Trusted Information for Healthy Pregnancies
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Ultrasound Reveals Breastfeeding Mechanics
May 12th
Although it might look like a baby is chewing on the mother's nipple, ultrasound images show that the infant actually removes milk by creating a vacuum - also known as sucking.
The finding is important, as it could explain why some babies fail to take to the breast. It may also shed new light on why - for a minority of women - breastfeeding really can be a painful experience.
"There have been two theories about how breast milk is expressed," says Donna Geddes of the University of Western Australia in Crawley.
"One is that the baby uses a peristaltic or compression motion to actually push the milk out of the nipple and breast. The other theory is that vacuum is primary in removing the milk."
Until now, most studies examining the mechanics of breastfeeding have focused on bottle-feeding infants, or on old X-rays that were of poor quality.
Instead, Geddes and her colleagues combined ultrasound imaging of infants suckling on the breast with measurements of the strength of the vacuum created by the baby's mouth in 20 infants aged 3 to 24 weeks as they breastfed.
"What we see is that when the tongue is lowered and the vacuum is applied, that's when the milk is coming out of the breast, and that doesn't involve any compression of the nipple," says Geddes. "It's not a milking action at all."
They also found that infants who struggled to breastfeed generated much weaker vacuums than successful breastfeeders. This may explain why babies with a cleft palate often fail to breastfeed, as do premature babies: preterm infants don't have strong enough mouth muscles to suck hard enough.
The next step is to devise a simple and universal test that could be used to assess babies' ability to suck. This could reassure mothers whose infants are struggling to feed that it's not their fault. "Currently there are no measurements to assure the mother or the clinician that things [in the breast] are working," says Geddes.
For such women, keeping the milk flowing using a breast pump and using this to top up breastfeeding until the baby is strong enough to suck effectively may be a better option than giving up on breastfeeding altogether.
The team also looked at women who found breastfeeding painful and discovered that their infants had a particularly vigorous action.
"They're strong suckers," says Geddes. Some were also distorting or crushing the nipple. Further study of these infants may aid the development of better nipple shields to reduce pain during breastfeeding.
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“Love” Hormone Released When Mom’s Voice is Heard
May 12th
The working mother who cannot be at home to cuddle a distraught child can relax - her voice on the phone soothes as much as a hug, a study suggests.
US researchers put more than 60 girls in a stressful situation and monitored their hormonal responses when they were either phoned or hugged afterwards.
Their mother's voice produced virtually the same amount of the stress-quelling hormone oxytocin as physical comfort.
The findings appear in the journal Proceedings of the Royal Society B.
The girls, aged between seven and 12, were asked to make an impromptu speech and then solve a series of sums in front of a panel of strangers - experiences which sent their hearts racing and levels of the stress hormone cortisol soaring.
For one group of girls their mother was on hand immediately afterwards to offer physical comfort - a hug, or an arm around the shoulder. Another group was handed a phone with mother on the line, while a third watched March of the Penguins - seen as an emotionally-neutral film.
Oxytocin - a hormone believed to be strongly associated with social bonding, and one which alleviates the effects of cortisol - rose in both groups to similar levels. Oxytocin levels in the film group did not increase.
"It was understood that oxytocin release in the context of social bonding usually required physical contact," said Dr Leslie Seltzer of the University of Wisconsin-Madison, who led the research.
"But it's clear from these results that a mother's voice can have the same effect as a hug, even if they're not standing there."
Previous research suggesting physical contact was necessary to produce oxytocin in stressful circumstances was primarily carried out on rodents, therefore failing to take into account the very human impact of language, the researchers said.
Research has suggested that even in the womb a fetus - at least in the later stages of pregnancy - is capable of recognizing its mother's voice.
But whether this has any emotional impact at this young age is unclear.
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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.
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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.
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Smoking moms tied to lasting kids’ sleep woes
May 10th
Mothers who smoke during pregnancy are more likely to have children with sleep problems from birth all the way through age 12, new research shows.
"The more cigarettes that mothers smoked during pregnancy, the more sleep problems the children had," Dr. Kristen Stone of Women and Infants Hospital in Providence, Rhode Island, one of the study's authors, told Reuters Health.
What's more, while most of the women who smoked during pregnancy used at least one other drug, Stone and her team found that nicotine was the only substance associated with sleep problems.
Stone and colleagues from centers in Miami, Detroit, and Memphis are following nearly 1,400 children born in 1993, 1994 or 1995 to investigate the long-term effects of exposure to substances during pregnancy.
The current study included children for whom data was available up to age 12. Among the 808 study participants, 374 had been exposed to cocaine or opiates such as heroin before birth, while 434 had not.
Children's mothers or other caregivers reported on whether a child had difficulty falling asleep and staying asleep during three periods: one month to four years of age; five to eight years, and nine to 12 years. Being exposed to cocaine, opiates, marijuana, or alcohol in the womb had no effect on a child's risk of having sleep problems, but nicotine did, and problems were seen at each of the three time points.
The researchers do not report what percentage of children had sleeping problems, but used a common measure of such problems that assigns points for items such as talking in one's sleep, sleepwalking, and having trouble falling asleep.
The link remained even after the researchers took into account factors such as socioeconomic status, whether or not a child had been abused, and whether the mother or caregiver smoked after the child was born.
The findings shouldn't be seen as showing that prenatal use of alcohol and drugs aside from cigarettes isn't as harmful to a child's sleep as smoking in pregnancy, Stone noted. Cigarettes are different from other substances, she explained, in that a person who smokes will typically do so much more frequently than a drug abuser uses cocaine or opiates.
Further, she said, many of the mothers in the study were using multiple substances while they were pregnancy. "When those substances are inside of us at the same time, they basically become a whole new substance because of their interactions with each other," she added. All of this makes it difficult to tease out the effects of nicotine and other drugs, according to the researcher.
When a child does have sleep problems, Stone said, "early and careful attention" to these issues can go along way toward helping that child sleep better.
"Even an emphasis on basic behavioral sleep education could serve those children well," she added. "Doing that would then likely improve the daytime experience for those children as well."
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Alcohol in pregnancy may boost child’s leukemia risk
May 6th
Women who drink alcohol while pregnant raise the risk that their child will develop a rare type of blood cancer called acute myeloid leukemia, or AML, a new study suggests.
In a pooled analysis of data from published studies, researchers found that drinking alcohol during pregnancy was associated with a 56 percent increased risk of AML in children.
But in an email to Reuters Health, Dr. Julie Ross of the University of Minnesota in Minneapolis, who was not involved in the study, said it's important for women to know that childhood AML is rare (about 700 cases are diagnosed each year) and likely has many causes.
Moreover, she said: "The vast majority of women who consume alcohol during pregnancy will not have a child who develops leukemia. However, given other risks associated with alcohol drinking during pregnancy, these results can help to reiterate the message that it is probably best to abstain from alcohol if you are pregnant or planning to get pregnant."
What causes leukemia in children is largely unknown, but researchers suspect it may be an interaction between genes and the environment, including drinking alcohol, Dr. Paule Latino-Martel of the Research Center for Human Nutrition in France and colleagues note in a report published online today.
When the researchers looked at 21 previous studies of women's drinking habits during pregnancy and childhood leukemia, they found that women who drank during pregnancy had a 56 percent increased risk of childhood AML, they report in the journal Cancer Epidemiology, Biomarkers & Prevention.
Ross cautioned, however: "While a 56 percent increased risk sounds like a lot, in real terms it means that with a childhood AML incidence rate in the US of about 8 cases diagnosed per million children, the risk might increase to about 12 cases diagnosed per million children. Thus about 4 more cases per million children."
Despite the recommendation that women abstain from alcohol while pregnant, it's estimated that 60 percent of Russian women drink while pregnant, as do 59 percent of their Australian counterparts. Fifty-two percent of French women, 30 percent of Swedish women and 12 percent of American women drink while pregnant, according to estimates.
For American women, Ross further explained: "If we are to believe that the risk (of childhood AML) is increased by about 56 percent, and that about 12 percent of US women drink alcohol sometime during pregnancy, this means that perhaps up to about 6 percent of childhood AML in the US might be attributable to alcohol consumption."
On the flip side, "this also means that 94 percent might be attributable to other causes," Ross noted.
Only a few of the studies reviewed by Latino-Martel's group reported results according to type of alcohol consumed -- beer, wine, or spirits -- and the existing evidence does not suggest that one type of alcohol could be more related to leukemia risk than another, they say.
The limited available data also make it impossible to tell whether it matters when women drink in the course of a pregnancy, although risk tended to be higher when alcohol was consumed later in pregnancy.
The researchers say it's possible the results were skewed because some women who drank during pregnancy did not admit to it "due to the stigma." There were other limitations: Only a few of the studies adjusted for smoking during pregnancy and factors such as exposure to pesticides, folate intake, birth weight and age of the women were largely not taken into account.
Despite these limitations and caveats, the current findings serve to strengthen the public health recommendation against drinking alcohol during pregnancy, the study team, and Ross, conclude.
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Both parents’ race may affect gestational diabetes risk
May 6th
Researchers found that among nearly 140,000 women in one large California health plan, Asian women had the highest rate of gestational diabetes, at nearly 7 percent. They were followed by Native American women, at 5.6 percent, and Latina women, at 5 percent.
Rates of gestational diabetes among white and black women, meanwhile, stood between 3 and 4 percent.
But it wasn't only women's race and ethnicity that mattered, the study found. Expectant fathers' backgrounds also showed an independent association with the risk of gestational diabetes.
When the father was Asian or Hispanic, the researchers found, a woman's risk of gestational diabetes was 41 percent and 29 percent higher, respectively, compared with when the father was white. That was with other factors -- including the mother's race and ethnicity, age, body weight and education -- taken into account.
Native American ethnicity was also linked to relatively higher risks, though the association was weakened when other factors were considered.
Estimated to affect between 3 percent and 8 percent of pregnant women in the U.S., gestational diabetes arises during pregnancy and goes away soon after childbirth, though women who develop it have a higher-than-average risk of eventually developing type 2 diabetes.
Gestational diabetes can raise the risk of certain pregnancy complications, like high blood pressure in the mother and having a larger-than-normal baby, which may require a C-section.
Studies have shown that in the U.S., minorities generally have a higher risk of gestational diabetes than white women do.
These latest findings, published in the American Journal of Obstetrics & Gynecology, confirm a role for women's race and ethnicity in gestational diabetes risk.
But they also suggest that "in addition to women who are Asian, Latina, or Native American, women whose partners are of these racial/ethnic groups also appear to be at higher risk for (gestational diabetes)," write Dr. Aaron B. Caughey and his colleagues at the University of California, San Francisco.
The findings may help guide gestational diabetes screening, the researchers note.
For women at average risk of gestational diabetes, doctors typically perform a blood sugar test at some point in the second trimester. Those considered to be at high risk may be screened at their first prenatal visit and then retested later in pregnancy.
It is not clear why certain racial and ethnic groups are at increased risk of gestational diabetes, but genetic predisposition likely plays a role, according to Caughey's team.
They point out that a number of studies have found increased risks among Asian women, despite the fact that they have relatively low levels of obesity, a risk factor for both gestational and type 2 diabetes.
As for why the father's race and ethnicity matters, the researchers explain that fathers' genes, as well as mothers', influence hormones in the placenta. Placental hormones, in turn, affect a pregnant woman's sensitivity to the hormone insulin, which regulates blood sugar. Impaired insulin sensitivity can then lead to gestational diabetes.
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Heavier Birth Weight Tied to Later Conduct Troubles
May 6th
Among twins whose weight differs markedly at birth, the heavier child is more likely to have conduct problems at ages 3 and 4, a new study finds.
"The findings suggest an effect of birth weight differences on development of subsequent conduct problems," researchers led by Dr. David Mankuta of Hadassah Hebrew University Hospital in Jerusalem, said in a news release. "Further studies are needed to clarify the mediating factors of this effect."
The team studied 112 pairs of Israeli twins in which one weighed at least 20 percent more than the other. The twins were born in 2004 and 2005.
The researchers found that the heavier twin had more conduct problems in 41 percent of the twin pairs. The twin who weighed less had more conduct problems in only 21 percent of the cases.
The study findings were published in the May issue of Archives of Pediatrics & Adolescent Medicine.
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Birth Defect Risk from Insect Bites Received by Mother During Pregnancy
May 4th
A North Carolina State University researcher has discovered that bacteria transmitted by fleas-and potentially ticks-can be passed to human babies by the mother, causing chronic infections and raising the possibility of bacterially induced birth defects.
Dr. Ed Breitschwerdt, professor of internal medicine in the Department of Clinical Sciences, is among the world's leading experts on Bartonella, a bacteria that is maintained in nature by fleas, ticks and other biting insects, but which can be transmitted by infected cats and dogs as well. The most commonly known Bartonella-related illness is cat scratch disease, caused by B. henselae, a strain of Bartonella that can be carried in a cat's blood for months to years. Cat scratch disease was thought to be a self-limiting, or "one-time" infection; however, Breitschwerdt's previous work discovered cases of children and adults with chronic, blood-borne Bartonella infections-from strains of the bacteria that are most often transmitted to cats (B. henselae) and dogs (B. vinsonii subsp. berkhoffii) by fleas and other insects.
In his most recent case study, Breitschwerdt's research group tested blood and tissue samples taken over a period of years from a mother, father and son who had suffered chronic illnesses for over a decade. Autopsy samples from their daughter-the son's twin who died shortly after birth-contained DNA evidence of B. henselae and B. vinsonii subsp. berkhoffi infection, which was also found in the other members of the family.
Both parents had suffered recurring neurological symptoms including headaches and memory loss, as well as shortness of breath, muscle weakness and fatigue before the children were born. In addition, their 10-year-old son was chronically ill from birth and their daughter died due to a heart defect at nine days of age.
Results of the parents' medical histories and the microbiological tests indicated that the parents had been exposed to Bartonella prior to the birth of the twins, and finding the same bacteria in both children, one shortly after birth and the other 10 years later, indicates that they may have become infected while in utero.
"This is yet more evidence that Bartonella bacteria cause chronic intravascular infections in people with otherwise normal immune systems, infections that can span a decade or more," Breitschwerdt says. "Also this new evidence supports the potential of trans-placental infection and raises the possibility that maternal infection with these bacteria might also cause birth defects."
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Antidepressant tied to risk of newborn heart defect
May 4th
Women who use the antidepressant bupropion during early pregnancy may have an increased risk of having a baby with a particular type of heart defect, a new study suggests.
Researchers caution that it is not clear whether the medication, marketed as Wellbutrin, is the cause. And even if it is, they say, the absolute risk of the heart defect would be small -- affecting just 2 out of every 1,000 infants born to women who used bupropion during the first trimester.
But the findings, published in the American Journal of Obstetrics & Gynecology, do add to questions about the risks of using antidepressants during early pregnancy.
Some studies have already linked other antidepressants -- including some of the commonly used selective serotonin reuptake inhibitors (SSRIs) -- to higher-than-average, though small, risks of certain birth defects.
A study last year, for example, found that among nearly half a million Danish children born between 1996 and 2003, the risk of heart defects was elevated among those whose mothers had used SSRIs such as fluoxetine (Prozac), sertraline (Zoloft) and citalopram (Celexa) during early pregnancy.
In this latest study, researchers found that among more than 12,700 U.S. infants born between 1997 and 2004, those whose mothers used bupropion during early pregnancy had more than double the risk of heart defects known as left outflow tract defects, compared with infants whose mothers had not used the drug.
Left outflow defects affect the flow of blood from the heart's left chambers to the rest of the body. In this study, the most common type of this defect was coarctation of the aorta -- a narrowing in the body's main artery that, in children, typically requires surgical repair.
The findings do not mean, however, that depressed women on bupropion should stop taking it if they are planning a pregnancy, according to the researchers.
"I think it's important that women understand that they should not just stop taking their medication," said Dr. Jennita Reefhuis, a senior epidemiologist at the U.S. Centers for Disease Control and Prevention and one of the researchers on the study.
Instead, she told Reuters Health, women should talk with their doctors, ideally when they are planning a pregnancy rather than after they conceive.
The potential risk of birth defects from using antidepressants must be weighed against the risks of a woman stopping her current depression therapy, Reefhuis said.
"This study needs to be replicated before we can say anything conclusive," Reefhuis said, noting that the findings point to an association between bupropion and left outflow defects, but cannot by itself prove cause-and-effect.
If the association is causal, she said, the absolute risk to any one woman would be small. For every 1,000 births, there are an estimated 0.8 cases of left outflow tract heart defects; based on the current findings, that rate would be 2 per 1,000 among women who use bupropion in the first trimester.
Reefhuis also pointed out that with any pregnancy, the overall risk of having a baby with some form of birth defect is 3 percent.
Guidelines released last year by the American Psychiatric Association and the American College of Obstetricians and Gynecologists state that psychotherapy may be an effective alternative to antidepressants for pregnant women with mild to moderate depression.
However, the guidelines say, women with a history of more severe depression, or other major psychiatric disorders, may need to continue with their medication.
Bupropion is also prescribed for smoking cessation, under the brand-name Zyban. In the case of smoking cessation, Reefhuis said, it may be easier for women to find an effective alternative to the drug.
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