low birth weight

Stress early in pregnancy increases risks to babies

Stressful situations in early pregnancy can lead to the birth of babies who are underweight or born too early, new research from China shows. Timing of the stress, the researchers found, was the key.

"The findings are modest, but significant," the authors write in the American Journal of Obstetrics and Gynecology.

The risks of premature births increased two-fold in women who were exposed to severe life events during their first and second trimesters - weeks 1-12 and 13-24, respectively. Premature birth, the authors note, is the single largest contributing factor in infant deaths in the developing world.

Researchers from Anhui Medical University, led by Dr. Peng Zhu, followed 1,800 pregnant women receiving prenatal treatment in 2008 at one hospital. The participants were surveyed on financial conditions, emotional support, traumatic events and their relationships with their spouses. Were jobs or fortunes lost, were family members cheated, did the family move, did a family member die or suffer an illness, or was there fighting or divorce?

There were 96 (5.3 percent) premature births and 55 (3.1 percent) low birth-weight babies.

Earlier studies have found that future moms with stressful lives were at greater risk of delivering preterm or low birth-weight babies. This study - looking at a long list of potentially stressful events experienced during pregnancy only - concluded that the earlier in pregnancy the stress occurred, the greater the risk.

The Zhu team found that premature birth was more than twice as likely if severely stressful events occurred during the first and second trimesters, but not the third. Low birthweight was nearly three times more likely if stress happened during the first trimester, compared to if it happened during the second or third trimester.

While for the most part consistent with earlier research, the Chinese researchers caution that the reach of their findings could be limited.

For instance, they warn that faulty memories, the small number of women in some of the stress categories, and the possibility that the list of stress events was flawed could weaken the power of the results.

The Zhu team concluded that health planners seeking to reduce the incidence of pre-term and low-weight births must take maternal stress into account when designing intervention programs.


Mother-daughter pregnancy sickness link found

Pregnant women are three times more likely to suffer from severe morning sickness if their mothers did, say Norwegian researchers,

Around 2% of women suffer excessive nausea and vomiting in pregnancy - known as hyperemesis gravidarum - which can require hospital treatment.

But a study of 2.3 million births showed a threefold higher rate in those whose mothers had the condition.

Experts said the results could help women better understand their risk.

Hyperemesis is defined as excessive sickness which starts before the 22nd week of pregnancy and in its most serious form it can lead to dehydration and weight loss because women cannot keep food or water down.

It can be extremely debilitating, women can't work, can't look after their families and they need to be admitted to hospital.

It is the most common cause of admission to hospital in early pregnancy and can be a cause of low birth weight and premature birth.

The researchers said that previous studies have attributed the condition to "psychological causes".

They analyzed birth records, which included information on pregnancy complications, from 1967 to 2006.

It found the daughters of women who had the condition during their pregnancy had a 3% risk compared with 1% in those whose mothers did not have it.

But there was no increased risk to the female partners of sons whose mothers had suffered from the illness.

The researchers said although the results suggest a genetic link between mothers and daughters, it is also possible that there are lifestyle or environmental factors shared between mother and daughter that increase the risk.

Dr Catherine Nelson-Piercy, a consultant obstetric physician at Guy's and St Thomas' Foundation Trust in London, said that better understanding of the genetic risks of hyperemesis may help clinicians when counseling women about the risk of recurrence in future pregnancies.

She said many women were undertreated because of the legacy of thalidomide - a drug given for morning sickness in the 1960s which caused birth defects - despite the availability of safe drugs.

"It is safe to take anti-sickness drugs and it's better for the baby and the pregnancy to treat this condition than let the woman get very severely ill and risk complications."

Patrick O'Brien, spokesman for the Royal College of Obstetrics and Gynaecology, said the study added to growing evidence that many conditions in pregnancy, such as diabetes or high blood pressure, were linked to a "genetic predisposition".


Very premature twins do just as well as singletons

Overall, very premature twins fare just as well as single babies born very early, and they may even face a lower risk of certain complications, new research shows.

But for twin pairs of the same sex but sharply different sizes who are born before 28 weeks, the risks of death and bleeding on the brain are higher than they are for single babies born at the same time, Dr. Jennifer Zeitlin of the Hopital Saint-Vincent de Paul in Paris and her colleagues found.

Premature birth is much more common among twins than singletons, Zeitlin and her team note; while one in every 10 twin pairs is born before 32 weeks' gestation, just one in 100 singletons is born this early. There is evidence that preemie twins do better than singles of the same gestational age, they add.

A full-term pregnancy lasts for 39 weeks, while babies born between 28 and 31 weeks are considered "very preterm." Babies born between 24 and 27 weeks' gestation are "extremely preterm."

To investigate outcomes for very premature and extremely premature twins compared to those of singletons born equally early, Zeitlin and her colleagues looked at births and stillbirths in nine European countries in 2003. Their analysis included 1,254 twins and 3,586 singletons born between 24 and 31 weeks' gestation.

The women carrying twins were less likely to develop high blood pressure during pregnancy than those with singletons, the researchers found: about 8 percent of those carrying twins, compared to about 22 percent of those carrying single babies.

They also found that severe bleeding and restrictions on the growth of the fetus were also less common in twin pregnancies.

Twins' mothers were also more likely to have been given corticosteroids before delivery; these drugs are administered to speed up premature newborns' lung development.

Among the very premature babies, the likelihood of dying in the first few weeks of life was lower for twins, who were also less likely to need oxygen. But once the researchers took factors such as mother's age, pregnancy complications, and infant health problems into account, the difference disappeared.

For the extremely premature infants, however, the researchers calculated that the risk of death or serious bleeding in the brain was about 1.5 times higher for twins than it was for single babies. While about 17 percent of singletons suffered from such bleeding, roughly 24 percent of twins did.

The greater risks were only seen for same-sex twins in which one twin weighed at least 15 percent more than the other twin at birth.

"Why the effects of these twin-specific complications were so much more pronounced for extremely preterm births is an area for further study," the researchers conclude.


Mom’s Lifestyle in Early Pregnancy Affects Baby’s Size

The lifestyle habits you bring into pregnancy can have lasting effects on your baby's health, new research shows.

A Dutch study found that women who smoked, had high blood pressure or low folic acid levels in early pregnancy had babies that were smaller in the first trimester of pregnancy and had a higher risk of complications later.

"Our study demonstrates that several maternal physical characteristics and lifestyle habits, such as smoking and non-use of folic acid supplements, affect first-trimester fetal growth," said study senior author Dr. Vincent Jaddoe, a pediatric epidemiologist at Erasmus Medical Center in Rotterdam, the Netherlands.

"First-trimester growth restriction is associated with higher risks of adverse birth outcomes and accelerated postnatal growth rates. Thus, the first trimester of pregnancy seems to be a very critical period for fetal growth and development. This is important, since it suggests that the fetus is already affected before pregnant women visit their midwife or obstetrician," he said.

For the study, published in the Feb. 10 issue of the Journal of the American Medical Association, the researchers followed 1,631 pregnant women from their first trimester through their pregnancies. The growth of their offspring was assessed until the children were 2.

The average age of the mothers was 31, and 71 percent were white. More than half had a higher than high school education. The average body mass index was 23.5, which is normal (over 25 is considered overweight). About one-quarter smoked at the start of the study.

The researchers found that certain factors affected the likelihood that a fetus would have a small crown to rump length (a standard way to measure babies using ultrasound). Babies whose mothers smoked or had higher diastolic blood pressure readings (diastolic is the bottom number in blood pressure) were more likely to be smaller. Women who didn't use folic acid supplements and those with higher levels of red blood cells also had smaller babies, according to the study.

A small size during the first trimester translated to a higher risk of certain complications later in the pregnancy, such as preterm birth and low birth weight.

Babies that had first-trimester growth restriction had 7.2 percent odds of being born preterm compared to 4 percent for babies who weren't growth-restricted. Odds of low birth weight were 7.5 percent for growth-restricted babies compared to 3.5 percent for other babies. And, the odds of being born small-for-gestational-age were 10.6 percent for babies who were growth-restricted compared to 4 percent for babies who grew normally during early pregnancy.

Jaddoe and Dr. Gordon Smith, author of an accompanying editorial in the same issue of the journal, believe that when a woman is exposed to poor lifestyle habits in early pregnancy, it may affect development of the placenta, which then affects the fetus' ability to survive and thrive.

The bottom line for women is that it's important to go to the doctor before getting pregnant to find out what steps to take to ensure that you're in the best shape possible before you get pregnant, such as quitting smoking and taking folic acid supplements.


Older mothers’ kids have higher autism risk, study finds

A 10-year study examining 4.9 million births in the 1990s has found more evidence that there's a link between autism and the mother's age at conception.

The link between the parents' age and children's health is not entirely new. Prior studies have indicated that babies born to older women have higher risks of birth defects, low birth weight and certain chromosome problems, such as Down syndrome.

A 2007 Kaiser Permanente study conducted in California reported that autism risk increased with both the mother's and father's age. An Israeli study based in statistics from 1980s had isolated only paternal age as being linked with increased risk for autism.

Dr. Max Wiznitzer, a pediatric neurologist at Rainbow Babies & Children's Hospital in Cleveland, Ohio, said the latest research had a far larger sample size.

In the latest study, researchers found that mothers over the age of 40 had 51 percent higher odds of having children with autism compared with mothers between the ages 25 and 29.

The father's age also played a factor, but only when he had a child with a woman under 30.

"When the mom has minimal age risk of an autistic child, we do see increased risks as dads get older," said lead author Janie Shelton, a graduate student researcher at UC-Davis.

It's unclear why the mother's age has more bearing in autism risk than the father's.

The study authors emphasize that while autism rates have risen 600 percent in the past two decades, older women having children contributed to only 5 percent more cases of autism.

As more women delay childbearing, it's important to keep the study in perspective, said Geraldine Dawson, chief science officer of Autism Speaks, the nation's largest autism science and advocacy organization.

"I don't think a mom blaming herself is going to help us understand what's causing autism or help prevent further cases," she said. "I would urge parents not to blame themselves, regardless of what age they are."

Shelton and the co-authors obtained all birth records in California from 1990 to 1999 and then collected data from the state's Department of Developmental Services to count the number of autism diagnoses from children born during that decade.

How parental age increases autism risks remains unknown, but several hypotheses exist. Some suggest that the cumulative effects of the environment, changes to the autoimmune system, stress and reproductive technology may affect autism risk.


Natural Delivery OK in Cases of Intrauterine Growth Restriction

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.


Massage Reduces Depression in Pregnant Women

New research shows massage therapy reduced depression in pregnant women, and also reduced the incidence of massaged women's babies being born prematurely.

The study was conducted by researchers at the Touch Research Institutes, where pioneering research about massage has been conducted since 1992.

Pregnant women diagnosed with major depression were given 12 weeks of massage, twice per week, by their significant other. A control group did not receive massage, according to an abstract published on www.pubmed.gov.

The massage-therapy group versus the control group not only had reduced depression by the end of the massage-therapy period, they also had reduced depression and cortisol levels during the postpartum period.

The massaged women's newborns were also less likely to be born prematurely and low birthweight, pubmed noted, and they had lower cortisol levels and performed better on the Brazelton Neonatal Behavioral Assessment habituation, orientation and motor scales.


Mothers with Celiac Disease Face a Higher Risk of Underweight and Early-term Births

Women with celiac disease face greater risks for adverse pregnancy outcomes. A team of researchers recently set out to examine the effects of treated and untreated maternal celiac disease on infant birthweight and preterm birth. Among their findings are that expectant mothers with celiac disease face a higher risk of underweight and early-term birth than those without celiac disease.

For their data, researchers used a population-based cohort study of all live births in Denmark between 1 January 1979 and 31 December 2004. During that period, 836,241 mothers gave birth to a total of 1,504,342 babies. Mothers with diagnosed celiac disease gave birth to 1105 of those babies, while 346 were born to women with undiagnosed celiac disease.

The team considered mothers with diagnosed celiac disease to be following a gluten free diet, and those with undiagnosed celiac disease to be on a gluten-inclusive diet. The team measured outcomes based on birthweight, small for gestational age, very small for gestational age and preterm birth. They then compared the results for the treated and untreated celiac disease mothers with those of a celiac-free reference group.

The research team found that mothers with untreated celiac disease gave birth to smaller babies [difference = –98 g (95% CI: –130, –67)], with a higher risk of SGA [OR = 1.31 (95% CI: 1.06, 1.63)], VSGA [OR = 1.54 (95% CI: 1.17, 2.03)] and early birth [OR = 1.33 (95% CI: 1.02, 1.72)] compared with women with no celiac disease.

The good news is that mothers with treated celiac disease showed no increased risk of reduced mean birthweight, or of delivering SGA and VSGA infants or preterm birth compared with mothers with no celiac disease.

From the results, the research team concluded that untreated maternal celiac disease increases the risk of low birthweight, SGA and VSGA, and preterm birth.

Diagnosis and treatment of maternal celiac disease with a gluten-free diet seems to return the birthweight and preterm birth rate to one comparable to women without celiac disease.


Untreated Gum Disease During Pregnancy Risks Life of Baby

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.”


Birth Weights Are Falling in U.S.

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.


Twitter links powered by Tweet This v1.6.1, a WordPress plugin for Twitter.