Trusted Information for Healthy Pregnancies
birth defects
Embryo screening test is ‘safe’
Dec 29th
An embryo screening test called pre-implantation genetic diagnosis (PGD) is safe for the children of singleton pregnancies, Belgian researchers say.
They looked at 581 children born at one Belgian centre over 13 years who had been screened using the PGD technique.
They found that rates of birth defects and deaths were similar to those of children born using other IVF methods.
However, significantly more deaths just after or before the birth were seen in multiple pregnancies following PGD.
The findings come after concerns that the PGD screening technique, which involves removing some of the embryo's cells at an early stage, could lead to problems.
But the researchers, writing in the journal Human Reproduction, found no significant difference in birth defect rates when compared to 2,889 children born using IVF but who did not undergo the screening.
In total, 2.13% of PGD children had birth defects compared with 3.38% of the other children.
The perinatal death rate - the period immediately before and after birth - was also similar at just over 1% for singleton children in both groups.
However, for multiple pregnancies there was a difference. In the PGD group it was 11.73%, whereas among the others it was 2.54%.
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No Link Seen Between Acetaminophen, Birth Defects
Dec 21st
New study findings offer reassurance to pregnant women that acetaminophen does not appear to raise the risk of birth defects.
Acetaminophen is the active ingredient in Tylenol and certain other painkillers, and is often found in over-the-counter cold and flu remedies. Taken as directed, acetaminophen is considered safe during pregnancy, making it the medication of choice for pregnant women's body aches and fevers.
However, there are still some questions about whether the drug can contribute to birth defects. Studies looking at birth defects as a broad group have either found no link to acetaminophen use or have yielded inconclusive findings.
Some research, meanwhile, has suggested that the drug may be linked to a higher risk of a birth defect called gastroschisis -- but other studies have found no such connection. Gastroschisis refers to a defect in the abdominal wall that allows the intestines to protrude; it has been linked to aspirin use during pregnancy.
In the new study, researchers analyzed data from a large U.S. study that included more than 11,600 children born with congenital defects such as spina bifida, cleft lip and various defects affecting the brain, heart, lungs, limbs and gastrointestinal system. They were compared with 4,500 children born with no major anomaly.
Overall, the study found, there was no evidence linking mothers' acetaminophen use in the first trimester to a heightened risk of any birth defect.
In fact, women who took the medication to treat a first-trimester fever had a lower risk of certain birth defects -- including gastroschisis -- than women who did not treat their fevers with acetaminophen.
Researchers led by Dr. Marcia L. Feldkamp, of the University of Utah in Salt Lake City, report the findings in the January 2010 issue of the journal Obstetrics & Gynecology.Among women who had fevers in early pregnancy, babies born to those who used acetaminophen had a 65 percent to 83 percent lower risk of certain birth defects of the brain, a 56 percent lower risk of cleft lip and a 59 percent lower risk of gastroschisis.
The researchers note that hyperthermia, or excessively high body temperature, has been implicated in the risks of certain birth defects. More studies, they conclude, are needed to confirm whether treating fevers with acetaminophen does in fact prevent some birth defects.
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Folic Acid May Help Prevent Fetal Heart Defects
Dec 9th
Here's another reason for pregnant women to take folic acid supplements: they help prevent fetal heart malformations, new research from the Netherlands suggests.
"Given the relatively high prevalence of congenital heart defects worldwide, our findings are important for public health," Dr. Ingrid M. van Beynum of Radboud University in Nijmegen and her colleagues write.
Folic acid supplements are now recommended for all pregnant women, and women planning on becoming pregnant, in order to prevent birth defects involving the neural tube such as spina bifida. Many countries, including the US, now require bread and other wheat products to be fortified with folic acid for this reason, but this practice hasn't been adopted in The Netherlands.
To investigate further, the researchers used a national register of birth defects to identify 611 mothers who had given birth to a child with a heart defect, matching them to 2,401 women who delivered babies with genetic defects or other birth defects unrelated to folate.
Women who took a supplement containing at least 400 micrograms of folic acid were nearly 20 percent less likely to have a child with a heart defect, compared to other non-folate-related malformations, while their risk compared to the general population was 26 percent lower.
Their risk of having a child with a heart defect involving the septum -- which separates one side of the heart from the other -- was nearly 40 percent lower than that of the general population.
The current study couldn't show whether taking more or less than 400 micrograms of folic acid would be more effective in preventing heart defects, the researchers note, although there's increasing evidence that heavier women may need to take more folic acid to get the same protective effects.
The researchers conclude that women who want to become pregnant should take folic acid supplements around the time of conception, not only to prevent neural tube defects but also to reduce the risk of congenital heart defects.
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March of Dimes Reveals Pregnant Moms Biggest Fears
Dec 9th
The March of Dimes polled about 1,200 moms to find out exactly what it is that caused them to lose sleep (other than the fact they were pregnant!) while they were pregnant. The results were presented today at the March of Dimes National Communications Advisory Council luncheon where experienced, practicing obstetricians and gynecologists discussed the survey results, as well as some of the frequently asked questions their patients ask.
The March of Dimes poll found that the number one thing moms worried about was birth defects - 78 percent said they were worried their child would be born less than perfect. Stress was moms' second fear, with 74 percent answering that they were concerned if stress in their life would harm their baby's health. Preterm birth was a close third with 71 percent saying they were worried their baby would be born too soon.
"Women should discuss all their questions with their doctors and should be concerned about their overall health - quit smoking, control their blood pressure, weight and any chronic diseases, such as diabetes - before they become pregnant so they will have a better chance at a healthy pregnancy," said Dr. Diane Ashton, March of Dimes deputy medical director, who took part in the panel discussion.
Surprisingly, only 70 percent thought about the fear of pain of childbirth and 55 percent were worried that they wouldn't get to the hospital on time!
Other things moms worried about were:
- 60 percent worried they wouldn't be able to breastfeed successfully.
- 59 percent worried about losing weight after pregnancy.
- And, 59 percent worried about getting pregnant in the first place.
- Sushi and fish was the number one food concern, with 61 percent concerned.
The poll was conducted Nov. 6 to Nov. 13, 2009 using the online software Zoomerang. There were 123 valid responses from the 1,224 women from the March of Dimes Moms e-Panel and March for Babies Family Teams who were invited by email to answer the 65 questions. Some 90 percent of the women surveyed have a child who was born preterm. Nearly two-thirds of the respondents are employed, about 60 percent are between the ages of 25 and 34, 90 percent have children under the age of five and 95 percent had attended some college. The survey was written by Betty Wolder Levin, Ph.D., professor of Public Health, Graduate Center of the City University of New York.
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FDA Updates Warning for Pregnant Women on Antiepileptic Drugs
Dec 4th
The FDA has issued a statement reminding patients and doctors that valproate sodium, valproic acid, and divalproex products increase the risk of birth defects in babies exposed to the chemicals during pregnancy.
The medications - used to treat epilepsy since 1978 and more recently for bipolar disorder and migraine - can cause neural tube defects, craniofacial defects, and cardiovascular malformations in unborn children during the first trimester. This is often before many women know they are pregnant, the FDA said in a statement.
Use of the products increases neural tube defects during the first 12 weeks of pregnancy from one in 1,500 to one in 20, on average, the FDA noted.
Babies born to women taking valproate for epilepsy are more than three times as likely to have birth defects as those born to women on a different therapy (10.7%, 95% CI 6.3% to 16.9% versus 2.9%, 95% CI 2.0% to 4.1%), according to data from the North American Antiepileptic Drug Pregnancy Registry.
The FDA cautioned women of childbearing potential to take valproate only if it is essential for managing a medical condition. Those taking the drug who are not planning pregnancy should use contraception, the agency said.
Women planning to become pregnant can reduce the risk of congenital neural tube defects by taking folic acid before and during the first trimester of pregnancy, the FDA noted.
The agency also noted a danger to pregnant mothers and their child if epilepsy or bipolar disorder is left untreated while the baby is developing. Likewise, it reminded doctors and patients of a major risk associated with ceasing valproate therapy suddenly.
The FDA recommended that women talk with healthcare professionals before stopping use of valproate products if they become pregnant.
It also recommended women who become pregnant while taking valproate or other antiepileptic drugs enroll in the North American Antiepileptic Drug Pregnancy Registry to help gather more information on the safety of the medications during pregnancy.
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Insect Repellent Linked to Genital Defects
Dec 2nd
European researchers have found an association between expectant moms who used the repellent in the earliest phase of pregnancy and an increased rate of a condition known as hypospadias, which occurs when the opening of the penis - the urethra - is on the underside of the penis, instead of the top.
The condition, which often requires corrective surgery, affects 1-2 boys in every 500 births.
"This particular defect of the male urethra is quite common, and has been linked to environmental sources as well as genetic problems," Chris Winder, a University of New South Wales Professor of Toxicology and Occupational Health in Australia said.
"Here is more evidence that pregnant mothers, or mothers planning pregnancy, should limit their exposure to chemicals such as insect repellents," he added.
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Many Pregnant Women Take Drugs Harmful to Baby
Nov 30th
With the help of their doctors, women planning to become pregnant should take an inventory of the medications they take, researchers from Canada advise.
In a study, they found that many pregnant women still take medications long known to cause birth defects.
Some medications with known fetal risk, such as drugs that control epilepsy, are essential during pregnancy, Dr. Anick Berard, at the University of Montreal in Quebec, noted in an email correspondence to Reuters Health.
Other medications, such as those that treat severe acne, anxiety and psychiatric drugs, antibiotics, and many drugs prescribed for heart disease and medical conditions, "can and should be avoided," according to Berard.
Women should understand the side effects of any drug they are taking -- especially drugs treating a chronic condition -- and plan pregnancies to avoid or minimize risks such drugs pose to babies, Berard added.
For the 5 years between January 1998 and the last day of 2002, Berard and colleagues analyzed the prescriptions filled by pregnant women for drugs available at the time and known to pose fetal risks.
Their report, in BJOG: An International Journal of Obstetrics and Gynecology, shows 56 percent of 109,344 pregnant women filled at least one medication prescription. A total of 6.3 percent (6,871 women) did so for at least one medication known to pose a risk to the fetus.
"These pregnancies were associated with an elevated number of (pregnancy terminations) and babies born with major (birth defects) in comparison with the expected numbers in the population," they note.
Specifically, terminations occurred in 47 percent of the pregnancies exposed to drugs with known fetal risks. Six percent of these pregnancies ended in miscarriage.
By contrast, in the much larger non-exposed group about 36 percent of the pregnancies had been terminated and fewer than 5 percent ended in miscarriage.
Berard's team further identified birth defects in 8.2 percent of 2,842 infants exposed to risky drugs during gestation and available for assessment, compared with 7.1 percent of the 59,287 infants not exposed. This is "a statistically significant difference," they note.
They emphasize, however, that it cannot be concluded that the drug exposure caused the birth defects. These pregnancies may have also been exposed to other harmful agents or maternal health conditions, they point out.
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Good News for Pregnant Women With Multiple Sclerosis
Nov 18th
- Good news for women with multiple sclerosis (MS) who are pregnant or thinking about becoming pregnant.
- A study published Wednesday shows that although women with MS have a mildly increased risk of certain pregnancy complications, by and large, their pregnancies are as healthy as other women's.
- Using a national database on nearly 19 million deliveries in the U.S., researchers found that women with MS had marginally higher risks of cesarean delivery and intrauterine growth restriction -- where a newborn's weight is below the 10th percentile for his or her gestational age.
- Among more than 10,000 women with MS who gave birth between 2003 and 2006, 42 percent had a C-section, compared with roughly 33 percent of women overall. Meanwhile, intrauterine growth restriction was seen in almost 3 percent, versus 2 percent of other women. Still, the overall findings, published in the medical journal Neurology, are being seen as good news for women with MS -- a disorder that is more prevalent among women of childbearing age than any other group.
- MS is believed to arise from an abnormal immune system attack on the body's own myelin, a protective sheath surrounding nerve fibers in the brain and spine. This leads to symptoms such as muscle weakness, numbness, vision problems and difficulty with coordination and balance.
- Years ago, women with MS were advised to avoid pregnancy, out of concern that it could exacerbate the disease. But studies in recent decades have shown that the opposite is true; many women see a remission in their symptoms during pregnancy -- possibly because immune system activity naturally declines and levels of anti-inflammatory corticosteroids naturally rise during pregnancy.
- The current study included information on 10,055 pregnant women with MS, as well as 4,730 with epilepsy and 187,239 with diabetes -- two disorders already associated with higher risks of certain pregnancy complications.
- Overall, women with either MS or epilepsy had elevated risks of C-section delivery and intrauterine growth restriction compared with U.S. women overall. They did, however, generally fare better than women with diabetes, who had higher rates of additional complications, like high blood pressure and premature rupture of the sac surrounding the fetus.
- Women who are planning on becoming pregnant also need to talk with their doctors about whether they should stop taking any of their MS medications. It is not known whether the so-called disease-modifying drugs often used for MS are safe during pregnancy, and research suggests that at least one -- beta-interferon -- may be associated with miscarriage.
- Chakravarty noted that the drug methotrexate, sometimes used for MS, is known to cause birth defects.
Lower Pregnancy Risks By Asking Mom’s History
Nov 12th
Experts say it's wise to know both your parents' health histories, but ask your mom the right questions and you may be able to avoid a struggle later on. "Knowing your mother's gynecological history can really arm you with what you need to know to take proactive steps in the future," says Tracy Gaudet, MD, executive director of Duke Integrative Medicine at Duke University and author of Body, Soul and Baby. Here are questions to help you start talking:
Did you have preeclampsia?
Preeclampsia is a pregnancy-induced condition that’s marked by high blood pressure, excess protein in the urine, severe headaches, and sudden weight gain that can lead to preterm birth and may require bed rest or induced labor near the end of a pregnancy. Women whose mothers had it are often thought to be at higher risk during their own pregnancies. But other factors may be more significant than your mom’s experience, Dr. Greene says. They include being overweight or older than 35, carrying multiples, having preexisting high blood pressure, or simply being pregnant for the first time. Of course, if you have any of these risk factors to go along with a mom who had preeclampsia, that can nudge the risk even higher.
How knowing helps: Tell your obstetrician if your mom had preeclampsia; she may want to monitor you extra closely. Keep your weight gain in the safe range (25 to 35 pounds if you’re not over- or underweight starting out), and go easy on salty and sugary foods.
Do we have a family history of any disease?
Family history can predict many health risks beyond gyno concerns, including heart disease, diabetes, some cancers, osteoporosis, depression, and stroke. You want to know both of your parents’ histories, “but the links to these diseases are often stronger on the maternal side for a daughter,” Dr. Pinkerton says.
How knowing helps: Your mom’s history may prompt your doc to refer you to a genetic counselor, who can discuss a blood test that screens for genetic mutations. For many other diseases, a healthy lifestyle and simple preventive measures (such as watching your sugar intake if diabetes is a threat) can lower your risk, no matter the family connection. If your mom suffers from low bone mass, or osteopenia, that’s useful info, Dr. Pinkerton says.
“You’ll want to build bone density in your 30s by eating enough calcium and doing weight-bearing exercises like lifting weights or practicing yoga,” she explains. And in your mid-40s, a bone-density test should go on your list of issues to discuss with your doctor.
Read about Genetically Related Birth Defects.
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