Trusted Information for Healthy Pregnancies
pregnancy complications
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
Very premature twins do just as well as singletons
Feb 18th
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.
Source
Migraine drugs don’t up birth defect risk: study
Feb 16th
A study in nearly 70,000 pregnant women has found no link between migraine drugs called triptans and the risk of birth defects.
However, the researchers did find a "slight increase" in the risk of excessive bleeding during labor, and the failure of the uterus to contract normally after delivery, for women who used the drugs while pregnant.
Triptans are among the most powerful drugs used for migraine; others include aspirin, Excedrin, and ibuprofen.
While as many as three in 10 women may develop migraines during their childbearing years, women often shy away from using such drugs during pregnancy because of safety concerns, according to study co-author Katerina Nezvalova-Henriksen of the University of Oslo in Norway and her colleagues.
However, the authors of the study in Headache note, untreated migraine may itself carry risks for mother and child; some studies have linked it to pre-eclampsia, a potentially deadly pregnancy complication.
"While it is important to exert caution when using any medications during pregnancy, this study indicates" that pregnant women can either start or continue taking triptans without "any major risk" of miscarriage, premature delivery, or other bad outcomes, the authors conclude.
Nezvalova-Henriksen and her team studied nearly 70,000 women. Two percent, or 1,535, had used sumatriptan (Imitrex), rizatriptan (Maxalt), zolmitriptan (Zomig), or eletriptan (Relpax) in pregnancy.
Less than one percent -- 373 women -- had used the drugs before getting pregnant but not during pregnancy.
The overall birth defect rate, which encompasses everything from large birthmarks to serious heart problems, was the same among women who had taken triptans during pregnancy and those who didn't have migraines: 5 percent. Among those who had used triptans in the past but not during pregnancy, it was slightly higher: 6 percent.
The women who used triptans were also more likely than non-triptan users to take other drugs during pregnancy, including acetaminophen (Tylenol) with codeine and non-steroidal anti-inflammatory drugs such as ibuprofen.
However, the rate of major birth defects - such as serious problems of the limbs or internal organs -- was 3 percent for all three groups. That rate - about one in 33 births - is about what would be expected for all birth defects in the general population.
The researchers did find that women who used triptans in their second or third trimester were more likely to develop a condition called atonic uterus, in which the uterus fails to contract back to its normal size after delivery. This is the leading cause of excessive bleeding after delivery. They were also more likely to lose significant amounts of blood during labor and delivery.
And during pregnancy, they were more likely to suffer from vomiting than women who had never used the drug; they were also more likely to develop pre-eclampsia or eclampsia, and more likely to have deficiencies in the B-vitamin folate.
While many women who suffer migraines will experience improvements in their symptoms after their first trimester, Nezvalova-Henriksen and her team note, those whose symptoms don't improve by then aren't likely to get better.
Source
Excess weight raises pregnancy risks: study
Feb 12th
Being overweight or obese increases a woman's chances of having an extra-big baby, even after the effects of pregnancy-related, or "gestational," diabetes are taken into account, new research shows.
Excess weight in and of itself also sharply increased a woman's risk of pre-eclampsia, a potentially deadly pregnancy complication, Dr. Boyd E. Metzger of Northwestern University Feinberg School of Medicine in Chicago and his colleagues found.
Women have more difficulty delivering very large babies, while these newborns are also at risk of suffering injury during birth, including shoulder dislocation. While women who are overweight or obese are known to run a greater risk of having very large babies and experiencing other pregnancy complications, it has been difficult to separate out the effects of a mother's weight from those of gestational diabetes, Metzger and his colleagues note in the British Journal of Obstetrics and Gynecology.
This led them to investigate whether body mass index (BMI) -- a standard measure of weight in relation to height used to gauge how fat or thin a person is -- might influence pregnancy risks and fetal and newborn health, independently of a woman's blood sugar levels.
The study involved 23,316 women from 15 different medical centers in nine different countries. All had undergone an oral glucose tolerance test, which is used to identify women with, or at risk for, pregnancy-related diabetes; at that time, their height and weight were measured, too.
The researchers then used statistical techniques to control for women's oral glucose tolerance test results. Even after this adjustment, they found that the women with BMIs of 42 or greater, denoting severe obesity (for example, a 5-foot-5-inch tall woman weighing at least 250 pounds), were at more than triple the risk of having an excessively large baby, compared to the thinnest women in the study, who had BMIs of 22.6 or less (a 5'5" woman weighing less than 138 pounds).
The heaviest women's risks of having a C-section were more than doubled, while their likelihood of pre-eclampsia was 14-fold greater than for the leanest women. However, the heaviest women's risk for delivering a preterm baby was actually cut in half.
These findings help sort out the role BMI and gestational diabetes each play in the risk of complications of pregnancy and delivery, Metzger told Reuters Health in an interview.
He noted that recent studies have shown that dietary changes can effectively treat gestational diabetes for more than 90 percent of women with the condition.
"We're pretty confident that treating gestational diabetes going forward is going to continue to be beneficial," the researcher said. "We have much less evidence at this point as to how to neutralize or reduce the impact of overweight on pregnancy outcome."
What is becoming clear, he added, is that it's probably a woman's weight before she gets pregnant, rather than how much she gains during pregnancy, that's important in determining risk.
Source
Mom’s Lifestyle in Early Pregnancy Affects Baby’s Size
Feb 10th
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.
Source
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.
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
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."
Source
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.
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).