Trusted Information for Healthy Pregnancies
pregnancy complications
Breastfeeding Could Offer Protection Against Metabolic Disorder
Dec 3rd
Breastfeeding may offer mothers long term protection against a condition linked to diabetes and heart disease, researchers report today.
The longer women breastfed, the lower their chance of developing metabolic syndrome, a cluster of risk factors such as high blood pressure and high triglycerides associated with obesity, the scientists found.
"Pregnancy may have some adverse effects on some of these cardiovascular risk factors," lead author Erica Gunderson says, "and lactation (breastfeeding) may offset some of these effects."
The impact of breast-feeding on the risk of metabolic syndrome was "slightly stronger" in women who'd had gestational — or pregnancy-induced — diabetes, says Gunderson, an epidemiologist and research scientist at Kaiser Permanente's Division of Research in Oakland. "This is the first study to really look at lactation and the metabolic syndrome in women with GDM (gestational diabetes)."
About 18%-37% of U.S. women ages 20 to 59 have metabolic syndrome, Gunderson says. A study she published in August found women with gestational diabetes are 2½ times more likely than other women to develop the condition after pregnancy.
Gunderson and her co-authors based their new findings on 704 women in an ongoing, government-funded study of heart-disease risk factors. When the women entered the study in 1985-1986, they were ages 18-30 and had never given birth; testing confirmed they didn't have metabolic syndrome.
They all went on to deliver at least one child; only 16% had more than two children. They returned for measurements of metabolic syndrome components seven, 10, 15 and 20 years after entering the study; 120 developed metabolic syndrome.
In women who didn't have gestational diabetes, breast-feeding cut metabolic syndrome risk 39%-56%. In those who did, it cut the risk 44%-86%. In both, the authors write in Diabetes: The Journal of the American Diabetes Association, the longer women breast-fed, the lower their risk.
Breast-feeding is associated with a quicker loss of pregnancy weight, but that's only "a little bit of the explanation," Gunderson says. Another possibility, she says: Breast-feeding might minimize the accumulation of belly fat, fat linked to type 2 diabetes risk.
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MRI Can Rule Out Risky Placental Disorder
Dec 2nd
MRI may be effective at ruling out placenta accreta, a potentially life-threatening complication of pregnancy, researchers say.
The test correctly identified 88% of positive cases and 96% of negative cases in about 70 high-risk women, Michele A. Browne, MD, of the University of California San Diego, reported at the Radiological Society of North America meeting.
"MRI is a useful and accurate adjunct to ultrasound for diagnosis of placenta accreta," Brown said. "Women at high risk for placenta accreta, such as those who've had multiple cesarean sections, should undergo ultrasound. And if ultrasound is inconclusive, MRI should be considered."
Placenta accreta is an abnormal attachment of the placenta with invasion into the wall of the uterus. Brown said it usually requires a hysterectomy, and maternal death occurs in 7% of cases.
The incidence of the condition has increased at least 10 times over the last six decades, from about one in 30,000 births in 1950 to one in 2,500, or as frequently as one in 533 births now, according to different estimates.
Browne said this is likely the result of more frequent cesarean sections, because scar tissue in the uterus interferes with a specific layer of the endometrium that involves placental attachment.
Other risk factors involve any kind of uterine surgery, including abortion, as well as maternal age over 35, both of which have increased substantially over the last 60 years.
To measure the efficacy of MRI for detection of placental accreta, the researchers looked at 108 patients who'd had an MRI at their imaging center between 1992 and 2009 and who were suspected to have the condition.
Outcome results were available for 71 of those women.
Overall, Browne said, the accuracy of MRI was 90.1%.
"Early, accurate diagnosis is very important for this condition because it allows for delivery planning, which improves outcome," Browne said.
That includes a scheduled delivery at 36 to 37 weeks and arrangements for sufficient blood products to be on hand because of high blood loss associated with the condition.
Browne noted that after birth, a cesarean-hysterectomy is usually performed because trying to separate the placenta carries a high risk of complications.
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Why Women Who Have Had Preeclampsia Should Be Evaluated For Hypothyroidism.
Nov 25th
This blog post was also published on preeclampsiaonline.net by Chukwuma Onyeije, M.D.
At present, the cause of preeclampsia is unknown. However, it is clear that patients who have had preeclampsia are at risk for other cardiovascular conditions in later life. Recently published studies now show that in addition to these concerns; patients who have had preeclampsia are also at risk for hypothyroidism later in life.
This presentation reviews why this is an important consideration for the long term health of these patients.
View more presentations from Chukwuma Onyeije.
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.
Preeclampsia Linked to Thyroid Problems Later
Nov 18th
New research offers bad news for women who develop a condition known as preeclampsia during pregnancy: They're at higher risk of reduced thyroid function and may be more likely to have thyroid problems in later life.
Preeclampsia develops in the second half of pregnancy and can cause serious problems such as extremely high blood pressure. The causes aren't clear, but may have something to do with high levels of proteins in the body.
Researchers in the United States and Norway looked at two groups of pregnant women: those who developed preeclampsia and those who didn't, and published their study findings in the Nov. 18 online edition of BMJ.
In the U.S study, researchers compared 140 healthy pregnant women who developed preeclampsia with 140 women who didn't. Those who had the condition showed double the levels of thyroid-stimulating hormone as those who didn't develop preeclampsia.
The Norwegian study followed 7,121 pregnant women for about 20 years and found that having had preeclampsia, especially in two pregnancies, boosted the risk that they would have high concentrations of the hormone years after being pregnant.
The researchers suggest that doctors should closely follow women who develop preeclampsia, keeping an eye out not just for heart and kidney disease, which are known risks, but also thyroid disease.
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Treatment Effective for Identical Twin Pregnancy Complication
Nov 12th
As the number of women having twins has increased, so has the odds of developing a serious pregnancy complication called twin-to-twin transfusion syndrome (TTTS). This disorder affects as many as 15 percent of identical twin pregnancies, and results in uneven blood flow between the fetuses. Until recently the outcome was usually death or disabilities for the surviving babies.
Now a new minimally invasive laser treatment has improved the odds. Available at NewYork-Presbyterian Morgan Stanley Children's Hospital -- one of only 10 centers to offer it, and the only one in New York -- the procedure involves coagulating unnecessary and harmful blood connections between the two fetuses.
"This laser treatment has saved the lives of many twins with TTTS, giving them the chance to grow up healthy and strong," says Dr. Lynn Simpson, medical director of the Center for Prenatal Pediatrics at NewYork-Presbyterian Morgan Stanley Children's Hospital and associate professor of clinical obstetrics and gynecology at Columbia University College of Physicians and Surgeons. "The laser approach is straightforward and safe. And while it isn't always successful, it is a major improvement over the traditional approach of draining the mother's amniotic fluid."
Studies show that in about 90 percent of laser cases, one twin will survive, and in 70 percent of cases, both will. The traditional approach has a survival rate of only 66 percent for a single fetus. Normal brain development is also more likely in babies treated with the laser procedure.
Since Morgan Stanley Children's Hospital began offering laser treatment in July, all TTTS cases meeting criteria for coagulation therapy have been treated using the laser.
The hour-long procedure is performed under local or regional anesthesia and uses a tiny scope that carries the laser wire and a camera though the mother's abdomen and into her uterus. While it can be done on an outpatient basis, mothers are usually kept overnight for observation.
In identical twin pregnancies with TTTS, the fetal blood supply is abnormally connected within a shared placenta. Although each fetus uses its own portion of the placenta, the connecting vessels allow blood to pass from one twin to the other. Depending on the number, type and direction of the interconnecting blood vessels, blood can be transferred disproportionately from one twin (the "donor") to the other (the "recipient"). This causes the donor twin to have decreased blood volume, retarding its development and growth, while the larger recipient is at risk of heart failure due to an overworked heart. In rare cases, the condition can happen with triplets or higher multiples, when a pair of fetuses shares one placenta. If untreated early in pregnancy, in 80 to 90 percent of cases, both twins will die. The condition is usually diagnosed during the second trimester with a routine ultrasound.
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