Trusted Information for Healthy Pregnancies
diabetes
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.
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Natural Delivery OK in Cases of Intrauterine Growth Restriction
Feb 5th
Waiting for natural birth is as effective as inducing labor in pregnant women with intrauterine growth restriction (IUGR), a new study shows.
IUGR, which affects about 10 percent of pregnant women, means that the fetus is much smaller than normal. At birth, these babies are more likely to have low blood sugar, an abnormally high red blood cell count and trouble maintaining their body temperature. These babies are also at increased risk for jaundice, infections and cerebral palsy.
Later in life, people who were restricted-growth babies may be more prone to behavioral disorders, obesity, heart disease, type 2 diabetes and high blood pressure.
Currently, doctors have two main approaches for women with suspected IUGR who are nearing delivery. Some doctors induce labor because they're concerned about complications, while others await natural delivery.
This study compared the effectiveness of the two strategies among 650 women in The Netherlands. The researchers found that median birth weight was significantly lower among babies born after induced labor (2,420 grams) than among those in the spontaneous delivery group (2,560 grams). Both groups of babies had similar rates of adverse post-delivery outcomes.
The findings show that waiting for birth is equally as effective as inducing labor, the researchers concluded.
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Birth Weights Are Falling in U.S.
Jan 21st
Mothers are giving birth to lighter babies in the U.S., and no one is quite sure why.
This finding, published Thursday in the Journal of Obstetrics and Gynecology, has potentially troubling public-health implications, if the trend continues. Low-birth-weight babies are at higher risk for a host of health problems.
Between 1990 and 2005, the birth weight of full-term babies in the U.S. declined nearly two ounces to an average of seven pounds and 7.54 ounces, a reversal of a trend that had seen birth weights climb steadily since the 1950s, according to the study. They were also born 2.5 days earlier on average in 2005 than in 1990, the study said.
The decrease in weight—based on an analysis of nearly 37 million non-multiple births from a national database—isn't likely to affect the health of the average baby in the study, according to researchers. But the data showed a 1% increase in the number of the lowest-weight babies and suggested the birth-weight decline didn't stop in 2005.
These data suggest that it may be important for medical professionals to pay attention to the weight of babies born around 37 weeks and 38 weeks, as well as those considered pre-term, or less than 37 weeks, according to Joann Petrini, senior adviser at the March of Dimes and assistant research director at Danbury Hospital in Connecticut, who wasn't involved in the study.
Researchers also found a 2% decrease in the number of babies considered large—those over the 90th percentile of weight for gestational age—which is a positive, according to Dr. Oken. Large babies can experience more birth trauma and cause more birth injury to the mother.
The lower-birth-weight trend could not be explained by common factors like how much weight mothers gained during pregnancy, whether the delivery was induced or by cesarean section, prenatal care, or common maternal-health issues such as smoking and hypertension, researchers said.
Researchers also repeated their analysis in a sample of low-risk women—healthy, educated Caucasians in their mid-to-late 20s—and found that the decrease in birth weight was even more pronounced, suggesting that the trend isn't the result of changes in the population of mothers.
Other investigators also have begun to note the same trend. "There's no question" about the change in birth-weight pattern, said Michael Kramer, scientific director of the Institute for Human Development and Child and Youth Health at the Canadian Institutes of Health Research, who wasn't involved in the study.
"It is a new trend," he said. "We really don't know why the birth weight has decreased." A similar pattern has been observed in Canada, he said.
Some potential factors that weren't examined in this study include better control of gestational diabetes—when a mother develops diabetes during pregnancy—and more physical activity during pregnancy, said Dr. Kramer.
Babies considered too large, as well as too small, tend to have more health problems in the long run. The optimal size for a newborn is around 4,000 grams, or roughly 8.8 pounds, according to Dr. Kramer. The average baby in the study was found to be smaller than optimal. In 1990, the average birth weight was 3,441 grams, and in 2005 it fell to 3,389 grams, according to the study.
Babies born too small tend to have higher blood pressure and a greater risk of diabetes in the long run, said Dr. Oken.
From the 1950s until the 1980s, birth weights had increased as a result of increases in mothers' weight and how many pounds they gained during the pregnancy, as well as reduced smoking and older maternal age, according to Dr. Kramer.
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Siblings key in pregnancy-related diabetes risk
Jan 13th
Women with a family history of diabetes who are free from the disease themselves are more likely to develop pregnancy-related diabetes, a new study confirms.
And the risks associated with having a brother or sister who is diabetic are much higher than having one or even two parents with the disease, Dr. Catherine Kim of the University of Michigan Medical School in Ann Arbor and her colleagues found.
The increased demands placed on the body during pregnancy can cause some women to develop abnormally high blood sugar. The condition, known medically as gestational diabetes, typically gets better after a woman delivers her baby, but it increases her risk of developing type 2 diabetes later on.
The more relatives a person has with type 2 diabetes, the greater their risk of developing the condition themselves. But little is known about how a woman's family history of the condition affects her risk of developing gestational diabetes.
To investigate, Kim and her team looked at 4,566 women participating in the National Health and Nutrition Examination Survey, all of whom had at least one child. Ninety-seven percent had never been diagnosed with diabetes, about 1 percent had gestational diabetes only, and 2 percent had type 2 diabetes.
Having a mother or father with diabetes increased the likelihood of having diabetes or gestational diabetes to a similar degree, the researchers report in the American Journal of Obstetrics and Gynecology. But while having two parents with diabetes boosted the likelihood of having diabetes eight-fold, this only doubled the likelihood of gestational diabetes.
On the other hand, having a diabetic brother or sister increased gestational diabetes risk more than seven-fold, but only slightly upped type 2 diabetes risk.
"The odds of increased most markedly when a sibling was affected," Kim and her team write. And when the researchers accounted for early-life factors such as education and poverty, the risk associated with having a diabetic sibling actually increased. "Sibling-only history may be a greater risk factor than previously documented," they say.
The findings suggest, the researchers say, that gestational diabetes may follow a different pattern of inheritance than type 2 diabetes, which is closely associated with being overweight or obese.
Further investigation of these patterns could help identify women who are at particularly high risk of developing type 2 diabetes after having the gestational form of the condition, they add, "and thus target them for future prevention interventions."
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Ultrasounds to be shown live to fathers via iPhone
Jan 11th
The new technology, which transmits video images via the 3G mobile phone network, was unveiled at the Consumer Electronics Show in Las Vegas.
Dr Topol, chief medical officer of the West Wireless Health Institute, which promotes the use of mobile phone technology in healthcare, demonstrated the technique by broadcasting images of an ultrasound examination in Sweden.
He said the new technology was designed to send ultrasound videos to doctors, friends and family, but could even be used to broadcast the examination to “Facebook, Twitter and the whole social networking scene”.
Dr Topol also showed the crowd an Apple iPhone application designed to allow doctors to check the vital signs of patients from any location.
Dr Topol said mobile phone applications have been developed to spot the early warning signs of the top ten causes of hospitalizations in the US, including Alzheimers, breast cancer and diabetes.
He said the technology had the potential to save hundreds of millions of dollars by allowing doctors to act pre-emptively and avoid expensive hospital treatment.
“These things are empowering consumers to take charge of their health,” he said. “You know how we check our emails? Next year we will be sitting here with a Band-Aids on checking our vital signs.”
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Inducing labor may lead to more C-sections
Jan 7th
Dr. J. Christopher Glantz at the University of Rochester School of Medicine found that inducing labor introduces a risk of 1 to 2 cesareans per 25 inductions that might have been avoided by waiting for spontaneous labor to begin.
While this risk to individual women is not particularly large, Glantz told Reuters Health that 1 to 2 cesareans per 25 inductions can quickly add up to tens of thousands of unnecessary cesareans over the course of millions of inductions.
While the procedures have become more common, C-sections are major surgeries, and carry risk of infection, bleeding, blood clots, and injury to other organs, Glantz emphasizes in a report in the journal Obstetrics and Gynecology.
The researcher analyzed birth certificate data for some 38,000 women from 13 hospitals in the Finger Lakes region of New York State from January 2004 to March 2008. He excluded women with scheduled or previous cesarean deliveries, or who had come to the hospital with ruptured membranes.
While previous studies have already shown that induced labor increases the risk for cesarean, Glantz examined how that risk might shift given a redefined comparison group.
He examined C-section rates after induction using three comparison groups: a week-by-week comparison of women induced to labor compared with those delivering spontaneously; women induced at a chosen week compared with women who delivered spontaneously after that week; and women induced at a chosen week compared with women who delivered spontaneously on or after that week.
In a nutshell, the study found that all labor induced groups faced increased risk for C-section, except for those women delivering after 39 weeks.
Glantz advises that pregnant women and their doctors may be better off waiting for spontaneous labor. "Try to reserve interventions for situations where risk outweighs benefit," said Glantz, such as in cases of diabetes, high blood pressure, problems with the placenta, a baby that is not growing well, or a woman being 10 days past her due date.
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
Glucose Intolerance in Pregnancy Associated With Postpartum Cardiovascular Risk
Dec 6th
Women who have gestational glucose intolerance (a condition less severe than gestational diabetes) exhibit multiple cardiovascular risk factors as early as three months after birth, according to a new study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).
Breastfeeding Could Offer Protection Against Metabolic Disorder
Dec 3rd
Breastfeeding may offer mothers long term protection against a condition linked to diabetes and heart disease, researchers report today.
The longer women breastfed, the lower their chance of developing metabolic syndrome, a cluster of risk factors such as high blood pressure and high triglycerides associated with obesity, the scientists found.
"Pregnancy may have some adverse effects on some of these cardiovascular risk factors," lead author Erica Gunderson says, "and lactation (breastfeeding) may offset some of these effects."
The impact of breast-feeding on the risk of metabolic syndrome was "slightly stronger" in women who'd had gestational — or pregnancy-induced — diabetes, says Gunderson, an epidemiologist and research scientist at Kaiser Permanente's Division of Research in Oakland. "This is the first study to really look at lactation and the metabolic syndrome in women with GDM (gestational diabetes)."
About 18%-37% of U.S. women ages 20 to 59 have metabolic syndrome, Gunderson says. A study she published in August found women with gestational diabetes are 2½ times more likely than other women to develop the condition after pregnancy.
Gunderson and her co-authors based their new findings on 704 women in an ongoing, government-funded study of heart-disease risk factors. When the women entered the study in 1985-1986, they were ages 18-30 and had never given birth; testing confirmed they didn't have metabolic syndrome.
They all went on to deliver at least one child; only 16% had more than two children. They returned for measurements of metabolic syndrome components seven, 10, 15 and 20 years after entering the study; 120 developed metabolic syndrome.
In women who didn't have gestational diabetes, breast-feeding cut metabolic syndrome risk 39%-56%. In those who did, it cut the risk 44%-86%. In both, the authors write in Diabetes: The Journal of the American Diabetes Association, the longer women breast-fed, the lower their risk.
Breast-feeding is associated with a quicker loss of pregnancy weight, but that's only "a little bit of the explanation," Gunderson says. Another possibility, she says: Breast-feeding might minimize the accumulation of belly fat, fat linked to type 2 diabetes risk.
Source
Sugary Soda Tied to Gestational Diabetes
Dec 2nd
Women who drink five or more servings of sugar-sweetened cola per week before they conceive increase their risk of developing diabetes during pregnancy, a new study indicates.
"Previous studies have shown an association with other chronic metabolic problems," said study author Dr. Liwei Chen, an assistant professor of epidemiology at Louisiana State University Health Sciences Center, in New Orleans. "This is the first to show an increased risk among pregnant women."
Gestational diabetes, known as glucose intolerance during pregnancy, is one of the most common complications of pregnancy. It increases the chances of lifelong diabetes for the woman and also can have permanent effects on the unborn child, Chen said. The report appears in the December issue of Diabetes Care.
"Other studies suggest that babies born to women who are diabetic during pregnancy have higher weight at birth and also higher rates of obesity and diabetes early in life," she added.
Chen, working with researchers at the Harvard School of Public Health and the U.S. National Institute of Child Health and Human Development, studied 10 years of medical records on a group of 13,475 women from the Nurses' Health Study II. After adjusting for known risk factors for gestational diabetes, such as age, family history and smoking, the researchers found that women who had more than five servings per week of sugar-sweetened cola beverages had a 22 percent higher risk of gestational diabetes than women who had less than one serving per month.
No such association was found for consumption of other sugar-sweetened beverages or artificially sweetened drinks.
It's not clear why only cola drinks are associated with the increased risk, Chen said. One explanation could be "the tremendous popularity of cola in the United States," she said.
According to the journal report, there are several potential explanations for the association. For example, sugar-rich foods or beverages can overload the body with glucose, which can impair the function of the beta cells of the pancreas, which make insulin that metabolizes glucose.
Sugar-sweetened beverages are the leading source of added sugar in the American diet, Chen said. The U.S. National Health and Nutrition Examination Survey found that soft drink intake more than doubled between 1977 and 2001 among 19- to 39-year-old Americans, going from 4.1 percent to 9.8 percent, and that those in this age group had the highest rate of soft drink consumption.
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