Trusted Information for Healthy Pregnancies
premature birth
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
Stress early in pregnancy increases risks to babies
May 10th
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.
Source
Mother-daughter pregnancy sickness link found
Apr 30th
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".
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
Birth planning leads to surprising increase in premature births
Feb 8th
The rising trend of expectant mothers being involved in every aspect of planning their births has had an unintended consequence - a rise in pre-term deliveries.
"It never would have occurred to me or anyone I knew to think you had any kind of control over when the baby would come out," said Laura Crawford, who gave birth more than a decade ago.
Crawford, producer of the Kentucky Educational Television documentary "Born too Soon," said the increasing incidence of what is called late pre-term births is among the topics explored in the film.
Prematurity rates in the nation have increased quietly over the past two decades, according to public health officials. The premature-birth rate in Kentucky is 15.2 percent, and it's rising faster than the national rate, which is 12.7 percent. Kentucky has one of the highest rates of pre-term births, trailing only Louisiana, Alabama, Mississippi and South Carolina.
Some of Kentucky's rise is related to some not-so surprising subjects, including the rate of maternal smoking (more than twice the national average), poverty and environment.
Other reasons are more surprising. They include the rise in scheduling births.
It's just within the last three or four years that the scope of the problem of late pre-term births - babies born between 34 and 36 weeks' gestation - has become apparent, said Dr. Ruth Shepherd, division director for maternal and child health in Kentucky's Department of Public Health. Roughly 10 percent of all babies born in Kentucky fall into the late pre-term category.
Ideally, she said, babies shouldn't be delivered before 39 weeks.
Often, there are legitimate reasons for early delivery, especially if the health of mother or child is at risk.
Increasingly, choices are made for reasons other than health. Delivery might be scheduled to coincide with grandparents' dates of arrival from out of town, or before Dad must ship out for Iraq.
There are several complicating factors, Crawford said. The documentary states that people tend to underestimate the impact of premature births, especially late pre-term births. They tend to overestimate how accurately a due date can be determined.
Shepherd said there can be real consequences. They can include immediate physical challenges, including underdeveloped lungs and long-term problems involving learning and behavioral disabilities, for example.
And even if a mother gets an ultrasound within the first 16 weeks - the best way to accurately determine the due date - the date can be off by two weeks either way.
Those two weeks can be crucial, she said.
"It's an issue of planning and control," she said. Planning is good. The Centers for Disease Control and Prevention recommends that mothers have a birth plan. But, Shepherd said, "you can take it too far if you don't pay attention to the science."
Source
Healthy Baby Campaign Uses Texts to Reach Mothers
Feb 4th
Expectant mothers are getting a new tool to help keep themselves and their babies healthy: pregnancy tips sent directly to their cell phones.
The so-called text4baby campaign is the first free, health education program in the U.S. to harness the reach of mobile phones, according to its sponsors, which include Johnson & Johnson, Pfizer, WellPoint and CareFirst BlueCross and Blue Shield. Wireless carriers including AT&T, Verizon and Sprint have agreed to waive all fees for receiving the texts.
Organizers say texting is an effective means of delivering wellness tips because 90 percent of people in the U.S. have cell phones.
"Especially if you start talking about low-income people, cell phones are the indispensable tool for reaching them and engaging them about their health," said Paul Meyer, president of Voxiva, a company which operates health texting programs in Africa, Latin America and India.
Studies in those countries have shown that periodic texts can reduce smoking and other unhealthy behaviors in pregnant mothers.
Meyer said the U.S. program, run by Voxiva, will be the largest health-related texting program ever undertaken.
Under the new service, mothers-to-be who text "BABY" to 511411 will receive weekly text messages, timed to their due date or their baby's birth date. The messages, which have been vetted by government and nonprofit health experts, deal with nutrition, immunization and birth defect prevention, among other topics. The messages will continue through the baby's first birthday.
Text4baby is expected to be announced Thursday morning by officials from the White House's Office of Science and Technology Policy. Government officials will be publicizing the campaign in speeches and promotional materials.
Organizers hope the effort can curb premature births, which can be caused by poor nutrition, excessive stress, smoking and drinking alcohol. About 500,000 babies are born prematurely in the U.S. each year, and 28,000 infants die before their first birthday, according to the Healthy Mothers, Healthy Babies Coalition. The nonprofit is among the sponsors of the campaign.
"The real scary thing is that we're an industrialized nation and we're not doing very well on infant mortality, and we know prematurity is a big part of that," said the group's director, Judy Meehan.
Currently the U.S. ranks 30th worldwide for infant mortality, according to Meehan, behind most Western European nations.
Researchers at the George Washington University have agreed to evaluate the effectiveness of text4baby by measuring health trends for mothers and newborns.
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
Omega-3 Supplements Don’t Reduce Risk of Preterm Birth
Jan 28th
Omega-3 fatty acid supplements are believed to have many health benefits, but the one thing they can't do is help women with a history of delivering their babies early carry their next child to full term, new research finds.
"The omega-3 did not add any benefit," said study author Dr. Margaret Harper, an associate professor of obstetrics and gynecology at Wake Forest University School of Medicine, Winston-Salem, NC. The study appears in the February issue of Obstetrics & Gynecology.
Harper and her colleagues randomly assigned 852 pregnant women with a history of a preterm birth either to get a daily omega-3 supplement or a placebo beginning about week 16 to 22 and continuing through week 36 of gestation.
All women also received weekly intramuscular hormone injections of hydroxyprogesterone caproate, which has been shown to improve the chances of carrying a baby to term, Harper said.
Her team followed up to see which women delivered before 37 weeks. Full-term is defined as 37 weeks of completed gestation.
Delivery before 37 weeks occurred in 37.8 percent of those taking omega-3, and 41.6 percent of those in the placebo group, a small difference.
Prematurity is the leading cause of newborn death, the authors write in the report, and it is increasing in the United States. A woman who delivers one baby before term is more likely to deliver future babies early.
Harper's team decided to study the value of the omega-3 supplements after conflicting findings about the value of the supplements for women at high risk of premature delivery. For those at low-risk, she said, the findings seem to agree that omega-3 supplements don't further reduce the risk of preterm birth.
A recent large review of published studies found only one that showed benefit of the supplements in high-risk women, she said.
According to Harper, omega-3 fatty acids, when metabolized, are converted to much less potent biochemicals called prostaglandins, which make the uterus contract, than are omega-6 fatty acids -- also essential fatty acids but typically over-eaten in Western diets. Adding omega-3s to an omega-6-heavy diet, so the thinking went, might result in better chances of carrying the baby to term.
Omega-3 supplements, in other research, have been found to help heart health, to lower blood pressure and to reduce the risk of abnormal heartbeats.
But in Harper's study, she also noted that women getting omega-3 supplements were more likely to give birth to a baby with respiratory distress syndrome (RDS). While 59 babies (13.9 percent) of those in the omega-3 group had RDS, only 35 (8.7 percent) of those in the placebo group did. In other words, the omega-3 mothers' babies were 1.6 times more likely to get RDS than infants born to mothers taking placebo. It's the first time such a finding has been reported in clinical trials, the authors wrote.
"While the study's results showed no difference, there is early evidence that omega-3 fatty acids are beneficial for fetal brain development, so women should still consider taking them, in conjunction with their doctor's advice, despite what seems to be little benefit for the reduction of spontaneous preterm birth."
Source
Massage Reduces Depression in Pregnant Women
Jan 26th
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.
Source
Mothers with Celiac Disease Face a Higher Risk of Underweight and Early-term Births
Jan 25th
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.
Source