Trusted Information for Healthy Pregnancies
black women
Prenatal testing curbs some genetic diseases
Feb 18th
Some of mankind's most devastating inherited diseases appear to be declining, and a few have nearly disappeared, because more people are using genetic testing to decide whether to have children.
Births of babies with cystic fibrosis, Tay-Sachs and other less familiar disorders seem to have dropped since testing came into wider use, The Associated Press found from interviews with numerous geneticists and other experts and a review of the limited research available.
Now, more women are being tested as part of routine prenatal care, and many end pregnancies when diseases are found. One study in California found that prenatal screening reduced by half the number of babies born with the severest form of cystic fibrosis because many parents chose abortion.
More couples with no family history of inherited diseases are getting tested before starting families to see if they carry mutations that put a baby at risk. And a growing number are screening embryos and using only those without problem genes.
The cost of testing is falling, and the number of companies offering it is rising. A 2008 federal law banning gene-based discrimination by insurers and employers has eased fears.
Genetic testing pushes hot-button issues: abortion, embryo destruction and worries about eugenics - selective breeding to rid a population of unwanted traits.
Some diseases - sickle cell, cystic fibrosis, Tay-Sachs, thalassemia, spinal muscle atrophy - occur when people inherit two bad genes, one from each parent. The genes can pass quietly for generations until two carriers mate; then children have a one-in-four chance of getting the disease.
Comparisons to couples not given prenatal screening suggested that screening had cut births of babies with severe disease in half, researchers reported at a genetics conference in 2008. Studies in Canada, Italy, Australia and in Europe also found that cases dropped after screening began.
Gene testing hasn't led to declines in all diseases. Sickle cell, a blood disorder that causes anemia and pain and raises the risk of stroke, has not dropped. It mostly afflicts blacks; gene carriers are said to have sickle cell "trait," which sounds harmless.
"Now we're actually learning that it's not as benign as we thought it was," and that carriers have higher risks for certain medical problems, said Dr. Lanetta Jordan, a Florida physician and chief medical officer of the Sickle Cell Disease Association of America.
Newborn screening is finding more sickle cell carriers and cases, but this doesn't seem to affect parents' future family plans, Jordan said.
The number of fertility treatments that include embryo screening has been on the rise in recent years, with nearly 5,200 screenings in 2006, according to the Society for Assisted Reproductive Technology. Carrier testing also is rising. A California company, Counsyl, sells a $349 saliva test for genes for more than 100 inherited disorders. Several thousand people used it over the last year, the company reports.
Eliminating disease is a noble goal but also "should give us pause," Lerner, the Columbia historian, wrote recently in the New England Journal of Medicine.
"If a society is so willing to screen aggressively to find these genes and then to potentially to have to abort the fetuses, what does that say about the value of the lives of those people living with the diseases?" he asked.
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
Docs have new treatment for pregnancy mask
Jan 11th
Melasma is hormonal disorder causing dark patches in the skin and most often, it's seen in pregnant women.
It's a common problem, affecting 45 million people worldwide, but because it's most noticeable in women with darker skin, it carries a confidence crushing stigma in Latin and African American cultures.
Until recently doctors say there wasn't a very effective treatment for the condition but fractionated laser resurfacing is changing all that.
Microscopic laser columns penetrate the dermis of your skin creating tiny wounds.
Those wounds stimulate the collagen and elastin production healing the spots from the inside out.
"It's probably the best treatment currently available for the treatment of melasma." Dr. Bill Johnson, an esthetics specialist, said.
Because melasma is a chronic condition, the treatment is not a cure.
Source
Chinese and Korean-American Women Have Increased Risk for Diabetes During Pregnancy
Dec 14th
Chinese and Korean-American women are at a higher risk than Caucasian and African-American women of developing diabetes during pregnancy, according to a new study. The study, by researchers at Kaiser Permanente, also found that Pacific Islanders, Filipinos, Puerto Ricans and Samoans were also at a higher-than-average risk of developing diabetes during pregnancy, while Caucasian, native-American and African-American women have a lower than average risk.
Untreated diabetes during pregnancy can lead to complications to the women and fetus. It can also lead to the child becoming obese later in life, the researchers said in a statement.
According to the study, as many as 10 percent of women of Chinese and Korean descent could be at risk of developing the disease during pregnancy.
The study is published in the journal Ethnicity and Disease.
Source
Why Women Who Have Had Preeclampsia Should Be Evaluated For Hypothyroidism.
Nov 25th
This blog post was also published on preeclampsiaonline.net by Chukwuma Onyeije, M.D.
At present, the cause of preeclampsia is unknown. However, it is clear that patients who have had preeclampsia are at risk for other cardiovascular conditions in later life. Recently published studies now show that in addition to these concerns; patients who have had preeclampsia are also at risk for hypothyroidism later in life.
This presentation reviews why this is an important consideration for the long term health of these patients.
View more presentations from Chukwuma Onyeije.
Nicotine Patches and Gum Seem Safe During Pregnancy
Nov 14th
Nicotine patches and gum seem to be safe and effective in pregnant women, according to a new study.
Such patches and gum have been shown to help non-pregnant adults stop smoking, study co-author Dr. Geeta K. Swamy told Reuters Health. However, women and their obstetricians have been uncertain about their safety and effectiveness during pregnancy.
Dr. Swamy, from Duke University Medical Center in Durham, North Carolina, and colleagues took another look at data on pregnant smokers who had participated in a study comparing psychological treatments with nicotine patches or gum to help them quit.
Adding nicotine patches or gum tripled the number of women who quit, from 8 percent to 24 percent.
Almost a third - 31 percent -- of the women who used the patch or gum had pregnancy complications, compared to 17 percent of the women who did not use it.
However, there was a much higher risk of such complications in black women, those with complications in previous pregnancies, and use of painkillers. The use of the patch did not seem to have a direct effect, the researchers note.
Based on the findings, although the patch is not "absolutely safe," it may still be worth using in heavy smokers, given the known association between smoking and bad pregnancy outcomes, particularly premature birth and low birth weight, they conclude.
Source