Trusted Information for Healthy Pregnancies
infections
Study: Oral Bacteria can Lead to Stillbirth
May 12th
Scientists say they've identified a culprit behind stillbirths and miscarriages in seemingly healthy pregnant women. It turns out that oral bacteria -- even the kinds that exist normally -- can travel through an open wound in the mouth into the bloodstream, settle in the placenta and potentially end a pregnancy.
When bacteria migrate from their normal environment (where they usually don't cause harm) to a new one, problems can arise. The placenta doesn't have an immune system, and it can become inflamed when the oral bacteria set up shop. This can lead to premature births as well as deaths, researchers say.
Yiping Han of the Case Western Reserve School of Dental Medicine led the study. She said they expected the bad bacteria, like the kind that causes gingivitis, to be responsible for aborted or premature pregnancies.
"We found many bacteria did locate to the placenta, but they were not the most famous periodontal pathogens," said Han. "In fact, many of the bacteria were the kind that are found in healthy people's mouths. The normal healthy woman is under risk. People should be concerned about it."
This research comes on the heels of earlier studies linking gum health to heart disease. Han said more research needs to be done to find out exactly which kinds of bacteria are colonizing the placenta so more effective treatments and therapies can be designed for pregnant women.
In the meantime, the American Dental Association recommends several ways to protect the health of your mouth. Fewer cuts and wounds inside your mouth means the oral bacteria will have less of a chance to get into the bloodstream and affect a pregnancy.
Source
Birth Defect Risk from Insect Bites Received by Mother During Pregnancy
May 4th
A North Carolina State University researcher has discovered that bacteria transmitted by fleas-and potentially ticks-can be passed to human babies by the mother, causing chronic infections and raising the possibility of bacterially induced birth defects.
Dr. Ed Breitschwerdt, professor of internal medicine in the Department of Clinical Sciences, is among the world's leading experts on Bartonella, a bacteria that is maintained in nature by fleas, ticks and other biting insects, but which can be transmitted by infected cats and dogs as well. The most commonly known Bartonella-related illness is cat scratch disease, caused by B. henselae, a strain of Bartonella that can be carried in a cat's blood for months to years. Cat scratch disease was thought to be a self-limiting, or "one-time" infection; however, Breitschwerdt's previous work discovered cases of children and adults with chronic, blood-borne Bartonella infections-from strains of the bacteria that are most often transmitted to cats (B. henselae) and dogs (B. vinsonii subsp. berkhoffii) by fleas and other insects.
In his most recent case study, Breitschwerdt's research group tested blood and tissue samples taken over a period of years from a mother, father and son who had suffered chronic illnesses for over a decade. Autopsy samples from their daughter-the son's twin who died shortly after birth-contained DNA evidence of B. henselae and B. vinsonii subsp. berkhoffi infection, which was also found in the other members of the family.
Both parents had suffered recurring neurological symptoms including headaches and memory loss, as well as shortness of breath, muscle weakness and fatigue before the children were born. In addition, their 10-year-old son was chronically ill from birth and their daughter died due to a heart defect at nine days of age.
Results of the parents' medical histories and the microbiological tests indicated that the parents had been exposed to Bartonella prior to the birth of the twins, and finding the same bacteria in both children, one shortly after birth and the other 10 years later, indicates that they may have become infected while in utero.
"This is yet more evidence that Bartonella bacteria cause chronic intravascular infections in people with otherwise normal immune systems, infections that can span a decade or more," Breitschwerdt says. "Also this new evidence supports the potential of trans-placental infection and raises the possibility that maternal infection with these bacteria might also cause birth defects."
Source
High-dose vitamin D safe during pregnancy
May 3rd
Taking high doses of vitamin D during pregnancy is safe and appears to reduce the risk of preterm birth and infections, say the authors of a study that compared different amounts of supplementation in expectant mothers.
But their recommendation that pregnant women should take 4,000 international units of vitamin D daily -- at least 10 times the standard recommended amount -- is sure to generate controversy.
"When we first proposed the study in 2002, it was heresy to even think about giving more than 400 international units a day of vitamin D," co-principal investigator Dr. Carol Wagner said from Vancouver, where the two-part study is being presented at an international pediatrics meeting.
"Diet doesn't provide enough vitamin D, and we don't go in the sun as much as we need (to)," said Wagner, adding that her research team set out to determine the optimal dose of vitamin D supplements for pregnant women that would promote health without doing harm.
The researchers enrolled 494 pregnant women at 12 to 16 weeks' gestation in the study and assigned them to three groups: one group received 400 IUs of vitamin D a day until delivery; the second got 2,000 IUs; and the third 4,000 IUs. The women were tested monthly to ensure they were not suffering any negative effects.
Neither the women nor the researchers knew what dose of vitamin D they were receiving in the study, a "blinded," randomized controlled trial whose methodology is considered the gold standard of medical science.
"What we found was that 2,000 was better than 400, and 4,000 was the best, without any adverse events that were associated with vitamin D," said Wagner. "And then ... we found fewer infections in the 4,000 group and fewer preterm labors and-or preterm birth deliveries in the 4,000 group compared to the 400 group."
Analysis of the data also showed that the women taking 4,000 units of vitamin D had half the rate of pregnancy-related disorders, such as gestational diabetes and preeclampsia, compared to expectant mothers taking 400 units.
However, Wagner conceded that the notion of pregnant women taking a daily dose of 4,000 IUs of vitamin D will likely stir some debate, especially within the medical community. The current recommended daily dose is 200 to 400 IUs daily.
Dr. Gideon Koren, head of the Motherisk Program at Toronto's Hospital for Sick Children, said the study is too small to provide such a definitive recommendation and to "declare therapeutic superiority" of 4,000 units of vitamin D.
"I think for now women should be sure that they get the recommended dose. I don't know that this study by itself should send women to buy 4,000. No, no way. I don't think this is sufficient."
"The study's important to show that it doesn't cause side-effects, but I think to tell women that they need 4,000 - to go from 400 to 4,000 - is huge."
However, Dr. Reinhold Vieth, head of the Bone and Mineral Laboratory at Mount Sinai Hospital in Toronto, has long argued that recommended daily amounts (RDAs) for vitamin D are outdated and woefully inadequate.
Vieth, who has conducted numerous studies on vitamin D in different patient populations, said the Canadian Pediatric Society has been advocating 2,000 units during pregnancy since 2007.
"The next step, 4,000, well, I bet you they'll come up with that in a couple of years, because this (the Wagner-group study) has to get published first," he said, adding that he agrees that pregnant women should be taking that level of vitamin D daily.
Dr. Robert Gagnon, a spokesman for the Society of Obstetricians and Gynecologists of Canada (SOGC), said the study was well-designed and its findings are important.
The Montreal specialist said SOGC is in the process of reviewing the medical literature before deciding on its official recommendation for expectant mothers.
"We need to see all the details of the study before we come to the recommendation," he said. "To say (pregnant women) should take 4,000, I think it's a little premature for that."
Source
Sterilization surgery not linked to sexual problems
Feb 18th
Women who have their "tubes tied" to prevent future pregnancies do not seem to have an increased risk of sexual dysfunction afterward, according to a new study.
In fact, researchers found, women in their study who'd had the procedure showed lower risks of certain sexual problems and tended to be happier with their sex lives than other women.
The surgery, known as tubal ligation, involves blocking the fallopian tubes that connect the ovaries with the uterus. It is done either right after childbirth -- through the vagina or during a cesarean section -- or via laparoscopic surgery, where one or two small incisions are made in the abdomen.
There are no physiological reasons to believe tubal ligation would cause sexual problems, but there has been little research on the subject, said Dr. Anthony Smith of La Trobe University in Melbourne, Australia, the lead researcher on the current study.
What studies there are have generally only asked women about their general sexual satisfaction, Smith told Reuters Health in an email.
For their study, Smith and his colleagues surveyed 2,721 Australian women about various sexual dysfunction symptoms and their overall satisfaction with their sex lives. Of those women, 447 -- or about 16 percent -- had had a tubal ligation, most of whom were between the ages of 40 and 64.
Overall, women who had had the procedure were less likely to report sexual problems and more likely to say they were happy with their sex lives, according to findings published in BJOG, a British medical journal.
Just over 42 percent said they lacked interest in sex, for example, compared with 51 percent of women who had not had a tubal ligation. And while 17 percent of the latter group said they "did not find sex pleasurable," only 14 percent of women in the tubal-ligation group said the same.
When the researchers accounted for other factors -- like age, education and marital status -- women who'd had a tubal ligation were roughly one-third less likely to lack interest in sex, take "too long" to reach orgasm, have vaginal dryness during sex or find sex unpleasant.
In addition, the study found, women in the tubal-ligation group generally gave higher marks to their sex lives. Thirty-six percent reported "extremely high sexual satisfaction," compared with 30 percent of women who had not had the procedure; when the researchers considered the other factors, women in the tubal-ligation group were two-thirds more likely to give such high ratings to their sex lives.
It's possible, Smith's team notes, that the women and their partners were enjoying sex more because they were free of anxiety over a potential unplanned pregnancy.
Of course, tubal ligation is only one method of birth control. In general, experts recommend it only for women who are sure they do not want to become pregnant in the future. And like any surgery, it carries some risks -- including bleeding or infection during the procedure, and incomplete closing of the tubes; about one in 200 women who have a tubal ligation later become pregnant.
Studies have also found that anywhere from 6 percent to 20 percent of women who have the procedure later regret their decision -- with younger women being more likely to express regrets.
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
Untreated Gum Disease During Pregnancy Risks Life of Baby
Jan 22nd
Pregnant women with untreated gum disease may have more at stake than just their teeth. They may also be risking the lives of their babies, a new study shows.
Expectant mothers have long been warned that gum disease can cause a baby to be born prematurely or too small. But for the first time scientists have linked bacteria from a mother's gums to an infection in a baby that was full-term but stillborn, according to the study which was published Thursday in Obstetrics and Gynecology.
Scientists from Case Western University made the discovery after a 35-year-old California woman contacted them to help investigate the death of her baby. Earlier studies by the same researchers showed that an oral bacteria called Fusobacterium nucleatum could spread from the bloodstream to the placenta in mice. The woman wanted to know if it was possible in humans.
Bacteria from the mouth can easily get into the bloodstream once a woman's gums are bleeding, explains the study’s lead author Yiping Han, an associate professor of periodontics and pathology at Case Western University. Generally, this type of bacteria can be easily combated by the immune system of the mom-to-be, whether mouse or human. But because of special conditions that exist in the womb, the fetus can be more susceptible, Han suspects.
“Once the bacteria are in the blood, they can go almost anywhere,” Han says. “The placenta is an immuno-suppressed organ, compared to other organs like the liver and the spleen. And that makes it easy for the bacteria to colonize the placenta.”
The California woman told researchers that she had experienced heavy bleeding from her gums — a sign of gum disease — during her pregnancy. Bleeding gums aren’t unusual in pregnant women, with about 75 percent developing the condition due to normal hormonal changes. Mild gum disease can be treated simply by brushing and flossing more often. Pregnant women with more serious cases may need dental surgery.
Usually women’s uterine infections, which can harm a fetus, are caused by bacteria that work their way up from the vaginal canal, says Han. But the researchers detected a bacteria in the baby not typically found in the vaginal region. Plaque samples from the woman’s teeth were found to be positive for the exact same strain of the oral bacteria found in the dead baby’s stomach and lungs.
Women shouldn’t be overly alarmed by the new study, says Dr. Richard H. Beigi, an obstetric infectious disease specialist and an assistant professor of reproductive science at the University of Pittsburgh Medical Center.
“This is just one case,” he explained. “Most pregnant women have bleeding gums and most don’t have dead babies. This can happen, but it’s rare. And this finding doesn’t mean that it’s increasing.”
Still, Beigi says, it should serve as a reminder that pregnant women with bleeding gums should see a dentist to treat their gingivitis. Gingivitis can increase the risk of preterm birth anywhere from twice to seven times, studies indicate.
The new study underscores the importance of oral hygiene not only for pregnant women, but also for those contemplating pregnancy, says Dr. Michael Lu, an associate professor of obstetrics, gynecology and public health at the University of California Los Angeles Medical Center.
“We know that gingivitis doesn’t happen overnight and that it’s important for women to enter pregnancy in good health,” Lu says. “I would love to see every woman who is contemplating pregnancy get pre-conception care that includes an oral-health check-up.”
Source
Tips for Pregnant Pet Owners
Jan 12th
Stephanie Shain lives with her husband, Adam, two daughters, two dogs and five cats.
Everyone needs attention. So when she was pregnant with her youngest, Mia, she knew she had to get her animals used to the idea of having a new baby in the house. Because of her work with the Humane Society, she knew animals handle change slowly.
Two or three months out start making those changes, so it's not a lot of changes all at once.
That means setting up the baby's room in front of the pet, and if the pet isn't allowed in the room keep the door shut.
And know your pet. If your cat or dog is protective, try to wean yourself away but let them know they are still loved.
If you're primarily the one who walks the dog, have someone else walk the dog; if you're spending a lot of time playing with your cat every day, make sure that someone else starts playing with your cats.
And if you're pregnant and have a cat, experts say be aware of Toxoplasmosis, a disease, caused by a parasite found in cat feces. It can cause birth defects. Doctors say the disease can be avoided by practicing good hygiene.
Usually the recommendation is to get somebody else to change the litter box.
Shain says taking precautions has paid off. Five-year-old Mia loves her fuzzy house mates and they seem happy to share the house with her.
Source
Readmissions After Cesarean Higher Than Vaginal Delivery
Jan 8th
Hospital readmissions for women in the postpartum period are often due to infections, and women have a higher risk of readmission after cesarean than vaginal deliveries, according to research published in the January issue of the American Journal of Obstetrics & Gynecology.
Michael A. Belfort, M.D., of the Hospital Corporation of America (HCA) in Nashville, Tenn., and colleagues analyzed 222,751 deliveries in 2007 in 114 HCA hospitals to evaluate reasons for readmission after delivery.
Of this group, the researchers found that 2,655 women (1.2 percent) were readmitted within six weeks. Readmission was more common after cesarean than vaginal delivery (1.8 versus 0.83 percent). Hypertension and uterine and wound infections were the most common reasons for readmission, though readmissions for cholecystitis, appendicitis, and pneumonia were also notable.
"Our data confirm that, although readmissions in the first six weeks after delivery are uncommon, cesarean delivery carries with it roughly twice the risk for readmission as does vaginal birth," the authors write. "Perhaps of most interest was our observation of a significantly higher rate of hospital readmission for cholecystitis, appendicitis, and pneumonia in the first few postpartum weeks than would be expected by chance. None of these conditions has ever before been linked causally to pregnancy or delivery."
Source
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
Avoiding Healthcare-Associated Infections during Childbirth
Dec 10th
With the H1N1 making the rounds and taking its toll on many pregnant women and babies, the spread of infection is in the spotlight. Receiving the vaccination is a good step, but there are other types of infections that can be spread, for which no vaccines are available.
About 1.24% of births in a hospital lead to a healthcare-associated infection. The hospital environment is notably sterile; unfortunately this leaves only the strongest bugs to survive. Pregnant women and infants have weaker immune systems making it an even riskier situation. In addition, studies have shown that only about half of doctors and nurses wash their hands between patients. Here are steps you can take and things to watch out for to avoid a healthcare-associated infection:
- Reduce invasive procedures. As much as possible try to limit epidurals, cesarean sections, catheters, IVs, internal monitors and episiotomies. Sometimes these procedures are necessary, but they can increase the risk of infection.
- Keep vaginal exams to a minimum.
- Try to find a hospital that has a separate maternity suite to the rest of the hospital.
- Nurses and doctors should be in full gown with gloves and mask when performing invasive procedures, such as inserting a catheter.
- Anyone entering the room should wash their hands thoroughly before touching the mother or baby. Don’t be afraid to insist on it for friends, family and medical professionals. Medical professionals will completely understand if you ask them to wash their hands in front of you.
- Sick friends, family members and medical professionals should stay away from the mother and baby.
- Disinfect areas with an alcohol-based sanitizer where the mother’s skin comes in contact, such as the birth ball.
- If, after giving birth, you find yourself becoming sick directly after, or feel increasing pain, return to the hospital immediately.
Kimberley-Clark is working to educate medical professionals and consumers about healthcare-associated infections in a campaign called “Not on My Watch”. Find out more information here.
