Trusted Information for Healthy Pregnancies
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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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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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ADHD Linked to Lead and Cigarette Exposure During Pregnancy
Nov 23rd
Children whose mothers smoked during pregnancy or who were exposed to lead have more than double the risk of having attention-deficit hyperactivity disorder (ADHD) as other children, new research shows.
And with exposure to both cigarettes and lead, the chances of having ADHD soared. Children whose mothers smoked during pregnancy and whose blood showed signs of lead exposure had eight times the risk of having ADHD.
"When you have both exposures, there is a synergistic effect," said study author Dr. Tanya Froehlich, a developmental and behavioral pediatric specialist and an assistant professor of pediatrics at Cincinnati Children's Hospital Medical Center.
The researchers concluded that about 38 percent of ADHD cases among children aged 8 to 15 in the United States may be caused by prenatal exposure to tobacco smoke, while 25 percent of ADHD cases are due to lead exposure, according to the study in the Nov. 23 online issue of Pediatrics.
Froehlich and her colleagues used data on 2,588 children aged 8 to 15 from around the nation who took part in the 2001-2004 National Health and Nutrition Examination Survey. Tobacco exposure was assessed by asking mothers if they smoked during pregnancy, while lead concentrations were measured by a blood test.
About 8.7 percent of children met the criteria for ADHD, which is marked by inattentiveness, difficulty focusing, impulsivity and hyperactivity, according to the study. The ADHD group included 16.8 percent of children whose mothers smoked during pregnancy, compared to 6.6 percent of children whose mothers did not smoke.
Lead exposure was divided into three groups: low, medium and high. About 5.2 percent of children who had the lowest lead blood levels had ADHD. About 9.1 percent of children in the middle range had ADHD, while 13.6 percent of children in the highest third had ADHD, the researchers found.
About 28.6 percent of children who were exposed to both prenatal smoking and who had higher blood lead concentrations had ADHD, Froehlich said.
Researchers did not find a strong link between exposure to secondhand cigarette smoke during childhood and ADHD.
Alarmingly, even children in the upper third had lead exposure levels lower than what the federal government considers "elevated." The U.S. Centers for Disease Control and Prevention considers levels of 10 micrograms per deciliter "actionable," Froehlich said. In the study, children in the upper third had blood lead levels that were 1.3 micrograms per deciliter or greater; children in the middle group had levels between 0.9 and 1.3 micrograms per deciliter.
About 250,000 U.S. children aged 1 to 5 have blood lead levels greater than 10 micrograms of lead per deciliter of blood, according to the CDC. Though blood lead levels have generally dropped in recent years, children, particularly those in poor, inner-city neighborhoods, may still be exposed to lead from peeling paint in old buildings. Leaded paint was banned for most residential uses in the United States in 1978.
Children may also ingest lead from old water pipes, soil and toys. In the last few years there have been multiple recalls, some by major toy manufacturers such as Mattel and Fisher-Price, of products manufactured in China that contained unsafe levels of lead.
"Lead is out there, and we need to take precautions, such as making sure we keep kids away from peeling paint and make sure they practice good hand washing before they eat if they are playing in the soil," Froehlich said.
In addition, good nutrition, including making sure children have adequate levels of iron and calcium, can also protect from lead exposure. Children with iron and calcium deficiencies absorb more lead than children with better diets, Froehlich explained.
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Nine Ways for Pregnant Moms to Avoid Premature Birth
Nov 17th
The following statistics regarding premature birth are sobering, to say the least.
- Currently the number of premature births in the United States is over 540,000 per year.
- The United States' infant mortality rate exceeds that of China, New Zealand, Canada, Hong Kong, Israel, Japan, Australia, and Singapore.
- It's estimated that simply by cutting the preterm birth rate in the US in half, to match Sweden's, would save approximately 8,000 babies.
- Even though preemies in the US are more likely to survive than anywhere else, they are still more likely to die than full-term infants.
- Just under half of premature babies grow up with some form of neurological or developmental disorder.
- Premature infants can develop lifelong health issues such as cerebral palsy, blindness, hearing loss and learning disabilities.
- Despite the increase in medical advances in the US, the amount of premature births has increased 36% in the last 25 years.
- It is the group of “late preterm” births, which occur after 34-37 weeks of pregnancy, that are the fastest growing subgroup of premature births.
- Get proper prenatal care throughout your pregnancy.
- Don’t smoke, drink or take drugs while pregnant.
- Avoid violent or abusive situations.
- Lower stress levels. Only take on as much as you are capable of, avoid extremely stressful situations and practice stress-relief exercises as needed.
- Avoid early elective inductions and cesareans. These might be used in emergency situations for the better of mom and baby, but elective cesareans and inductions should not be undertaken before 39 weeks of pregnancy.
- Eat a well-balanced, nutritious diet, including fish or fish oil and folic acid.
- Exercise regularly.
- Avoid exposure to environmental toxins like car exhaust, pesticides and phthalates.
- Avoid working situations where you need to stand for long periods of time.
- To learn more about premature labor, click here.
- KeepEmCookin.com is another resource that I would strongly recommend for patients at risk for preterm labor
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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