Trusted Information for Healthy Pregnancies
low birth weight
Drugs for depression, anxiety tied to preterm birth
Jan 21st
Pregnant women who take certain drugs for depression or anxiety may have heightened risks of preterm delivery or other birth complications, according to a new study.
Researchers found that among nearly 3,000 women who gave birth in Washington State, those who started taking antidepressants known as selective serotonin reuptake inhibitors (SSRIs) in the second or third trimester had a higher risk of preterm birth.
Compared with their counterparts not on the medications, these women were nearly five times more likely to deliver prematurely.
The same risk was not seen, however, among women who started on an SSRI before pregnancy or during the first trimester. SSRIs include drugs like sertraline (Zoloft), paroxetine (Paxil) and fluoxetine (Prozac).
The researchers also found a higher risk of preterm delivery among women who took anti-anxiety drugs known as benzodiazepines, regardless of when they began treatment.
Those drugs, which include medications like lorazepam (Ativan) and alprazolam (Xanax), were linked to higher risks of other complications as well - including low birth weight, newborn respiratory distress and a low Apgar score, a standard measure of newborn health.
The findings of the study are published in the American Journal of Obstetrics & Gynecology.
Exactly what the study means for women on SSRIs or benzodiazepines is not entirely clear. A major limitation is that it could not estimate the benefits of treatment, lead researcher Dr. Ronit Calderon-Margalit, of the Hebrew University-Hadassah School of Public Health in Jerusalem, noted in an email to Reuters Health.
Any risks of using the medications during pregnancy need to be balanced against the risks of leaving depression and anxiety disorders untreated.
"It is very important to have other studies of the risks associated with (these) drugs, but also of benefits associated with treating mothers," said Calderon-Margalit, who was at the University of Washington in Seattle at the time of the study.
In addition, SSRIs did not appear to present equal risks for all women. Calderon-Margalit described the antidepressant findings as "mostly reassuring" for women who start the drugs before pregnancy or in the first trimester -- as most SSRI users in the study had.
The study included 2,793 pregnant women, 11 percent of whom used a psychiatric medication during pregnancy. Of these, 138 were on an SSRI, while 85 used a benzodiazepine.
Among women who were not on any medication, 9 percent gave birth prematurely, versus nearly half of women on benzodiazepines.
Meanwhile, 14 percent of women on SSRIs had a preterm birth, but the elevated risk turned out to be concentrated among those who started an antidepressant after the first trimester. Of those 21 women, 16 delivered prematurely.
Several other birth complications, often related to preterm birth, were also higher-than-average among women on benzodiazepines.
Seventeen percent of their newborns suffered respiratory distress syndrome and one-third ended up in the neonatal intensive care unit. Those figures were 3 percent and 6 percent, respectively, among newborns whose mothers had not used psychiatric medications during pregnancy.
Calderon-Margalit pointed out that most women on benzodiazepines used lorazepam (Ativan), so it is possible that the risks are associated mainly with that drug. However, further research is needed to determine whether any particular medications carry particular risks.
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Premature Birth Tied to Later Behavioral Problems
Dec 16th
Children who were born prematurely and at a very low weight may have an increased risk of certain behavior problems and symptoms of depression and anxiety, research suggests.
As the survival rates of very preterm newborns have improved in recent years, studies have uncovered some of the potential long-term challenges these infants will face - including lower IQ and higher rates of behavioral problems compared with their peers born at term.
In the new study, researchers found that among 104 7- to 16-year-olds they assessed, the 49 who were born very prematurely had higher rates of hyperactivity and attention problems, as well as symptoms of depression and anxiety.
The higher risk was not explained by lower IQ scores, however. Nor was families' socioeconomic status an important factor in children's odds of behavioral or emotional issues.
Instead, birth weight itself was the strongest factor, the researchers report in the journal Pediatrics.
The finding "suggests that in children born prematurely, behavioral issues might be more biologically based and not easily compensated for by improvements in the environment," explained lead researcher Dr. Amy L. Conrad, of the University of Iowa College of Medicine in Iowa City.
"It does not mean that environment can't help," she told Reuters Health in an email, "just that it might not have as strong of an impact as for children born at term and of average birth weight."
In addition, while the study found that parents of premature children reported more behavioral and emotional symptoms than other parents did, most kids did not have significant problems.
According to Conrad, 18 percent of preterm children had hyperactivity/inattention problems that were in the "clinical range" -- or significant enough to warrant therapy -- while 14 percent had depression or anxiety symptoms in that range.
For the study, Conrad's team had 104 children and teenagers take standard intelligence tests, while their parents and teachers completed a standard questionnaire on behavioral issues. Forty-nine of the kids had been born significantly preterm -- between the 24th and 33rd week of pregnancy. A normal pregnancy lasts 40 weeks.
Their birth weights ranged from "extremely low" -- less than 2.2 pounds -- to "very low," or between 2.2 and 3.3 pounds.
In general, parents of preterm children reported more behavioral issues than parents of children born full-term, with the highest rates among children with extremely low birth weights. The link between birth weight and behavior did not fade after the researchers factored in children's age, gender, IQ and socioeconomic status.
It's possible that very low birth weight affected some children's brain development in a way that made them more vulnerable to behavioral problems.
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Less caffeine better during pregnancy, study says
Dec 8th
For years, medical professionals have been telling pregnant women to reduce their caffeine intake, and that by doing so they could reduce their risks for problems such as premature delivery, low birth-weight babies and miscarriage.
However, for some pregnant women giving up caffeine completely simply is not realistic. For them, how much caffeine is too much?
A report from the British Medical Journal tried to answer this question. Researchers followed more than 2,600 low-risk women at two large teaching hospitals in England from 2003 to 2006. They screened pregnant women for caffeine, tobacco and other drug use. Close monitoring also noted miscarriages, low birth-weight deliveries, preterm delivery, elevated blood pressure and stillbirths.
In attempting to determine a safe upper limit of caffeine intake, the researchers looked for pregnant women who admittedly ingested significant amounts of caffeine as coffee, tea, soda or chocolate. In those women, the average amount of caffeine intake prior to pregnancy was almost 240 milligrams per day. That dropped to an average of 140 milligrams of caffeine during their pregnancies.
To put caffeine levels in perspective, a soda or cup of coffee has about 30 to 40 milligrams of caffeine.
What the researchers found answered some questions, but also raised some new ones. In comparing the women who ingested more than 300 milligrams of caffeine vs. those who ingested 30 milligrams of caffeine per day, the most dramatic differences were noted in infant birth weights. Higher amounts of caffeine ingestion were associated with lower birth weights.
From past studies we have also seen a correlation of higher caffeine usage with miscarriage and premature delivery.
So the British researchers confirmed what we already knew - that less caffeine is better when it comes to pregnancy. Unfortunately, they were not able to determine if there is a safe upper limit of caffeine ingestion.
The American College of Obstetricians and Gynecologists suggests a maximum of 300 milligrams per day. The British government's Food Standards Agency recommends no more than 200 milligrams per day. Some doctors say to patients who just cannot say no to that morning cup of coffee is to try to keep their caffeine ingestion to less than 100 milligrams per day.
Of course, we have to keep the results of this British study in context. While levels of caffeine usage greater than 30 milligrams per day were associated with smaller birth weight babies, these differences in weight were fairly small (a few ounces).
Of course, when combined with the use of tobacco, alcohol or other substances, a few ounces could make a big difference.
Source
Stain repellents linked to low birth weight and premature births
Dec 7th
Research finds that stain repellent and anti-adhesive chemicals may be linked to low birth weight and premature births in those born near a factory that both produces and uses the chemicals.
A study that surveyed members of a West Virginia community finds that higher exposures - presumably through water and air - to antistick chemicals released from a nearby factory may be linked to low birth weight and early birth in babies born to women who live in the area.
The synthetic chemicals of concern in the study are called polyfluorinated compounds (PFCs). They are widely used in the manufacture of stain repellents applied to carpets and furniture and as anti-adhesives in pots and pans.
Two of the most common PFCs are perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS). While they are designed for use in product coatings, PFOA and PFOS may also form when other PFCs break down. The chemical plant located near Parkersburg, West Virginia used PFOA since 1951 to make nonstick coatings.
These chemicals are very persistent and have been detected worldwide in wildlife and humans. The most recent National Health and Nutrition Examination Survey (NHANES) reported that virtually all US residents are exposed to PFOA and PFOS.
Animal studies have reported reduced fetal weight and increased neonatal mortality after exposure to high doses of PFCs. Results from previous human studies have been inconsistent.
In this study, women with PFOS blood levels above the median (13.6 nanograms/milliliter (ng/mL)) had a 50 percent increased risk of low birth weight and a 10 percent increased odds of preterm birth when compared with women with exposure below the median. These women were also 30 percent more likely to have preeclampsia, which is characterized by high blood pressure during pregnancy and is in turn a risk factor for abnormally slow fetal growth.
Data were collected as part of a survey of more than 69,000 people living close to a chemical plant located in the Mid-Ohio Valley in West Virginia. These data were collected following a class action lawsuit alleging health damage due to exposure to PFOA, which is believed to have occurred through groundwater contamination and air deposition. Researchers measured PFCs in the blood of 1,845 women and obtained information on pregnancy outcomes based on participant interviews.
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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.
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
Long Term Relationships Lead to Healthier Babies
Nov 13th
Women in long-term relationships appear to have healthier pregnancies and births, claim scientists.
Researchers found they were less likely to suffer high blood pressure during pregnancy and less likely to give birth to smaller babies.
Scientists found that women who had slept with a partner exclusively for at least six months had fewer undersized babies and a lower rate of pre-eclampsia - pregnancy induced high blood pressure.
Experts believe that the reason for the healthier birth is long-term exposure to the biological father's sperm which boosts the immune system.
In the study by Auckland University in New Zealand researchers asked 2,507 first time pregnant women how long they had been with the baby's father.
It was found that when the pregnancies came to term, pre-eclampsia was found to be less common in women who had long-term sexual relations exclusively with the biological father, than in those who had been with their partner only for a short time.
The study also revealed that women who had undersized babies were also more likely to have been in shorter relationships.
Dr Larry Chamley, the lead author from the think tank Faculty of 1000 Medicine and also Associate Professor of Obstetrics and Gynaecology at Auckland, said that female immune system was boosted by exposure to "paternal antigens" - beneficial antibodies in the male sperm.
"Although the issue of whether prolonged semen exposure does protect against developing pre-eclampsia is not yet resolved this paper seems to tip the weight of evidence back in favor of suggesting that prolonged semen exposure is protective," he said.
The results of the study, published in the Journal of Reproductive Immunology, were adjusted for the lifestyle and background of the women including their weight, whether they smoked and their general health.
Those who did not know the identity of the father were excluded from the research.
Source
Exercise Until End of Pregnancy Deemed Beneficial
Nov 12th
"Partaking in low-level physical activity has beneficial effects on materno-fetal health." These findings have recently been published in the International Journal of Obesity and highlight the benefits for the health of the baby and the mother when a physically-active lifestyle is maintained throughout pregnancy.
"An exercise regime carried out during the second and third trimester of pregnancy does not harm the health of the fetus," said Jonatan R. Ruiz, researcher at the Karolinska Institute, Sweden, and principal author of this study, who has coordinated a team from the Polytechnic University of Madrid in collaboration with the Swedish centre.
160 healthy women between the ages of 25 and 35 took part in the study, all of whom had sedentary habits and no risk of premature birth. Of this group of women, half followed an exercise regime under the supervision of experts in Physical Activity and Sports Science in collaboration with the Gynaecology and Obstetrics Unit of Hospital Severo Ochoa in Madrid.
The researchers used multiple variables to assess the health of the fetus (body weight, size and gestational age) in women, and they analyzed the effect of the training program carried out during the second and third trimester of pregnancy on the weight and size of the fetus.
"Body size and gestational age, as well as other health parameters, were similar in the group of women who followed the exercise regime compared to those who did no form of physical activity during pregnancy, which indicates that exercise poses no threat to the health of the fetus," Ruiz emphasizes.
The authors also measured the pre-pregnancy body weight of the mother, the body size of the fetus, and whether diabetes was developed during gestation. In the group of women who did not partake in any exercise (control group), it was observed that the mother's weight before becoming pregnant was positively associated with the weight of the newborn.
"Sedentary mothers of higher pre-gestational weight gave birth to heavier newborns. This relationship, however, was not observed in the group of women who exercised during pregnancy," the researcher concludes. According to experts, babies with excessive weight (more than 4 kg) are more at risk of developing diabetes and certain types of cancer as adults, in addition to complications that may occur at birth.
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