use to depression, At the birth, specimen collectors would scoop up her placenta and even her baby’s first feces for scientific posterity.
She ultimately decided that participating would “help the next generation.”
Chalk one up for the scientists, who for months have been dispatching door-to-door emissaries across the country to recruit women like Alejandra for an unprecedented undertaking: the largest, most comprehensive long-term study of the health of children, beginning even before they are born.
Authorized by Congress in 2000, the National Children’s Study began last January, its projected cost swelling to about $6.7 billion. With several hundred participants so far, it aims to enroll 100,000 pregnant women in 105 counties, then monitor their babies until they turn 21.
It will examine how environment, genes and other factors affect children’s health, tackling questions subject to heated debate and misinformation. Does pesticide exposure, for example, cause asthma? Do particular diets or genetic mutations lead to autism?
But while the idea is praised by many experts, the study has also stirred controversy over its cost and content.
In August, the Senate committee overseeing financing for the study accused it of “a serious breach of trust” for not disclosing that the initial price tag of $3.1 billion would more than double, and said the study needed to release more information if it wanted to get “any” financing in the next budget year.
And an independent panel of experts and some members of the study’s own advisory committee say it misses important opportunities to help people and communities — emphasizing narrower medical questions over concerns like racial and ethnic health differences, leaving unresolved crucial ethical questions concerning what to tell participants and communities about test results.
“This study is of the magnitude of the accelerator in CERN, or a trip to the moon — a really big science issue,” said Milton Kotelchuck, a professor at the Boston University School of Public Health and a member of the independent panel. “But if you have a flawed beginning, then you’ve got 20 years of working on a flawed study.”
Officials are making changes, putting all but the pilot phase, to involve 37 locations, on hold while conducting an inquiry into the cost and scientific underpinnings, Dr. Collins said. Some data may no longer be collected if “we can’t afford” it, he said, and every aspect will receive “the closest possible scrutiny.”
The study is far from its plan of recruiting 250 babies a year for four or five years in each community. By December, 510 women were enrolled and 83 babies were born in the first seven locations, including Orange County, Calif., and Salt Lake County, Utah.
That was after knocking on nearly 64,000 doors, screening 27,000 women and finding 1,000 who were pregnant and in their first trimester (and therefore eligible).
The time and information required from families could also make the study “too burdensome to be conducted the way it is,” said Dr. Susan Shurin, former acting director of the National Institute of Child Health and Human Development, part of the National Institutes of Health and the study’s supervising agency. The fear is women will “go ‘Oh no, you again,’ and slam the door in your face.”
Specimens include blood, urine, hair and saliva from pregnant women, babies and fathers; dust from women’s bedsheets; tap water; and particles on carpets and baseboards. They are sent to laboratories (placentas to Rochester, N.Y., for example), prepared for long-term storage, and analyzed for chemicals, metals, genes and infections.
Participants provide the names and phone numbers of relatives and friends, so researchers can find them if they move. As children grow, scientists, including outside experts, can cross-reference information about their medical conditions, behavioral development and school performance.
Besides looking at widespread conditions, like diabetes, the study will consider regional differences. Maureen Durkin, principal investigator in Waukesha County, Wis., wonders if radium in the county’s water, and houses built on “farm fields that may be contaminated with nitrates and atrazine,” have different health consequences than pollution or industrial chemicals in Queens.
But study officials are trying to determine what information to give participants and when. Some experts say people should get results of their chemical or genetic tests only if medical treatments exist because otherwise it only causes anxiety. Others agree with Patricia O’Campo, a member of the study’s advisory committee and the independent panel, who says the study should be “less ivory towerish” and disclose more information to families and communities.
Source
Use of Acetaminophen in Pregnancy Associated With Increased Asthma Symptoms in Children
Feb 5th
Children who were exposed to acetaminophen prenatally were more likely to have asthma symptoms at age five in a study of 300 African-American and Dominican Republic children living in New York City. Building on prior research showing an association between both prenatal and postnatal acetaminophen and asthma, this is the first study to demonstrate a direct link between asthma and an ability to detoxify foreign substances in the body. The findings were published this week in the journal Thorax.
The study, conducted by the Columbia Center for Children's Environmental Health at Columbia University's Mailman School of Public Health, found that the relationship was stronger in children with a variant of a gene, glutathione S transferase, involved in detoxification of foreign substances. The variant is common among African-American and Hispanic populations. The results suggest that less efficient detoxification is a mechanism in the association between acetaminophen and asthma.
The researchers assessed the use of analgesics during pregnancy and found that 34 percent of mothers reported acetaminophen use during pregnancy, and 27 percent of children had wheeze, an asthma-related symptom. The children whose mothers had taken acetaminophen were more likely to wheeze, visit the emergency room for respiratory problems, and develop allergy symptoms, compared to those children whose mothers did not take acetaminophen. The risk increased with increasing number of days of prenatal acetaminophen use. The children in this study live in neighborhoods of New York City that have been the hardest hit by the asthma epidemic: Northern Manhattan and the South Bronx.
Acetaminophen use among children in the U.S. has increased substantially since the early 1980s and has become increasingly common among women during pregnancy so that most women in the U.S. take acetaminophen during pregnancy. This increase coincided with a doubling of the prevalence of asthma among children in the country between 1980 and 1995.
"These findings might provide an explanation for some of the increased asthma risk in minority communities and suggest caution in the use of acetaminophen in pregnancy," says Matthew S. Perzanowski, PhD, assistant professor of Environmental Health Sciences at the Mailman School of Public Health.
Reasons for prenatal acetaminophen use vary, but in this study population the observed associations with headaches suggest pain management as likely; however, other host factors that caused mothers to take acetaminophen and also cause asthma may explain their association. While infection is one such potential confounder, the Mailman School researchers found no association between the reported use of antibiotics and acetaminophen, and adjustment for antibiotic use during pregnancy did not affect the results.
According to the researchers, the prevalence of current wheeze diminished as the children aged, from 40 percent at age one year to 25 percent, 17 percent and 27 percent at ages two, three, and five, respectively. However, the association between prenatal acetaminophen exposure and current wheeze strengthened as the children aged.
The Columbia Center for Children's Environmental Health study adjusted relative risks for sex, race/ethnicity, birth order, maternal asthma, maternal hardship, exposure to environmental tobacco smoke, antibiotic use and postnatal acetaminophen use.
In a similar study conducted in the UK, the frequency of acetaminophen use during pregnancy and the magnitude of association in the UK study were similar to that in New York City.
Source
Childhood asthma in premature babies linked to pregnancy bug
Feb 2nd
A common complication during pregnancy may predispose children born prematurely to asthma, a large study reports today.
The condition, chorioamnionitis, is inflammation of the fetal membranes and amniotic fluid from a bacterial infection. It is thought to be linked to more than half of all preterm births, before 37 weeks' gestation, scientists write in today's Archives of Pediatric and Adolescent Medicine.
The infection may have ascended to the uterus from the mother's genital tract or traveled through her bloodstream from a more remote site, such as her gums or upper respiratory tract, says lead author Darios Getahun, a scientist at Kaiser Permanente Southern California's Department of Research and Evaluation in Pasadena.
In animals, chorioamnionitis has been shown to cause lung and brain damage in offspring, Getahun says. Scientists also have found lung scarring in infants who died after pregnancies complicated by the condition.
Getahun and his co-authors analyzed electronic health records for all singleton children born at Kaiser's Southern California hospitals in 1991 to 2007, a total of 397,852. Of those, 28,869 were preterm.
Among children born full-term, chorioamnionitis wasn't linked to an increased risk of being diagnosed with asthma by age 8. But among those born prematurely, the condition was associated with double the risk of childhood asthma in blacks, a 70% increase in Hispanics and a 66% increase in whites. The researchers observed these differences even after accounting for other possible risk factors such as whether the mother smoked or had asthma herself. Only in Asian/Pacific Islanders preemies did chorioamnionitis not seem to make a difference in childhood asthma risk.
Getahun speculates that chorioamnionitis wasn't related to asthma risk in full-term children because their mothers might not have had it as long as those born prematurely. But, he adds, his team didn't have information about how early in their pregnancy women were diagnosed.
Diagnosing the condition is tricky, Getahun says, because symptoms — fever in the mother, tenderness or pain in the uterus, foul-smelling amniotic fluid — aren't definitive, and some women never exhibit symptoms. Getahun's team is now trying to find a marker in the mother's blood that would signify her symptoms are because of chorioamnionitis.
A study of 1,096 children published in 2008 found a higher risk of wheezing by age 2 in preemies whose mothers had had chorioamnionitis.
Source
Breast not always best, study shows
Jan 6th
Women should forget what they have been told about the health benefits of breastfeeding, researchers have claimed.
A controversial new study has concluded that, contrary to the view of many experts, breast is not necessarily best for children in the first months of life.
Professor Sven Carlsen, who led the Norwegian team, declared: "Baby formula is as good as breast milk."
What really affects the health of a growing infant is the hormone balance in the womb before birth, according to the research.
This in turn influences a woman's ability to breast feed, resulting in a misleading association between breastfeeding and child health, it is claimed.
The only benefit from breastfeeding supported by genuine evidence is a "small IQ advantage", said the scientists. And even this was yet to be properly confirmed.
Prof Carlsen's team reviewed data from more than 50 international studies looking at the relationship between breastfeeding and health. Most concluded that the more children were breastfed, the healthier they were.
On the surface this was correct, said Prof Carlsen, from the Norwegian University of Science and Technology in Trondheim. But he added: "Even if this is statistically true, it is not because of breastfeeding itself. There are very few studies that have examined the underlying controls on breastfeeding ability."
The largest study on breastfeeding was conducted in Belarus and involved more than 17,000 women and children who were monitored for six years. It "cut the legs out from underneath most of the assertions that breastfeeding has health benefits" said the scientists. For example, the study found no evidence that breastfeeding reduced the risk of asthma and allergies in children.
The research is published in the January edition of the journal Acta Obstestricia and Gynecologia Scandinavica.
Source
Study Links Folic Acid Supplement in Late Pregnancy to Asthma in Offspring
Nov 4th
Women who take folic acid supplements during the later months of pregnancy may be increasing their baby's risk of developing asthma, according to a newly released Australian study.
Found in its natural form in leafy green vegetables, legumes and some nuts, folic acid is commonly recommended to women trying to conceive to prevent neural defects in the first weeks of pregnancy.
But the Australian study found that women who continue to take folic acid late into pregnancy were 30 percent more likely to give birth to a child which would develop asthma.
"We see a substantial proportion of women taking these folate supplements throughout pregnancy, and it may be because people think it is entirely benign," said Michael Davies, associate professor at Adelaide University.
"Folate is incredibly important because of its role in preventing neural tube defects (like spina bifida). But because it is so important, and so bioactive, it needs to be treated with some respect as well."
Of the 550 women studied, those who took the folic acid supplements before conception and not more than several weeks into their pregnancy had no increased risk of asthma in their children.
But women who took it during weeks 16 to 30 of the pregnancy increased their risk of having a child with asthma by about 30 percent, according to the research, published in the American Journal of Epidemiology.
"Our finding should be reassuring to women who take folate for the purpose of preventing neural tube defects because we found no evidence of early supplementation (leading to asthma)," Davies told newswire AAP.
Davies said a diet rich in natural folate carried no increased risk of asthma for the baby.
Source