Trusted Information for Healthy Pregnancies
premature birth
Stress, Anxiety Can Up Risk of Depression in Pregnancy
Jan 22nd
Stress, history of depression, lack of social support and unintended pregnancy are among the major factors that contribute to increased risk of depression in pregnant women, a new study shows.
Other important factors are maternal anxiety, domestic violence and having public insurance coverage, said the University of Michigan researchers, who reviewed 159 studies conducted between 1980 and 2008.
The study appears in the January issue of the American Journal of Obstetrics & Gynecology.
Depression, which occurs in about 12.7 percent of pregnant women, can cause problems for mothers and babies, including pre-term delivery, preeclampsia, sleep disturbances and disrupted mother-infant bonding.
It's important for physicians to know how to identify depression in pregnant women, said the study authors, who noted that not all women who test positive on depression screening tests have or will develop clinical depression.
"We are hoping that [health-care] providers can use the presence or absence of risk factors such as those identified in our study to enhance their assessments for depression in addition to the information they obtain from the screening test," study author Dr. Christie A. Lancaster, a clinical lecturer in the obstetrics and gynecology department at U-M, said in a news release.
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Untreated Gum Disease During Pregnancy Risks Life of Baby
Jan 22nd
Pregnant women with untreated gum disease may have more at stake than just their teeth. They may also be risking the lives of their babies, a new study shows.
Expectant mothers have long been warned that gum disease can cause a baby to be born prematurely or too small. But for the first time scientists have linked bacteria from a mother's gums to an infection in a baby that was full-term but stillborn, according to the study which was published Thursday in Obstetrics and Gynecology.
Scientists from Case Western University made the discovery after a 35-year-old California woman contacted them to help investigate the death of her baby. Earlier studies by the same researchers showed that an oral bacteria called Fusobacterium nucleatum could spread from the bloodstream to the placenta in mice. The woman wanted to know if it was possible in humans.
Bacteria from the mouth can easily get into the bloodstream once a woman's gums are bleeding, explains the study’s lead author Yiping Han, an associate professor of periodontics and pathology at Case Western University. Generally, this type of bacteria can be easily combated by the immune system of the mom-to-be, whether mouse or human. But because of special conditions that exist in the womb, the fetus can be more susceptible, Han suspects.
“Once the bacteria are in the blood, they can go almost anywhere,” Han says. “The placenta is an immuno-suppressed organ, compared to other organs like the liver and the spleen. And that makes it easy for the bacteria to colonize the placenta.”
The California woman told researchers that she had experienced heavy bleeding from her gums — a sign of gum disease — during her pregnancy. Bleeding gums aren’t unusual in pregnant women, with about 75 percent developing the condition due to normal hormonal changes. Mild gum disease can be treated simply by brushing and flossing more often. Pregnant women with more serious cases may need dental surgery.
Usually women’s uterine infections, which can harm a fetus, are caused by bacteria that work their way up from the vaginal canal, says Han. But the researchers detected a bacteria in the baby not typically found in the vaginal region. Plaque samples from the woman’s teeth were found to be positive for the exact same strain of the oral bacteria found in the dead baby’s stomach and lungs.
Women shouldn’t be overly alarmed by the new study, says Dr. Richard H. Beigi, an obstetric infectious disease specialist and an assistant professor of reproductive science at the University of Pittsburgh Medical Center.
“This is just one case,” he explained. “Most pregnant women have bleeding gums and most don’t have dead babies. This can happen, but it’s rare. And this finding doesn’t mean that it’s increasing.”
Still, Beigi says, it should serve as a reminder that pregnant women with bleeding gums should see a dentist to treat their gingivitis. Gingivitis can increase the risk of preterm birth anywhere from twice to seven times, studies indicate.
The new study underscores the importance of oral hygiene not only for pregnant women, but also for those contemplating pregnancy, says Dr. Michael Lu, an associate professor of obstetrics, gynecology and public health at the University of California Los Angeles Medical Center.
“We know that gingivitis doesn’t happen overnight and that it’s important for women to enter pregnancy in good health,” Lu says. “I would love to see every woman who is contemplating pregnancy get pre-conception care that includes an oral-health check-up.”
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Birth Weights Are Falling in U.S.
Jan 21st
Mothers are giving birth to lighter babies in the U.S., and no one is quite sure why.
This finding, published Thursday in the Journal of Obstetrics and Gynecology, has potentially troubling public-health implications, if the trend continues. Low-birth-weight babies are at higher risk for a host of health problems.
Between 1990 and 2005, the birth weight of full-term babies in the U.S. declined nearly two ounces to an average of seven pounds and 7.54 ounces, a reversal of a trend that had seen birth weights climb steadily since the 1950s, according to the study. They were also born 2.5 days earlier on average in 2005 than in 1990, the study said.
The decrease in weight—based on an analysis of nearly 37 million non-multiple births from a national database—isn't likely to affect the health of the average baby in the study, according to researchers. But the data showed a 1% increase in the number of the lowest-weight babies and suggested the birth-weight decline didn't stop in 2005.
These data suggest that it may be important for medical professionals to pay attention to the weight of babies born around 37 weeks and 38 weeks, as well as those considered pre-term, or less than 37 weeks, according to Joann Petrini, senior adviser at the March of Dimes and assistant research director at Danbury Hospital in Connecticut, who wasn't involved in the study.
Researchers also found a 2% decrease in the number of babies considered large—those over the 90th percentile of weight for gestational age—which is a positive, according to Dr. Oken. Large babies can experience more birth trauma and cause more birth injury to the mother.
The lower-birth-weight trend could not be explained by common factors like how much weight mothers gained during pregnancy, whether the delivery was induced or by cesarean section, prenatal care, or common maternal-health issues such as smoking and hypertension, researchers said.
Researchers also repeated their analysis in a sample of low-risk women—healthy, educated Caucasians in their mid-to-late 20s—and found that the decrease in birth weight was even more pronounced, suggesting that the trend isn't the result of changes in the population of mothers.
Other investigators also have begun to note the same trend. "There's no question" about the change in birth-weight pattern, said Michael Kramer, scientific director of the Institute for Human Development and Child and Youth Health at the Canadian Institutes of Health Research, who wasn't involved in the study.
"It is a new trend," he said. "We really don't know why the birth weight has decreased." A similar pattern has been observed in Canada, he said.
Some potential factors that weren't examined in this study include better control of gestational diabetes—when a mother develops diabetes during pregnancy—and more physical activity during pregnancy, said Dr. Kramer.
Babies considered too large, as well as too small, tend to have more health problems in the long run. The optimal size for a newborn is around 4,000 grams, or roughly 8.8 pounds, according to Dr. Kramer. The average baby in the study was found to be smaller than optimal. In 1990, the average birth weight was 3,441 grams, and in 2005 it fell to 3,389 grams, according to the study.
Babies born too small tend to have higher blood pressure and a greater risk of diabetes in the long run, said Dr. Oken.
From the 1950s until the 1980s, birth weights had increased as a result of increases in mothers' weight and how many pounds they gained during the pregnancy, as well as reduced smoking and older maternal age, according to Dr. Kramer.
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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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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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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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Mothers’ Genes Important in Preterm Birth Risk
Dec 9th
A mother's genes may be an important factor in the risk of preterm birth, two new studies suggest.
Past research has shown that genes likely play a role in a pregnant woman's odds of delivering prematurely - before the 37th week of pregnancy.
The risk is increased, for example, among women who were themselves born prematurely or have a sister who ever gave birth preterm, And findings from twin studies suggest that up to 40 percent of preterm deliveries involve some genetic susceptibility.
But little is known about the specifics of how genes influence preterm labor.
The two new studies, reported in the American Journal of Epidemiology, suggest that the mother's genes - rather than genes affecting fetal development that are inherited from both parents - are key.
In one study, Danish researchers analyzed national database information on more than 1 million singleton births in Denmark between 1978 and 2004. They found that, not surprisingly, women with a history of preterm delivery were at increased risk of having a subsequent early birth.
But the risk was also elevated among women with a mother, sister or half-sister (born to the same mother) who had delivered prematurely. Compared with women without such a family history, these women were 60 percent more likely to have a preterm birth.
In contrast, preterm births among female members of the father's side of the family, or among the female partners of a woman's male relatives, had no bearing on a woman's own risk of premature delivery.
The findings were similar in the second study - this one of more than 989,000 births in Sweden between 1992 and 2004. Researchers found that sisters of women who had delivered preterm had an 80 percent higher risk of early delivery, versus women without that family history.
There was no evidence of an increased risk, however, when a brother's partner had delivered prematurely. Nor was there evidence that the increased risk shared by sisters was explained by non-genetic factors that could influence the chances of preterm delivery, like smoking or lower education levels.
Overall, the researchers estimate that mothers' genes account for one-quarter of the variation in preterm delivery risk across the population. In contrast, fetal genes - which are inherited from both parents - showed little influence.
The vast majority of women in the studies did not deliver early, regardless of family history. In the Danish study, for example, about 7 percent of women with a sister who had delivered prematurely had a preterm birth themselves; that compared with 4.5 percent of women whose sisters had no history of preterm delivery.
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March of Dimes Reveals Pregnant Moms Biggest Fears
Dec 9th
The March of Dimes polled about 1,200 moms to find out exactly what it is that caused them to lose sleep (other than the fact they were pregnant!) while they were pregnant. The results were presented today at the March of Dimes National Communications Advisory Council luncheon where experienced, practicing obstetricians and gynecologists discussed the survey results, as well as some of the frequently asked questions their patients ask.
The March of Dimes poll found that the number one thing moms worried about was birth defects - 78 percent said they were worried their child would be born less than perfect. Stress was moms' second fear, with 74 percent answering that they were concerned if stress in their life would harm their baby's health. Preterm birth was a close third with 71 percent saying they were worried their baby would be born too soon.
"Women should discuss all their questions with their doctors and should be concerned about their overall health - quit smoking, control their blood pressure, weight and any chronic diseases, such as diabetes - before they become pregnant so they will have a better chance at a healthy pregnancy," said Dr. Diane Ashton, March of Dimes deputy medical director, who took part in the panel discussion.
Surprisingly, only 70 percent thought about the fear of pain of childbirth and 55 percent were worried that they wouldn't get to the hospital on time!
Other things moms worried about were:
- 60 percent worried they wouldn't be able to breastfeed successfully.
- 59 percent worried about losing weight after pregnancy.
- And, 59 percent worried about getting pregnant in the first place.
- Sushi and fish was the number one food concern, with 61 percent concerned.
The poll was conducted Nov. 6 to Nov. 13, 2009 using the online software Zoomerang. There were 123 valid responses from the 1,224 women from the March of Dimes Moms e-Panel and March for Babies Family Teams who were invited by email to answer the 65 questions. Some 90 percent of the women surveyed have a child who was born preterm. Nearly two-thirds of the respondents are employed, about 60 percent are between the ages of 25 and 34, 90 percent have children under the age of five and 95 percent had attended some college. The survey was written by Betty Wolder Levin, Ph.D., professor of Public Health, Graduate Center of the City University of New York.
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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.
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Simple test can spot premature birth false alarms
Dec 8th
A simple test can help reliably determine whether signs of an imminent premature delivery are likely to result in a false alarm, research suggests.
Less than half of women showing these signs actually go on to give birth soon after, and they often have to undergo what turn out to be unnecessary tests.
UK researchers found a test that looks for a protein called fetal fibronectin (fFN) could solve the problem.
The study was conducted by University College London.
fFN is the protein that helps attach the foetal sac, in which the foetus develops, to the uterus.
Previous research has shown that when fFN is found to be leaking at a certain stage of pregnancy, a premature birth is more likely.
A test to detect fFN levels is relatively cheap and easy to perform - but it is not commonly used in all maternity units.
It is done at the same time as a vaginal examination, which is routinely carried out when a woman is admitted with abdominal pain in pregnancy.
If the results show low levels of fFN, then the chance of a women having a premature delivery imminently is low.
The researchers conducted an audit to determine whether use of the test made any significant difference.
Initially they analysed 22 cases of women admitted to hospital showing signs of being about to go into premature labor.
Of these, 17 did not give birth during their hospital stay, which averaged just more than eight days.
Most received steroid drugs to improve their baby's lung function, or tocolytic drugs to halt labor contractions.
The situation changed significantly after staff began to use the fFN test.
It proved to be 98.6% accurate in identifying women who, despite showing signs of premature delivery, did not go into labor for at least another two weeks.
As a result just seven women out of 78 who showed signs of being about to go into labor, but who registered low levels of fFN, required hospital treatment - for pain management.
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