Trusted Information for Healthy Pregnancies
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Aspirin During Pregnancy May Help Preemies
Dec 29th
The children of women who take low-dose aspirin during pregnancy because they are at high risk for delivering prematurely might have fewer behavioral problems at age 5, new research suggests.
Obstetricians sometimes give low-dose aspirin to pregnant women who are apt to have such complications as fetal growth restriction (when a fetus doesn't grow properly in the womb) or preeclampsia (high blood pressure that's dangerous to both mother and the fetus), said Dr. Ashley Roman, a clinical assistant professor of obstetrics and gynecology at NYU Langone Medical Center. Roman was not involved in the research.
In the study, French researchers used data on 656 children born before 33 weeks of gestation to 584 women from nine regions in France. A full-term birth is at 40 weeks' gestation. The women had a history of placental vascular disease, fetal growth restriction, chronic hypertension, and renal or autoimmune diseases.
About 21 percent of the women took low-dose aspirin during pregnancy.
At age 5, children whose mothers had taken aspirin were slightly less likely to have behavioral difficulties or hyperactivity, though the results were not statistically significant, according to the study.
In addition, the babies whose mothers had taken aspirin faced no increased risk for death, cerebral lesions or cerebral palsy.
One of the fears of giving aspirin to women during pregnancy is that aspirin interferes with platelet function, which is important for blood clotting. Because of that, it could raise the risk for brain bleeds in already susceptible premature infants, Roman said. The study found no increase in the risk for brain bleeds.
The study findings are published online Dec. 21 and in the January print issue of the journal Pediatrics.
Still, much remains unknown about the role of aspirin in pregnancy, including exactly how well or why aspirin works, Roman noted. One theory is that fetal growth restriction might be caused by tiny blood clots in the placenta, and aspirin helps blood flow between the placenta and the fetus. Low-dose aspirin is also taken by adult men and women at risk for heart attack and stroke.
Dr. Michael Katz, senior vice president for research and global programs at the March of Dimes, said the study is intriguing, but the findings are too preliminary to be of much help to women or their physicians. Many women in the study were also given other drugs, including corticosteroids, and it's unknown how much that affected the outcomes.
"Behavioral difficulties," as cited in the study, is a broad term that could encompass everything from excessive temper tantrums to learning disabilities to hyperactivity to autism, he said, each of which could have very different underlying causes.
Premature babies are at higher risk for neurological problems, including learning disabilities, cerebral palsy, and hearing and vision problems.
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No Link Seen Between Acetaminophen, Birth Defects
Dec 21st
New study findings offer reassurance to pregnant women that acetaminophen does not appear to raise the risk of birth defects.
Acetaminophen is the active ingredient in Tylenol and certain other painkillers, and is often found in over-the-counter cold and flu remedies. Taken as directed, acetaminophen is considered safe during pregnancy, making it the medication of choice for pregnant women's body aches and fevers.
However, there are still some questions about whether the drug can contribute to birth defects. Studies looking at birth defects as a broad group have either found no link to acetaminophen use or have yielded inconclusive findings.
Some research, meanwhile, has suggested that the drug may be linked to a higher risk of a birth defect called gastroschisis -- but other studies have found no such connection. Gastroschisis refers to a defect in the abdominal wall that allows the intestines to protrude; it has been linked to aspirin use during pregnancy.
In the new study, researchers analyzed data from a large U.S. study that included more than 11,600 children born with congenital defects such as spina bifida, cleft lip and various defects affecting the brain, heart, lungs, limbs and gastrointestinal system. They were compared with 4,500 children born with no major anomaly.
Overall, the study found, there was no evidence linking mothers' acetaminophen use in the first trimester to a heightened risk of any birth defect.
In fact, women who took the medication to treat a first-trimester fever had a lower risk of certain birth defects -- including gastroschisis -- than women who did not treat their fevers with acetaminophen.
Researchers led by Dr. Marcia L. Feldkamp, of the University of Utah in Salt Lake City, report the findings in the January 2010 issue of the journal Obstetrics & Gynecology.Among women who had fevers in early pregnancy, babies born to those who used acetaminophen had a 65 percent to 83 percent lower risk of certain birth defects of the brain, a 56 percent lower risk of cleft lip and a 59 percent lower risk of gastroschisis.
The researchers note that hyperthermia, or excessively high body temperature, has been implicated in the risks of certain birth defects. More studies, they conclude, are needed to confirm whether treating fevers with acetaminophen does in fact prevent some birth defects.
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FDA Updates Warning for Pregnant Women on Antiepileptic Drugs
Dec 4th
The FDA has issued a statement reminding patients and doctors that valproate sodium, valproic acid, and divalproex products increase the risk of birth defects in babies exposed to the chemicals during pregnancy.
The medications - used to treat epilepsy since 1978 and more recently for bipolar disorder and migraine - can cause neural tube defects, craniofacial defects, and cardiovascular malformations in unborn children during the first trimester. This is often before many women know they are pregnant, the FDA said in a statement.
Use of the products increases neural tube defects during the first 12 weeks of pregnancy from one in 1,500 to one in 20, on average, the FDA noted.
Babies born to women taking valproate for epilepsy are more than three times as likely to have birth defects as those born to women on a different therapy (10.7%, 95% CI 6.3% to 16.9% versus 2.9%, 95% CI 2.0% to 4.1%), according to data from the North American Antiepileptic Drug Pregnancy Registry.
The FDA cautioned women of childbearing potential to take valproate only if it is essential for managing a medical condition. Those taking the drug who are not planning pregnancy should use contraception, the agency said.
Women planning to become pregnant can reduce the risk of congenital neural tube defects by taking folic acid before and during the first trimester of pregnancy, the FDA noted.
The agency also noted a danger to pregnant mothers and their child if epilepsy or bipolar disorder is left untreated while the baby is developing. Likewise, it reminded doctors and patients of a major risk associated with ceasing valproate therapy suddenly.
The FDA recommended that women talk with healthcare professionals before stopping use of valproate products if they become pregnant.
It also recommended women who become pregnant while taking valproate or other antiepileptic drugs enroll in the North American Antiepileptic Drug Pregnancy Registry to help gather more information on the safety of the medications during pregnancy.
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Clinical Question: Topamax and Seroquel in a Woman with Bipolar Disorder Planning to Breastfeed
Dec 1st
A clinician asks: “I am a psychiatrist treating a patient with Bipolar Disorder on Seroquel and Topamax. I would like to know what information is available regarding the safety of these medications to the infant if used during breastfeeding.”
With regard to topiramate (Topamax), there is relatively little information on breastfeeding. One case series included five [...]
Many Pregnant Women Take Drugs Harmful to Baby
Nov 30th
With the help of their doctors, women planning to become pregnant should take an inventory of the medications they take, researchers from Canada advise.
In a study, they found that many pregnant women still take medications long known to cause birth defects.
Some medications with known fetal risk, such as drugs that control epilepsy, are essential during pregnancy, Dr. Anick Berard, at the University of Montreal in Quebec, noted in an email correspondence to Reuters Health.
Other medications, such as those that treat severe acne, anxiety and psychiatric drugs, antibiotics, and many drugs prescribed for heart disease and medical conditions, "can and should be avoided," according to Berard.
Women should understand the side effects of any drug they are taking -- especially drugs treating a chronic condition -- and plan pregnancies to avoid or minimize risks such drugs pose to babies, Berard added.
For the 5 years between January 1998 and the last day of 2002, Berard and colleagues analyzed the prescriptions filled by pregnant women for drugs available at the time and known to pose fetal risks.
Their report, in BJOG: An International Journal of Obstetrics and Gynecology, shows 56 percent of 109,344 pregnant women filled at least one medication prescription. A total of 6.3 percent (6,871 women) did so for at least one medication known to pose a risk to the fetus.
"These pregnancies were associated with an elevated number of (pregnancy terminations) and babies born with major (birth defects) in comparison with the expected numbers in the population," they note.
Specifically, terminations occurred in 47 percent of the pregnancies exposed to drugs with known fetal risks. Six percent of these pregnancies ended in miscarriage.
By contrast, in the much larger non-exposed group about 36 percent of the pregnancies had been terminated and fewer than 5 percent ended in miscarriage.
Berard's team further identified birth defects in 8.2 percent of 2,842 infants exposed to risky drugs during gestation and available for assessment, compared with 7.1 percent of the 59,287 infants not exposed. This is "a statistically significant difference," they note.
They emphasize, however, that it cannot be concluded that the drug exposure caused the birth defects. These pregnancies may have also been exposed to other harmful agents or maternal health conditions, they point out.
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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.
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